Safety First: the Hierarchy of Needs for Home Health

If you majored in psychology, sociology, human services, or some other humanities field, you’re probably already familiar with Maslow’s Hierarchy of Needs. You can probably picture it now; the pyramid denoting how a human’s needs are organized and prioritized, neatly written and potentially color-coded. It’s not dissimilar to the now unfavored food pyramid you might have learned about in elementary school: basic “most important” needs on the bottom (I.e. bread and pasta in the antiquated food pyramid - who could ever eat 8-12 servings of bread in a day anyway?) and the “less important” needs, or more difficult to attain at the top (I.e. that unbranded candy bar at the top of the food pyramid). For home health professionals, I’m sure gas station coffee is somewhere on the hierarchy of needs!

In Maslow’s Hierarchy of Needs, the top need is “self-actualization”. This one was always a bit harder to teach to undergrads, but, essentially it’s the idea that you’re “doing exactly what you were meant to be doing”. Maybe it’s the feeling for you when a patient makes a breakthrough or when you stop your car after a long drive home after visiting a client and realize “I’ve made it”. You have actualized the ideal version of yourself. But before achieving self-actualization, you must see to your self-esteem needs. Maybe you get that need met at work when you get promoted to team supervisor or when you get that ultimate job with the GOOD agency - you know, the one you dreamed about since grad school. 

Maslow’s Hierarchy of Needs can be used as a way to understand the needs of community mental health and home health professionals (in addition to the needs of their patients)

Before those two, you must meet your need for Love and Belonging, such as connections made in friendships or with family. And somewhere between Love and Belonging and Physiological Needs, the needs on which all other needs are built such as food, water, and shelter, lies the need for Safety. 

Safety is really the basis of the work you do. You don’t need me to tell you (but I will because you probably didn’t hear it enough in grad school and you probably certainly don’t hear it enough at work now) that without a sense of safety and security, it can be incredibly difficult for you to focus on using your years of knowledge effectively in the home. My dissertation covered counseling theory application in home-based services, and, if you’ve attended one of my trainings before, you might have heard me say “It’s hard to remember what Carl Rogers said about unconditional positive regard when a toddler is climbing up your back, the family dog is peeing on your home health backpack, and the television is on in the background”. 

It’s notoriously difficult to FULLY understand the safety needs and realities of in-home therapy. Those of you who have done research or even taken a research class will understand the question how do we even operationalize safety issues in home health research. What counts as a safety issue? A structural issue in the home? A patient becoming angry with you? Then after you’ve identified what counts as a safety issue, who gets to define it as such? The healthcare provider themselves? The patient? A third party such a supervisor? Research conservatively suggests at least half of you will experience a safety issue at work. And, probably, that number is does not even begin to touch underreported issues - those times where you felt a sense of unease in a patient’s home, but it was right on the line between “uncomfortable” and “unsafe”. 

We also have to ask ourselves: Why does the clinician’s safety matter? Why keep talking about your safety providing home healthcare? After all, it should be simple - if there’s a safety issue in the home, just leave the home. But as a community mental health professional, you understand that it’s not just about whether or not a situation is unsafe, but, rather, how safe you FEEL in situations. When you feel safe in a home, it allows you to focus on the whole patient. When you’re not consumed with a safety issue, you can assess patient needs better, treatment plan better, and, ultimately, provide better services overall. But there’s another part to safety and self-care that I think is rarely talked about; You are a human being deserving of feeling safe in the workplace, regardless of how feeling safe affects your ability to serve others. 

For those of you who were able to attend one of my in-home therapy and home health safety trainings before, this is something I stress. This is why safety is the cornerstone of the work that I do at My Car Is My Office. It’s the foundation on which all other skills and needs are built upon - if you don’t feel safe, it is impossible for you to work effectively. For those of you who were able to attend one of my in-home therapy and home health safety trainings before, this is something I stress over and over again. 

That’s why in 2024, I’m sharing more tips of how to promote safety, but I’m also focusing on helping you learn how you can feel more comfortable in your work. Your comfort matters - not just because it allows you to do your job better with patients, but also because you are a human being deserving of comfort.

If you’re interested in learning how to intentionally design a strategy for living comfortably and well as a healthcare provider, check out my next workshop “Wellness Strategies for the Booked Up Therapist”.

In the meantime, check out my FREE Safety Checklist for In-Home Providers for a simple, thorough guide to safe practices when seeing patients in their homes.