Recognizing Danger on the Home Front

Vol. 12 •Issue 3 • Page 28
Home Pathways

Recognizing Danger on the Home Front

The safety risks home health care providers face daily can range from ferocious pet bites to violent crimes. In one of the most extreme examples, a wheelchair-bound patient shot and killed his home care nurse. An analysis of the circumstances showed the nurse had ignored many warning signs, including the patient’s aggressive behavior and threats to use firearms in the home.

Today it’s not enough for home respiratory therapists to just be knowledgeable in disease management. A watchful eye and sharp decision-making skills are necessary for RTs to provide quality patient care while keeping their jobs hazard-free.

“Many of our therapists are assaulted on a daily basis,” said Timothy Buckley, RRT, of Walgreens Health Initiatives, Deerfield, Ill. “We just kind of take this in stride and say, ‘Well, our patients are crabby,’ but we have to put limits on behaviors of patients and make sure that our staff is skilled at spotting these behaviors and dealing with them.”


Home care therapists from DeKalb Memorial Hospital, Auburn, Ind., participate in orientation programs where they learn the ropes of safe home care practices, said Betty Hunter, BSN, director of home health and hospice. They’re taught that safety precautions begin as soon as a patient admits a therapist into his or her home.

Therapists perform an intake and make special note of anything that could be hazardous to them or their patients. This can include — but isn’t limited to — firearms, drug and alcohol abuse, and indications of physical or sexual abuse.

Therapists then assess the structural integrity of the home. The hospital is affiliated with a community resource program that provides social workers if home repairs need to be made to steps or otherwise dangerous areas of a house.

During these first meetings, the RTs need to set agreements with patients and their families that cover what services the home care providers perform and the length of the visits. These parameters give patients clear expectations and prevent confusion over the care plan.

The therapists also are trained to follow emergency protocols DeKalb has in place for specific situations, such harsh weather, bomb threats and fire. For example, last year DeKalb employees faced a severe ice storm that caused power outages, disrupted office and staff communication, and made roads treacherous. Wanting to keep her staff as safe as possible, Hunter told her therapists that their No. 1 priority was to treat those patients who really needed help, such as patients who were bed-bound, on IVs and oxygen, and those who lived alone.

“Home health providers need to be mature and know how to assess a situation because you never know what you can expect,” Hunter said.


Sometimes therapists are confronted with threatening patient behaviors or crime in a patient’s home. Patients exhibit violent behavior in several ways, said Buckley, who lectured on the safety of home RTs at the 2002 American Association for Respiratory Care Congress in Tampa, Fla. “They can be aggressive, they can yell and scream, but if they’re pushing, shoving or touching you inappropriately, we tell therapists to end the visit and walk out of the house.”

In such instances, Buckley recommends returning to future visits with more than one therapist, or in a worst-case scenario, a patient can be dropped from a provider’s care with adequate notice.

A well-trained RT will know how to prevent himself from becoming victim to a dangerous situation by monitoring a patient’s behavior and reporting problems immediately. Managers can analyze situations on a case-by-case basis and more .carefully tailor risk management plans for their employees. Everyone has a story to tell, but they might not be telling it, so managers should check in routinely with their staff to make sure they’re not ignoring any potentially dangerous scenarios.

Managers also should be aware of where their workers are at all times. Take time to complete route sheets that are kept on file so both manager and therapists are kept in the loop. These files should show the times a therapist is with a patient and stops made en route to the patient’s home or on the way back to home care headquarters.

For added safety and communication, home care providers should supply therapists with a cell phone or radio for emergency communication. This would be especially helpful in a situation where a patient refuses a caretaker use of the home telephone or in a case of the therapist being lost in a bad part of town.

“Many patients don’t live in the safest areas,” Buckley said. But patients in these areas can’t be denied care, so therapists need to take measures to make sure they can get in and out to their patients safely. “Often we advertise who we are, and we may look like we have at least lunch money in our pocket. This could make you a target for someone in more hostile neighborhoods.”

On-the-job hazards, no matter how big or how small, shouldn’t be tolerated. Effective risk management in the home setting is the best way for health care organizations to keep their therapists safe and their patients healthy.

Debra Yemenijian is editorial assistant of ADVANCE.


Sometimes common sense things are overlooked when home care respiratory therapists are on the job:

• Dress conservatively when entering unfamiliar territory so that you don’t stand out.

• Don’t carry purses or personal items into home visits.

• Lock your car doors.

• Buckle your seat belt.

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