Violence in Aging Services

July 18, 2017 | Aging Services Risk, Quality, & Safety Guidance

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When violence erupts in a long-term, short-stay, or home care setting, the consequences are many and unpredictable, potentially including injury or death of building occupants; property damage; lawsuits; and diminished resident, staff, and community trust. The risk of workplace violence looms in continuing care facilities—where a stressful work environment can quickly become volatile, visitors may be highly emotional, and drugs or expensive equipment may become targets of robbery. In addition, home care employees may walk alone into homes where individuals served or their family members keep weapons or drugs or may visit homes in areas with high crime rates, increasing the risk of encountering violence while on the job.

Many violent events in healthcare, particularly assaults on staff members, are caused by residents; however, this guidance article focuses on violence committed by visitors, employees, and trespassers (e.g., robbery, stalking of a patient or employee, intimate partner violence). For more information on violence caused by residents, see Resident Aggression and Violence.

Resident Aggression and Violence

The National Institute for Occupational Safety and Health defines workplace violence as "violent acts, including physical assaults and threats of assault, directed toward personnel at work or on duty." Many other sources include verbal aggression (e.g., threats, verbal abuse, hostility, harassment) in the definition of workplace violence. Not only can verbal aggression cause significant psychological trauma and stress, it can also escalate to physical violence. (OSHA "Caring")

The Occupational Safety and Health Administration (OSHA) reports that in each year from 2011 to 2013, U.S. healthcare workers suffered 15,000 to 20,000 serious workplace-violence-related injuries; serious injuries are those that require time away from work for treatment and recovery (OSHA "Caring").

Violence is significantly more common in healthcare than in other industries, and violence-related injuries to healthcare workers account for almost as many similar injuries as are sustained by workers in all other industries combined. In 2013, healthcare and social assistance workers experienced 7.8 cases of serious workplace violence injuries per 10,000 full-time equivalents (FTEs), while other large sectors such as construction, manufacturing, and retail all had fewer than 2 cases per 10,000 FTEs. (OSHA "Caring")

Additionally, in 2016, the U.S. Government Accountability Office (GAO) published an analysis of three federal datasets revealing that in 2013 healthcare workers at inpatient facilities including...

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