Explaining the Issues of Violence from Clients in the Caregiving Field and Workers' Compensation & Liability Claims

Violence from clients in the caregiving sector is a serious issue that imposes significant physical and mental strain on caregiving staff. Violence, particularly from clients with conditions such as dementia, is difficult to predict and often results in physical and psychological harm to the caregivers.

In response to such violence, issues of workers’ compensation and liability for damages arise, involving several laws and systems. Comprehensive measures are necessary to address violence in the caregiving setting, including support from the facility and legal responses. Risk management to prevent violence and improvements to the workplace environment are also crucial components.

This article provides a detailed explanation of the reality of violence, the potential for workers’ compensation recognition and damage claims, as well as specific preventative and response measures. Please use this information to help ensure the safety and peace of mind of both the facility and its staff.

The Reality of Violence in the Japanese Caregiving Sector

In the Japanese caregiving sector, various forms of violence exist that have a serious impact on the mental and physical well-being of staff members. These acts of violence range from physical and psychological to sexual in nature. Below, we will provide a detailed explanation of the realities of each type of violence.

Physical Violence in the Workplace

Physical violence poses a serious threat to caregiving professionals in Japan, taking many forms. For example, the following incidents can occur:

• Being struck by an angry service user
• Being kicked by someone swinging their leg
• Having one’s arm pinched
• Being scratched on the face or neck

Direct attacks like these from facility users can happen, potentially causing physical injuries such as bruises or cuts, which are highly dangerous. It is not uncommon to have objects thrown at you, including items like dishes used during meals, remote controls, or canes. Being forcefully pulled by the clothes is also a form of physical violence.

Other examples include:

• A case where a caregiver was suddenly hit by a service user during bathing assistance, resulting in facial injuries
• A case where a caregiver was injured on the arm by dishes thrown by a service user who was displeased with something during meal distribution
• A case where a caregiver experienced scalp pain after a service user, losing balance during a wheelchair transfer, pulled their hair

Physical violence not only inflicts physical pain on staff but can also cause significant psychological distress. Staff members who have experienced violence may suffer from fear and anxiety, and there is a risk of developing PTSD (Post-Traumatic Stress Disorder). This can lead to a decrease in motivation to work and, in some cases, result in resignation.

Psychological Abuse in the Workplace

Psychological abuse, unlike physical violence, is less visible and often underestimated in terms of its severity. However, it can leave deep emotional scars on employees and cause long-term distress.

Verbal abuse is a typical example. Being subjected to derogatory language or insults that attack one’s personality can damage an employee’s self-esteem and lead to a decrease in self-affirmation.

Intimidating attitudes and behaviors also constitute psychological abuse. Being yelled at loudly or glared at can cause employees to shrink back and develop a sense of fear. In such situations, it becomes difficult to make calm decisions, potentially leading to a decline in the quality of care provided.

Being repeatedly subjected to unreasonable demands can also be a mental burden for employees.

• Being ordered around in a commanding tone, such as “Bring that here” or “Do it now”
• Being called upon regardless of the time of night

All of the above can exhaust an employee’s mental and physical health. Continuously responding to these demands can lead to excessive stress and disrupt the employee’s mental and physical balance.

Specific examples include the following:

• Cases where a caregiver was verbally abused by a service user who refused bathing assistance, being called “useless” or told “just quit your job”
• Cases where, during a night shift, an employee was repeatedly summoned by the nurse call and then yelled at with phrases like “Come quickly” or “You’re making me lose sleep”
• Cases where an employee was persistently blamed for minor mistakes and berated with “Can’t you even do this?” or “You’re fired”

Psychological abuse is often difficult for others to understand, and it’s not uncommon for affected employees to bear the burden alone. Some may blame themselves, thinking “Is it my fault?” However, it is crucial to recognize that this is not the case. Psychological abuse is a problem on the part of the perpetrator and should never be tolerated.

Sexual Violence in the Japanese Caregiving Sector

Sexual violence is a despicable act that significantly harms the dignity of caregiving staff and inflicts serious physical and psychological damage. Inappropriate physical contact is a typical example.

For instance, the following situations can be cited:

• Touching the body more than necessary during caregiving
• Forcing hugs or kisses
• Touching the body with a sexual purpose

These actions constitute sexual violence. They can instill disgust and fear in staff members and have a high potential to cause trauma.

Lewd behavior and speech are also forms of sexual violence. Acts such as making sexually explicit comments or telling obscene jokes can cause discomfort to staff and inflict mental anguish. Additionally, showing images or videos of a sexual nature is also sexual violence. It not only violates the dignity of staff members but also contributes to a deteriorating workplace environment.

The coercion of sexual acts is another serious issue that cannot be overlooked.

• Forcing sexual acts
• Demanding sexual services

These are acts that deny the personality of the staff and should never be tolerated. They can cause severe psychological damage to staff members and may lead to mental health issues such as PTSD (Post-Traumatic Stress Disorder).

More specific examples include the following:

• Cases where caregivers were touched or spoken to in a sexual manner by clients during bathing assistance
• Cases where caregivers were coerced into sexual acts by clients during home visits

Sexual violence often goes unreported due to the victim’s feelings of shame and fear. However, it is an act that should never be tolerated.

The caregiving sector should be a place where clients and staff build a relationship of trust and mutual respect. Sexual violence fundamentally undermines this trust and requires strict measures to be addressed.

Violence in the Caregiving Field and Workers’ Compensation Recognition in Japan

Violence in the caregiving field can have a serious impact on the mental and physical health of staff and may contribute to job turnover. Such violence may be recognized as a work-related injury under Japanese workers’ compensation law.

Injuries from physical violence, as well as mental disorders caused by verbal abuse or sexual harassment, may be eligible for workers’ compensation recognition if certain conditions are met. We will explain each case in detail below.

Injuries from Physical Violence

In the caregiving field in Japan, it is unfortunately not uncommon for staff to be injured by violence from clients. However, injuries resulting from such violence may be recognized as work-related injuries.

The criteria for workers’ compensation recognition are twofold: work-relatedness and causation. Work-relatedness refers to whether the injury occurred during work, and causation refers to whether there is a causal relationship between the injury and the work. If a caregiving staff member is injured by violence from a client, these criteria are met.

This means that if you are injured by violence from a client while on duty, there is a high likelihood of recognition as a work-related injury. If recognized, you may receive benefits such as medical expenses and compensation for lost wages, which can alleviate the financial burden on the staff member.

Workers’ compensation recognition is determined by the Labor Standards Inspection Office, and not all applications are approved. However, remember that injuries from client violence have a high likelihood of being recognized as work-related injuries. It is crucial to actively utilize the workers’ compensation system to create a safe and focused work environment.

Mental Harm from Verbal Abuse or Sexual Harassment

In the caregiving field in Japan, not only physical violence but also verbal abuse and sexual harassment are serious issues. Invisible violence can deeply wound the staff’s psyche, potentially leading to mental illnesses such as depression or adjustment disorders. Such mental harm may also be recognized as a work-related injury if certain conditions are met.

The conditions for workers’ compensation recognition of mental disorders are as follows:

• The mental disorder in question must be recognized as eligible.
• There must be evidence of significant mental stress due to work within the six months prior to the onset.
• The disorder must not be attributable to factors outside of work.

Especially in cases of mental disorders caused by verbal abuse, proving the causal relationship with work is crucial. Objective evidence such as recordings of the abuse or testimonies from colleagues and supervisors must be collected to demonstrate the significant mental stress caused by work.

Because mental violence is less visible, it may seem difficult to get workers’ compensation recognition. Therefore, it is important to consult with professional institutions or attorneys and proceed with the appropriate procedures.

To create a safe working environment for caregiving staff, employers must not only address physical violence but also pay close attention to mental violence and take appropriate measures.

Issues of Compensation for Violence from Clients in the Japanese Caregiving Sector

In Japan, workers’ compensation insurance provides certain benefits for injuries or illnesses sustained during work, but it does not cover all damages incurred. Specifically, compensation for mental anguish caused by violence from clients is not covered by workers’ compensation insurance. In such cases, staff members who have suffered from violence can seek to recover the shortfall through damage claims.

A damage claim is an action to seek compensation for damages from the perpetrator, and even in the case of workers’ compensation, it is possible under certain conditions.

The basis for damage claims due to violence from clients lies in two aspects: third-party act disasters and the violation of the duty of care for safety.

A third-party act disaster refers to cases where the cause of a work-related accident is the act of a third party (in this case, the client). Since violence from a client falls under this category, in principle, it is possible to claim damages from the client. If the client lacks the capacity to be held responsible, their family or other supervisors may bear the responsibility.

Furthermore, if there is a violation of the duty of care for safety on the part of the facility, the business operator may be subject to a damage claim. The duty of care for safety is the obligation of the business operator to take necessary measures to protect the safety and health of employees.

For example, if a business operator is aware of a client’s violent tendencies but fails to take appropriate measures, there may be a potential violation of the duty of care for safety, so please be cautious.

Six Strategies to Address Violence in the Japanese Caregiving Sector

Violence in the caregiving sector, perpetrated by clients and their families, not only has a profound impact on the mental and physical well-being of staff but also poses a significant barrier to the provision of high-quality care. It is essential for caregiving service providers to implement comprehensive measures to address these issues and ensure a safe working environment for their employees.

Below, we detail six particularly important strategies for responding to and preventing violence in the caregiving sector.

Creation of Individual Care Plans

Individual care plans are tailored to meet the specific conditions and needs of clients and play a crucial role in addressing and preventing violence.

The plan should meticulously document the client’s physical condition, cognitive functions, mental state, and any past incidents of violence, outlining specific measures for response. For instance, if certain situations or stimuli are known to trigger violent behavior, the plan should incorporate environmental adjustments and communication strategies to avoid these triggers.

Furthermore, it is essential to regularly assess changes in the client’s condition and revise the care plan as necessary.

Environmental Adjustments

Environmental adjustments are crucial measures for enhancing user comfort and suppressing violent behavior. It is essential to devise lighting, sound, temperature, and furniture arrangements to create a space where users can relax and spend time comfortably.

Additionally, it is important to ensure that emergency evacuation routes are secured and that both users and staff are prepared for safe evacuation in case of an emergency.

Communication

Communication is the foundation for building trust with clients and preventing violent behavior. It is essential to listen to the clients’ words and engage with them with an empathetic attitude.

Furthermore, encouraging clients to understand their emotions and express them in appropriate words is also effective. Keeping records of communications with clients and sharing them with other staff members can lead to the pursuit of more effective communication methods.

Staff Training

It is crucial to conduct regular staff training aimed at preventing and addressing violence and verbal abuse. During these sessions, employees learn about the organization’s fundamental policies and basic principles regarding violence.

By examining case studies and sharing response strategies, staff can tailor their actions to the specific circumstances of the individuals they serve, thereby preventing various types of trouble.

Recording and Reporting

In the event of a violent incident, it is crucial to meticulously record details such as the date, location, circumstances, and the response taken. Changes in the condition of those involved and the care provided should also be documented to analyze any correlation with the violent act. Sharing these records among staff members is vital for an organized response to such incidents.

The information recorded must be shared with staff to facilitate an organized response. To achieve this, proper reporting is necessary. Reports should be made promptly to supervisors or managers, conveying the facts accurately. Sharing written records, in addition to verbal communication, enables more precise information transfer.

Accurate recording and swift reporting are not only essential for preventing the recurrence of violence but also for ensuring the safety of staff and providing appropriate care to clients.

Organizational Response

An organizational response is essential for effectively addressing and preventing violence. Leaving the discretion solely to individual staff members when violence occurs increases the risk of exacerbating the situation.

If the staff member involved bears the problem alone, the violence or demands may escalate, potentially leading to a more serious situation. Furthermore, if left unaddressed with appropriate measures, not only does it increase the risk of staff turnover, but the facility may also face the suspicion of violating the duty of care for safety.

Therefore, it is important for supervisors, such as management, to participate in the response and work on problem-solving as an entire organization, while considering other users.

Specifically, creating and sharing a manual for responding to violence among staff is effective. The manual should clearly outline emergency response procedures, reporting systems, and consultation contacts. Additionally, holding regular meetings to share information about violence and consider response measures can lead to improvements in the quality of service.

Summary: Consult an Attorney for Workers’ Compensation and Damages in the Caregiving Field

Violence in the caregiving field is a serious issue that not only has a profound impact on the mental and physical health of staff but also hinders the provision of high-quality care. Forms of violence vary widely, including physical, psychological, and sexual violence, and staff are constantly at risk.

Staff who have experienced violence can receive economic support such as treatment costs and compensation for lost wages through workers’ compensation recognition. Additionally, claims for damages can compensate for losses not covered by workers’ compensation insurance, such as compensation for mental anguish.

To prevent the occurrence of violence and create a safe working environment for staff, multifaceted measures are essential. Understanding the conditions and needs of clients and providing appropriate care can prevent violent incidents. It is also important to enhance training and support systems for staff.

Caregiving is a noble profession that takes place within the connections between people. By creating an environment where staff can work with peace of mind, better care can also be provided to clients. Please take proactive steps towards realizing a violence-free, safe, and secure caregiving environment.

Reference: Ministry of Health, Labour and Welfare | Measures to Prevent Occupational Accidents in Social Welfare Facilities

Guidance on Measures by Our Firm

The caregiving industry in Japan is governed by a complex web of laws, including the Long-Term Care Insurance Act, the Elderly Welfare Law, and the Companies Act. Monolith Law Office serves as legal counsel for the National Association of Caregiving Service Providers and caregiving service providers in prefectures nationwide, possessing extensive know-how related to legal matters concerning caregiving businesses.

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