The research design is a cross-sectional study that reviewed established WPV policies within home healthcare agencies against a set of criteria for an effective WPV policy. Ethics approval for this study was obtained from the Institutional Review Board at the University of Cincinnati.

Only one agency’s WPV policy was found to meet more than 50% of the criteria (see Table 1 for a complete breakdown). Among all policies, reporting was the only section of the grading rubric that was largely covered (5 agencies with all 3 criteria and 2 with 2 of 3 criteria). The reporting section in the grading rubric was to ensure that the policy discusses the reporting process and subsequent protection of the reporter from retaliation by the perpetrator or other involved parties. Three sections of the grading rubric were nearly absent from the policies reviewed. These included WPV policy (all but one of the agencies under 50%), workplace conduct (no agency satisfied any items), and policy review (all but two were under 50%). The WPV training section was not meant to evaluate the content of training but rather the existence of training with three agency policies satisfying less than 50%.

Table 2 provides a breakdown summary of the individual items across the seven agencies. Only four items were found to be satisfied completely (two were under Reporting) but seven items were found to have not been satisfied by any of the agencies (five were under Workplace Conduct).

Home healthcare is a complex sector with unique challenges within the healthcare industry. Home healthcare providers are particularly vulnerable to WPV due to their independent work environments and the lack of resources typically available in hospitals or long-term care facilities. The first line of defense against WPV is implementing a comprehensive policy that outlines procedures and provides training specifically tailored for home healthcare providers.

The current study examined the robustness of WPV policies across seven agencies in three states: Ohio, Texas, and Oregon. The findings revealed that although all agencies had protocols for reporting WPV as well as included WPV training, most failed to address workplace conduct adequately. Given home healthcare providers most often work alone, the risk of WPV may be particularly elevated. WPV policies reviewed did not address protections that could assist in protecting home healthcare providers. Agencies reviewed did not include requirements for measures like working in pairs, ending a visit early, limiting after-dark visits, informing a point-of-contact upon arrival, or using a security escort. The lack of policies for workplace conduct may place home healthcare providers at risk of escalation and improper response to WPV events. Additionally, most policies did not address specific procedures or protections for various WPV acts, except acts from co-workers or management of physical or sexual assault. Nearly all agencies failed to extend their policies beyond basic WPV protections, such as reporting and training. Furthermore, only a few agencies had annual policy review procedures. Overall, only one agency had a WPV policy that met more than half of the criteria (52%), highlighting the need for significant improvements in WPV policy development and implementation within the home healthcare industry.

Some of the variations in WPV policies between agencies may result from different regulations at the state level. If a state has stronger regulations for WPV policies, agencies will likely have more developed policies and procedures. For example, Oregon regulations require that employees immediately terminate the healthcare encounter and notify their employer (Oregon Secretary of State, 2021); however, not all employers were compliant with their state’s regulations for WPV possibly because home healthcare agencies believe the policies are for acute care facilities not home healthcare. Further, policies are only as good as how they are implemented and complied with by the home healthcare providers.

A companion paper investigated the perceptions of home healthcare providers about their agency’s WPV policy, incidence of WPV, and reporting of WPV events. Together, these two papers provided evidence of the quality of WPV policies and how they are implemented. These agencies represent a small portion of the total number of home healthcare agencies but are likely a good representative of current WPV policies and compliance.

It is important to note the limitations of this study. First, recruitment of agencies was limited to Texas, Ohio, and Oregon for the policy evaluation reaching out to 350 agencies in total but only had 7 agencies that responded. State regulations and other legal requirements may have influenced the policies. Therefore, this policy review represented a small sample, which may not completely represent the status of many agencies across the United States. They also may represent the best policies or worst policies. This sample has provided a starting point for future investigation into WPV policies and how they can be improved. The assessment has indicated that most policies need to be improved. Future research should expand to other states with a much larger sample. Second, although the criteria were developed from a previously validated and published assessment tool, other criteria could have been used to further evaluate the policies. The comprehensive evaluation that was completed could have been improved by more specific criteria rather than just the existence of certain items.

Overall, this study has provided insight into existing WPV policies and how these policies lack the proper procedures and training required to ensure the protection of home healthcare providers. If these agencies are truly representative of current WPV policies, the home healthcare industry needs to increase its focus on the health and well-being of its employees by adopting more comprehensive WPV policies. This may require more extensive state regulations.