How Do You Respond When the Harasser Is an Elderly Patient?
According to a 2017 survey by Danish union FOA, one in four of its 91,526 members working in home care, social work and health sectors reported experiencing sexual harassment on the job.
Care workers in Denmark are reporting increasing rates of harassment, raising thorny ethical questions.
WHY YOU SHOULD CARE
The elderly are some of the world’s most vulnerable, but their caregivers also face abuse.
Imagine you are a female caregiver, tending to an elderly client with dementia in his home. It’s just the two of you in the house, and as you help your client get into the bath, he squeezes your backside. You ignore the gesture, knowing he probably doesn’t mean it, but then he grabs at your chest — this time, with force. He doesn’t know what he’s saying, but as he comments on the shape of your body, you become acutely aware of how isolated you are. You desperately want to leave, but you can’t abandon this elderly man alone in the bath.
By 2060, 155 million Europeans, 30 percent of the population, will be 65 years or older, according to the Global Coalition on Aging. The number of Europeans living with dementia will jump from 10.5 million in 2015 to 18.7 million by 2050. While there’s been some public dialogue about elder abuse — when adults over 60 are abused, neglected, or financially exploited, sometimes by their caregivers — there’s little conversation about what happens when the roles are reversed. According to a survey this year by Danish Union FOA, 25 percent of roughly 3,000 of its members working in home care, social work and health sectors reported experiencing sexual harassment on the job in the last year. And not just from colleagues. In fact, according to FOA’s research:
90 percent of the sexual harassment experienced by Danish workers in home care, social work and health sectors came from their patient or client.
This marks a big uptick since 2015, when FOA found that 16 percent of home health care workers had experienced sexual harassment within the prior year, according to Jens-Jørgen Krogh of the FOA. And it’s far higher than the national average, with 2 percent of nearly 7,600 Danish employees reporting that they were exposed to sexual harassment by clients or customers in a 2017 survey for BMC Public Health. Meanwhile, 27.6 percent of 1,214 U.S. home care workers surveyed for a 2015 cross-sectional study published in BMC Public Health said they had experienced sexual harassment during the course of their work.
A note on terminology: There’s a distinction between home care workers and home health care workers. In the U.S., home care involves managing daily activities like bathing, dressing and meal preparation, while home health care indicates medical care like administering medications. The FOA study included both of these groups.
Experts admit it’s especially tricky to define sexual harassment in the home care field. Since the primary demographic is seniors, the majority of clients have some form of dementia or Alzheimer’s and experience a deteriorated mental state, says Elvin Rodriguez, administrator of Trinity HomeCare Solutions (Disclosure: Rodriguez is the father of OZY staffer Eva Rodriguez). In certain stages of dementia, this population might behave inappropriately as a result of their condition, says Phil Bongiorno, executive director of the Home Care Association of America (HCAOA). For caregivers, helping to manage that behavior is part of the job.
The caregiving industry has always been concerned with what constitutes abuse, but #MeToo has drawn more public attention to it.
However, groups like FOA don’t define sexual harassment differently because of clients’ circumstances. “We alter the way to address the problem,” Krogh explains. The procedures for handling these situations differ by establishment, but for HCAOA companies, if a caregiver requests a reassignment, the next person to take the job would be made aware of the client’s condition through a detailed care plan (all caregivers receive this, including the original one assigned).
Workers can choose to call the police or take legal recourse. In August 2018, the U.S. Equal Employment Opportunity Commission (EEOC), for example, sued Amada Senior Care for alleged sexual harassment and retaliation against two female employees who reported the abuse, according to a press release. The company SoloProtect developed a badge caregivers can wear, which can contact the agency or emergency responders, and record patient or police conversations.
As the #MeToo movement has swept through the global consciousness, complex questions have resurfaced within this sector. The caregiving industry has always been concerned with what constitutes abuse, but #MeToo has drawn more public attention to it, says Bongiorno.
Misclassifying home care workers as independent contractors also leaves them more vulnerable. American home care workers employed by agencies receive protections from the company, which become particularly important in harassment situations. But there’s less oversight under registry models, where independent contractors are matched with clients as direct hires.
Even more problematic are unregulated situations, when a family goes under the table or contracts with someone from a website. “That’s where you’re likely to see concerns because the worker has no recourse at all,” Bongiorno says. Along these lines, the EEOC flagged decentralized workplaces, like those of home care and home health care, as a risk factor for harassment going unchecked in a 2016 report.
Lack of regulation poses similar challenges in Europe, particularly for undocumented workers as demand for caregivers rises with Europe’s aging population. In 2016, the European Economic and Social Committee, an advisory body, called on the EU to work with member states to improve safeguards, referencing long-standing invisibility of live-in care.
In the U.S., a newly announced federal bill of rights for domestic workers is expected to be introduced in the 116th Congress. Domestic work, from which home health care evolved, was excluded from labor protections of the New Deal-era and historically such workers have been disadvantaged. Even today, the majority of American home care workers come from minority or low-income backgrounds, according to nonprofit PHI (previously known as Paraprofessional Healthcare Institute).
Around the world, efforts to address harassment in this field reveal an inherent tension: Caregivers tend to be compassionate people, likely to understand that misbehaving clients might not intend to inflict harm. But intentions and actions were not created equal. So how should recognition of a medical condition be distinguished from tolerance of a hostile work environment? As this #MeToo conversation unfolds, one thing is certain: This ethical line is blurry.