NAHC Report

September 27, 2018

Workplace Violence and Reducing Turnover of Home Health Employees

A special to NAHC Report by Louis C. Kirby, MD

One of the two most significant limitations on growth in the home health and hospice sector is labor shortages – recruiting and retaining qualified nurses and home health workers. Registered nurses are retiring faster than new ones can be trained1, and one of the primary causes of home care nurse and aide burnout is workplace violence. Aside from the benefits of implementing a workforce safety plan, equipping your staff with the training and tools to mitigate their safety risks has a direct impact on your ability to attract and retain qualified employees.

The facts surrounding the issue of workplace violence in the home health care sector (discussed below) are compelling and alarming. Developing a robust safety program for your mobile workforce has been proven to reduce healthcare worker stress and turnover2. In addition, clearly communicating a commitment to workforce safety in your hiring materials allows your organization to distinguish itself amongst others as a caring and supportive place to work.

Because violent incidents are routinely underreported3, many employers are unaware of the frequency and degree of the violence their employees face, and the impact that violence is having on employee retention. Only “about 1 in 5 violence incidents are ever reported in part due to embarrassment, organizational culture, tolerance or excusing the behavior of ‘ill’ clients4.” Nurses have cited fear of retribution from supervisors, the complexity of the legal system, and disapproval of administrators as barriers to reporting workplace violence3.

A review of health care worker safety reported in the New England Journal of Medicine found that 61 percent of home care workers faced violence each year, including verbal abuse and threats, sexual harassment, sexual abuse, rape, assault, shoving or displays of weapons3. Risk factors include drugs and alcohol, access to weapons, client dementia or mental illness, and solo work without backup such as an onsite co-worker or panic button. Home health workers also face risks from the surrounding community, which can include robbery, a belief that nurses carry drugs or money, after dark travel, and car theft and vandalism, and risks of violence from other family members or friends in the patient’s home5.

Available research clearly establishes that unaddressed workplace violence and aggression against mobile healthcare workers leads to stress, depression, anxiety, sleep problems, PTSD, worsened physical health, and burnout leading to turnover2. Burnout and stress can also adversely influence the quality of care, increasing the risk for medical or care administration errors. Violence and the threat of violence lead employees to leave the employer or the industry altogether6.

Because home health workers provide care in an uncontrolled environment without the protections offered in traditional health care facilities, they need specific safety tools that enable them to get help when they need it most. Reliance on safety training alone is likely to have limited effectiveness3. In OSHA’s Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers7, they recommend the use of specific tools to address home health worker concerns, including panic buttons, personal alarm devices and GPS devices. The implementation of a credible safety program that is geared to the very specific needs of mobile healthcare and hospice workers represents a significant and largely untapped opportunity to both increase the safety of the home health workforce and enhance employee retention outcomes.


  • Sector spotlight: Home health and hospice.
  • Hanson, et al. BMC Public Health(2015) 15:11
  • J Phillips New England Journal of MedicineApril 2016. p1661
  • Mayhew, C. (2000). Preventing Client-Initiated Violence: A Practical Handbook. Research and Public Policy Series, no. 30. Canberra: Australian Institute of Criminology.
  • Gross, N. et al (January 31, 2013) “Workplace Violence Prevention Policies in Home Health and Hospice Care Agencies” OJIN. Vol. 18, No. 1, Manuscript 1
  • Estryn-Behar, et al. “Violence risks in nursing – results from the European ‘NEXT’ Study” Occupational Medicine2008 58:107–114


Louis C. Kirby, MD

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