Boundaries in Home Health Care

1. Boundaries in Home Health Care Anne McCord, MSW, LSW According to http://hci.learn.com/files/pdf/Professional_Boundaries_JA.pdf and www.ohiohcp.org/professionalboundaries4licensedpersonnel.doc

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

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

4. What’s the impact? Impact areas include: • clinical outcomes • patient satisfaction • agency resource utilization • staff burnout • potential legal or risk management issues According to http://hci.learn.com/files/pdf/Professional_Boundaries_JA.pdf and www.ohiohcp.org/professionalboundaries4licensedpersonnel.doc

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

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

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

8. Common ways clinicians cross boundaries • Financial • Inappropriate Self-Disclosure • Super Clinician • Non-Clinical Focused Relationship According to http://hci.learn.com/files/pdf/Professional_Boundaries_JA.pdf and www.ohiohcp.org/professionalboundaries4licensedpersonnel.doc

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

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

11. Super Clinician • Insisting on making all patient visits • Insisting on performing all scheduling functions related to the patient’s 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 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 http://hci.learn.com/files/pdf/Professional_Boundaries_JA.pdf and www.ohiohcp.org/professionalboundaries4licensedpersonnel.doc

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

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

14. 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 patient’s plan of care • Support improved work‐life balance • Develop and strengthen communication skills According to http://hci.learn.com/files/pdf/Professional_Boundaries_JA.pdf and www.ohiohcp.org/professionalboundaries4licensedpersonnel.doc