Risk Factors Associated with Patient Assaults of Home Healthcare Workers

Abstract

This study used surveys from 677 home healthcare aides and nurses to explore factors associated with assaults by patients. Among respondents, 4.6% reported one or more patient assaults (being hit, kicked, pinched, shoved, or bitten) during the past year. Logistic regression analysis examined associations between several potential risk factors and assaults. Three factors were significant, including having one or more patients with dementia (OR = 4.31, 95% CI 1.47-12.67), routinely handling patients (OR = 8.48, 95% CI 1.89-37.94), and perceiving threats of violence by others in and around patients' homes (OR = 4.45, 95% CI 1.75-11.32). Assaults were not significantly associated with worker age, gender, race, job title, hours of work, or use of needles during patient care. Assaulted workers and workers who perceived threats of violence by others were significantly more likely to have shortened home care visits. More detailed research is needed to confirm these results and evaluate methods to reduce assault risk.

What Is Known About Dementia Care Recipient Violence and Aggression Against Caregivers?

“…Assault may include being hit, kicked, pinched, shoved, grabbed, or bitten. Assaults in this context may also include believable threats to the caregiver(s), or physical aggression against property which could induce fear of assault or danger to the caregiver (Galinsky et al, 2010; Shah, 1995; Ryden, 1988; Enmarker, Olsen, & Hellzen, 2011; Kunik et al, 2010). Note that “agitation” is not necessarily “aggression.” These two concepts are not always clearly separated in the literature, but while agitation generally implies verbal or physical behaviors related to discomfort or confusion, aggression clearly implies hostile physical motion, regardless of the trigger or intent.…”

“…Aggression towards caregivers in home environments can result in injury or trauma to the caregiver and may impact health outcomes for caregivers (Cahill & Shapiro, 2008). There is some evidence that home healthcare workers are four times more likely to experience assault if they have one or more patients with dementia (Galinsky et al, 2010), and this led to significantly shortened home care visits (impact on quality of care). In LTC environments: “Being subjected to abuse ... may compromise a workforce's ability to provide person-centered care” (Scott, Ryan & Mitchell, 2011, p.111).…”

Safety risks associated with physical interactions between patients and caregivers during treatment and care delivery in Home Care settings: A systematic review

“…This could contribute to risks for both patients and caregivers when visits were shortened due to concerns about abuse, physically challenging tasks (moving and handling), missing/inadequate equipment and consumables (Galinsky et al, 2010). There could also be pressure from the patient (and family) to deliver care when the caregiver did not feel that they had the appropriate knowledge, training and skills (Faucett et al, 2013;Munck et al, 2011).…”

“…The close interaction can lead to additional requests from patients which were not on the treatment plan and/or outside the caregiver job description (moderate evidence : Beer et al, 2014;Skoglind-Ohman & Kjellberg, 2011;Swedberg et al, 2013;limited evidence: Denton et al, 2002). The most serious risk is perhaps that of abuse and violence from patients and their family (strong evidence Dellve et al, 2003;moderate evidence: Craven et al, 2012;Galinsky et al, 2010;Markkanen et al, 2007;SimsGould et al, 2013).…”

Serving Our Homeless Veterans: Patient Perpetrated Violence as a Barrier to Health Care Access

“…Participants also stated that they wrapped up their visits "as soon as possible." Kendra and colleagues proposed that, when visits were wrapped up "as soon as possible," the quality of patient encounter and care was compromised (Arnetz & Arnetz, 2000;Galinsky et al, 2010).…”