Home care clinicians (HHCs) work in patients' homes and unfamiliar neighborhoods, leaving them vulnerable, unprotected, and at risk for occupational hazards. When HHCs are not protected and their safety and health are jeopardized, there can be direct and indirect effects experienced by patients such as medication errors and poor patient outcomes (Institute for Healthcare Improvement [IHI], 2018).
Working in home care involves unique risks. Unlike healthcare professionals working in institutionalized settings, those working in home care have unpredictable and uncontrolled work environments along with frequent commutes to patients' homes throughout the day (IHI, 2018; Markkanen et al., 2014). The "worksite" is the patient's home, which is unregulated and beyond the control of the employer or clinician. Each worksite varies and can be located in potentially dangerous neighborhoods, further contributing to the personal safety of the HHCs. On any given workday, HHCs can be exposed to a variety of risks including violence in the community or home, unrestrained animals, pests, unhygienic conditions, poor indoor air quality, and driving-related accidents.
Risk factors for violence outside of the home include seeing patients in high-crime neighborhoods and the presence of gangs and drug trafficking on street corners. Risk factors inside the home include the presence of weapons such as guns, illicit drug use, family violence, alcohol and substance abuse by the patient or other individuals in the home, and patients with mental illnesses and dementia (Occupational Safety and Health Administration, 2015). Also, HHCs face the risk of being attacked by an unrestrained animal in the community and in the home.
Providing care in dilapidated, cluttered, or unclean homes exposes HHCs to pests and unsanitary conditions. The most frequently encountered pests include bedbugs, mice, rats, and roaches (Polivka et al., 2015). In addition to unsanitary conditions, HHCs may be subject to working in homes with poor air quality from secondhand smoke and/or poor ventilation (Polivka et al.).
Driving can be challenging when dealing with inclement weather, traffic congestion, and poor road conditions. In addition, distracted driving, texting while driving, lack of seatbelt use, speeding while trying to get to the next patient's home, aggressive driving, and driving while tired contribute to motor vehicles accidents.
Some strategies for mitigating risks include performing a community and home risk assessment prior to the first home visit, employee training on safe driving and workplace violence prevention, and implementation of nonsmoking policies while clinicians are working in the home. In addition, because homes are not regulated, patients can be required to complete a household safety checklist so risks and hazards are identified prior to the home visit (Markkanen et al., 2014). Lastly, with the demand for home care services coupled with the range of occupational hazards, there is a need for policy development and implementation to protect the safety and health of HHCs.
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