In the United States, the home health care sector of the healthcare industry is booming. More and more seniors are choosing this care model over traditional facilities like nursing homes, opting instead to remain in the comforts of their own homes. Care providers visit residents in the home setting, providing medical care and helping with daily tasks. Unfortunately, along with the rise of home health care options, crime and violence risks against caregivers have also risen. While insurance for home health care providers offers valuable protection against many risks, preventing criminal activity in the first place is the key to safety for the caregivers upon which so many people depend.
Home Health Care-Related Crimes: Fraud and Workplace Violence
Home health care is one of the fastest-growing sectors in the healthcare industry. The United States Bureau of Labor Statistics estimates that demand for this care delivery model will only grow in the coming years; demand is expected to increase by 48% or more by the year 2022. Along with the growth experienced in this fast-paced and growing sector, unfortunately, has come a rise in criminality, including home care fraud. Home care fraud can include:
- Insurance billing and benefits claim fraud – billing for care, services, or supplies never received.
- Elderly and at-risk abuse – typically committed by family members where medical care benefits and financial support are diverted away from the recipient and into the hands of unscrupulous individuals.
- Compliance and regulatory fraud – including enrolling individuals who were not in need of home care services in order to bill hospitals and Medicare/Medicaid for unneeded services.
- Fraudulent accounting – including false billing, false tax claims, and many other forms of illegal accounting practices.
- Fraud in background checks – falsifying background checks of home care workers or failing to ensure adequate background checks were conducted in the first place.
Together, these forms of fraud cost billions of dollars in losses, contributing to the significant increases in healthcare insurance premiums.
Home health care workers face unique risks in the delivery of care for at-home patients. The nature of the industry itself, including caregivers serving patients in remote locations and the need to travel between locations, opens up healthcare nurses to significant challenges and risks. One of the most prominent risks is that of workplace violence; numerous surveys have indicated that as many as 61% of home care workers have experienced some form of violence in the workplace. About 30% of home care workers have also reported being sexually harassed.
Crime Prevention: Foundations of Risk Management for Home Health Care
It is important for home care agencies and their staff to understand that insurance for home health care providers is only one part of a more comprehensive risk management program. Preventing crime in the first place – including fraud, harassment, violence, and abuse – helps to protect vulnerable caregivers while ensuring continuity of care for at-home patients.
To combat the rising levels of fraud, it is imperative that home health care staffing agencies conduct rigorous background checks of employees. Agencies must also continually review processes and procedures such as billing practices and regulatory compliance. Finally, technology can be used to identify fraudulent behaviors, preventing these practices from impacting the financial security of agencies and the care delivered to at-home patients.
To prevent violence and sexual assault against home health caregivers, the International Association for Healthcare Security and Safety (IAHSS) has put together a best practices manual for home health workers and their employing agencies. Workplace violence prevention can employ several strategies, including:
- Training programs to help staff members identify potentially hostile or dangerous situations and individuals.
- So-called “windshield surveys”, where caregivers assess a neighborhood or residence by recording what is observed in the area.
- Reviewing crime reports for a given service area.
- Ensuring adequate communication between caregivers and staffing agencies or law enforcement personnel, employing radio and cellphone equipment to help caregivers seek help when needed.
- Assessing individual households for safety, including physical hazards, prior to enrolling patients for home health care services.
- Instructing caregivers to leave residences or situations where they feel unsafe.
- Implementing zero-tolerance policies for any instance of workplace violence, and clearly conveying those policies to clients.
With these crime-prevention practices and with the coverage afforded by insurance for home health care providers, home health caregivers and their agencies can continue to deliver quality and safe care to America’s seniors.
About Caitlin Morgan
Caitlin Morgan specializes in insuring assisted living facilities and nursing homes and can assist you in providing insurance and risk management services for this niche market. Give us a call to learn more about our programs at 877.226.1027.