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Keeping Clear Boundaries in Patient and Elder Care

By Greg Pittenger

Whether you are a patient or a senior caregiver crossing boundaries is non-therapeutic and unhelpful, often resulting in substantial setbacks to maintaining a healthy environment.  The great fear is the sexual and/or emotional relationship that could develop between a man and a woman, but usually inappropriate interaction is not sexual in nature but violates privacy and intimacy boundaries. Inappropriate boundaries can present themselves in many combinations and most begin innocently.  Simply sharing a meal invites a level of familiarity and comfort which may lead to a sense of indebtedness or obligation.

Sharing personal stories of oneself or family can lead to individuals to be deeply concerned and invested in one another’s affairs.  Once rapport has been built and people are conscious of body language and shifts in tone in voice, it becomes second nature to spot when others are distraught.  The natural human tendency is to help those around us.  However, it is unfair to expect or even receive the pity or charity of those we are caregivers for.

With several years of supervisory experience in the care giving profession, I have seen all possible combinations. While the argument can be made that the resulting turmoil can be exciting at first, it usually results in awkwardness or insinuation and accusation.  It is difficult to regain a sense of propriety in a professional situation once it has become too casual, but it can be done.  

Awareness is the first step.  Most of the time, the boundaries are approached by people trying to make a genuine connection.  Being genuine is an excellent quality in caregivers, but there are limits to what information we should share.  A client may desire to tell a family caregiver too much personal information about themselves. A caregiver has the responsibility to respectfully ask the client to be appropriate in conversation and to keep family issues within their families. The following is a list of issues, submitted by Austin home care that caregivers should avoid discussing about their personal lives:

1. Finances
2. Employment details
3. Marriage/Relationships
4. Health Issues
5. Politics
6. Religious Beliefs
7. Alternative Interests/Lifestyles


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    • 0 votes vote up vote up

      Lori Daniell wrote Oct 23, 2009
    • Wow, I could not agree more.  Having been a RN for 21 years and working alot in LTC administration, I have seen the downward spiraling of staff morale as well, as a result of poor boundaries.

      Having personal boundaries is especially difficult though, considering that most health care professionals as well as paraprofessionals have a certain level of codependence. The health care profession is an enabler for codependency.  

      When the staff member does not receive the level of “acceptance” from a particular patient that they feel they deserve based on what they ‘give’ the patient, burn out or compassion fatigue ensues, hence ultimately creating employee dissatisfaction and a carryover of even further negativity and dysfunction into their personal lives.  That means higher incidences of depression, alcohol and substance abuse.

      I have created workshops called “Healing The Healer: A Transpersonal Approach, and Heal The Healer: A Spiritual Approach which address these very issues. The workshops offer a safe place to explore the importance of boundaries as well as where lack of boundaries often stem from. The work explores the concepts such as self love, self worth and self esteem. The health care professional is able to tap into their own spiritual set of tools that they will have in their heart all times and will be able to apply what they have learned in their work settings and their personal lives.

      Great article.  Thank you!



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    • 0 votes vote up vote up

      Sonya Yount wrote Sep 7, 2011
    • Just recently my family had to deal with this issue with my grandmother. She is in the nursing home and some of the family goes by to see her everyday. My mother calls the other day and says that my grandmother had purchased twenty dollars worth of yard sale items. I asked how she was able to get to a yard sale a mother tells me that a CNA had brought the items to work and “sold” them to her. The problem with that, other than the obvious, is that grandmother has no money nor any access to money. Her son takes care of her finances and usually sees to it that she has all of her needs met. So, grandmother is trying to get the money from the family. Its ridiculous and has put us all in a terrible position. It is a small town and everyone knows everyone.... Meaning that if we complain, a relatively good person will lose a much needed job; however, we cannot let this go on. We are trying to address this issue with minimal negative results, but it seems unlikely that that is possible. If the ethics classes had kicked in, none if this would be happening.



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    • 0 votes vote up vote up

      Michaelo23 wrote Feb 26, 2014
    • According to www.OurHappySchool.com , Euthanasia, also known as, Physician-assisted suicide or the angel of death complex is the deliberate advancement of a person’s death for the benefit of that person and, until now, a widely disputed argument. We are committed to the fundamental belief that the intentional killing of another person is wrong but we have this deep sympathy for those people who are suffering, too.



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    • 0 votes vote up vote up

      Michaelo23 wrote Feb 26, 2014
    • For me euthanasia is immoral because in god's will killing without mercy or had mercy is murderous.  Even though they are suffering from pain or illness that cannot be cured by any doctors. They need to be live in their last breath so they cannot regret what life they lived up in the time that they are born. Not that someone's opinions are deciding on whether you're live or not people make their own decisions.



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    • 0 votes vote up vote up

      Michaelo23 wrote Mar 2, 2014
    • i agree in euthanasia. that we need that treatment to practice in hospital for the patience that are suffer from uncured disease
      and the suffer patience that their limit is exceeded in max. we need euthanasia to heal their suffering.



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    • 0 votes vote up vote up

      Michaelo23 wrote Mar 2, 2014
    • i know euthanasia is illegal. if you use euthanasia in patience you will be in jail. and we don’t need that mercy killing . let our life live to the fullest  you said we need euthanasia in healing are u insane that’s not healing that’s killing. its the most suffering treatment ever.



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