New research shows that home care workers are frequently verbally abused by clients and their families.

Clients living in cramped conditions and those with dementia or limited mobility were most likely to abuse their carers, according to the study, out of the University of Massachusetts and published in Occupational and Environmental Medicine. Unpredictable work schedules were also found to be a contributing factor to the levels of abuse.

A quarter of nursing, hospice, and personal care aides surveyed said they’d been verbally abused in the last year, and 7.5 per cent had been physically assaulted.

The findings could be reflective of the situation here in New Zealand.  Chief Executive of New Zealand’s Home and Community Health Association (HCHA) Graeme Titcombe says research on health and safety of home based support workers in New Zealand is currently being finalised; this includes, but is not limited to, research in regard to physical and verbal abuse by clients and families.

“Indications are that a high proportion of all home and community staff working in the aged care sector in New Zealand have suffered physical abuse from clients at some point. Reports of verbal abuse appear to be lower but is growing,” says Titcombe.

“However it is also highly indicated that a substantial majority of staff reported feeling safe at work; this could be due, in part, to home-based staff developing a reasonably high level of tolerance for challenging behaviour that would be considered unacceptable in many other work settings.”

The researchers agree, suggesting their findings may actually underestimate the prevalence of verbal abuse as recall fades over time, and home care workers may make allowances for violence because of their client’s age or health condition.

“Home care workers may be especially vulnerable to impacts from verbal abuse, as the isolated nature of their jobs and requirements of client privacy leave them with fewer resources for social support that can help moderate the stress response,” they write.

The researchers drew on 954 responses to the US Safe Home Care Survey, which was carried out as part of a larger study (Safe Home Care Project) on home care aides’ working conditions. The responses refer to a total of 3189 separate visits.

Verbal abuse was defined as being yelled at or spoken to in an angry or humiliating tone;  being made to feel bad about oneself; subjected to racial, ethnic, or religious insults/taunts; being threatened with violence.

Around one in four (206; 22%) care workers reported at least one incident of verbal abuse by clients or their relatives during the preceding 12 months. Around half (51%) experienced more than one type of verbal abuse; one in 20 (5%) experienced all four.

Physical abuse was much less common (7.5%), but care workers experiencing verbal abuse were 11 times more likely to be subjected to physical abuse than those who had not been verbally assaulted.

Older workers above the age of 48 were less likely to be verbally abused than younger workers, which may indicate greater experience and therefore better coping and communication skills, suggest the researchers.

But after taking account of age, certain factors were significantly associated with a heightened risk of verbal abuse. These were cramped client living conditions (52% heightened risk) and having a client with dementia (38% heightened risk) Other factors included a client with limited mobility and an unclear care plan. And workers with predictable working hours had a 26% lower risk of being verbally abused.

Ageing populations mean the care worker industry is expanding worldwide, so the researchers say managing abuse – which can be harmful to health and lead to job dissatisfaction and burnout – is essential in order for this industry to thrive.


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