NIOSH Research Backgrounder:Study Examines Risk of Job-Related Violence for Home Healthcare Workers

Contact: Fred Blosser, (202) 245-0645
December 21, 2009

The National Institute for Occupational Safety and Health (NIOSH) is conducting a research study to better understand on-the-job risks to home healthcare workers from work-related violence, and how to reduce those risks.

A safe, trained, secure, and motivated home healthcare work force is essential for efficient and high-quality healthcare delivery. The aging of the Baby Boomer generation is expected to increase the need for home healthcare workers. Care provided in the home saves healthcare dollars for patients and their families, but the work is hard for the practitioner. These workers tend disproportionately to be ethnic minority women who may themselves lack health insurance.

Recruitment and retention are linked to job satisfaction, part of which depends on working in a safe environment. In a recent Columbia University study, 48 percent of Registered Nurses reported three or more stressful household conditions in their current caseload, including unsanitary conditions, unsafe conditions conducive to slips/ trips/ falls, presence of aggressive pets, poor lighting, neighborhood violence/ crime, drug use in homes, and racial/ ethnic discrimination.

In the NIOSH study, survey responses from 677 home healthcare aides and nurses were used to explore factors associated with violence against home healthcare workers by their patients. Whereas previous research has addressed home healthcare violence generally, without specifying perpetrators (patients themselves or others in the home) or forms of violence (physical abuse or verbal abuse), this is one of the first scientific studies in which researchers focused specifically on physical assaults by patients on workers.

"By pursuing this line of inquiry, we hope to generate data that will help to improve safety for workers and patients alike," said Traci L. Galinsky, Ph.D., the lead investigator for the study. "Based on available data from earlier research, this approach addresses an issue of great concern for our stakeholders, and holds promise for leveraging safety interventions that have proven successful in other healthcare settings."

The preliminary results were presented last April at the 2009 Safe Patient Handling and Movement Conference at Lake Buena Vista, Florida. Detailed results from the NIOSH study of violence in home healthcare are being prepared for peer-reviewed journal publication in early 2010. The preliminary results included these findings:

• Thirty-one (4.6 percent) of the survey respondents reported having been assaulted (hit, kicked, pinched, shoved, or bitten) by a patient one or more times during the past 12 months.
• Certain factors were predictive of risk of physical assault by patients: patient handling (lifting/moving/bathing/dressing), caring for patients with dementia, and feeling threatened by violence from others in and around the patients' homes.
• Workers who had been assaulted by patients were generally more likely to shorten visits when feeling threats to their safety. Shortening visits in those circumstances is a justifiable strategy for protecting workers, but it inevitably reduces the quality of patient care.

An area for further study suggested by the preliminary findings would be research on methods for preventing injuries from home healthcare patients, and particularly from patients with dementia, the researchers suggest. One promising intervention involves the use of ergonomic assistive devices such as hoists for lifting and moving patients, which has led to reduced violence by nursing home patients in previous NIOSH research. Although the benefits of ergonomic patient handling devices have been well-demonstrated in hospitals and nursing homes, they have not been used much in home healthcare. In addition to the potential for reducing assaults by patients, these methods are designed to reduce work-related overexertion injuries from manually lifting patients, and to prevent patient falls and related injuries.

NIOSH has funded several studies on risk of needle stick injuries for home healthcare workers, published guidelines for pandemic flu preparedness, and developed safety and health curriculum guides and training materials for home healthcare workers. NIOSH is the federal agency that conducts research and makes recommendations to prevent work-related injuries, illnesses, and deaths. The research reflects needs identified by partners and involves their input, review, and participation. More information about NIOSH research for preventing work-related injury, illness, and death in the healthcare sector can be found at www.cdc.gov/niosh/topics/healthcare/.

Did you Know?...

Home healthcare is one of the largest and most rapidly growing industries in the U.S., with an expenditure of more than $40 billion per year.

The home healthcare industry currently employs more than 1.3 million workers who provide about 8 million home visits per year.

Home healthcare employees include 1.1 million paraprofessional aides and personal assistants, more than 126,000 registered nurses, and about 25,000 other professional staff such as physical therapists.

By 2030, the number of home healthcare workers needed to meet the demand for their services is expected to double.

The daily costs of receiving care at a nursing home or hospital are $109 and $3,838. Receiving care at home costs only a fraction as much and is becoming increasingly desirable for patients and their families.

Home healthcare aides made an average of $7.19 per hour in 2006, compared with the national average hourly wage of $9.66 for all workers.