That concern that violence is committed in the nursing home environment is an established fact. What may be a lesser-known challenge is that nursing home staff are among the victimized.

It’s a concern for medical professionals in all settings and a barrier to recruiting when the shortage of qualified workers is an ongoing hurdle. It’s hard to attract people to work in an environment where the risk of violence is high. 

And caregivers to aging populations are especially at risk when older adults have chronic conditions that limit their physical health or cognitive abilities. They may strike out with verbal abuse, sexual advances or physical aggression.

Due to the numbers employed in both assisted care facilities and nursing homes, nursing assistants are frequent targets of violence and aggressive behavior by patients. These caregivers play a vital role in the long-term care sector but often face a high risk of injury from violent assaults at work.

Solutions needed

Various industry and community groups have pushed for more stringent guidelines to protect healthcare workers as a class. Professional associations, for example, have been pushing for legislative action that would criminalize assault and intimidation as it has for airline employees.

And government oversight agencies are stepping up, too. In November, the Centers for Medicare & Medicaid Management Services, issued a new Quality, Safety and Oversight (QSO) memo concerning violence and its prevention in the wider healthcare setting. 

The memo stressed that CMS prioritized enforcement of regulatory expectations of a safe environment for effective delivery of care. It did not issue an enforcement change for nursing homes with the memo, although that may happen at some time.

OSHA steps up

Currently, there is no federal Occupational Safety and Health Administration (OSHA) standard for preventing workplace violence in any industry, but some states, such as California, have their own. 

But one for healthcare, including residential care facilities, is being studied, and a working panel has been convened to lay the groundwork for a new regulatory framework. 

The panel is charged with exploring a variety of topics as baseline concerns, not the least of which is what a “programmatic” approach to a workplace violence prevention standard might entail. But other topics will include hazard assessments, violence control measures, preventive training, and investigations and documentation. One concern is the ability to avoid stigmatizing residents, patients and clients.

The standard would cover about 14 million workers and 300,000 healthcare establishments, including hospitals, nursing homes and various types of social services. The cost of compliance to employers is estimated by OSHA at $1.2 billion annually; within nursing homes alone, the cost is estimated at $177 million, with an average annual investment of $10,000 to sustain it.

Adopt an enterprise-wide perspective

The good news is that despite the growing risk of violence against workers in senior care, the trend has not yet had an impact on the cost of insuring against it. Availability and cost of general liability (and management liability, to some extent) and workers’ compensation are holding steady.

Even so, owners and management would do well to step up precautionary training and follow best safety practices as a pre-emptive move as OSHA guidelines come down. The development of an enterprise-wide, multi-disciplinary violence program will both manage the risk and advance a culture of safety and quality.

The Joint Commission’s new and revised standards for workplace violence prevention, effective Jan. 1, 2022, provide a best-practices blueprint. Requirements include a violence prevention program managed by a multidisciplinary team and regular education and training on intervention and de-escalation. The emphasis is on prevention, recognition, response and reporting.

At a basic level, every violence prevention program needs to be built on a better understanding of the risks. This means identifying all of the possible triggers (violence from a patient is very different than from an outside intruder) and ensuring appropriate safeguards are in place (like tighter security at ingress/egress points and well-lit parking lots).

It’s challenging to prepare effective pre-event mitigation plans for situations as unpredictable as those resulting in violence against a nurse, doctor or health aide. 

Chances are that most nursing homes never included it — or a global pandemic, either, for that matter — in their top 10 list of crises to worry about. But, there is no time like the present to re-think that.

Gigi Acevedo-Parker is National Practice Leader – Clinical Risk Management for global insurance brokerage Hub International. She is a nurse executive with more than 30 years as a healthcare clinician, nursing leader, healthcare consultant and educator with a focus on healthcare risk mitigation and patient safety. 

Jim Burke is a Vice President/Sr. Risk Consultant on Hub International’s Risk Services team. He has over 30 years of experience in professional safety and risk control consulting with direct, practical experience in a broad range of diversified business operations. 

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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