Single-Medic Response Safety

The future of EMS appears to hold more single-medic responses, whether for emergency calls or for community paramedicine programs. That leaves medics even more vulnerable than when working in teams—but they are not alone in this situation.

Home-health agencies have long dealt with this aspect of care delivery, facing questions of security for lone, usually female, care providers. Another way in which the home-health care industry mirrors EMS is that it encompasses numerous business models and forms of care delivery, and has no single lead organization or set of standards.

As a result, policies vary from agency to agency, experts say.

“They all have their individual policies,” says Mary Carr of the National Association for Home Care and Hospice. Typically, she says, providers are expected to use their discretion and environmental awareness to pinpoint any concerns, and then have some latitude in how to respond.

For example, if providers are asked to go out at night, it’s common to have a security escort available. Or, if they see weapons in a home, they can typically ask the patient to lock them up or decline to treat the patient. It helps that home care visits are anticipatory and that concerns can often be addressed from one visit to another, Carr says. On the flip side, situations can also take a turn for the worse. A provider might feel safe at a patient’s home until an unstable relative moves in, for example.

Training, including any for safety, typically occurs upon hiring and during annual review/training sessions, Carr says.

Her view is echoed by Stephen Tweed, CEO for Leading Home Care in Lousiville, Ky.

“Every owner or CEO of a home care company has in the back of their mind the safety of their employees,” he says. “The extent to which they address it varies from location to location.”

Variation Across the Home Care Industry

Much of the variation in safety policies occurs by geography and business type, Tweed says.

While issues like assault can occur anywhere, the concern is typically highest in high-crime areas.

Training, including that for safety, is also commonly tied to the level of skill provided by an agency, plus factors of time, pay rate and levels of education, Tweed says.

He notes there are five distinct types of home health agencies that can all have their own approaches: skilled intermittent care; hospice; home medical equipment providers; home infusion therapy; and private duty home care, which ranges from non-medical personal care to companionship.

What Is Typical in Home Care Safety?

What is typical among all agencies is the home assessment, Tweed says. When an employee opens a case, they take note of everything at the home from structural integrity, to slip and fall hazards, to fire hazards, to availability of emergency exits, to who else is living or visiting at the home, to whether there are drugs or weapons in the home, etc. This is part of a formal process for developing a plan of care.

“If they don’t think they can deliver the care safely, they are able to decline that case,” Tweed says. “If they believe they are in danger, they are to get out immediately and call 911.”

Tweed says agencies should have a process in place so that if a care provider needs to leave a patient unexpectedly, the manager will be accepting and have a plan to follow up.

Differences in EMS/Home Care Concerns

While EMS is most often focused on the risk of entering a patient’s home and the potential for violence from the patient or patient’s family, home health agencies are typically most focused on the risks involved in getting to and from patient homes in dangerous communities.

One reason may be differences in the populations of patients served; while EMS patients run the gamut, home care clients are often elderly, disabled or bedbound. Another reason may be differences in transportation; while EMS responses are typically handled via ambulance, home care providers typically drive in their private vehicles, and have to contend with finding parking spaces and walking some distances.

Tweed offers an anecdote of a Boston-based home care agency that contracted with a taxi service to transport care providers from home to home, as both a safety and cost-saving measure. When one nurse still had her nursing bag stolen on her way out to the cab, her cabbie called up coworkers and they got it back. When the CEO asked the cabbie what happened to the thief, he was told, “Don’t ask.”

Handling Tough Neighborhoods

Tweed says the highest level of security that he sees is when a home care company contracts with off-duty police officers as escorts, who either transport the care providers themselves or meet them on location.

It’s also common for agencies to organize their employees into geographic teams, so they get to know patients, doctors, neighborhoods and reduce travel. As part of this arrangement, they often utilize care providers in the areas they already know best, so those who live in or come from high-risk areas and are the most knowledgeable and comfortable with them are typically the ones assigned to them.

Home Care Provider Injuries and Deaths

Tweed says he has heard some anecdotes of on-the-job provider injuries and deaths over the years, but from his perspective they seem to be rare and he isn’t aware of a central reporting system.

Concern Growing?

There’s no official indication of whether concern for safety in the home care industry has grown or changed over time.

“In my personal opinion, it’s getting stronger with what’s been going on in the last couple of years,” Carr says, referencing the rise of mass shooting incidents.

Tweed says he isn’t aware of any more attention than usual. “I haven’t heard more about it in the last couple of years because there have been so many other pressing issues for the industry,” he says, specifically regarding health care reform and changes to reimbursement.  

“The reality is that the incidence of violence against home care providers is relatively low considering the number of them out there daily... It could happen to anyone in any occupation, but they are in a position to see higher levels of risk.”