Boundaries in Home Health Care

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Boundaries in Home Health Care

• Anne McCord, MSW, LSW

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What are boundaries?

• Professional boundaries are limits that define
  and support a therapeutic clinician-patient
  relationship. Boundary violations can carry
  serious repercussions for home health and hospice
  organizations.

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Why are boundaries needed?

• Professional boundaries are necessary to perform
  objective assessments, carry out orders
  appropriately, make professional clinical
  decisions, provide education, and exercise good
  clinical judgment to determine and meet the needs
  of the patient.

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Whats the impact?

• Impact areas include
• clinical outcomes
• patient satisfaction
• agency resource utilization
• staff burnout
• potential legal or risk management issues

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Red Flags

• Discussing intimate or personal problems with a
  patient or family
• Accepting or giving gifts
• Keeping secrets with a patient, including
  withholding necessary information from other
  healthcare professionals and the family
• Sharing inappropriate humor or jokes with a
  patient
• Believing that no one else is capable or
  competent enough to meet the needs of a patient
• Spending more time with a patient than is
  necessary based on the plan of care

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Red Flags (cont)

• Visiting or calling a patient for non-medical
  reasons
• Visiting a patient after discharge
• Performing special favors for a patient, like
  purchasing groceries, performing household
  chores, or driving the patient to appointments
• Exchanging home and cell phone numbers with a
  patient or family
• Lending personal items to a patient or family
  member
• Addressing a patient unprofessionally, like
  sweetheart or honey

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Red Flags (cont)

• Inviting a patient or family member to social
  events or accepting their invitation to such
  functions
• Imposing personal or religious beliefs on a
  patient or initiating unsolicited discussions
  related to religious matters
• Failing to address or resolve inappropriate or
  provocative comments from a patient or family
  member  
• Flirting that occurs between a patient or family
  and the clinician

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Common ways clinicians cross boundaries

• Financial
• Inappropriate Self-Disclosure
• Super Clinician
• Non-Clinical Focused Relationship

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Financial

• Theft
• Inappropriate acceptance of gifts
• Selling items to the patient or caregiver
• Offering financial advice or making financial
  decisions for the patient or caregiver

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Inappropriate Self-Disclosure

• Discussing personal issues with the patient or
  caregiver
• Providing the patient or caregiver with personal
  telephone numbers
• Discussing other patients with the patient or
  caregiver
• Discussing other staff members with the patient
  or caregiver
• Imposing religious or personal beliefs on the
  patient or caregiver

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Super Clinician

• Insisting on making all patient visits
• Insisting on performing all scheduling functions
  related to the patients care
• Making negative comments to the patient about the
  skills of other clinicians
• Keeping secrets with the patient or caregiver
• Failing to disclose changes in the patients
  status with the physician or other members of the
  interdisciplinary team
• Planning other patient visits around the needs of
  the patient

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Non-Clinical Focused Relationship

• Running errands for the patient or caregiver
• Performing special favors for the patient or
  caregiver
• Driving the patient to appointments
• Financing patient or caregiver expenses
• Calling the patient for non-clinical related
  reasons
• Visiting the patient outside of planned home care
  or hospice visits
• Visiting the patient after discharge
• Engaging in non-clinical-related activities
  during patient visits
• Accepting invitations from the patient or
  caregiver for non-clinical-related activities or
  extending such invitations to the patient or
  caregiver

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What Can Happen if Boundaries are Crossed

• Disciplinary action per agency protocol
• Report to law enforcement per agency protocol
• Report to licensure body per agency protocol
• Possible loss of professional license

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Ways to Avoid

• Establish boundaries up front
• Ongoing professional boundary education
• Support improved work-life balance
• Increase involvement of the interdisciplinary
  team
• Set limits related to acceptable role and
  responsibility in the patients plan of care
• Support improved work-life balance
• Develop and strengthen communication skills