The in-home care industry continues to navigate the widespread challenges of high turnover and burnout rates among caregivers. Verbal and physical abuse caregivers experience on the job is compounding these issues.

Indeed, home care workers frequently experience some form of abuse by clients and their families when delivering care in the home, a recent survey published in Occupational and Environmental Medicine Journal found.

That includes verbal abuse — or words spoken to caregivers in an angry, humiliating or hateful fashion. It also all too often includes threats of violence and physical abuse.

Conducted by researchers from the Department of Public Health and the Department of Biomedical Engineering at the University of Massachusetts, the survey collected data from more than 900 caregivers. Responses represented over 3,000 separate client visits.

As part of the study, researchers factored in caregiver demographics, general conditions of employment, health issues and living conditions.

Overall, researchers found that 22% of home care workers faced at least one incident of verbal abuse coming from clients or their family members in the 12 months prior to participating in the survey.

Among the 22%, 51% of home care workers reported experiencing more than one type of verbal abuse, with 5% experiencing four types.  

Home care workers participating in the study reported experiencing physical abuse much less frequently — at 7.5% of the time. Caregivers who faced verbal abuse were 11 times more likely to face physical abuse than workers who had not been verbally assaulted.

Additionally, younger workers were more likely to be verbally abused than workers age 48 and up.

Things such as cramped client living conditions increased the risk of verbal abuse. As did clients living with dementia and limited mobility, as well as clients with unclear care plans.

“[Home care] workers may be especially vulnerable to impacts from verbal abuse, as the isolated nature of their jobs and requirements of client privacy leave them with fewer resources for social support that can help moderate the stress response,” the researchers wrote.

Abuse on the job can lead to occupational injuries, illness, job dissatisfaction and burnout.

In 2018, the home care industry turnover rate hit 82% — an all-time high. The study’s findings suggest that home care agencies with effective support systems in place for addressing abuse may be better positioned to keep their caregivers.

“We are in the business of protecting the independence and dignity of people,” Emma Dickison, CEO and president of Home Helpers, told Home Health Care News in an email. “And that’s all people — not just the clients that we serve, but the caregiver who provides much-needed support and safety ensuring the clients have peace of mind.”

Cincinnati-based Home Helpers is a national home care franchise company with over 300 offices providing services across more than 1,000 communities.

Training, sharing experiences across its franchise network and periodic home visits from supervisors have played a role in protecting workers and preventing turnover, according to Dickison.

“At the start of service, we set very clear expectations with the client and their family,” she said. “[Processes are] in place that if for any reason the client or family is not respectful to our caregivers, we reserve the right to discontinue service. [Whether] it’s verbal, physical or inappropriate demands or expectations, we want to ensure that our caregivers are in an environment where they can thrive.”

Homewatch CareGivers has a similar view, according to Nicole Brackett, a quality and training specialist for the home care franchise.

Brackett noted that caregivers should always be sure to report aggressive behavior from clients, as it could be a sign that they may be experiencing unknown health issues.

“There is an opportunity to re-evaluate a client who is acting aggressively because such behaviors can mean something else is going on with them, such as the progression of dementia or other illnesses, or some other issue that the care team needs to be made aware of for the health and wellness of the client,” Brackett told HHCN in an email. “Caregivers who don’t understand this may disappear without saying anything and then the problem may be repeated without appropriate resolution for either party.”

Denver-based Homewatch CareGivers provides home care services and has more than 200 locations in the U.S., Canada and throughout Latin America.

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