Many home-based care workers often feel unsafe in their jobs, having a direct impact on hospice recruitment and retention.

More than 50% of 400 home-based care employees said they had experienced or witnessed at least one instance of workplace violence or harassment in a recent report from Transcend Strategy Group. About 20% indicated that they had experienced or witnessed at least seven such incidents, the research found.

“They are entering a space that is very personal to provide very personalized care. We want to say that nine times out of 10, it’s all going to be fine. Family caregivers are going to receive them with open arms and be grateful for the care that they are there to provide,” Nicole McCann-Davis, senior client advisor and research director for Transcend, told Hospice News. “However, there are some instances where there may be some other dynamics happening that can unfortunately contribute to a negative experience, and at times an unsafe experience for family and for professional caregivers.”

Transcend surveyed home-based care workers from across the country, working in industries such as hospice, home health, palliative care, private duty nursing and personal care services. Respondents represented a diverse range of ages, genders, races and U.S. regional demographics, according to Transcend.

Among other key findings, 48% strongly agreed that they could leave an unsafe environment without fear of retaliation from their employer, and 30% indicated that they did not feel that their organization prioritizes their safety.

Factors that contribute to unsafe conditions include the mental and emotional state of patients and families and attitudes regarding women and racial and cultural bias, among others, McCann-Davis indicated.

“When people are going into the home, you don’t really know what to expect, what issues families are facing, especially as they are encountering their normal day to day lives in addition to being family caregivers, going through some of that anticipatory grief,” McCann-Davis said. “There’s so much that’s happening with the family caregivers, and, while people typically have very good intentions, you just don’t know what it is that you’re walking into.”

The report identified three elements that can enhance feelings of safety among the home-based care workforce — trust and autonomy, assurances that employers trust their judgment and consistent and open communication, training and protocols around safety.

Employees need to feel like their organizations trust them to make decisions about unsafe conditions in patients’ homes and respect their ability to make choices on how to respond, the research found.

They also cited a need for resources such as training to de-escalate potentially dangerous situations, best practices for removing themselves, support for self-care and stress management, strategies for dealing with aggressive pets in the home and effective communication for cultural sensitivity.

“We all should be in a space, especially as adults who are working and have professional experience, to have the autonomy over ourselves and our personal safety to decide this isn’t a space that feels good to me. I should be able to leave without fear of consequence,” McCann-Davis said. “Staff need to feel as valued as they feel like patients are valued within their organizations. So that open communication, having trust between employees and their employers, is incredibly important.”