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Managing the Risk: Home Health Care

Home Health Nurse

The home health and hospice industry are experiencing rapid growth as US consumers become open to new futures in their care experience. As of 2014, the CDC reported that there were over 12,400 home health agencies in operation employing over 2 million home healthcare workers. This turn has brought innovation to the health care industry, freeing up hospital beds and offering patients quality long-term, short-term, and palliative care in the comfort of their own homes.

Of course, with change comes challenge. Providing in-home care exposes nurses and attendants to a slew of risks that can be difficult to manage. They may face environmental risks related to visiting a home, such as difficult driving and parking conditions and cluttered or hoarded rooms that make their workspace a challenge. Even more arduous is the social risk they face each and every time they enter the home. Social risk is the set of risks that stem from people, and home health nurses frequently bear the brunt of agitation and aggression. Patients, as well as their family, friends and even people in the neighborhood or apartment complex could pose a threat. The US Bureau of Labor reports that while the healthcare industry makes up only 9% of the working economy, the industry’s workers experience nearly as many violent injuries as all other industries combined. In addition, they frequently receive verbal abuse and threats, making for a contentious and stressful workplace at times.


It is vital that healthcare employers have a specific safety plan for home care employees, providing clear policy as well as actionable procedures for incidents. When a nurse enters a home, they need to know that their employer is fulfilling their duty of care and providing a safe environment for work. That is a necessity. The question then becomes: how to do so with such variable risk?

Nurse in home

First, educate each member of your staff on what to look out for when entering a home. Many companies develop policies that keep employees in common spaces (living room, kitchen, etc.) and clearly state that patients and any others in the home may not lock doors while the employee is present. Awareness of hazards in the home such as excessive clutter (hoarding), aggressive animals, alcohol, drug paraphernalia, and weapons should be noted. Employers should encourage their staff to know where the exits are at all times and perhaps even to have an exit script prepared should they need it. The challenge they may face with an exit script, however, is the typical reliance on a cell phone.


The best safety procedures are those that mitigate stress in a crisis instead of adding to it. Using a dedicated lone working safety device like the SoloProtect ID enables staff members to simply press a button and be connected to a Monitoring Center Operator who will listen, assess, and record audio of the incident, escalating it quickly and appropriately. Employees can be assured that the right help is on the way without aggravating the current situation by reaching for a phone. The use of a dedicated and discreet device that includes audio monitoring and recording also allows for post-incident review and provides evidence in case of litigation.

SoloProtect Safety DeviceOnce there is a safety device and plan in place, it is important to educate staff members on how to stay calm if a situation of aggression or abuse arises. Often, agitation is the first indication of increased probability of an incident. If a patient or anyone else begins to become terse or emotional, these are signs that they may be ramping up toward aggressive behavior. As soon as those signs begin to show, press the “Red Alert” button on the SoloProtect ID to instantly connect to the Monitoring Center where a trained Operator is listening and assessing whether an employee may need back-up from a manager or even police assistance. The SoloProtect ID does not make any sound, making sure the aggressor is unaware that help has been called, though it does emit a heartbeat vibration so that only the user knows they are connected to help. 


If the situation continues to heighten, de-escalation may become necessary in which case the Western Journal of Emergency Medicine recommends the following to help bring an aggressive party back to neutral:

  1. Respect personal space while maintaining a safe position.
  2. Do not be provocative.
  3. Establish verbal contact.
  4. Be concise; keep the message clear and simple.
  5. Identify wants and feelings.
  6. Listen closely to what the person is saying.
  7. Agree or agree to disagree.
  8. Set clear limits.
  9. Offer choices and optimism.
  10. Debrief the patient and staff.

Ideally, these strategies will return the room to a safe space where the nurse or attendant can continue their care protocol, but even the best-laid plans need back up. A personal safety device provides staff members with a dedicated tool to help keep them safe when working alone. They can work feeling assured that their employer cares for their safety and wants to make sure that they come home safe to their family each night.

An investment in your staff is an investment in your business. Learn more about the SoloProtect ID here and make sure your employees are equipped to work safely every day with every patient.

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