Home Healthcare Workers: How to Prevent Violence on the Job

Home healthcare workers can be vulnerable as they face an unprotected and unpredictable environment each time they enter a client’s community and home. The spectrum of violence ranges from verbal abuse, to stalking or threats of assault, to homicide. Verbal abuse from the client, family members, or people in the community is a form of workplace violence. Verbal abuse may be subtle, such as asking for help beyond the scope of the job (such as with cleaning), or it may be obvious, such as complaining about job performance or worker appearance—or even threatening to cause harm.

EMPLOYERS SHOULD

Establish a zero-tolerance policy for all incidents of violence.
Train workers on recognizing and preventing workplace violence.
Investigate all reports of violence.
Work with police to identify dangerous neighborhoods where special precautions need to be taken and provide that information to employees.

EMPLOYEES SHOULD

Participate in violence-prevention training.
Report to your employer all incidents of violence, no matter how minor.

MANAGING VIOLENT SITUATIONS

Consider working with an escort in high-crime areas, and if possible, schedule visits during daylight hours.
Be sure of the location and have accurate directions to the house or apartment.
Always let your employer know your location and when to expect you to report back.
When driving alone, have the windows rolled up and doors locked.
Park the vehicle in a well-lit area, away from large trees or shrubs where a person could hide.
Keep healthcare equipment, supplies, and personal belongings locked out of sight in the trunk of the vehicle.
Before getting out of the car, check the surrounding location and activity. If you feel uneasy, do not get out of the car.
Stay in your car and contact your manager if you notice anything that might threaten your security, such as strong odors from a drug lab, gunshots, or shouting and sounds of fighting.
During the visit, use basic safety precautions by (1) being alert, (2) evaluating each situation for possible violence, and (3) watching for signals of impending violent assault, such as verbally expressed anger and frustration, threatening gestures, signs of drug or alcohol abuse, or the presence of weapons.
Notify your employer if you observe an unsecured weapon in the client’s home.
Maintain behavior that helps to defuse anger by (1) presenting a calm, caring attitude, (2) not matching threats, (3) not giving orders, and (4) acknowledging the person’s feelings.
Avoid behaviors that may be interpreted as aggressive (for example, moving rapidly or getting too close, touching unnecessarily, or speaking loudly).
If possible, keep an open pathway for exiting.
Trust your judgment.
Avoid situations that don’t feel right.
If you are being verbally abused, ask the abuser to stop. If the abuser does not stop, then leave and notify your employer.
If you cannot gain control of the situation, shorten the visit and remove yourself from the situation. If you feel threatened, leave immediately.
If you need help, use your cell phone to call your employer or 911, depending on the severity of the situation.
If you observe a crime, contact the police.

This is one in a series of six fast fact cards developed to provide practical advice for home healthcare workers and is based on NIOSH Hazard Review: Occupational Hazards in Home Healthcare, NIOSH Pub No. 2010–125.

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Email: cdcinfo@cdc.gov | Web: www.cdc.gov/niosh/topics/healthcare
DHHS (NIOSH) Publication No. 2012–118
February 2012

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