Part 4 - Violence Against Homecare Field Staff: "The Gift of Fear"

Dear friends,

The following article provides guidance about how to protect field staff
from threatened and actual violence, in light of Gavin de Becker's book, The
Gift of Fear. Feel free to share this information. If you decide to use
this material, please include our copyright designation that is shown at the
end of the article and send us a copy of any publication in which the
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Please do not hesitate to contact us with comments, questions, or requests
for additional information.


Elizabeth E. Hogue, Esq.

Office: (877) 871-4062

Fax: (877) 871-9739

Twitter: @HogueHomecare

Part 4 - Violence Against Homecare Field Staff: "The Gift of Fear"

Homecare field staff members who provide services on behalf of private duty
agencies, hospices, Medicare-certified home health agencies and home medical
equipment (HME) companies are extremely vulnerable. Contributing to their
vulnerability is the fact that they work alone on territory that may be
unfamiliar and over which they have little control. Staff members certainly
need as much protection as possible.

In Part One of this series, exposure to workplace violence was considered in
view of requirements of the Occupational Safety and Health Administration
(OSHA). Part Two of this series addressed the potential liability of home
care providers of all types for negligence when employees are injured as a
result of violence. Part Three of this series provided guidance about how
to manage risks associated with discontinuation of services to patients in
the face of violence or threatened violence. The purpose of this article is
to explore practical aspects of threatened and actual violence included in
The Gift of Fear by Gavin de Becker.

The premise of Mr. de Becker's book is that there is never violence that
comes without warning. In fact, if caregivers learn to listen to their
intuition, there are warning signs that are likely to prevent injury. This
point is not intended to blame caregivers by saying that violence is their
fault because they did not listen to their "gut," but to encourage
caregivers to pay attention to their instincts and to act upon them.

Mr. de Becker uses the example of a woman who was raped in her apartment to
illustrate this point. Her rapist said that he was going to the kitchen to
get a drink of water and told her not to move. As he was leaving the
bedroom, he closed an open window. The woman said that she knew
instinctively at that moment that the rapist was going to kill her and
wanted to minimize the sound of his crime. So, in what the woman describes
as an "out of body" experience, she silently followed the rapist down the
hall and slipped past him in the kitchen, out of the door to the apartment
and into the apartment across the hall. As she left the apartment, she
could hear the rapist rummaging in kitchen drawers for what turned out to be
a large knife.

Mr. de Becker points out that many people who suffer violence say that it
came "out of nowhere" or "out of the blue," or that it was "random." After
some thought, however, the victims of violence are often able to identify
that they felt uneasy with the perpetrator or that the criminal seemed
suspicious. "I just knew," say many victims of violence.

These intuitive feelings must be balanced against the overwhelming tendency
to deny that violence is possible. As Mr. de Becker points out:

It may be hard to accept its importance, because intuition is usually looked
upon by us thoughtful Western beings with contempt. It is often described
as emotional, unreasonable or inexplicable. Husbands chide their wives
about 'feminine intuition' and don't take it seriously. If intuition is
used by a woman to explain some choice she made or a concern she can't let
go of, men roll their eyes and write it off. We much prefer logic, the
grounded, explainable, unemotional thought process that ends in a
supportable conclusion. In fact, Americans worship logic, even when it's
wrong, and deny intuition, even when it's right. (p. 12)

Mr. de Becker's point is that there are almost always "pre-incident"
indicators; detectable factors that occur before violent acts. Caregivers
need to use their "radar" to identify these indicators and to act upon them
in order to avoid violence.

Managers and supervisors may be tempted to minimize and deny caregivers'
concerns about potential violence, especially because they often do not have
direct contact with patients and their families. Managers and supervisors
should recognize that fearful caregivers have likely experienced some
"pre-incident indicators" that are described in detail in Mr. de Becker's
book. They should help caregivers express their concerns, as opposed to
denying them.

From a practical perspective, violence against home care providers may be
minimized by encouraging field staff to pay attention to their intuition
about patients, their families and others they encounter as they make
visits. In any event, Mr. de Becker's book is a must-read for home care
providers and their staff members. Christmas gift?

C2016 Elizabeth E. Hogue, Esq. All rights reserved.

No portion of this material may be reproduced in any form without the
advance written permission of the author.
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