Home Health Care Worker Safety: An Overview and Call for Increased Worker Protections

Abstract

An un-vaccinated home health aide develops Hepatitis B after she sticks herself with a patient’s used insulin syringe. A Florida caseworker is stabbed to death by her patient after previously noting that he made her “very uncomfortable” and recommending that home care workers should visit him only in pairs.[1] A home health aide severely injures her back when she attempts to prevent a patient from falling as he gets off of the toilet. A home health nurse in Arizona is threatened by a demented patient who points a gun at her and then turns the gun on herself.[2] Nurses on the South Side of Chicago are accompanied to their patients’ homes by armed guards.[3] Dedicated home health workers care for our nation’s frail and elderly, sometimes at great personal risk, but who is protecting the safety of these caregivers?

          In 2014, U.S. home health agencies provided care to roughly 4.7 million patients.[4] Many factors point to a greatly increasing need in the United States for the provision of home health care over the next several decades. These factors include the “graying” of America, the chronic health conditions which accompany aging, the preference of the vast majority of Americans to “age in place,” and the fact that home health care is often a lower cost alternative to inpatient care for patients with chronic conditions.

          The U.S. population is rapidly aging. By 2030, 20% of the population will be 65+ (nearly doubling from 13% in 2010).[5] The 85+ population will double by 2036.[6] In fact, by 2050, those 85+ will be 4% of population, a ten-fold increase from 1950.[7] Medicare enrollment is predicted to increase by 50% over the next fifteen years, from a current 54 million to 80 million people.[8]

          Seniors often experience physical and cognitive deficits. Almost 26% of adults 65+ have type 2 diabetes.[9] The rate of clinical obesity in adults 65+ rose to 27.4% in 2014.[10] Many seniors have functional limitations (due to such conditions as heart disease, arthritis and mobility issues) or cognitive deficits which necessitate help with activities of daily living (ADLs): eating, bathing, paying bills, dressing, toileting, and preparing meals.[11] One third of those 65+  and two thirds of those 85+ have cognitive deficits.[12] More than two thirds of people over 65 will need assistance to deal with some loss of function at some point before their deaths.[13]

          This article will cover home health care background information in Part II, before moving on to examine three broad categories of workplace hazards which home health care workers face: Part III—Infectious Disease; Part IV—Safe Patient Handling; and Part V—Workplace Violence. Each section which covers a workplace hazard will explore what is currently being done at state and federal levels to mitigate these risks and will make recommendations about what should be implemented. Part VI will address how risks are compounded for low wage home health care workers and the means that are available to advocate for the safety of these workers. Finally, Part VII will conclude the article by repeating the call to action for increased regulation and enforcement to protect the health and safety of all home health care workers, who will be increasingly vital for U.S. society as the population continues to rapidly age and need their services.

[1] Fla. Caseworker stabbed to death during home visit  (13 December 2012)

tampa.cbslocal.com/2012/12/13/fla-caseworker-stabbed-to-death-during-home-visit.

[2] Interview with Karen Rizzo, R.N., Division Director of Bayada Home Health Care, Tucson, Arizona (October 9, 2017).

[3] Stephanie Smith, Nurses dodge bullets to provide care (2 March 2013) www.cnn.com/2013/03/02/health/nurses-gunfire-chicago/index.html.

[4] Selected Long-Term Care Statistics, Family Caregiver Alliance (31 January 2015) https://www.caregiver.org/selected-long-term-care-statistics.

[5] Steven Landers et al. The future of home health care: a strategic framework for optimizing value, Home Health Care Management & Practice 2016, Vol 28(4), 263.

[6] Id.

[7] Rising demand for long-term services and supports for elderly people (26 June 2013) https://www.cbo.gov/publication/44363, 1.

[8] Landers et al., supra at 263.

[9] Type 2 Diabetes Statistics and Facts Healthline, https://www.healthline.com/health/type-2-diabetes/statistics.

[10] Rachael Rettner, U.S. Obesity Rates Have Risen Most in Older Adults

(27 January 2015) https://www.livescience.com/49587-obesity-rates-older-adults.html.

[11] Rising demand for long-term services and supports for elderly people, supra at 1.

[12] Id.

[13] Id.