1. Not Friend Or Family Maintaining Effective Boundaries in the Helping Professions: Ethical & Practical Considerations Paula M. Taliaferro, MGS, LSW

2. The Balancing Act– What Are the Expectations of: Your Family Your Friends Your Social Obligations Your Employer Your Employees(If applicable) Your Residents Your Regulators Where are the Boundaries???

3. What are Boundaries? 1. Help to differentiate you from me—kind of like a fence—Lets each one know where I end and where you begin— 2. Very Individual—But Also Very Important! 3. Need to be clear about our boundaries and this is not always easy 4. Best if they are established early in a relationship because they are hard to modify later on

4. Why are Boundaries Important? Sometimes called Roles or Limits Respecting these limits creates order in relationships Crossing these limits can create confusion and disorder Sometimes boundaries are defined incorrectly as selfishness—but healthy boundaries are not selfish-they allow people to function in all sorts of situations without the danger of burnout or exploitation

5. Why Are Boundaries Important? Often there is an unequal power balance—or differing expectations between two sides. Clear boundaries provide: Protection against charges of either favoritism or exploitation Protection from both liability or burnout

6. Common Life Situations With Boundary Challenges Employing a friend/relative Selling/buying a service from a friend Sharing confidences with both partners in a marriage Seeking friendship with supervisors, therapists, clergy, doctors, attorneys

7. Common Boundary Challenges in Long Term Care Consumers & their families want to make you into family or at the very least close friends—can make it difficult to enforce or follow your rules. It is very common to get close to consumers & their families especially if they are with you for a while

8. Common Boundary Issues Disclosure of Personal Information The Balance Between Giving and Receiving of Services Maintaining Personal Space and Time Maintaining Confidentiality Closure After a Death or Loss

9. Disclosure of Personal Information You often have to give some personal information in order to build trust with older consumers. However, information should only be shared in the interest of the person. What does this mean? Consumers should not become part of your support system if you have problems or stressful issues(in your job or personal life).

10. Disclosure of Personal Information Complaining about your family, peers, supervisor, company policies to clients and/or their families is never appropriate. In general, you should not be sharing very personal information like your personal cell phone number or closely identifying information to consumers or their families.

11. The Balance Between Giving and Receiving of Services Need for balance between giving and receiving. A powerful need in our culture. It is difficult for most people to receive without giving in return. We spend most of our lives maintaining this balance in our families, among our friends, and in our organizations. Consequently asking for assistance without a means of repaying it, is not something most of us are comfortable doing. However chronically ill people find themselves accepting assistance very often.

12. Results of a Lack of Balance Between Giving and Receiving Persons can react with anger or resentment at people who are there to “help.” Can lead people to conceal their true needs from family and friends. Can prevent people from accepting assistance which is truly needed Can lead people to offer(sometimes quite strongly) gifts, extra payments, and other items to those who assist them- outside the expected compensation. IF ACCEPTED, CAN LEAD TO manipulation, unrealistic expectations, charges of favoritism, or even charges of theft.

13. Building a Healthy Giving and Receiving Relationship In general, you should not be spending lots of uncompensated time or extra money on one consumer’s needs over the needs of the others. Doing small special/individual things that greatly improve quality of an interaction can be ok. Realize that healthy give and take-- can be built in other ways: Listening to a story, accepting advise, accepting some food item to share, accepting something made to share, accepting a compliment.

14. Building a Healthy Giving and Receiving Relationship Follow your company policies and don’t accept gifts or extra money(I.e tips) from residents and encourage other staff not to do so either. You should explain this simply and clearly to consumers and their families.

15. Maintaining Personal Space & Time When it is time to go home, do it—have separation between your life on the job and your private life. These recommendations are for the good of you and your family. You need to be able to maintain a private life outside your job.

16. Maintaining Personal Space & Time Space Violations— You have the right not to feel uncomfortable or unsafe in your job. You have the right not to be injured or harmed in your job. Do not hesitate to let consumers or their families know if you feel your space is violated. Ask your employer for training and clear policies for interacting successfully with those who have cognitive impairments or behaviors you find challenging

17. Maintaining Confidentiality Keeping information confidential means keeping it private. To protect confidentiality means: Not discussing one consumer with other consumer (health concerns, medicines etc). Not discussing a consumer with your family. Not telling a consumer’s family members what the person said about them outside of their hearing. Not discussing consumers with other employees or colleagues in a public place.

18. Maintaining Confidentiality It can be appropriate to discuss a consumer’s needs or concerns with colleagues during staff meetings or in order to provide better service for the person. Other times it may be appropriate to break confidentiality with a consumer: If the person talks about suicide. If the person talks about hurting someone else. If you suspect someone is abusing or stealing from the person because of what he/she has told you. In any of these cases, it is appropriate to report what the person has said to the appropriate sources.

19. Closure After a Death or Loss People die, they leave our service, they move- we work with people, not inanimate objects Therefore--Closure(moving on) should be a normal part of our job—pay attention to this issue in Home Care….. For you, your staff, your family and other members, closure needs are different- How do you say goodbye? How do you accept and process grief?

20. Closure After a Death or Loss Pay Attention to Closure for yourself-professional caregivers who do not risk burnout and depression Pay Attention to closure needs for other Consumers– often neglected but this is important as well Examples of Closure Activities-saying goodbye(in person or by phone), going to funerals, memorial services, visitation to graves, sending cards, sharing experiences, visiting people in new environments