boundaries in home health care anne mccord, msw, lsw according to oundaries_ja.pdf and

Boundaries in Home Boundaries in Home Health CareHealth CareAnne McCord, MSW, LSW

According to http://hci.learn.com/files/pdf/Professional_Boundaries_JA.pdf and www.ohiohcp.org/professionalboundaries4licensedpersonnel.doc

What are boundaries?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.


Why are boundaries Why are boundaries needed?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.


What’s the impact?What’s the impact?

Impact areas include:clinical outcomespatient satisfactionagency resource utilizationstaff burnoutpotential legal or risk

management issues


Red FlagsRed FlagsDiscussing intimate or personal problems

with a patient or familyAccepting or giving giftsKeeping 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 careAccording to

http://hci.learn.com/files/pdf/Professional_Boundaries_JA.pdf and www.ohiohcp.org/professionalboundaries4licensedpersonnel.doc

Red Flags (cont)Red Flags (cont)Visiting or calling a patient for non‐medical

reasonsVisiting a patient after dischargePerforming “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” According to


Red Flags (cont)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


Common ways clinicians Common ways clinicians cross boundariescross boundariesFinancialInappropriate Self-DisclosureSuper ClinicianNon-Clinical Focused Relationship


FinancialFinancialTheftInappropriate acceptance of giftsSelling items to the patient or

caregiverOffering financial advice or

making financial decisions for the patient or caregiver


Inappropriate Self-Inappropriate Self-DisclosureDisclosureDiscussing personal issues with the

patient or caregiverProviding the patient or caregiver

with personal telephone numbersDiscussing other patients with the

patient or caregiverDiscussing other staff members

with the patient or caregiverImposing religious or personal

beliefs on the patient or caregiverAccording to http://hci.learn.com/files/pdf/Professional_Boundaries_JA.pdf and www.ohiohcp.org/professionalboundaries4licensedpersonnel.doc

Super ClinicianSuper ClinicianInsisting on making all patient visitsInsisting on performing all scheduling

functions related to the patient’s careMaking negative comments to the

patient about the skills of other cliniciansKeeping secrets with the patient or

caregiverFailing to disclose changes in the

patient’s status with the physician or other members of the interdisciplinary team

Planning other patient visits around the needs of the patient According to


Non-Clinical Focused Non-Clinical Focused RelationshipRelationship 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


What Can Happen if What Can Happen if Boundaries are CrossedBoundaries are CrossedDisciplinary action per agency

protocolReport to law enforcement per

agency protocolReport to licensure body per

agency protocolPossible loss of professional

licenseAccording to http://hci.learn.com/files/pdf/Professional_Boundaries_JA.pdf and www.ohiohcp.org/professionalboundaries4licensedpersonnel.doc

Ways to AvoidWays to AvoidEstablish boundaries up frontOngoing professional boundary

educationSupport improved work‐life balanceIncrease involvement of the

interdisciplinary teamSet limits related to acceptable role and

responsibility in the patient’s plan of care

Support improved work‐life balanceDevelop and strengthen communication

skillsAccording to http://hci.learn.com/files/pdf/Professional_Boundaries_JA.pdf and www.ohiohcp.org/professionalboundaries4licensedpersonnel.doc

boundaries in home health care anne mccord, msw, lsw according to oundaries_ja.pdf and

Documents

professional boundaries

family member flirting

family lending personal

red flags cont

inappropriate humor

personal problems

home health care anne

plan of care