The fear of violence against home care aides, nurses, and therapists may be adding to the already-severe shortage of care workers and adding to the burden on family caregivers.

In our increasingly aggressive society, home care workers say they are being assaulted by angry and frustrated family members as well as people in the neighborhoods they visit. In some cases, they are being robbed of personal possessions. Other times, thieves see a vehicle with a home care logo or an aide in scrubs and think they can steal drugs (though aides never carry them). Even patients themselves are assaulting aides.

“It is happening across the board,” says Andrea Devoti, executive vice-president of the National Association for Home Care & Hospice.  And, she says, it occurs among all socio-economic groups. “Private pay patients, those with commercial insurance, those on Medicare, Medicaid, you name it,” she says.

Uptick in assaults

It is impossible to know for sure whether the problem is worsening since there are no reliable nationwide data on these assaults. But since the pandemic, home care workers, nurses, and managers all say they’ve seen an uptick in assaults.

Nurses and aides in all settings, including hospitals and nursing homes, struggle with this problem. But facility-based staff have colleagues and security close by to help. A home care aide is alone. And it can be frightening.

They visit homes full of guns. Or drug dealers. They are mugged going to a client’s home. They are greeted at the front door by someone holding a shotgun.

A former hospice chaplain tells about the adult child of a dying patient waving a pistol in the house. When the chaplain called adult protective services, she was told there was nothing that could be done unless the son specifically threatened someone. Or actually fired a shot.

While the problem may be getting worse, it isn’t new. A 2019 survey found that one in five home care workers reported being victims of verbal abuse from patients or family members.  One recent review of research found significant amounts of verbal and physical abuse around the world, not just in the US.

In 2021, the trade journal Home Health News reported that the federal Occupational Safety and Health Administration (OSHA) was investigating complaints of violence against aides. Researchers identified the problem as far back as 2010. But much of the regulatory focus has been on aides assaulting patients, not on violence against aides.

Dangerous work  

Even before the recent wave of violence and the Covid-19 pandemic, direct care workers had some of the most dangerous jobs in the US. Due mostly to back injuries, they were more likely to be hurt on the job than coal miners. All this for a 2021 median hourly wage of $14.15 (an aide hired through an agency generally gets about half the hourly rate, the rest goes for insurance, taxes, benefits, other overhead, and the firm’s profit).

Shrinking supply, growing demand

Covid-19 killed thousands of care workers and drove millions of others to leave their jobs. Many who left the direct care workforce never have returned.

On top of that, layer the increase in violence across the US. More guns. A seemingly insatiable demand for drugs such as Fentanyl. A growing mental health crisis. A post-Covid-19 spike in anger and frustration. And like teachers, flight attendants, and others with public-facing jobs, home care workers bear some of the abuse.

Yet, demand for home care aides is exploding. Increasingly, programs like skilled nursing (SNF) at home or hospital at home are moving medical care out of facilities and into people’s residences. Long-term care is increasingly being delivered at home. These shifts all require more aides willing to work in patients’ houses.

Some home care agencies are trying to respond. Many are encouraging staff to report assaults, events that aides and nurses may have keep to themselves in the past. Indeed, NAHC’s DeVoti thinks we may be seeing more reporting of violence rather than an actual increase in attacks.

Agencies respond  

Home care companies also are providing staff with panic buttons and other security devices. They are requesting police escorts in high-risk neighborhoods. To avoid street robberies by criminals seeking drugs or money, home care companies have removed logos from their vehicles and staff are swapping street clothes for scrubs.

Some agencies are taking even more extreme measures. They increasingly are refusing to accept clients in homes they deem unsafe and even have stopped making any home visits in dangerous neighborhoods.

Home care agency operators say staffers are quitting and recruits are turning down offers due to increasing fear of violence. The consequence: Even more responsibility for personal care and medical treatment will fall on the shoulders of adult children, spouses, or other relatives.

Shortages of aides and nurses was a serious issue even before covid-19. Low pay, limited opportunities for advancement, and immigration restrictions all shrunk the pool of workers willing to provide home care. Now, we can add fear of violence the causes of this severe labor shortage.