Home health care aides often face verbal abuse from clients

For many home healthcare aides, verbal abuse from clients or clients' family is a real problem, a U.S. study suggests.

Caregivers who reported verbal abuse were also more likely to report physical abuse, researchers found.

Verbal abuse can hurt these aides' long-term health and lead to higher turnover rates, said senior study author Margaret Quinn, who is director of an industry outreach initiative called Safe Home Care Project at the University of Massachusetts in Lowell.

"There already are not enough home care aides to take care of the aging population," Quinn told Reuters Health on the phone. "This problem is going to increase rapidly."

Quinn's team recruited 954 home healthcare aides and had them fill out questionnaires about themselves and their experiences at work.

More than one in five caregivers, or 22%, reported at least one incident where they had been verbally abused in the past 12 months.

The actual number of incidents may have been higher, as people's ability to recall relatively minor incidents of verbal abuse may decrease over time, the researchers say.

Among aides who reported verbal abuse, 17% said they had been yelled at or spoken to in an angry or humiliating tone, 10% said they were made to feel bad about themselves, 6% reported racial, ethnic, religious or personal insults and 5% said they had received verbal threats of harm.

Dementia in the care recipient was strongly linked with instances of abuse, Quinn's team writes in the journal Occupational & Environmental Medicine.

Quinn and her team suggest training aides to handle patients with dementia, which sometimes causes aggressive behavior. Quinn says a caregiver may arrive in the home knowing that her client has dementia but not really knowing what can be done to alleviate symptoms.

"I think including the aide and having them more integrated into the care team, including and especially with clients with dementia could help both the client as well as the aide," said Quinn.

"In the United States, home care aides are often not included as part of (the) medical team," Quinn added, referring to what she says are considered health professionals such as physical therapists.

Aides with unpredictable schedules were more likely to face verbal abuse than those with predictable working hours. Making hours predictable for caregivers, though challenging, could help address employee turnover, the research team suggests.

Cramped work conditions were also linked with higher odds of verbal abuse for the aides. The researchers suggest that assessing the client's home to be sure aides will have space to perform their care tasks might help reduce some of the risk of verbal abuse.

"Home care aides really take reward and satisfaction from their jobs. They are rewarded by relationships that are overall very positive," said Quinn.

She says the new research aims to improve quality of job experience for the aides. It's about "going forward and finding solutions that work for all the parties that need home care."

Care at home has many advantages for the consumer, said Ginger Hanson, an assistant professor at the School of Nursing at John Hopkins University, Baltimore. "We need to better understand the impact that this trend is having on home care workers, who are also a vulnerable population who often face financial insecurity," Hanson, who was not involved in the study, said by email.

Clare Stacey, an associate professor of sociology at Kent State University in Ohio who was not involved with the study, told Reuters Health, "I am not surprised by these findings but I am thankful that this work gives us quality data to substantiate what many of us who study home care know, anecdotally."