Home Health & Hospice Week

Panic buttons, escorts are among OSHA and NIOSH suggestions.

The deaths of two home health nurses in the space of a year — Doug Brant in Washington state in December 2022 and Joyce Grayson in Connecticut in October 2023 — have left visiting staff uneasy and agency management unsure how to combat the growing problem of workplace safety.

“Home healthcare workers can be vulnerable as they face an unprotected and unpredictable environment each time they enter a client’s community and home,” says the CDC National Institute for Occupational Safety and Health (NIOSH) in its “How To Prevent Violence On The Job” resource for home health. “The spectrum of violence ranges from verbal abuse, to stalking or threats of assault, to homicide,” NIOSH acknowledges.

“From 2002 to 2013, the rate of serious workplace violence incidents (those requiring days off for an injured worker to recuperate) was more than four times greater in healthcare than in private industry on average,” the DOL Occupational Safety and Health Administration says on its website. “In fact, healthcare accounts for nearly as many serious violent injuries as all other industries combined.”

Following citations in the Grayson case (see story, p. 116), OSHA has some suggestions. “To address workplace violence, employers should have in place a comprehensive workplace violence prevention program,” OSHA says in a May 1 release.

The agency suggests providers of care in the home should adopt these elements of a plan:

• management commitment and employee involvement;
• a written program including the establishment, membership and role of a Workplace Violence Safety Committee;
• analysis of home environments upon new patient admission;
• hazard prevention and control;
• training and education, including resources for impacted employees;
• recordkeeping; and
• solicitation of employee feedback during the review process.

OSHA says Elara Caring also “could have reduced the hazard of workplace violence by, among other ways;”

• performing root cause analyses on incidents of violence and near misses;
• providing clinicians with comprehensive background information on patients prior to home visits;
• providing emergency panic alert buttons to clinicians; and
• developing procedures for the use of safety escorts for visits to patients with high-risk behaviors.

NIOSH offers these tips for home health employers:

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

NIOSH also offers numerous pointers for employees and on “managing violent situations.” 

Note: The OSHA guidance in the Grayson case is at www.dol.gov/newsroom/releases/osha/osha20240501-0. The NIOSH guidance is at www.cdc.gov/niosh/docs/2012-118/pdfs/2012-118.pdf.