Workplace Violence in Home Health: Staff and Leadership Experiences and Strategies

Workplace violence (WPV) in healthcare has increased over the last decade, yet limited evidence exists to guide home health agency (HHA) prevention efforts. This study examined HHA leaders and staff WPV experiences, including the type of violence, risk factors, and prevention strategies.

We conducted one-on-one semi-structured phone interviews with a purposive HHA sample of (a) 105 leaders, each representing a different organization, between November 2020-December 2022 and (b) 28 staff from five agencies between April 2023-August 2025. The socioecological framework guided the thematic analysis.

Leaders and staff contrasted the solitary, uncontrolled, and unpredictable HHA work environment with institutional healthcare contexts. HHA staff experiences reflected three types of WPV (i.e., criminal intent, violence perpetrated by the patient or others in the home, ideological violence perpetrated by the public). WPV risk factors spanned all domains of the socioecological framework. HHA staff and leaders described individual- and organizational-level WPV prevention strategies that targeted risk factors across framework domains. There was an absence of prevention strategies initiated at the community- and societal-level (e.g., WPV prevention legislation). Organizational strategies extended beyond annual staff training to include patient-specific safety plans, employing safety escorts, and discharge protocols for patient non-compliance with safety plans.

Fostering HHA staff safety within the context of service delivery is complex and multi-dimensional. Findings emphasized the importance of a comprehensive approach that is tailored to the HHA's community and populations served and a need for societal-level policies addressing WPV prevention and mitigation.