VIOLENCE - IN HOME HEALTHCARE
INTRODUCTION:

Your job as a home healthcare provider is an extremely important and valuable one.  More than ever before, primary healthcare is
being administered at home rather than at the hospital.  Giving healthcare in the home is usually very safe.  But your work does
involve some risk.  Consider these factors:

  • You usually work alone.
  • You travel to work in different neighborhoods.
  • You work in some high crime areas.
  • You work with severely stressed and sometimes unstable patients and family members.

Consider these other factors that affect our society at large:

  • There is an increased availability of guns and other weapons.
  • The problem of drug abuse, with its destructive side effects, is widespread.
  • There is a general rise in violent crime – especially in domestic violence.

It is not surprising that many of your professional organizations are addressing the growing concern for the personal physical
safety of home healthcare workers.  Consider these results from the Bureau of Labor Statistics:

  •  Homicide accounts for one out of every six fatal workplace injuries.
  •  For females, homicide is the leading cause of job-related fatality.

This information will help to ensure your personal safety in every aspect of your work.  The best weapon you have for defending
yourself is knowledge.  This discussion will:

  • Outline a broad range of safety measures to assist you in recognizing and avoiding potentially dangerous situations.
  • Identify which actions you can take to help de-escalate a violet situation.
  • Review many useful precautions that will reduce personal risk when you are in the field.

ASSAULT CYCLE

In your job, it is essential to recognize warning signs that an individual is prone to violence.  When a situation escalates into
violence, it is called an “assault cycle.”  Sometimes an upsetting incident can trigger the cycle.  Other times a situation builds slowly.
The assault cycle is made up of a series of events or phases:

  • The Escalation Phase
  • The Attack Phase
  • The Recovery Phase
  • The Post-Crisis Phase

If you understand how the assault cycle escalates, you will be better able to protect yourself.  Remember, identifying a potentially
violent situation is the surest way of avoiding violence in the first place.

ESCALATION PHASE

During the Escalation Phase of an assault cycle, a potentially violent individual will exhibit behaviors that should serve as clear
warning signs.  Examples include:

  • Staring
  • Rapid breathing
  • Flushed appearance
  • Tense and anxious body posture
  • Pacing
  • Constantly shifting body position
  • Shouting
  • Swearing

Regardless of whether a situation is triggered by a particular event or builds slowly, you should recognize the signs and take
immediate action to prevent the situation from escalating.

  • Remain calm and alert.
  • Let the person express his or her feelings.
  • Listen carefully and show empathy.

ATTACK PHASE

The Attack Phase occurs when the situation continues to escalate into some form of physical confrontation.  When confronted by
an actively violent person, you should:

  • Maintain an assertive position with your body: feet held hip-width apart with one foot in front of the other.
  • Always keep the perpetrator at arm’s length.
  • Have someone call the police or get help from the nearest possible source.
  • Position yourself near an exit for easy escape.

RECOVERY PHASE

During the Recovery Phase, the perpetrator’s anger subsides and he becomes calm.  You should continue to calm the individual
and de-escalate the situation.  Be aware that any perceived threat could trigger additional hostilities.

POST-CRISIS PHASE

This is the end of the assault cycle.  The violent individual’s anger is played out.  He is
withdrawn, depressed or even remorseful.
If you experience a physical confrontation or assault, you will be subjected to intense stress and anxiety, possibly more than you
realize.  A personal trauma like this requires recuperation or even counseling.  After such a violent encounter, remove yourself
from the area of the attack and calm yourself down.  Seek medical a you’ve sustained.
If you still experience anxiety and a stress reaction fifteen minutes to a half hour after the attack, don’t return to work.  This anxiety
is perfectly normal, and you should discuss it with your supervisor or a professional counselor.

SAFETY PRACTICES

Your safety is a prime concern before, during and after each home visit.  Use the following potentially threatening situations during
all stages of your visit:  the pre-visit, visit and post-visit stages.

Pre-visit Safety Practices
The pre-visit stage includes all of the necessary steps that you should take before visiting a client.  Being fully prepared will
minimize the risk factor when you go to your assignment.  It will also ensure an efficient visit and reduce the change of delays,
mistakes or unwelcome surprises.

  • Review the client’s chart thoroughly.  Note the type of medical procedure that is required.  Familiarize yourself with your
    client’s history.  Are there instances of violence, drug abuse or mental illness?  Telephone In advance to confirm the visit
    and time with the patient.
  • Leave an accurate schedule for your day’s activities with your agency or medical facility.
  • Dress appropriately.  Leave jewelry at home.  Wear comfortable shoes that allow you to run, if necessary.
  • Keep your car in good working order.  Check your gas gauge.  
  • Do not carry a purse to the job.  Keep identification or whatever you need in your pocket.
  • Plan your trip in advance.  Use maps or written directions.
  • Keep your care locked while driving.
  • Look for the access to your client’s home or apartment before you park.  Park as close as possible.  Lock your car.  Lock
    valuables in the trunk before leaving.
  • Look for working public telephones.  Remember their locations.  Keep your cell phone charged and carry it with you.
  • Take note of your surroundings, such as buildings and side streets.
  • Be aware of the body language of people you encounter.  Confident eye contact and a hello can ward off trouble.
  • Avoid walking down alleys or taking short cuts across deserted lots or private property.
  • Never walk through a crowd.  If a group of people are blocking the sidewalk, walk around them or cross the street.

Visit Safety Practices
The visit phase of your job takes place in a much more fluid situation.  You are working with your client’s social environment and
the community at large.  The following are some personal safety guidelines for this phase of your job.

  • Carry a flashlight for poorly lit corridors and hallways.
  • If you are uneasy, ask a family member to meet you at the entrance and walk you in.
  • Look before you enter elevators.  Never enter a home uninvited.  If an unfamiliar person answers the door, make sure the
    client is there before entering.
  • Keep your bag in plain sight.  When not using it, keep it closed.
  • Avoid any lengthy or emotional conversations with the family or neighbors of the client.
  • If drug activity takes place during your visit, ask that it wait until the visit is complete.  If the persons do not comply, tell them
    you will return at a later date to complete the visit.  Don’t simply walk out.  That may give the impression that you are going
    to call the police.
  • If you see firearms, ask the family to move the weapon to another room for the duration of the visit.
  • If a pet becomes a nuisance, ask the family to put the animal in another room during your visit.
  • If, during your visit, you witness or suspect violent or threatening activities, make sure that they are recorded for future
    reference.
  • If the situation appears unsafe for any reason, calmly inform the patient of your return visit plans. Then leave the area and
    contact your agency as soon as possible.

Remember, a key factor in ensuring your safety during home visits is your ability to make a rapid assessment of the potential for
violence in each household that you visit.  Be especially alert when you know of any pre-existing conditions such as mental illness,
drug abuse or abusive relationships.

Post-Visit Safety Practices
This stage can be divided into two basic parts:  leaving the visit site and documenting each visit, especially with regard to any
circumstances that could affect the safety of home healthcare visitors.  Here are the guidelines in detail:

  • Remain vigilant as you leave your client.  Observe windows and doorways for loiterers.  If you suspect someone is following
    you while walking, go into the nearest business establishment.  If a car is following you, cross the street and walk in the
    opposite direction.
  • If you are threatened by someone who wants to take your bag, give up the bag and report the incident to the police and to
    your supervisor.
  • Carry your keys in your hand for accessibility as well as a means of protecting yourself.
  • Look underneath your car and check the back seats before opening the door.  Once inside, lock the door immediately.  
    Keeping your car doors locked will help prevent attempted robbery or carjacking.
  • If you think that your car is being followed, pull into the nearest police, fire or gas station.  If you experience car trouble and
    can’t find a service station, try to park in a well-lighted, populated area and call for help.
  • Keep your cell phone charged and use it in case of an emergency.
  • When you return to your agency, make sure that your clients’ records are updated to reflect any potentially   threatening
    situations for future reference.








    Revised 12/2/2016
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