i) Professional workers and boundaries

Professional workers:

• Act in the interests of their clients through their work
• Work with their clients to achieve their clients’ goals
• Abide by an ethical code of conduct
• Have appropriate skills and expertise
• Provide quality work (effective, timely, respectful, etc.).

Professional boundaries exist so that workers always act in the interests of the clients

Professional boundaries exist so that workers always act in the interests of the clients and not for other reasons, e.g. personal gain, to feel needed, to make friends, etc.

Professional boundaries are based on ethical principles.

Professional boundaries exist to allow for safe connections between people in situations where one person is working in the interests of their clients.

Crossing professional boundaries always causes harm.  However the harm is not always evident to all parties.

Maintaining professional boundaries is essential for getting the best possible attendant care. 

Maintaining professional boundaries looks like:

Workers:

• Working with you so as you are able to be as independent as possible.
• Working with you on achieving your goals.
• Being friendly but not being your friend.
• Developing rapport with you but not being part of your family.
• Sticking to their role and not be doing work outside their agreed role.
• Not accepting gifts.
• Not visiting you or your family outside work hours.

Clients and family members:

• Recognising that workers are paid to do their role.
• Recognising that if workers, for example, are given gifts, become friends, do extra things outside their role there is a conflict of interest for the worker and in the long run that conflict of interest will cause harm.
• Not mistaking friendliness for being friends.
• Not wanting workers to be friends.
• Not giving gifts to workers.
• Not asking workers to do things that are outside their role.
• Not asking workers for personal details about their lives.
• Not inviting workers to visit outside their work hours.
• Not visiting workers at their homes or at their social events.

Professional boundaries in place

Where professional boundaries are in place you and your worker are working together on achieving your goals.

There are clear boundaries between you and your worker. There is a clear line that separates your friends from their friends, your home from their home. Your worker is not, for example treating you or your family as their friends. Your worker is not for example, treating your home as their home.

Your worker is always acting in your interests.

Your working is ensuring you are in control.

 

 

 

ii) The Principles

Professional workers

Professional workers:

• Act in the interests of their clients through their work
• Work with their clients to achieve their clients’ goals
• Abide by an ethical code of conduct
• Have appropriate skills and expertise
• Provide quality work (effective, timely, respectful, etc.).

Professional boundary

A professional boundary is:

• the line that separates a professional relationship from one where there is a conflict of interest in social, sexual, religious or business interests.

Professional workers act in the interests of their clients through their work.  As soon as they are acting for any other interests there is a conflict of interest.

Professional boundaries exist to allow for safe connections between people.

Where professional boundaries are crossed relationships can be:

• exploitative (for example a worker using a client’s kitchen to cook the worker’s evening meal to take home to the worker’s family).
• manipulative (for example a worker making friends with a client so the client will give the worker gifts).
• coercive (for example a worker compelling a client to do something by withholding service , e.g. I will only help you cook your meal if I can use your oven for cooking my families meal at the same time).
• deceptive (for example a worker pretending to be a client’s friend).

Ethical principals

Professional boundaries are based on ethical principles:

• Promoting client self- determination, i.e. the freedom of clients to choose their own direction
• Doing no harm – which includes refraining from actions that risk hurting another whether this be intentionally or unintentionally
• Doing good for others which includes clients, their family members, other workers, the service provider, the worker’s own role in a professional relationship.
• Providing fair and equal treatment to others.
• Making honest commitments and honouring these commitments.
• Using truthfulness in all communications.

Boundaries most commonly crossed

The boundaries crossed most commonly are in the areas of:

• intimate relationships  (e.g. worker having a personal intimate relationship with a client)
• pursuit of personal benefit (e.g. making friends with a client so the client will give the worker gifts)
• how people respond to their own emotional and dependency needs (e.g. a worker wanting to be needed and so keeping the client dependent on the worker rather than building true independence)
• altruistic gestures (e.g. a worker also coaches a football team and invites the client to come along to games to be part of the community or a worker gives a gift to a client on their birthday or a worker meets a client at a worker's personal social gathering)
• responses to unanticipated circumstances (e.g.  a worker discovers their client is the son of one of the worker’s friends).

Crossing professional boundaries causes harm

Crossing professional boundaries causes harm to:

• the person receiving the service
• the worker
• the service provider.

Harm is not always evident to all parties.
Crossing professional boundaries is sometimes done with good intentions, nonetheless, crossing professional boundaries causes harm.

 

 

iii) Service provider policies

Service providers have policies to help maintain professional boundaries.  They can include:

• Do not give gifts/items to clients (new or old) or from your home
• At no time or for any reason, give a client your personal phone number or address
• Do not visit a client after work hours
• Do not take clients to visit your family or have your family members with you on a shift
• Do not provide extra hours of support without organising it with the Manager first
• Do not discuss your own personal issues with clients (particularly relationship problems you may be experiencing at home)
• Do not discuss other clients or staff members in front of the client you are with
• It is illegal to go to work with a client if you are under the influence of drugs or alcohol.  It is also a dismissible offence.
• Do not partake of drugs or alcohol while you are with a client

iv) Family polices

People getting attendant care and their family members also need policies.
Clients and family members' polices could include:

• Do not give gifts/items to workers.
• Do not ask workers for their personal phone number or address.
• Do not allow workers to visit after work hours.
• Do not visit your workers or their families or friends.
• Do not ask workers to provide extra hours of support – ask their manager or service coordinator.
• Do not discuss your workers’ personal issues, e.g. their relationship issues or problems they may be experiencing in their home.
• Do not discuss your views of other staff members in front of your worker.
• If your worker arrives under the influence of drugs or alcohol report it to their manager/service coordinator.
• If your worker partakes of drugs or alcohol while on shift report it to their manager/service coordinator.

v) Conflicts of interest

Professional boundaries are in place so that the worker is working in the interests of the client.  If the worker is working for any other reasons than in the interests of the client there is a conflict of interest.

Examples

Examples of conflicts of interests are:

• Workers becoming friends with clients and so the work is no longer solely in the client’s interest but is also in the worker’s interests as a friend of the client.
• Workers becoming “part of the family” so the work is no longer solely in the client’s interest but is also in the worker’s interests as a ‘ member’ of the family.
• Workers being motived from the need to be needed.
• Workers taking control away from the client.
• Workers accepting gifts and/or monetary payments.
• Workers misusing the client’s property (e.g. doing the worker’s cooking in the clients home).
• Workers misusing confidential client information.
• Workers not declaring conflicts of interest.

Friendly worker NOT Friend

Many clients receiving attendant care are socially isolated.  The worker's role can be to support them in accessing places, groups etc., where they can meet others and develop friendships.
The Workers role is NOT to be a friend. 

While it is important in working relationships with clients to develop a rapport with them, it is just as important to remember that it is a WORKING relationship.   The worker is there as a paid employee of a professional service provider.

Worker with rapport NOT Part of the family

When the client lives with their family the workers are working with other family members coming and going.  The workers need to build rapport with the client and their family members. 

However the worker is NOT part of the family.  The worker is in a WORKING relationship with the client and their family.

Caring workers meeting the clients’ needs NOT meeting the need of the worker to be needed

It is important workers respect and care for their clients.  However sometimes workers can care because they need to be needed.  If the workers need to be needed becomes a driver of their work they will no longer be working in the best interests of their clients.

They may for example subtly keep the client dependent on them as a carer rather than supporting the client to be as independent as possible.

A worker with the client making decisions NOT the worker taking control

It’s important not to let the balance of power slide away from the client into the support workers hands. E.g.: clients have choice, make the decisions around their care. It is not appropriate for the support worker to take these things away from the client.

For example a worker taking a client to a doctor’s appointment and speaking for the client without the clients permission is taking control away from the client.

A worker re-organising the client’s kitchen (without their permission) so that it makes it easier for the worker to find their way around the kitchen is taking control away from the client.

Building rapport WITHOUT giving or accepting gifts

Building rapport with the client and their families is very important.  In personal settings with one’s own friends, giving and receiving gifts is part of building rapport and friendships.

However in a professional relationship, i.e. between a worker and a client, giving and receiving gifts is NOT acceptable practice because it creates a conflict of interest – for example doing the work in order to get given gifts, or alternatively doing the work in order to build one’s own friendship networks, in either case, it is not doing the work in the interests of the client.

Respecting the clients property NOT misusing property

The client’s property is for the use and benefit of the client.
The following are examples of misusing the client’s property:

• Accepting gifts.
• Using the client’s kitchen to do your own cooking.

Respecting confidential client information NOT misusing confidential information

The client has a right to expect that all their confidential information will be treated confidentially. 
The following are examples of misusing confidential information:

• A worker discussing the client’s difficulties with money management with a shop assistant.
• A worker answering questions for the client while at a doctor’s appointment (without the client’s consent).
• A worker talking about one client with another client.

Declaring conflicts of interest NOT keeping conflicts of interest hidden

Workers should declare all conflicts of interest to their supervisor/coordinator.  Some conflicts of interest arise through unanticipated circumstances.
Examples of conflicts of interest arising through unanticipated circumstances are:

• A worker discovers their client is the son of one of the worker’s friends.
• A worker discovers a new client lives in the workers own suburb and their children are friends at school.

It is important the worker declares these conflicts of interest to their supervisor/coordinator.

vi) What’s wrong in these situations?

The worker discussing the client’s difficulties with money management with a shop assistant

This may seem like the worker is helping the shop assistant understand the client’s situation.
However it is unacceptable practice.
The worker is breaching client confidentiality; and taking control away from the client.

Answering questions for the client while at a doctor’s appointment without their consent

This may seem like the worker is helping the doctor understand the client’s situation. 
However it is unacceptable practice.
The worker is breaching client confidentiality; and taking control away from the client.

Making a comment about a client’s increase in weight during their personal care routine

This may seem like you are helping by talking about the client’s weight, e.g. supporting the client in their weight goals.
However it is unacceptable practice as the comment is personal not professional.  If the worker were supporting the  client with their weight goals as part of their individual service plan there would be specific actions planned  for that goal  – not a passing comment in a personal care routine.

The worker posting a comment on a social media about how happy they are to see one of their clients progressing with their therapy goals.

If the client is not named this may seem innocent – but it does raise the question about whether the worker is acting in the interests of the client or their own interests, i.e.  in being seen to be doing good things.
If the client is named it is a breach of client confidentiality and is clearly unacceptable practice.

Acceptance of gifts and/or monetary payments from a Client

This may seem like it is part of building a relationship with the client, however it is unacceptable practice.
The worker is crossing a professional boundary because it creates a conflict of interest.   
The worker may be motivated to work differently because of the gifts/payments.

Disclosure of personal information including your phone number or address

Superficially this looks like part of building a relationship with the client but it is crossing a professional boundary because it creates a conflict of interest.  The client and the worker can now perceive the relationship as a personal one, not a professional one.

Dropping in to the clients home when you are not on shift

Same as above:

Superficially this looks like part of building a relationship with the client but it is crossing a professional boundary because it creates a conflict of interest.  The client and the worker can now perceive the relationship as a personal one, not a professional one.

Giving a client a kiss on the cheek when you arrive on shift

Same as above:

Superficially this looks like part of building a relationship with the client but it is crossing a professional boundary because it creates a conflict of interest.  The client and the worker can now perceive the relationship as a personal one, not a professional one.

Client asks the personal carer to swap a shift with another worker

Services providers roster workers.  If there is a need for a change the request should be made to the workers supervisor/service coordinator.

The worker finds the client’s kitchen difficult to work in and decides to reorganise it to better suit  his own work habits.

A client’s kitchen needs to suit the client and their family, and maintaining an environment that empowers clients is an element of carer competence.
If the personal carer genuinely feels that some aspect of the kitchen organisation is presenting an OH&S issue, then they should be able to discuss this with their client and come to a workable compromise which minimises the risk.

The personal carer has small children and often has trouble getting someone to mind them, so she brings them to the client’s house and lets them play in the house during her shift.

The presence of a personal carer’s children in the client’s home presents a risk to all parties.
The worker will be conflicted between meeting the needs of the client and meeting the needs of her children.
This is unacceptable practice.  If it were necessary in a one off situation the decision whether to bring the children or not should be made by the workers supervision/service coordinator.

The personal carer goes in for their shift with their mobile phone switched on, expecting to receive an important call. The phone rings when the client is halfway through a hoist transfer and the personal carer answers the phone.

Answering a phone in the middle of a transfer can be unsafe for both the client and the personal carer. If a genuine emergency is anticipated, the carer could wait until the client is in a safe position before returning the call. The client should be consulted about their feelings on phone etiquette in their home – but it would generally be seen as unacceptable to be taking personal calls while working.

Professional boundaries in place

Where professional boundaries are in place you and your worker are working together on achieving your goals.

There are clear boundaries between you and your worker. There is a clear line that separates your friends from their friends, your home from their home. Your worker is not, for example, treating you or your family as their friends. Your worker is not, for example, treating your home as their home.

Your worker is always acting in your interests. Your working is ensuring you are in control.

Professional boundaries crossed

Where professional boundaries are crossed there is the potential for less focus on acting in your interests as the client and more potential for the worker to act in their own interests.

For example

• The way the worker does their work may be based on the workers cultural and beliefs rather than yours.
• The worker may start to organise your kitchen, or your house the way they want it so its more convenient for the worker.
• The worker may start to treat you and your family as friends.

As each boundary is crossed it becomes more possible for the worker to be acting in their interests rather than your intersts.

In the graphic below, there is less and less blue (you) and more and more red (worker) compared with the original graphic above where professional boundaries were in place.