Home Care Health Aides Endure Frequent Verbal Abuse from Clients and Their Families

Home care (HC) health aides frequently endure verbal abuse from their clients and their clients’ families and mitigating such occurrences would require specific changes in work organization and training, according to a study published in Occupational & Environmental Medicine.

Among US healthcare and social assistance workers, incidences of abuse are a serious occupational hazard, and according to the study authors, “HC 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. In HC, verbal abuse has been found to be related to negative emotional reactions; burnout, stress, sleep problems and depression.”

In conducting this questionnaire study, called the Safe Home Care Survey, data were collected on 954 HC aides between September 2012 and April 2013 as part of a larger mixed methods research initiative called the Safe Home Care Project. Participants who were agency-hired were recruited from seven HC agencies (16 sites) throughout Massachusetts, while the study subjects hired directly by HC clients or clients’ families were enrolled via their labor unions. All aides comprising this survey cared for clients who were non-family members, because family caregivers may perceive harmful behaviors differently than non-family caregivers.

The researchers defined incidences of verbal abuse based on whether the HC workers had at least one abusive experience within the past 12 months either from a client or a client’s family member. They ascertained four forms of verbal abuse from the survey responses: ‘being yelled at or spoken to in an angry or humiliating tone’; ‘made to feel bad about myself’; ‘racial, ethnic, religious or other personal insults’ and ‘verbal threat of harm’. Client health conditions, and behaviors were selected as potential risk factors, and log-binomial regression was used to estimate relative risk (RR) of verbal abuse.

Troubling Results

According to the results of the study, 206 aides (22%) reported experiencing at least one occurrence of verbal abuse in the 12 months preceding the survey. HC aides who experienced abuse reported being yelled at or spoken to in an angry or humiliating tone of voice (17%), were put down and made to feel bad about themselves (10%), had to endure racial, ethnic, religious, or other personal insults (6%), or received verbal threats of harm (5%). While physical abuse was less common than verbal abuse (7.4%), the two forms of abuse are strongly correlated as aides who reported verbal abuse were 11 times more likely to also report physical abuse. Moreover, the study identified three important factors for abuse in multivariable models: clients with dementia (RR=1.38, 95% CI, 1.07 to 1.78), homes with limited space for aides to work (RR=1.52, 95% CI, 1.17 to 1.97), and predictable work hours (RR=0.74, 95% CI, 0.58 to 0.94). Two additional factors which were moderately associated with verbal abuse: clients with limited mobility (RR=1.35, 95% CI, 0.94 to 1.93) and an unclear plan for care delivery (RR=1.27, 95% CI, 0.95 to 1.69).

Enhanced Training and Assessments are Necessary

“We identified verbal abuse risk factors for which preventive interventions can be implemented,” the study authors wrote. “While the study cannot prove that these factors are causal, all suggested interventions also have benefits for improved care quality and work conditions beyond abuse prevention.”

In conclusion, the authors emphasized that “training on dementia can offer helpful work practice and communication strategies for aides,” adding that “initial and periodic client home assessments can include the determination of space requirements for care tasks and need for assistive devices to mobilize clients as well as development of care plans that consider the safety of both client and aide. While providing aides with predictable work hours can be challenging to the HC industry, it may benefit clients and aides, and potentially help address employee turnover, one of the industry’s biggest challenges.”