Health care professionals working in acute settings are often in the line of fire when it comes to workplace violence. That is well documented.

Yet, despite the difference in care setting, their home-based care counterparts aren’t immune to these same dangers.

“[Workplace violence in the home] is very underreported — and always has been,” Andrea Devoti, executive vice president of the National Association for Home Care & Hospice (NAHC), told Home Health Care News.

Provider leaders, at least, are aware of the problem.

That’s why they are being proactive – and implementing processes, programs and training – in order to keep caregivers and clinicians safe in the home.

For home-based care workers, there are many factors that differentiate their care settings and all that goes into it.

“In a person’s home, not only is the person more comfortable because they’re in their own space, but you are subject to all the other things that revolve around their life, be it the people that live in the home, extended family members, pets or neighbors,” Devoti said. “You’re really seeing the true person, which can be very positive when caring for someone … but it also can be more threatening for the health care worker, because people let their guard down in their own space.”

Devoti noted that individuals working in both personal care and home health care face significant workplace violence.

At VNS Health, there have been a number of measures taken to ensure the safety of its clinicians, including having a cross-functional team in place dedicated to safety and awareness.

“The team is comprised of people who work in our safety organization, our facilities organization and people who work in HR,” Tracy Dodd, executive vice president and chief people officer at VNS Health, told HHCN. “They meet on a very regular basis to ensure that all of our policies, processes and practices are kept current. And [to make sure] that we are continuously listening to our employees’ voices, collecting feedback from them and understanding what their experience is like, so that we can ensure we’re supporting them.”

New York-based VNS Health is a full-service home health care organization. The company provides care to over 40,000 patients daily in the five boroughs of New York City via its over 10,000 employees.

One of the ways the company supports its clinicians is a mobile app called AlertMedia. The app provides safety monitoring, activation of the emergency alert system, as well as a panic alarm notification to local authorities.

VNS Health has also partnered with local anti-violence organizations to offer self-defense courses, as well as safety awareness courses on empowerment, defense, commuting and transit safety.

The company offers online training to its clinicians through Care Connect.

“We help them understand how to identify and report unsafe surroundings and share emergency reporting procedures with them,” Dodd said.

Plus, VNS Health gives clinicians access to escort services.

“If they don’t feel safe, they can call and have someone escort them to a building, or to a patient’s home or apartment, so that’s really something that our clinicians appreciate,” Dodd said.

When instances of violence do occur, VNS Health has made sure that the organization is equipped to offer their clinician support.

“We have social workers and psychologists on staff who are part of our organization,” Dodd said. “We rally around individuals who may have experienced some type of a challenge, whether it was in a patient’s home or whether it was during a commute. We offer counseling services, we offer time off. We have an employee assistance program where they can get access to additional resources.”

For Elara Caring, fortifying the company’s risk and safety programs has been a key focus area in 2023.

“Front and center in that effort is our workplace violence prevention strategy,” Betta Swanson, chief compliance and privacy officer at Elara Caring, told HHCN.

Part of this effort was making a key hire. Earlier this year, Chris Corrigan joined Elara Caring as general counsel.

“He has extensive experience in both risk and safety and also workplace violence prevention,” Swanson said. “As an organization, we have a zero-tolerance policy toward workplace violence.”

The company also has a workplace violence prevention program, and training is a major component.

“They are trained on assessing the work environment for safety, which involves training on how to control known hazards, how to anticipate and recognize new hazards, how to evaluate the risks that they pose, identifying warning signs of possible violence, such as aggressive body language, verbal abuse or threats,” Swanson said. “We train on verbal de-escalation techniques, and then on the extreme end escape and egress, if necessary.”

Because training is such a big part of keeping the staff at Elara Caring safe, the company is focused on figuring out the most effective modes or methods of delivering that training.

This involves using a mix of in-person training and virtual training – the latter throughElara Caring’s learning management system. The company also has an internal app where it posts news, information and videos.

Elara Caring has also established safety committees where caregivers and clinicians discuss incidents that have occurred, factors that contributed to the incident and strategies for preventing similar incidents in the future.

“Those committees roll up and report to an enterprise risk management committee that analyzes trends in workplace violence incidents, and also analyzes near misses to identify what additional training or support we can provide,” Swanson said.

Another thing the company is working on is a process for evaluating how effective its prevention policies and practices are.

“We want to make sure we’re measuring the baseline and then measuring after we apply these interventions,” Swanson said.

As far as response when violence takes place, Elara Caring has an internal reporting system.

“We do have a good internal reporting and investigation feedback loop to make sure that the incident is investigated and addressed appropriately, and that the impacted individuals immediately get wraparound support,” Swanson said.

Ultimately, providers should be engaging with caregivers and clinicians when it comes to how to keep them safe.

“They are the boots on the ground,” Swanson said. “They’re the ones who are seeing this and dealing with it day in and day out.”

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