A nurse's fatal last visit to patient's home renews calls for better safety measures

The killing of a Connecticut nurse making a house call in October was a nightmare come true for an industry gripped by the fear of violence.

Already stressed out by staffing shortages and mounting caseloads, heath care workers are increasingly worrying about the possibility of a patient becoming violent – a scenario that is too common and on the rise nationwide.

Joyce Grayson, a 63-year-old mother of six, went into a halfway house for sex offenders in late October, to give medication to a man with a violent past. She didn't make it out alive.

Police found her body in the basement and have named her patient as the main suspect in her killing.

Grayson’s death has her peers and lawmakers renewing their yearslong pleas for better protections for home health care workers, including sending them out with escorts and providing more information about their patients. The calls come during an era of increasing violence against medical professionals in general.

“I used to go into some pretty bad neighborhoods," said Tracy Wodatch, a visiting nurse and chief executive of the Connecticut Association of Healthcare at Home. She said she used to call the police and get an officer to escort her when she felt unsafe. But, because of budget and staffing issues, this is no longer an option, she said.

Grayson, who had been a nurse for over 36 years including the last 10 as a visiting nurse, was found dead Oct. 28 in the Willimantic halfway house. She didn’t return from a visit to patient Michael Reese, a convicted rapist. No charges have been filed in the killing yet.

“It’s all nurses are thinking about right now, even the hospital nurses because they’ve had so many close calls,” said Connecticut state Sen. Martha Marx, a visiting nurse and New London Democrat who is calling for changes in both state and federal laws.

Marx said she was once sent to a home and didn’t find out until she talked to clients there that it was a residence for sex offenders. Often, if a nurse asks for a chaperone, the agency will simply reassign the work to another employee who won’t “make waves,” she said.

Grayson's death came about 11 months after another visiting nurse, Douglas Brant, was shot to death during a home visit in Spokane, Washington — a killing that also drew calls for safety reforms, including federal standards on preventing workplace violence.

While killings are rare, nursing industry groups say non-fatal violence against health care workers is not. From 2011 to 2018, the rate of non-fatal violence against health care workers increased more than 60%, according to the latest analysis by the federal Bureau of Labor Statistics.

In fact, the number of non-fatal injuries from workplace violence involving health care workers has been higher than that of other industries for years, according to the bureau.

In a survey released in late 2022 by the National Nurses United, the largest union of registered nurses in the U.S., 41% of hospital nurses reported an increase in recent workplace violence incidents, up from 30% in September 2021.

“I knew a home health aide who got punched in the stomach,” said Ha Do Byon, a former visiting nurse and now a nursing professor at the University of Virginia, who has been studying violence against home health care workers. “Many more nurses got bitten, kicked, or slapped by their patients or family members in the patients’ homes. Some were attacked by vicious dogs or were called names or sworn at. Notably, the majority of these workers were female.”

Byon said specific statistics on visiting nurses has been lacking and he has been working on improving the data.

“There’s no way home health workers should be sent into somebody’s home or apartment by themselves,” said U.S. Rep. Joe Courtney, a Democrat who represents the congressional district where Grayson was killed. “You have to have systems and tools to reduce the risk."

Courtney has been pushing legislation since 2019 that would set up federal regulations requiring health care and social service employers to develop and implement comprehensive workplace violence prevention plans. While several states require such prevention plans, there is no federal law, industry groups say.

He says the problem highlighted by Grayson’s case is not just about safety, but also about attracting and retaining health care workers, many of whom feel the job is just too dangerous.

“It’s honestly a huge factor in terms of the burnout that employers are so concerned about, ” Courtney said.

Marx wants to see laws requiring security escorts for nurses in some cases, and for police to provide caregivers regularly updated lists of addresses where violent crime has occurred. She also said patients’ charts should be flagged to alert nurses about past incidents of violence, if they’re registered sex offenders and other information.

Grayson was a nurse for the Connecticut Department of Mental Health and Addiction Services for 26 years before serving as a visiting nurse for over a decade, according to her family. She also was a beloved foster parent, taking in nearly three dozen children and being honored with the state's Foster Parent of the Year award in 2017.

What exactly Grayson knew about Reese and the halfway house in Willimantic is one of many unanswered questions in the case.

Her employer, Elara Caring, said Grayson had Reese’s medical file before she went there, but it declined to say what information was in the file, citing medical privacy laws.

Elara, which provides home care for more than 60,000 patients in 17 states, says it is reviewing its safety protocols and talking to employees about what more is needed. Scott Powers, chairman and chief executive, said company workers were shocked and grieving over Grayson’s death.

The company said it had safeguards in place when Grayson was killed. This includes working with states to ensure patients, including ex-cons, are deemed safe by state officials to be cared for in the community and training for employees to prepare them for such clients. It declined to go into deeper details about its security protocols, citing the investigation into Grayson's death.

Police still haven't said how Grayson died, and the medical examiner's office said autopsy results remain pending. Willimantic's police chief, Paul Hussey, called the killing one of the worst cases he has seen in his 27 years in law enforcement.

Reese, who was on probation after serving more than 14 years in prison for stabbing and sexually assaulting a woman in 2006 in New Haven, was taken into police custody while leaving the halfway house on the day Grayson was killed. He was released from prison in late 2020 and was sent back to detention two times for violating probation, state records show.

Authorities said he had some of Grayson's belongings, including credit cards, and was charged with violating probation, larceny and using drug paraphernalia. He is detained on $1 million bail. A public defender listed in court records as representing Reese did not return emails seeking comment.

Grayson’s family is devastated and is seeking answers to an array of questions, including if there were failures of oversight by the state Department of Correction, state probation officials and the company that runs the halfway house. They also want to know whether Elara Caring adequately protected her, according to their lawyer, Kelly Reardon, who said a lawsuit is planned.

“They were extremely concerned that it was preventable,” Reardon said. “They certainly felt from the get-go that there were failings in the system that led to this and they want that to be investigated.”

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Collins reported from Hartford, Connecticut.