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CHW 104: Service Skills, Case Management and Documentation
104.3 Home Visits: Safety, Boundaries and Conflict
Before, during and after a visit, plus de-escalation practice
Your materials
Slides (PowerPoint) Handout (Word)
For instructors
Facilitator guide Printable pre and post tests Quiz (LMS import)
What you will learn
- Plan a home visit with a personal safety plan and check-ins
- Spot risks in a home and know when to leave
- Keep professional boundaries and manage visit time
- Use calm words and body language to lower conflict
Start here
When someone comes into your home, what makes you feel respected, and what makes you feel judged?
Lesson
Before the visit
- Review the file: Read past notes for goals, safety flags, pets and who lives there.
- Confirm the visit: Call ahead. Ask who will be home and ask that pets be put away.
- Share your plan: Tell your supervisor when and where you are going, per program policy.
- Pack what you need: Charged work phone, ID badge, forms, resource list, water. Keys easy to reach.
- Plan two visits if needed: Visit in pairs for evenings or flagged homes, as your program decides.
Arriving and during the visit
- Scan first: Look around before you leave the car. If people or animals make you feel unsafe, do not go in.
- Know your exit: Sit near the door when you can. Keep a clear path out and some distance from others.
- Notice risks: Weapons in sight, drug use, aggressive pets, or anger that keeps rising. Name it and act.
- Phone ready: Keep your work phone charged and close, but do not look at it while walking.
Home care workers face real risk
- 18-65% of home care workers report verbal abuse in studies
- 27% of home care nurses in one study named aggressive pets as a risk
- 9% of nurses in that study named firearms in the home
Source: CDC NIOSH Science Bulletin, 2021
Stay or leave
Adjust and stay
- Client is upset but calms when you listen
- TV is loud; you ask to turn it down
- Pet is friendly and gets put away
- Family member joins and the client agrees
Leave now, then report
- Someone threatens you or blocks the door
- A weapon is shown or used to scare
- Active drug use or someone very impaired
- Your gut says you are not safe
Boundaries, time and emotional dynamics
| Situation | A professional response |
|---|---|
| Client offers a meal or gift | Thank them; follow agency policy on gifts |
| Client asks for your personal number | Give only your work number and hours |
| Client asks you to run errands | Connect to the right service instead |
| Visit keeps running long | Set the time at the start; plan next steps |
| Client's story brings up your own pain | Stay present, then talk with your supervisor |
Lowering the heat: de-escalation
When someone gets angry, slow everything down:
- Keep yourself calm: Breathe, lower your voice, and speak slowly.
- Give space: Stand or sit at an angle, at least an arm's length away.
- Listen and reflect: Name the feeling: It sounds like you are really frustrated.
- Offer choices: Give two small, real choices so the person feels some control.
- Know your limit: If it keeps rising, leave calmly and report it.
What we see in the home
- What we see: Ms. Brooks in Hough is short-tempered at the visit, and the apartment is cold in January.
- Why it happens (upstream): Her gas was shut off, her landlord ignores repairs, and her hours were cut. Stress shows up as anger.
- What we can build on (assets): Utility help programs through 211, tenant groups, a church warming center, and a neighbor who checks on her.
Situation: the visit that heats up
Situation: You are visiting Mr. Patel in Old Brooklyn about his diabetes goals. His adult son comes home, sees your badge, and starts yelling that you are there to take something away. He stands between you and the door.
What do you do?
- Stay calm, speak slowly, and keep your hands visible
- Explain who you are in one short sentence
- If he does not calm or keeps blocking the door, leave
- Once safe, check in with your supervisor and document facts
After the visit
- Check out: Tell your supervisor you have left, per program check-in policy.
- Write the note: Finish your note within 24 hours; flag safety concerns the same day.
- Report incidents: Report any threat or injury, even if it seems small.
- Debrief and recover: Talk with your supervisor. Get support if a visit shook you.
Study sheet
The big idea: A good home visit is planned, respectful and safe, and we never trade our safety for finishing a visit.
Key points
- Before: review the file, confirm the visit, ask that pets be put away, and share your plan.
- Check in with your supervisor when you arrive, leave and return, as your program requires.
- Scan before entering, know your exit, and keep your work phone ready.
- Leave right away if threatened, if a weapon is used to scare, or if your gut says unsafe.
- Keep boundaries: work number only, follow gift policy, and stay out of clients' finances and relationships.
- De-escalate: stay calm, give space, reflect feelings, offer choices, and know your limit.
- After: check out, write the note, report incidents, and debrief.
Remember
- Danger right now: call 911
- Mental health crisis, for clients or workers: call or text 988
- Write notes within 24 hours; flag safety concerns the same day
- Ohio rule 4723-26-10: set and keep professional boundaries with each client
Ask yourself
- What signs tell me, in my own body, that I do not feel safe?
- Which boundary will be hardest for me to keep, and who can help me keep it?
Vocabulary
| Word | What it means |
|---|---|
| Home visit | A planned meeting with a client in their home to support their goals. |
| Personal safety plan | Your written steps for staying safe: check-ins, exit plan, and when to leave. |
| Check-in | Telling your supervisor when you arrive, leave and return, as your program requires. |
| Exit plan | Knowing how you will leave a home quickly and calmly if you need to. |
| Professional boundaries | Limits that keep the CHW and client relationship safe, fair and focused on the client. |
| Dual relationship | Having a second role with a client, like friend or business partner, besides being their CHW. |
| Emotional dynamics | The feelings in the room, from the client, family and worker, that shape a visit. |
| De-escalation | Using calm words and body language to lower anger and tension. |
| Conflict management | Handling disagreement in a way that keeps people safe and respected. |
| Debrief | A talk after an event to review what happened and what to do next time. |
| Near miss | Something unsafe that almost caused harm. Report it so the team can learn. |
Real-life situations
The aggressive dog
You arrive for a visit with Ms. Jones in Glenville. A large dog is loose in the yard and barking hard at the gate.
What to do
- Stay in your car or at a safe distance
- Call Ms. Jones and ask her to put the dog away
- If she cannot, offer to meet by phone or in a public place
- Note it in the file so future visits plan for the dog
Why: Aggressive pets are a common home visit risk. Asking that pets be confined is a standard safety step.
The gift
After months of visits, Mr. Reyes in Clark-Fulton tries to hand you $40 to say thank you for helping him get his benefits.
What to do
- Thank him warmly for the thought
- Explain kindly that you cannot accept money
- Suggest another way to give, like a thank-you note to your program
- Tell your supervisor and follow agency policy
Why: Ohio rules bar CHWs from seeking personal gain from clients. Turning it down kindly keeps the relationship strong.
The visit that will not end
Your visit with Ms. Carter in Lee-Harvard is over time. She keeps bringing up new problems, and you have another client at 2:00.
What to do
- Name the time kindly: we have five minutes left today
- Write down her new concerns so she knows they matter
- Pick the most urgent one to start on next visit
- Set the next contact date before you leave
Why: Time management is a home visit skill in Ohio's curriculum rule. Setting time at the start helps.
Something you see
On a visit in East Cleveland, you see a young child alone in a room with pills and a lighter on the floor within reach.
What to do
- Calmly point out the safety risk to the parent and help make the space safe
- If the child is in danger right now, call 911
- Tell your supervisor the same day and follow agency protocol and Ohio law
- Know the Cuyahoga County children services hotline: 216-696-KIDS (216-696-5437)
Why: Home visits let us see risks others miss. Acting fast and following protocol protects the child.
Activity: Lab: simulated home visit
About 90 minutes.
- In groups of three, assign roles: CHW, client, and observer. Use the facilitator's made-up case cards.
- The CHW writes a short safety plan: check-in times, exit plan, and what would make them leave.
- Run a 15 minute visit: greeting, setting the time, checking goals, and setting the next contact.
- The facilitator adds a challenge partway through, such as an angry family member, a pet, or a gift.
- The observer uses the checklist to note safety, boundaries, time and de-escalation skills.
- Debrief, then re-run the same visit using the feedback. Rotate so everyone plays the CHW.
- Each CHW writes a DAP note for their visit and submits it for review.
Post-test
Ten questions. You need 75% to pass, with one retake. Your result is saved in this browser.
Sources
- Ohio Administrative Code 4723-26-13, CHW training program curriculum
- Ohio Administrative Code 4723-26-10, Standards of safe care by the CHW
- CDC NIOSH Science Bulletin, Home Healthcare Workers: A Growing Workforce at High Risk for Workplace Violence
- NIOSH Hazard Review: Occupational Hazards in Home Healthcare
- Developing a CHW Home Visiting Policy
- SAMHSA, In Crisis (988 Suicide and Crisis Lifeline)
- Cuyahoga County Division of Children and Family Services
- Crisis Prevention Institute, Responding to Abusive Patient Behavior