Sexual harassment has been in the national spotlight, with multiple celebrities and executives felled by revelations of their mistreatment of colleagues. Now, the conversation has shifted to less glamorous industries, and home care and home health agencies should be ready.

In response to the many scandals, 300 female Hollywood executives and other figures, including actress Reese Witherspoon, television executive producer Shonda Rhimes (pictured above) and Universal Pictures chairwoman Donna Langley, created the Time’s Up initiative to combat sexual harassment in the workplace. The initiative, which includes a legal defense fund for individuals who have experienced sexual harassment or related retaliation, was announced in a “Dear Sisters” open letter published in the New York Times on Jan. 1. The letter acknowledged an often overlooked issue: Home care workers are uniquely vulnerable to inappropriate behavior.

“Whenever abuse is talked about in home care, it is primarily talked about in terms of workers abusing the client,” Dr. Robyn Stone, senior vice president of research at LeadingAge, told Home Health Care News. “I think it is really important for folks to understand the tremendous potential… of abuse for home care workers.”

Corporate culture of transparency

While the Hollywood environments that produced headlines are far from the home health and home care space, the industry can still draw lessons from the scandals coming to light.

Many home health and home care companies are smaller employers that lack the comprehensive human resources (HR) departments of larger employers, Demery Ryan, an employment attorney with Littler in Los Angeles, California, told HHCN.

“What happens in a lot of these organizations is that sexual harassment event takes place with a very powerful individual and in many instances… the HR departments feel powerless,” Larry Pernosky, chief human resources officer at Baton Rouge, Louisiana-based Amedisys (Nasdaq: AMED), told HHCN.

A culture that normalizes feedback from all levels is essential for handling harassment situations well, Pernosky stressed.

Employees at Amedisys, a home health company with more than 17,000 workers, would contact their supervisor or their supervisor’s supervisor in the case of harassment, Pernosky said. This would then lead to an investigation of the incident and a review. Whatever the outcome, any incident is on the books from the moment of reporting, he explained.

“There’s no way that the complaint can get squashed or hidden,” he said.

Fortunately, harassment from home care clients to caregivers, as outlined in the Time’s Up initiative letter, isn’t common, in the experience of Mike Magid, chief operating officer at Griswold Home Care in Plymouth Meeting, Pennsylvania. But when it occurs, there are commonly cognitive issues involved, he said.

“A lot of this comes from the dementia-related diseases,” he told HHCN. “I can’t even recall an incident that was of a sexual harassment nature that was from a lucid client who just needed additional care around the activities of daily living.”

However, the U.S. Equal Employment Opportunity Commission (EEOC) has flagged decentralized workforces, like in-home care, among risk factors for harassment. Home care and home health work, due to the separation from the employing agency, have high potential for such cases.

“Decentralized workplaces, marked by limited communication between organizational levels, may foster a climate in which harassment may go unchecked,” an EEOC report from June 2016 states.

Domestic workers are also particularly vulnerable to abuse, including sexual assault, according to a report to the United Nations Human Rights Committee from several nongovernmental organizations.

“This is part of a larger issue of the home care workforce that is undertrained, undersupported and sometimes put into very serious situations in a system without a lot of infrastructure around it,” Stone explained.

The lack of hard data on harassment for home care workers is also a major issue, she told HHCN.

“Nobody has done a widespread scale representative study,” she said. “There’s no reporting registry on the abuse. The ombudsman who handles this is typically looking at abuses of clients, they are not looking at abuses of workers.”

Complexities of home care culture

Part of the issue of harassment with caregivers pertains to the environment where workers are often alone in a client or patient’s home. Many home care workers could tell stories of harassment similar to those found in the recent high-profile cases in Hollywood and beyond, if they felt able to speak about it, Helen Adeosun, cofounder of online home care education platform CareAcademy, told HHCN.

“If they’re not working with a direct supervisor who can say something and advocate on their behalf, they feel they have to suppress that to keep their job,” she said.

Another factor that’s overlooked in harassment in home care is culture, Adeosun explained. Companies can act on incidents of harassment that are reported to them, but for many frontline home care workers, cultural differences may keep them from reporting.

“A lot of women are coming from places where the protected status of the individual at work or in the domestic space is not talked about,” she said.

What’s next

As the conversation about harassment at work expands to other U.S. industries, home care companies should be ready to have discussions about what constitutes a hostile work environment, Magid said. He doesn’t expect a specific focus on sexual harassment training, but on the behaviors that create a hostile work environment.

“There are so many innocuous things that are said between the client and the caregiver that you don’t think about until the relationship goes sour,” he said.

Home care and home health agencies should also make sure their equal employment opportunity policies are up-to-date and disseminated to employees, particularly those in supervisor positions, Ryan said.

“Especially for small business owners, it’s an opportunity to make sure that your policies and awareness of reporting policies and expectations, and the risk inherent in behavior, is rolled out to everybody in the company,” she explained. 

And though there’s no easy fix for the problem of incidents that aren’t reported, agencies can work to better understand the position of their frontline workers. Managers can ride along with workers, as the executives at Amedisys do to better understand the environments they’re entering. They can also find someone to serve as an ambassador to workers of a specific community, a trick that Adeosun found useful in her education work.

“I don’t think agencies have to take on the burden of doing this themselves,” she said. ”They can appoint someone from the respective community.”

Written by Maggie Flynn