Welcome to Part 2 of our winter safety series for home-visiting therapists. Part 1 addressed preparation—vehicle readiness, winter driving strategies, and personal health maintenance. Now we turn our attention to what happens once you arrive at patient homes: navigating winter-specific environmental hazards, implementing personal safety protocols during visits, and building comprehensive safety infrastructure whether you work for a home health agency or operate your own outpatient practice.
As occupational and physical therapists specializing in home modifications and patient safety, we conduct thorough environmental assessments for clients. This same systematic approach must extend to our own safety as we enter unfamiliar and sometimes hazardous environments during the most challenging season of the year.
Personal Safety During Home Visits
While we focus extensively on patient home safety, therapist safety within those same environments requires equal attention. Home health workers face unique safety concerns including unfamiliar and sometimes unsafe home environments, unpredictable client or family member behaviors, and isolation without immediate backup support.
Pre-Visit Safety Protocols
Information Gathering: Review patient intake information and previous visit notes for safety concerns including history of violence, substance abuse, aggressive pets, environmental hazards, or behavioral issues. Contact previous providers or case managers if available to understand potential risks (NCWWI, 2014; Community Health Alignment, 2023).
Scheduling Considerations: When possible, schedule first-time visits or visits to homes with documented concerns during times when supervisors or colleagues are available for support. Avoid late-day visits to unfamiliar locations where arriving darkness creates additional risk—particularly important during winter when darkness falls by mid-afternoon.
Communication Protocols: Always inform your supervisor or designated safety contact where you’re going, expected arrival time, and anticipated departure time. Many agencies use buddy systems where therapists text or call colleagues before and after visits. Never skip these protocols, even for familiar patients—situations can change unexpectedly (Reddit Therapists, 2023; NCWWI, 2014).
If you’re in private practice without agency infrastructure, create your own check-in systems using location-sharing apps with trusted contacts, scheduled check-in calls, or personal safety apps that alert emergency contacts if you don’t respond to timed prompts (ROAR for Good, 2025; SimplePractice, 2022).
Professional Appearance: Wear clearly visible professional identification. Carry minimal jewelry and secure valuables out of sight. Professional appearance establishes credibility and purpose, making community members less suspicious of unfamiliar vehicles in neighborhoods.
During-Visit Safety Awareness
Environmental Assessment: Upon entering, quickly assess exits and potential hazards. Position yourself near exits when possible, never allowing the client to block your path to doors. Sit where you can view hallways and additional rooms. Be aware of who else is in the home and their locations (NCWWI, 2014; Reddit Therapists, 2023; Crisis Prevention Institute, 2016).
Parking Strategy: Park on the street facing the direction you’ll leave, never blocking yourself in driveways or parking areas. This allows quick departure if needed and prevents becoming trapped by other vehicles. Keep keys accessible, not buried in bags or pockets (Reddit Therapists, 2023).
Trusting Instincts: If a situation feels unsafe—threatening behavior, intoxication, presence of weapons, hostile family members—trust your instincts. Politely excuse yourself and leave immediately. Reschedule when situations improve or request supervisor accompaniment for future visits. No visit is worth your safety (NCWWI, 2014; Reddit Therapists, 2023; Crisis Prevention Institute, 2016).
Maintaining Boundaries: Use non-threatening body language, remain calm and polite, and respect the client’s home and emotions while maintaining professional boundaries. If clients become inappropriate or aggressive, clearly state boundaries. If behavior continues, end the visit and document thoroughly.
Communication During Visits: Keep your phone accessible (but not visible to avoid appearing distracted). If you sense escalating danger, create an excuse to step outside and call for help. Some practitioners use code words with colleagues or supervisors that signal “call me with an urgent message so I have an excuse to leave” versus true emergencies requiring police response (Crisis Prevention Institute, 2016).
Winter-Specific Hazards at Patient Homes
Patient homes present amplified hazards during winter that affect therapist safety as much as client safety. The same environmental challenges you assess for patients become your occupational hazards.
Navigating Icy and Snow-Covered Properties
Footwear Requirements: Invest in professional-appearing footwear with deep treads and non-slip soles. Consider removable ice traction devices (YakTrax, STABILicers) that attach to shoes for outdoor navigation and remove before entering homes. Keep both professional shoes and boots in your vehicle to change as conditions require (Care Options for Kids, 2021; NARA, 2024).
Pathway Assessment: Before approaching patient homes, assess pathways for ice, snow, and other hazards. If walkways are unsafe, contact the patient or family to request they clear paths before your arrival. Don’t risk injury attempting to reach homes across dangerous terrain. Many patients have family members or services available for snow removal if they understand the visit depends on it (Care Options for Kids, 2021).
Use of Equipment and Supplies: If you use rolling equipment carts or bags, select wheeled devices designed for all-terrain use. Consider backpacks or shoulder bags that keep hands free for balance and catching yourself if you slip. Allow extra time for carefully navigating icy or snow-covered pathways—rushing increases fall risk dramatically (Care Options for Kids, 2021).
Large Icicle Awareness: Look up before approaching homes—large icicles on eaves and overhangs can fall without warning, causing serious head injuries. Choose pathways avoiding areas directly below icicle formations (Care Options for Kids, 2021).
Stair and Step Navigation: Exterior stairs and steps become particularly treacherous in winter. Use handrails consistently, test each step before full weight transfer, and take your time. If stairs are icy and no handrail exists, consider whether the visit can be safely conducted or needs rescheduling.
Documenting Unsafe Conditions: If you encounter persistently unsafe exterior conditions at a patient’s home, document this thoroughly. Work with case managers, social workers, or family members to arrange for pathway clearing before future visits. Unsafe access affects not only you but emergency responders, meal delivery services, and others the patient depends upon.
Indoor Environmental Hazards
Temperature Extremes: Some patient homes may be inadequately heated due to financial constraints, cognitive impairment, or heating system failures. Dress in layers you can adjust for varying home temperatures. Be prepared to address dangerously cold homes through appropriate referrals to social services or utility assistance programs (Wisconsin DHS, 2025; Health in Aging, 2018).
Conversely, some homes may be overheated. Being able to remove layers prevents overheating that can cause dizziness or fainting—particularly problematic if you’ve just come from outdoor cold.
Clutter and Fall Hazards: Many patients receiving home health have mobility limitations that contribute to cluttered, hazardous home environments. Carry a small flashlight to supplement inadequate lighting. Watch carefully for trip hazards, especially in low-light conditions. Your environmental assessment benefits both your safety and informs your patient intervention plan.
Wet Floors from Melting Snow: Your own boots and coat may track snow and water into patient homes. Be mindful of creating slip hazards on hard floors. Consider keeping towels in your car to wipe off boots before entering or changing into indoor shoes at the door.
Pet Hazards: Winter confinement means pets may have more pent-up energy and be more reactive. Establish protocols about securing pets during your visits. If dogs show aggression or cannot be controlled, this is grounds for declining or terminating services.
Air Quality and Ventilation: Homes sealed tightly against winter cold may have poor air quality. Be aware of strong odors from inadequate ventilation, gas leaks, or carbon monoxide. If you suspect gas leaks or carbon monoxide, evacuate immediately and call emergency services from outside the home.
Infection Control: Winter brings increased respiratory illness including flu, COVID-19, RSV, and common colds. Follow standard precautions consistently: hand hygiene before and after each patient contact, use of appropriate PPE, and maintaining personal health through vaccination and adequate rest. Carry hand sanitizer, masks, and gloves in your vehicle. If patients are acutely ill with infectious conditions, consult with supervisors about whether the visit should proceed or be rescheduled (Care Options for Kids, 2021; NCWWI, 2014).
Safety Systems and Infrastructure: For Agencies and Private Practitioners
Comprehensive safety requires more than individual vigilance—it demands organizational systems and, for private practitioners, self-created infrastructure that supports safe practice. Whether you work for a home health agency or operate your own outpatient home visit practice, implementing robust safety systems protects your wellbeing and ensures practice sustainability.
For Home Health Agencies: Essential Organizational Safety Systems
Comprehensive Safety Training: Agencies should provide thorough safety training covering winter driving, home visit safety protocols, emergency response procedures, infection control, and de-escalation techniques. Training should occur during onboarding and annually thereafter with scenario-based practice (Solo Protect, 2025; Community Health Alignment, 2023).
Communication Infrastructure: Real-time check-in systems, GPS location sharing, and reliable methods for therapists to request emergency assistance provide safety nets for isolated practitioners. Panic button apps or wearable devices offer immediate connection to emergency services and supervisors. Many agencies use automated check-in systems where therapists log arrival and departure times for every visit (ROAR for Good, 2025; Solo Protect, 2025).
Reasonable Scheduling: Schedulers must account for realistic winter travel times, weather conditions, and the physical and mental demands of home health practice. Overloaded schedules compromise safety as therapists rush between visits or work while exhausted. Build buffer time between appointments and allow therapists to decline unsafe visits without penalty.
Hazard Assessment Protocols: Agencies should conduct written hazard assessments before assigning visits, including violence risk screening, infection risk, presence of pets, home layout concerns, neighborhood safety, and travel risks (Solo Protect, 2025). Share this information with therapists before visits to enable informed safety planning.
Vehicle and Equipment Support: Some agencies provide vehicles, maintenance, and insurance for home health staff. Whether using agency or personal vehicles, agencies should ensure vehicles meet safety standards and support winter-related maintenance costs. Provide or subsidize emergency equipment and winter safety supplies.
Safety Incident Response: Clear protocols for reporting safety concerns and responding to incidents demonstrate organizational commitment to staff safety. Post-incident support including debriefing, counseling, and time off should be standard. Track incidents to identify patterns requiring intervention (Solo Protect, 2025).
Workplace Violence Prevention Plan: OSHA guidelines recommend comprehensive workplace violence prevention plans including pre-visit screening, de-escalation training, options for two-person visits when needed, and processes for declining unsafe assignments without penalty (Solo Protect, 2025).
For Private Practice and Outpatient Therapists: Building Your Own Safety Infrastructure
Private practitioners and outpatient therapists providing home visits face unique challenges—you are both clinician and administrator, responsible for creating safety systems typically provided by agencies. This requires intentional planning and resource investment.
Pre-Visit Screening and Assessment: Develop comprehensive intake procedures that assess safety before accepting home visit clients. Include questions about who will be present during visits, pets in the home, weapons in the home, substance use, history of violence or aggressive behavior, and infectious illnesses (SimplePractice, 2022; Private Practice Navigator, 2020). Consider phone or video consultations before committing to in-home services to assess both clinical appropriateness and safety.
Some practitioners conduct initial evaluations in office settings before transitioning to home visits, allowing assessment of client behavior in controlled environments (Reddit Therapists, 2023). Others research clients online before first visits—if you do this, disclose it in your informed consent documentation (Dr. Zur, 2018).
Communication and Check-In Systems: Without agency infrastructure, create your own safety communication protocols. Options include:
- Buddy systems with colleagues in your professional network who text/call before and after each visit
- Location-sharing apps (Google Maps, Life360, Find My Friends) with a trusted person during work hours
- Scheduled check-in times with family members or answering services
- Personal safety apps (ROAR for Good, bSafe, SafeTrek) that alert emergency contacts if you don’t check in as scheduled or activate panic features
- GPS tracking devices or apps that log your locations automatically
Share your daily schedule including patient names, addresses, and appointment times with your designated safety contact. Establish protocols for what should happen if you don’t check in as scheduled (SimplePractice, 2022; ROAR for Good, 2025).
Professional Liability Insurance: Verify that your professional liability insurance covers home-based services. Some policies exclude or limit coverage for services provided in client homes or outside traditional office settings. Discuss coverage specifics with your insurance provider and obtain riders if necessary (Private Practice Navigator, 2020).
Business Insurance Considerations: If using personal vehicles for home visits, ensure your auto insurance covers business use. Standard personal auto policies may not cover accidents occurring during business activities. Commercial auto insurance or business use riders may be required. Review homeowner’s or renter’s insurance if storing equipment or records in your home (Private Practice Navigator, 2020).
Medicare and Insurance Compliance: Understand billing requirements for home-based outpatient services. Medicare allows outpatient therapy in patient homes and reimburses at the same rates as office-based services, but documentation must support the services provided (Gawenda Seminars, 2023). Private insurance coverage for home-based outpatient therapy varies by carrier—verify coverage before initiating services to prevent billing issues.
Informed Consent Specific to Home Visits: Develop informed consent documentation addressing unique aspects of home-based practice including:
- Confidentiality limitations when others are present in the home
- Your right to decline or discontinue services if safety concerns arise
- Expectations for visit environment (adequate lighting, appropriate space, control of pets, absence of weapons and substance use)
- Your policies regarding who may be present during sessions
- Pre-visit screening procedures including any online research you conduct
- Procedures if client becomes ill, intoxicated, or threatening
- Your communication and check-in protocols
This documentation protects both you and clients by establishing clear expectations before services begin (SimplePractice, 2022; Private Practice Navigator, 2020; Dr. Zur, 2018).
Safety Equipment Investment: Budget for and invest in quality safety equipment including:
- Personal safety devices (panic buttons, personal alarms, GPS trackers)
- High-quality cell phone with reliable service and backup power sources
- Professional vehicle emergency kit (as detailed in Part 1)
- Quality winter footwear and clothing appropriate for varied conditions
- Professional bag or backpack that keeps hands free for balance
- Pepper spray or other legal self-defense tools if comfortable using them
These investments are business expenses that directly support your ability to practice safely.
Professional Network and Consultation: Build relationships with other therapists providing home-based services. Share safety strategies, discuss challenging situations, and provide mutual support. Consider forming formal consultation groups focused on home-based practice where you can troubleshoot safety concerns and share resources (SimplePractice, 2022).
Policies for Declining or Terminating Unsafe Services: Develop clear internal policies about circumstances under which you will decline new clients or terminate existing therapeutic relationships due to safety concerns. These might include:
- Active substance use during scheduled visits
- Presence of threatening individuals in the home
- Uncontrolled aggressive pets
- Weapons visible or accessible during visits
- Client or family member threats or aggressive behavior
- Unsafe home conditions (lack of heat, structural hazards, severe hoarding)
- Unsafe neighborhood or travel conditions
Document your decision-making process and provide appropriate referrals to alternative services when possible. Your safety is not negotiable, and establishing policies in advance helps you make difficult decisions without guilt (SimplePractice, 2022; Crisis Prevention Institute, 2016).
Continuing Education on Safety: Pursue continuing education on de-escalation techniques, crisis intervention, safety planning for home-based providers, and cultural competency that helps you navigate diverse home environments respectfully and safely. Organizations like the Crisis Prevention Institute offer specialized training for home-visiting professionals.
Emergency Action Plans: Develop written emergency action plans for various scenarios: medical emergencies with clients, natural disasters while in client homes, vehicle breakdowns in unfamiliar areas, threatening situations requiring immediate departure, and exposure to infectious diseases. Review these plans regularly and update as needed (Community Health Alignment, 2023).
Setting and Maintaining Boundaries
Both agency-employed and private practice therapists must maintain professional boundaries that support safety:
Session Location Boundaries: Establish where in the home therapy will occur. Many practitioners prefer common areas (living rooms, dining rooms) over private spaces like bedrooms unless clinical necessity dictates otherwise. This boundary supports both safety and professional appropriateness (Private Practice Navigator, 2020).
Presence of Others: Clarify policies about who may be present during sessions. While some clients require caregivers or family members present, you have the right to request privacy for therapeutic work when clinically appropriate and safe to do so.
Gifts and Hospitality: Develop policies about accepting food, drinks, or gifts from clients during home visits. While gracious refusal maintains boundaries, cultural factors may make this complex. Consider policies that balance cultural sensitivity with safety (not accepting unsealed food/drinks) and ethical boundaries.
Personal Information: Avoid sharing personal information about yourself, your family, your home address, or your schedule beyond what clients need for appointments. Be cautious about social media connections with clients (Community Health Alignment, 2023; Crisis Prevention Institute, 2016).
Advocating for Your Safety
For Agency Employees: If your agency lacks adequate safety support, advocate for necessary changes. Document safety concerns, propose specific solutions, and involve colleagues in advocacy efforts. Professional associations including AOTA and APTA offer resources on home health safety standards that support advocacy efforts. Remember: you cannot provide quality patient care if you’re injured, ill, or placed in unsafe conditions. Your safety is not negotiable.
For Private Practitioners: Your advocacy is primarily with yourself—giving yourself permission to implement robust safety systems, invest in necessary equipment, decline unsafe situations, and charge fees that support sustainable practice with adequate time between appointments. Join professional groups addressing home-based practice to access collective wisdom and advocacy resources.
Consider whether home-based services are appropriate for your practice model, risk tolerance, and client population. Home visits can differentiate your practice and serve clients with genuine access barriers, but they’re not required. Many successful practices serve homebound clients through telehealth rather than in-person home visits, particularly for therapy services that don’t require hands-on intervention.
Integrating Safety Into Professional Identity
As home accessibility specialists and patient safety advocates, modeling comprehensive safety practices strengthens our professional credibility. When we arrive prepared, navigate winter conditions skillfully, and demonstrate systematic risk assessment in unfamiliar environments, we embody the safety expertise we teach clients.
Whether you work for a large home health agency or operate a solo outpatient practice, your commitment to safety reflects your professionalism and supports practice longevity. The environmental assessment skills you use entering patient homes mirror the comprehensive safety evaluations you conduct for clients. Your vehicle emergency preparedness (discussed in Part 1) demonstrates the same proactive planning you encourage in patients preparing for aging in place.
Winter home visiting challenges you professionally and physically—but with proper preparation (Part 1), safety protocols during visits (Part 2), and organizational or self-created support systems, you can continue providing essential services even during the most challenging season. Your expertise reaches clients where they live precisely because you navigate these challenges skillfully and safely.
Stay safe out there, and remember: the most important person you protect is yourself, because your patients need you to return tomorrow.
References
Care Options for Kids. (2021). 5 winter survival tips for home health care workers. https://careoptionsforkids.com/blog/winter-survival-tips-for-home-health-care-workers/
Community Health Alignment. (2023). Home visitation safety best practices. https://communityhealthalignment.org/wp-content/uploads/2023/10/CHW-Safety-training-SE-Summit-UPDATED.pdf
Crisis Prevention Institute. (2016). How to stay safe during home visits. https://www.crisisprevention.com/blog/behavioral-health/how-to-stay-safe-during-home-visits/
Dr. Zur, O. (2018). Home office: When the therapy office is at home. https://drzur.com/clinical_updates/home-office/
Gawenda Seminars. (2023). Can I treat patient’s in their home as an outpatient. https://gawendaseminars.com/can-treat-patients-home-outpatient/
Health in Aging. (2018). Tip sheet: Winter safety for older adults. https://www.healthinaging.org/tools-and-tips/tip-sheet-winter-safety-older-adults
National Child Welfare Workforce Institute. (2014). Home visitor safety training. https://ncwwi.org/files/Incentives__Work_Conditions/Home_Visitor_Safety_Training.pdf
North American Rental Alliance. (2024). Preparing for winter: Fall prevention & safety tips. https://www.naranet.org/blog/post/preparing-for-winter-fall-prevention-safety-tips
Private Practice Navigator. (2020). Psychotherapy: To home visit or not to home visit. https://privatepracticenavigator.coach/2020/02/08/psychotherapy-to-home-visit-or-not-to-home-visit/
Reddit Therapists. (2023). How do therapists stay safe while doing home visits? https://www.reddit.com/r/therapists/comments/18e7hiy/how_do_therapists_stay_safe_while_doing_home/
ROAR for Good. (2025). 10 safety tips for therapists. https://www.roarforgood.com/blog/safety-tips-for-therapists-roar-for-good/
SimplePractice. (2022). Clinician safety in home-based care. https://www.simplepractice.com/blog/clinician-safety-in-home-based-care/
Solo Protect. (2025). OSHA compliance and lone worker safety in home healthcare. https://www.soloprotect.com/blog/what-every-home-care-administrator-should-know-about-osha-and-lone-worker-safety
Wisconsin Department of Health Services. (2025). Winter safety measures for health care providers. https://www.dhs.wisconsin.gov/climate/winter.htm
The Home Accessibility Therapist LLC 
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