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Home Care and boundaries; how close is too close? Most of us enter helping fields because we are caring, kind, empathetic individuals who want to help support those who cannot support themselves. This is not easy work and we often enter situations that blur professional lines and require us to reflect on our own boundaries. We must ask the question, how close is too close?

In addition to ethical standards set by the medical and mental health fields, as home care workers we also adhere to professional standards set by the organization for which we work. However, given the personal nature of home care and types of tasks home care workers administer, the nature of our relationships with our patients and the boundaries we set with them can be complicated.

Home care workers provide support to a very vulnerable population who require assistance with basic needs such as personal hygiene and medication reminders. However, the support a home care worker provides often extends past these tasks and patients can quickly develop a strong emotional connection and often dependence on their caregiver. Physical touch, which is something discouraged among many other kinds of providers is required of home care workers increasing the potential for crossing personal boundaries and developing non therapeutic relationships with those we serve.

A great example of this is a case observed in which a home care worker was supporting an elderly woman in her late 80’s nearing the end of her life. The home care worker had been working with this individual for over a year and was one of the only supports in this woman’s life. When completing her Advance Directive, the woman wanted to designate her worker as medical power of att????orney. She indicated that her worker knew her bett????er than anyone else and was familiar with her preferences in medical care. Despite having grown close to this individual throughout the time she had worked with her, it was inappropriate for the worker to assume this role given the nature of their relationship. She discussed this issue with the woman and offered problem solving support to connect her with resources to assist her in completing this very important document.

In Maine, an incident came to light in which a home care worker had actually moved in with a patient when she lost her apartment. She had also been taking some of the patient’s psychotropic medication (offered by the patient herself to the worker) to self medicate for her own mental health issues. This particular patient was well known within the agency for blurring personal boundaries and encouraging unprofessional activity from workers.

While the patient had encouraged this behavior, the worker was ultimately responsible as she did not adhere to the professional and ethical requirements of the field and the organization for which she worked. Additionally, the therapeutic relationship was severed as the patient ultimately became the caregiver, providing shelter and medication to her home care worker. Upon the discovery of this severe transgression, the supervisor indicated that she had no knowledge of this staff member’s activities.

In situations such as these, we must ask ourselves how do we maintain professionalism and boundaries while still providing kind, compassionate, therapeutic service to our patients? Professional/clinical supervision is essential for processing difficult situations with in-home staff and to further the development of those caring for patients. Requiring supervision allows for the development of a supportive relationship between staff and supervisor and also provides the organization a link to what is happening to it’s remote workers in the home. Home care workers are able to use supervision to discuss situations in which their personal/professional boundaries are being challenged and develop strategies to address these issues safely, ethically and effectively.

Supervision should be encouraged for all those who perform home care. When home care workers feel supported,they make be????tter, safer decisions for their patients and are able to foster a more therapeutic relationship with those they serve. Additonally, the potential for incident or litigation of the organization is also reduced by application of supervision for all in-home staff.

Goldleaf offers compassionate and professional in home support services. To learn more please contact us.