Home Health safety starts with asking the right questions

By Brian Uridge, CTM, CHPA, CPP, MPA

Home Health professionals offer compassionate, crucially important care to patients. But because of the nature of their work, they often are working alone in high-risk areas and have to discern the safety of a situation, not just once when they arrive at work, but over and over again as they change locations throughout the course of a day.

In my previous article, I discussed the three foundational principles of Home Health safety. In this article, I want to zoom in on the first of those principles: situational awareness.

Many unsafe situations can be avoided if you are alert and have learned to recognize the signs that something in your environment is “off.” In-depth situational awareness training empowers Home Health workers to enter the varied environments they face in a day with confidence, knowing that they have the wisdom and skills they need to make smart decisions to keep themselves safe.

Here are three steps Home Health professionals should take in every environment they enter to improve their situational awareness: 

1. Establish a Baseline

Maintaining safety requires preparation and careful observation—before you even arrive at the patient’s home. Home Health providers should have a solid understanding of what is normal for a given environment. You can’t recognize that something is “off” if you don’t know what is standard. General norms for home environments are helpful to keep in mind, but those are best paired with knowledge about what is normal for a specific patient’s home or neighborhood.  

Gather information and observations about a home before you visit:

• Establish a professional presence and project confidence.

• When calling a household to arrange a first visit, ask for directions, where to park, where to enter the home, who will greet you, and if any pets are in the home. 

• Preview your route of travel before driving to the patient’s home. 

2. Look for an Anomaly

Too often, people go about their day oblivious to their surroundings. We in the Threat Assessment community call this “Condition White.” Home Health workers need to have a baseline of “Condition Yellow” when they are on the job. This means:

• Maintaining a relaxed state of general alertness, with no specific focal point 

• Keeping your head up and your eyes open

• Stowing away your phone

• Trusting your “sixth sense”

Think of being in “Condition Yellow” as a continuous, conscious 360-degree radar sweep. When you are difficult to surprise, you are difficult to harm. 

Specifically, pay attention to the collective mood of a situation or place, comparing it to what is normative. This is certainly important in a patient’s home, but it begins when you enter their neighborhood. Ask yourself:

• Do I see any safety hazards?

• What are the road and sidewalk conditions?

• Can I park in a well-lit place with no spaces where someone could hide?

• Are homes well kept?

• Are people loitering on the streets or in yards?

• Do I smell anything unusual (such as odors from the manufacture of illegal drugs) or hear potentially dangerous sounds (such as gunshots or shouting)?

Inside the home, always remain alert to your surroundings and watch for things that are out of the ordinary and signals of potential violence. These include shouting, verbal abuse, threatening gestures, signs that someone is carrying a weapon, or signs of drug or alcohol misuse. 

3. Make a Decision

Situations where you sense a potential threat to your safety require quick decision-making and decisive action. For this reason, you should always maintain a safe path of egress and keep space between you and your client or their family members.

While safety training is essential to elevate your situational awareness and learn to recognize the signs that a situation is potentially dangerous, this is no replacement for trusting your instincts. If you ever feel unsafe while providing care, leave the situation. Period.

A helpful acronym is SAFE:

• Scan your surroundings

• Assess for anomalies

• Fight at the first point of contact

• Escape and evade rather than hide

Home Health workers deserve to feel safe in their work environments. This is why training is so essential; it allows Home Health professionals to take control, building their confidence and sense of safety through the knowledge and skills they gain.

Safety is something that happens between your ears, not something you hold in your hands.