The following article was provided by Elizabeth Hogue, Esq. and a serious reminder of safety risks and precautions for home care personnel:
Home care field staff members who provide services on behalf of private duty agencies, hospices, Medicare-certified home health agencies and home medical equipment (HME) companies are extremely vulnerable. Contributing to their vulnerability is the fact that they work alone on territory that may be unfamiliar and over which they have little control. Staff members certainly need as much protection as possible.
Evidence of the danger that field staff members face is the December 1, 2022, shooting death of Douglas Brant, 56, a home care nurse in Spokane, Washington. Brant was shot and killed by his patient’s grandson during a home care visit. Brant was visiting the home that his patient, her husband, and grandson shared. It was Brant’s first visit to the home.
According to the police report, both the patient and her husband were in the living room with Brant while the patient’s grandson was cooking in the kitchen. After talking for about an hour with Brant, the patient heard “three loud booms” and Brant said, “I’ve been shot.” Brant put down his computer and tried to stand up, but fell to the ground. The patient’s husband tried to help him and then went to the kitchen to get his grandson for help. At that point, the grandson walked into the living room from the kitchen and shot Brant again while standing over him.
From a practical point of view, it is important to ask what home care companies of all types can do to protect their employees from harm. The most important answer to this question is that managers must listen and act when staff members complain about safety hazards. One of the strengths of the home care industry has always been that staff members are often willing to go beyond the extra mile to care for patients.
The perception of many who know the industry well is that workers tend to put up with safety hazards that others would not hesitate to avoid. It becomes essential, therefore, for supervisors to listen carefully to staff members who complain about safety hazards. Assessments by most staff members that they regard situations as unsafe are usually valid since their natural inclination is often to continue to provide services to patients in unsafe situations.
It is also extremely important for managers to act in response to complaints by personnel. There is an old legal adage that “every dog is entitled to one bite.” This means that, as soon as the dog has bitten one person, those responsible for the animal are on notice that the dog is dangerous. They must then take reasonable precautions to prevent further injury or damage. Consequently, once employees register even a single complaint regarding dangers associated with the care of certain patients, employers are likely on notice that further care may involve harm to workers. In view of this “first bite,” so to speak, providers must take appropriate action or face possible liability for injuries to their personnel.
What kinds of actions are appropriate? The Centers for Medicare & Medicaid Services (CMS) issued guidance to state survey agency directors on November 28, 2022, entitled “Workplace Violence – Hospitals." Although the title of the guidance seems to focus on hospitals, language in the guidance focuses on other healthcare settings, such as patients’ homes.
First, CMS points out that a Bureau of Labor Statistics Fact Sheet from April of 2020 states that healthcare workers accounted for 73% of all nonfatal workplace injuries and illnesses due to violence in 2018. The Fact Sheet also points out that the number of injuries and illnesses due to violence has been steadily increasing since tracking of these events began in 2011.
CMS goes on to assert that violence can be addressed with appropriate controls in place. According to CMS, appropriate controls applicable to care in patients’/clients’ homes include:
For all types of providers of services in homes, termination of services to patients/clients is certainly an appropriate response to concerns regarding the safety of home care staff members. Termination of services must, of course, be consistent with applicable requirements to avoid liability for abandonment.
The use of so-called “escorts;” including armed, off-duty police officers; may also be appropriate. Some home care personnel, however, object to use of escorts. The basis for their concern may be that the presence of escorts interferes with their relationships with patients. They point out that there is an essential inconsistency between the caring and nurturing relationships they wish to foster with patients and their families, and the use of escorts. Providers may, therefore, decide to establish and implement a policy that staff may not reject escorts when management deems that their use is appropriate. Refusal of escorts should be defined as insubordination in such policies and procedures, and appropriate disciplinary action, including termination of employment, may be taken in response to this type of insubordination.
Home care personnel knock on the doors of thousands of patients each day, unaware of what may be inside their homes. They regularly encounter unfamiliar terrain and unknown risks. These risks are likely to become even greater as the use of home care services continues to expand. Managers and field staff must be prepared to deal with the constant potential for compromised safety.
©2023 Elizabeth E. Hogue, Esq. All rights reserved.
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