Home Health caregivers need more than just medical training
By Brian Uridge, CTM, CHPA, CPP, MPA
If you follow your local news, there is a good chance you have seen a report covering an act of violence against a Home Health professional. These individuals often work alone in high-risk areas. They may be exposed to potentially serious hazards including weapons, illegal drugs, verbal abuse, or other forms of violence. In fact:
Over 60 percent of home care workers report at least one instance of some form of workplace violence, according to My American Nurse.
In a study published in Home Healthcare Now, 37 percent said they experienced instances of verbal or emotional abuse on a daily basis.
Another 20 percent of workers said they experienced monthly occurrences of physical violence.
Home Health safety is a hot-button topic. Whether you care for patients in their homes, lead a Home Health organization and carry the responsibility for caregivers’ safety, or have a loved one or neighbor who receives care in their home, this is an issue that touches many people’s lives. As a threat assessment and management expert who is often invited to conduct trainings for Home Health organizations, the main question I get from leaders is this:
How do we keep caregivers who go into the home safe?
To answer this question effectively, I took a multidisciplinary approach. I was part of a team that participated in ride-alongs with Home Health professionals and participated in actual visits. Then, we developed the training together with nurse educators. What we realized as we looked at the data and observed real-life Home Health interactions and environments was that the most effective tactics for Home Health caregivers mimicked those used in military and law enforcement, but with a necessarily softer edge appropriate for providing care.
The best support Home Health organizations can offer their caregivers is thorough and frequent training that built on these three principles:
1. Situational awareness
2. Proxemics
3. De-escalation
Here is a brief overview of each of these key Home Health safety principles:
Situational awareness
Home Health professionals need to be given the tools to evaluate their environment quickly and make rapid decisions to ensure their safety. From calling ahead to get an understanding of the environment (e.g. Who else will be in the home during the visit? Where should the care provider enter the home? Are there any pets in the home?), to knowing what to pay attention to as you enter a neighborhood, to awareness of threat indicators, to recognizing the signs that someone is carrying a weapon, in-depth training can increase caregivers’ confidence going into any environment and allow them to make wise choices to promote their and their patients’ safety and well-being.
Proxemics
Proxemics is the study of personal space and how we use it to communicate and create a sense of safety for ourselves and others. Believe it or not, factors like where you focus your eyes, the way you stand, the position of your hands, and the distance you’re standing from the patient can do as much to communicate with a patient as the words you are saying. Caregivers also need to have an understanding of how to interpret nonverbal signs and positioning of the patient and how to situate their bodies in relation to the patient in order to maintain their own safety while on a home visit.
De-escalation
If a patient or family member’s behavior begins to escalate, caregivers can employ techniques to de-escalate the situation and diffuse tension. It is essential to remain calm and caring and maintain an even tone; don’t match threats or give orders. In a tense situation, or one that’s getting more tense, asking too many questions can be overwhelming and patients and families can get irritated. When tension is rising, caregivers need to be able to discern which questions are essential to completing their visit and save other questions that concern the patient’s general condition for another visit.
In-depth training in situational awareness, proxemics, and de-escalation is invaluable to increase the safety of Home Health professionals, but the most important thing to emphasize to caregivers is this: Trust your instincts. If a situation feels “off” or unsafe, leave immediately.
Remember: your best weapon is what’s between your ears.