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COVID-19: When sheltering at home isn't safe

May 6, 2020 | Karla VonEschen, MS, CPC, CPMA

At this point in the fight to prevent the spread of COVID-19, most states have encouraged people to stay home and, in some cases, mandated sheltering in place. It’s understandable given the circumstances, and many of us are complying without a problem, but what happens when the home environment isn't safe? 

During times of crisis—such as epidemics, wars, or natural disasters—the risk of gender-based-violence escalates. The Centers for Disease Control and Prevention (CDC) provides the following statistics via the National Intimate Partner and Sexual Violence Survey:

  • In the U.S., about 1 in 3 women and nearly 1 in 6 men experienced some form of contact sexual violence during their lifetime.
  • In the U.S., more than 27 percent of women and 11 percent of men have experienced contact sexual violence, physical violence, and/or stalking by an intimate partner in their lifetime and experienced intimate partner violence-related impact.
  • 1 in 6 women and 1 in 19 men experienced stalking at some point during their lifetime.

While social distancing and mandatory lockdowns benefit those most at risk of becoming seriously ill and help prevent the spread of COVID-19, it also traps victims in their homes with their abusers, isolated from the people and the resources that could help them. Domestic violence adds additional layers of complexity to an already complicated medical situation, and abuse hotlines have previously noted an uptick in calls seeking assistance. According to the National Domestic Violence Hotline, there are additional ways COVID-19 may uniquely impact those who have experienced intimate partner violence:

  • Abusive partners may withhold necessary items, such as hand sanitizer or disinfectants.
  • Abusive partners may share misinformation about the pandemic to control or frighten survivors, or to prevent them from seeking appropriate medical attention if they have symptoms.
  • Abusive partners may withhold insurance cards, threaten to cancel insurance, or prevent survivors from seeking medical attention if they need it.
  • Programs that serve survivors may be significantly impacted. Shelters may be full or may even stop intakes altogether. Survivors may also fear seeking help at a shelter because of being in close quarters with groups of people.
  • Survivors who are older or have chronic heart or lung conditions may be at increased risk in public places where they would typically get support, like shelters, counseling centers, or courthouses.
  • Travel restrictions may impact a survivor’s escape or safety plan. It may not be safe for them to use public transportation or to fly.
  • An abusive partner may feel more justified and escalate their isolation tactics.

Those of us who work in health care are in a unique position to identify and help victims of abuse. Most healthcare providers will ask a patient if he or she feels safe in their home environment during office visits, or these days via telehealth, or ask other screening questions. Often, signs such as evident bruising are not visible on the patient, but there are other indicators healthcare workers should keep in mind:

  • Multiple injuries such as bruises, burns, lacerations, bites
  • Behaviors showing a delay in seeking treatment for injuries
  • Injuries hidden by clothing or on central body areas
  • Injuries at different stages of healing
  • Patients who state they are "accident prone"
  • Domestic partners present at an office or telehealth visit who speaks for the patient
  • History of drug or alcohol abuse
  • Low self-esteem
  • Frequent visits for somatic complaints

In addition to staying hyper-aware of abuse signs, healthcare providers are encouraged to post national and local domestic violence resources where patients can easily see them.

While COVID-19 is front and center in our everyday lives, let’s not forget about some of the other downstream impacts of being homebound. Stay safe and healthy!

Karla VonEschen is a coding analyst at 3M Health Information Systems.

During a pandemic, healthcare information is gathered, studied, and published rapidly by scientists, epidemiologists and public health experts without the usual processes of review. Our understanding is rapidly evolving and what we understand today will change over time. Definitive studies will be published long after the fact. 3M Inside Angle bloggers share our thoughts and expertise based on currently available information.

Visit the 3M HIS COVID-19 resource page.

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Domestic violence
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