Editor’s Note: This story originally published on November 27, 2017.

There’s been a lot of discussion lately about professional standards of workplace contact: beware hugging, patting or any touching.

But for some workers, their job requires touch – intimate, sometimes-uncomfortable contact, like what we see in healthcare and physical therapy.

“I think that particularly in the care industry, where even the slightest touch is intended to help someone, it can be misinterpreted,” says Laphonza Butler, president of SEIU Local 2015, a labor organization for long-term care workers.

“I have been in conversations with our members where they feel like the only thing they did was try to help someone sit up in bed, and that was taken as an invitation, that touching their body was somehow invited.”

Mari Carmen, who worked as a caregiver for a 92-year-old male client, says any kind of touch would be taken as permission for more.

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“I had to change [his clothes] in the middle of the night … and he tried to touch my body,” she says. “I said, ‘Right now, I am your caregiver. I am not your lover.’”

Healthcare workers are much more likely to experience “nonfatal violence in the workplace” than are workers in other industries, according to research by Jill S. Boissonnault, associate professor at the George Washington University physical therapy program. Nurses, physical therapists and others are up to 16 times more likely to have some kind of encounter like this with a patient or client, her research showed.

Boissonnault says female physical therapists are more than twice as likely to be targets of inappropriate patient sexual behavior than male therapists. The risk is even higher when they work with male patients.

Nurses need to learn how to recognize harassment in health care – and then how to report it, according to Dr. Seun Ross, director of work environment at the American Nurses Association.

“If there’s a message we could get out to 3.6 million nurses, it’s ‘We need you to report. Be empowered. Report,’” she says.

In investigating and punishing these cases, care workers often hit another hurdle: their code of ethics requires that they continue to provide care for the patient or client. They can’t just fire them, Boissionnault says, as might happen with offenders in other industries.

“That doesn’t mean we would tolerate a client jeopardizing our safety, we still are encouraged to do whatever we need to do to remain safe in the workplace, but the clients’ best interests need to be forefront in our minds,” Boissonnault says.

This could mean reassigning the patient to a different care worker or a different clinic or floor of a hospital.

Butler says her union members still struggle to find a path forward. One even suggested workers wear body cameras to work to deter harassment.

“[They fear] that nobody is going to get punished, that the only person who’s going to get punished is them: they’re going to lose their job, they’re going to have to find another person to take care, another place to work. So a lot of victims wind up remaining silent from the embarrassment and the financial hardship that’s created.”

Certain things have proven to lessen workers’ contact with inappropriate patient sexual behavior, Boissonnault says, most effectively, years on the job.

Greater awareness of the issue will lead to a greater number of reports, according to Ross – and then, to greater progress.

“The more it’s reported, the more it’s addressed, the less likely it is to happen,” she says.