Exploration of Risk Factors for Patient Violence toward Direct Care Workers in the Home Setting Using an Ecological Model

Abstract

Background: In the US, direct care workers in the home setting (DCWHs) provide paid personal home care for people with illnesses or disabilities. However, DCWHs faces increased risks for patient violence by providing health care in the private homes. Purpose: The purpose of this research is to explore risk factors for patient violence on DCWHs using an ecological framework. Specific aims are to: 1) explore the factor structure of the Job Demands-Resources (JD-R) model when patient violence on DCWHs is included, 2) empirically derive subtypes of patient relationships with DCWHs and explore the association between DCWH-patient relationships and patient violence toward DCWHs, 3) explore the association of availability of patient history of violence and mental illness/substance abuse with patient violence toward DCWHs, and 4) explore potential individual and organizational level risk factors for patient violence on DCWHs. Methods: Data were derived from two large surveys: 2007 National Home Health Aide Survey (n=3,377), and 2006 Chicago DCWH Survey (n=980). Statistical analyses were performed, including exploratory and confirmatory factor analyses (aim 1), latent class analysis (LCA) (aim 2), logistic regression (aim 3), and complex sample data analysis and generalized estimating equation (aim 4). Results: A 3-factor model was the best fit for our data. Four subtypes of DCWH-patient relationship were identified, and a significant association between DCWHs in the Overly Involved class and patient violence toward DCWHs was found. Physical acts (adjusted OR=6.60; 95% CI= 2.13, 20.48; p=0.001) and physical or verbal threats (adjusted OR=10.78; 95% CI= 5.14, 22.61; p<0.001) of patient violence were common among DCWHs caring for patients with a previous violence history, while threats (adjusted OR= 5.80; 95% CI= 2.42, 13.90; p<0.001) were a hazard among DCWHs caring for patients with a mental illness/substance abuse disorder. An association between injury from violence and language barrier between DCWHs and patients was noted (adjusted OR=4.44; 95% CI= 1.57, 12.56; p=0.005). Conclusion: Findings suggest that prevention efforts focus on supporting a positive relationship between DCWHs and their patients (relationship level), providing DCWHs with information on patient violence and mental illnesses/substance abuse disorder (individual level), and reducing their language barrier (workplace level).