When I talk about the importance of the home health care model, the dialogue inevitably concludes with a simple question: if a loved one needed care after a hospital discharge or navigating the complexities of ongoing treatment, wouldn’t you want them to receive the highest quality care available? Would you not want them to have the ability to work with whatever health care professionals they needed to ensure the best possible health outcome?
As a board-certified psychiatric nurse practitioner with over 25 years of experience, I have come to understand the variety of factors that can impact a patient’s health outcome, none of which are as significant as quality home health care. This encompasses a range of medical, behavioral health, and other support services in the place where a patient feels most comfortable and at ease. This place is often a patient’s home, but it can also be a stoop or on the street depending on the patient’s circumstances.
However, while we treat our patients where they are most comfortable, this does not mean that a home health care worker performs their job without a multitude of risks and challenges.
Although the recent tragic deaths of home healthcare workers in Willimantic and East Lyme have shed new light on the safety risks we face, this is not a new problem.
According to a 2021 CDC report, as many as 44% of home health care workers have reported being physically assaulted, and 41% have reported sexual harassment.
In many instances when we first arrive at a patient’s home, we do not fully understand whether there is a safety risk. When a patient is discharged and transferred into our care, we often only have a brief summary from the hospital of information they deem relevant to our services. This lack of access to a patient’s full medical record can leave home health care workers in the dark about a patient’s pre-existing conditions, medication history, and other key details that help inform us of the risks we may be facing when we open the door.
However, awareness of the risks involved is not always a guarantee of safety. When we treat patients who are known to be high-risk, we reach out to the state’s mobile crisis or assertive community treatment (ACT) teams. These are multidisciplinary teams that provide support to home health care workers when treating patients with severe mental health or substance abuse issues. While these teams can be invaluable, home health care workers must often wait hours before a team arrives at a patient’s home — hours that can have a significant impact on a patient’s health outcome, especially when it comes to providing essential care.
Beyond the risks to safety, there are the grim realities that accompany our jobs. We are on call 24 hours a day, which includes providing care alone early in the morning or late at night. Our duty of care doesn’t stop simply because it is dark and a patient lives in a high-crime area where our cars run the risk of being towed because we don’t have special vehicle identification.
We continue to do our jobs and work through long days despite taking home a salary that’s lower than other nurses, and which does not measure up to the cost of living in our state. We incur fees and mileage to pick up medications and supplies for our patients that does not get reimbursed. We face a multitude of risks to our safety, our vehicles, and our profession because we believe everyone deserves care regardless of where they are or what their circumstances are.
But our commitment to our patients is not enough to keep us safe.
It is long past time that changes were made to protect home health care workers and to improve systemic inequities that affect both clinicians and their patients. I am hopeful that the legislature will come together this session to take the first steps toward these improvements. Change will not happen overnight, but action must be taken to safeguard those who do all that they can to care for us.
After all, if your loved one was a home health care worker, wouldn’t you want them to have what they needed to come home safe?
Sasa Harriott is the President and CEO of Harriott Home Health Services, which is a full-service state-licensed and Medicare-certified home healthcare agency.