Boundaries in Home Health
Care
Anne McCord, MSW, LSW
According to
http://hci.learn.com/files/pdf/Professional_B
oundaries_JA.pdf and
www.ohiohcp.org/professionalboundaries4li
censedpersonnel.doc
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_B
oundaries_JA.pdf and
www.ohiohcp.org/professionalboundaries4li
censedpersonnel.doc
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_B
oundaries_JA.pdf and
www.ohiohcp.org/professionalboundaries4li
censedpersonnel.doc
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_B
oundaries_JA.pdf and
www.ohiohcp.org/professionalboundaries4li
censedpersonnel.doc
Red Flags

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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_B
oundaries_JA.pdf and
www.ohiohcp.org/professionalboundaries4li
censedpersonnel.doc
Red Flags (cont)
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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_B
oundaries_JA.pdf and
www.ohiohcp.org/professionalboundaries4li
censedpersonnel.doc
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_B
oundaries_JA.pdf and
www.ohiohcp.org/professionalboundaries4li
censedpersonnel.doc
Common ways clinicians cross
boundaries
Financial
 Inappropriate Self-Disclosure
 Super Clinician
 Non-Clinical Focused Relationship

According to
http://hci.learn.com/files/pdf/Professional_B
oundaries_JA.pdf and
www.ohiohcp.org/professionalboundaries4li
censedpersonnel.doc
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_B
oundaries_JA.pdf and
www.ohiohcp.org/professionalboundaries4li
censedpersonnel.doc
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_B
oundaries_JA.pdf and
www.ohiohcp.org/professionalboundaries4li
censedpersonnel.doc
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_B
oundaries_JA.pdf and
www.ohiohcp.org/professionalboundaries4li
censedpersonnel.doc
Non-Clinical Focused Relationship
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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
According to
the patient or caregiver
http://hci.learn.com/files/pdf/Professional_B
oundaries_JA.pdf and
www.ohiohcp.org/professionalboundaries4li
censedpersonnel.doc
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_B
oundaries_JA.pdf and
www.ohiohcp.org/professionalboundaries4li
censedpersonnel.doc
Ways to Avoid
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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_B
oundaries_JA.pdf and
www.ohiohcp.org/professionalboundaries4li
censedpersonnel.doc