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Original article
Home care aides’ experiences of verbal abuse: a survey of characteristics and risk factors
  1. Nicole D Karlsson1,
  2. Pia K Markkanen1,
  3. David Kriebel1,
  4. Rebecca J Gore2,
  5. Catherine J Galligan1,
  6. Susan R Sama1,
  7. Margaret M Quinn1
  1. 1 Department of Public Health, University of Massachusetts, Lowell, Massachusetts, USA
  2. 2 Department of Biomedical Engineering, University of Massachusetts, Lowell, Massachusetts, USA
  1. Correspondence to Professor Margaret M Quinn, Department of Public Health, University of Massachusetts Lowell, Lowell, MA 01854, USA; margaret_quinn{at}


Objective Violence from care recipients and family members, including both verbal and physical abuse, is a serious occupational hazard for healthcare and social assistance workers. Most workplace violence studies in this sector focus on hospitals and other institutional settings. This study examined verbal abuse in a large home care (HC) aide population and evaluated risk factors.

Methods We used questionnaire survey data collected as part of a larger mixed methods study of a range of working conditions among HC aides. This paper focuses on survey responses of HC aides (n=954) who reported on verbal abuse from non-family clients and their family members. Risk factors were identified in univariate and multivariable analyses.

Results Twenty-two per cent (n=206) of aides reported at least one incident of verbal abuse in the 12 months before the survey. Three factors were found to be important in multivariable models: clients with dementia (relative risk (RR) 1.38, 95% CI 1.07 to 1.78), homes with too little space for the aide to work (RR 1.52, 95% CI 1.17 to 1.97) and predictable work hours (RR 0.74, 95% CI 0.58 to 0.94); two additional factors were associated with verbal abuse, although not as strongly: having clients with limited mobility (RR 1.35, 95% CI 0.94 to 1.93) and an unclear plan for care delivery (RR 1.27, 95% CI 0.95 to 1.69). Aides reporting verbal abuse were 11 times as likely to also report physical abuse (RR 11.53; 95% CI 6.84 to 19.45).

Conclusions Verbal abuse is common among HC aides. These findings suggest specific changes in work organisation and training that may help reduce verbal abuse.

  • workplace violence
  • verbal abuse
  • home care
  • home health aides
  • occupational health

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Supplementary materials


  • Contributors NDK, PKM and MMQ conceived of the study. PKM, DK, RJG, CJG, SRS and MMQ designed the questionnaire and collected the data. NDK conducted the statistical analyses with substantial contributions from DK, RJG and MMQ. NDK drafted the manuscript. All authors contributed to the interpretation of the findings and substantially commented on iterations of the manuscript. MMQ submitted the manuscript. All authors approved the final version.

  • Funding This publication was supported by the US National Institute for Occupational Safety and Health (NIOSH)/Centers for Disease Control and Prevention (CDC) grant numbers R01OH008229 and T01OH008424.

  • Disclaimer Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

  • Competing interests None declared.

  • Ethics approval All methods and materials were approved by the University of Massachusetts Lowell Institutional Review Board, Protocol Number: 10–040-QUI-XPD.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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