Professional boundaries: Respecting the feelings of residents in aged care

Young supportive female caregiver sitting by senior man in wheelchair and keeping her hand on his shoulder while comforting him

She called him *Shorty. He called her *Smiley. She was one of his nurses in the aged care facility. He was my dad.

When I first heard this exchange of pet names I felt slightly uneasy about just how familiar it was. It seemed to border on the unprofessional. But she was warm, radiated youthful joy, brightened my dad’s day and of that, I was glad.

Dad was a highly intelligent and compassionate man who excelled in his chosen field but in this last stage of life he had become frail and some dementia had crept in. He had short term memory loss and some confusion at times. He gracefully accepted his declining health and rarely complained. His gentleness shone brightly. He was a compliant and ‘easy’ client and with a cheeky grin, joked with each nurse that she was his favourite.

But we all knew the truth. His favourite far and away was Smiley.

Then one day in a whispered and excited tone he placed his hand over his heart. He took a folded piece of paper from his chest shirt pocket and handed it to me to read. It was a letter from Smiley. My heart sank. I knew this would not end well.

Smiley told Dad how much she admired and valued him. She told him he provided her more encouragement to study and better herself than her own family ever had, and she finished with, “You are truly a great man … and will always be in my heart”.

He carried that letter next to his own heart for weeks. On face value it was a lovely acknowledgement of how he had positively touched her life but for someone with a slight touch of infatuation on top of worsening dementia it was an invitation to despair.

The letter was the tipping point. He was now in love. It was painful to see his longing for her and his irrational and futile hopes. Mum had died years before when dad was only 51. In more than 35 years since her death he had never had another relationship, such was his life-long devotion to her. And now … Smiley.

We all knew that if he still had the cognitive powers of his younger years he would have been utterly humiliated by his declarations of love for a woman more than 60 years his junior but his feelings, which were very real to him, could not be dismissed. When Smiley walked past his door he would beckon her in and his face would light up in her presence. He began to request kisses, and marriage proposals followed. He begged her to sit and hold his hand and talk with him as before. He couldn’t understand why she always had to dash off and what had changed.

Then one day I arrived to find tears streaming down his cheeks, his green eyes sad and stormy. Smiley had said goodbye to him on a Friday and on Monday had informed him she was now married. Of course it wasn’t true. In her youthful naivety she thought this would solve the problem but of course it only made things worse.

He was devastated. He told me many times they would have made a wonderful couple and could have had a happy life together. His world became dark and sad. Many of the staff thought the whole situation was ‘cute’ and amusing but my heart was breaking for him. No amount of suggesting that, perhaps it wouldn’t have worked anyway given the age difference, would register.

But after her ‘marriage’ he knew all hope had gone and his grief was deep. And yet, despite his dementia he wasn’t stupid and even he could see that her story didn’t make much sense. He would ask me, “Where is her wedding ring and why hasn’t she shown me her wedding photos as promised?”

Then, again and again, “Did Smiley really get married?” to which I could only answer, “Well that’s what she told us”. Over time he seemed to become more and more confused and forgetful. Why couldn’t he just forget all about her?

As the weeks passed Dad spoke less and less of Smiley but always remained suspicious about whether or not she had lied to him. Often I caught him looking around for her in the dining room smiling and waving enthusiastically whenever he saw her.

Then in his last weeks Mum once again came into focus for him. He started to believe he had seen mum here and there and was worried about who was looking after the children (the youngest of whom – my brother – was by then, already a grandfather!).

Dad died a peaceful death surrounded by family and will be forever loved and missed.

Was she unprofessional to have called him by a pet name which no one else used?

Was she unprofessional in giving him a personal letter?

Was she unprofessional in lying to him about getting married?

Did she receive enough guidance from management about how best to deal with the situation?

Did she receive enough education in her training and from her employer about what constitutes professional conduct?

Was it ironic that the very one charged with caring for him was the cause of so much hurt?

Did she intentionally hurt him? Of course not. She was a bubbly naive young woman. But with better education and guidance perhaps Dad’s suffering may have been avoided or lessened.

As we care for those who are most vulnerable, is it time once again in our training courses and workplaces to discuss what is appropriate and professional for us as nurses and be encouraged to think more about the impact that crossing professional boundaries might have?

Yes it is!

(*Names have been changed to protect privacy).

Roslyn West (Ros) is a Registered Nurse (Bachelor of Nursing Degree Post Graduate Certificate in Advanced Nursing [Neonatal Intensive Care]) and Care Manager in the Neonatal Intensive Care Unit at the Royal Women’s Hospital, Melbourne Victoria

2 Responses

  1. This is a very valuable warning to me – thank you. I’m a fairly new aged care worker who particularly values building individual relationships with those I care for. I feel like I’m doing a good job when they are so happy to see me specifically. Before reading this a few weeks ago, I honestly hadn’t considered the risks or that perhaps I overstep professional boundaries. I came back again to reread today as I’m noticing myself getting swept up in how much I love those I care for, especially given their loneliness in current lockdowns.

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