1. Jenna Crawley, LICSW Chief Social Worker Medical House Call Program MedStar Washington Hospital Center Washington, DC ©AAHCM

2. The FieldThe Office  Unique & individual to the pt  Unpredictable  Uncontrolled setting  Risks & hazards  Practice alone  Standard setting  Predictable  Staff ©AAHCM

3.  Know before you go ◦ Location & route you plan to take ◦ Awareness of the neighborhood ◦ Review chart for hx  Getting there ◦ Full tank of gas ◦ Phone & laptop charged ◦ Distracted Driving ©AAHCM

4.  The location ◦ Unsafe neighborhood ◦ Poorly lit areas ◦ Isolated  Hazards outside the home ◦ Slippery walks ◦ Uneven stairs ◦ Missing handrails  Risks within the home ◦ Individuals ◦ Animals ◦ The home itself ©AAHCM

5. Risk FactorsResponse ◦ Hx of violence ◦ Drug/alcohol abuse ◦ Mental illness with hx of  Delusions  Hallucinations  Agitation  Excitement  Suspicious  hostile ◦ Lack of social support  Remain calm  Do not engage in a threatening way  Remind you are trying to help  Keep a safe distance  Leave  Trust your instincts ©AAHCM

6.  Resurgence  “Equal Opportunity Problem”  Train & Educate Staff ◦ Be mindful of what you wear ◦ Do not sit on upholstered furniture ◦ Only carry essentials ◦ Self-inspect following the visit ◦ Utilize containment kit in car  Patient feelings ◦ shame, stigma, embarrassment, discrimination ©AAHCM

7.  Communication ◦ Ensure your daily schedule is known to someone else ◦ Consider a code word or phrase that indicates a hazardous situation ◦ Carry list of emergency phone numbers ◦ Emergency contact info for each staff  Emergency Supplies in Car ©AAHCM

8.  Team meeting discussion  Joint visit &/or Escort service  Change visit times  Place services on hold  Standardized process & policies ©AAHCM

9.  Home care medicine is rewarding yet challenging  Preparation & awareness can help mitigate risk  Key to assess risk for not only the provider but for also the patient ©AAHCM