Professional Boundaries
In this article, I want to write about a concept that should be well understood by all DSP’s. Here, we’re going to discuss what can happen when we become overly attached to a client, or their family and the implications this has upon the home.
One of the better changes for some group Homes is consistent staffing. However, this staffing model has created some unintended consequences.
DSP’s develop long term relationships with those we are charged to care for. We grow to love them and will do all the little “extras” for them. Usually this doesn’t present a problem for anyone. But there are times when our relationships become unhealthy- for us, for the client, for the other clients we’re assigned to; to our peers and to the program we work for.
Over Attachment
In group homes, DSP’s can become too attached to a certain client, in different ways. The DSP will be very upset if they are not assigned to care for this client, or, will use their relationship with this client as an excuse for being exempted from floating to other units. The DSP might spend inordinate amounts of time with this client, and therefore shortchange the others assigned to him/her. The direct care staff will always cater to this clients’ every whim before all others. This client will have more needs than all others as well- and these “needs” will increase as times moves along.
Sometimes, the client develops a fondness for a direct care staff that isn’t healthy. The client becomes dependent upon the direct care staff’s presence to be happy. He or she refuses to allow other direct care staffs to work with him/her. Clients have “bad” days when their favorite direct care staff isn’t at work. I have seen clients who believe they are “in love” with their favorite direct care staffs, especially those with mild dementia. I’ve also seen direct care staffs who care for clients in short term rehab centers develop “crushes” on these clients. The age difference between client and direct care staff isn’t that far apart.
Other assigned clients are neglected. Often. Or, the needs of these clients are tended to by the DSP’s peers. This creates a problem for everyone. Resentment sets in and working relationships suffer.
Being Objective
One of the problems with this arrangement, as it’s often called, is when the direct care staff loses his or her ability to be objective. This is a serious concern. We must be able to truthfully report the conditions of our clients. This includes, but isn’t limited to, the clients progress or decline in all areas: Ability to speak, bath, dress, feed self, walk- are all very important. The DSP who is too close to certain clients isn’t able to accurately describe the client’s true abilities.
This effects the client directly: A client who cannot really dress herself can be assessed as being able to do so. This might end up in a care plan…and other direct care staffs who work with this poor client will get frustrated at THEIR ability to motivate this client. Families are told their loved one can still dress herself when in fact she cannot, and hasn’t been able to perform this task for a while.
We have professional boundaries
DSP’s are considered to be the professionals in the care giver-client relationship. A DSP is expected to maintain a therapeutic relationship and not anything else. We have the upper hand because of our knowledge and skills. We are responsible for the care we deliver. Within the ethical discussions on this subject, the care giver always has power over the client. Many times these relationships are for the benefit of the care giver and not the client.
When the care becomes intertwined with personal friendships and over-advocacy, it’s not healthy. What is OVER ADVOCACY? It’s when we demand clients be given care, therapies and attention they don’t truly need. This is often where over attachment to a client’s family starts. This is another whole problem- and the legal implications are high.
Ask yourself these questions. And be honest. If you can answer more than two of these with a YES, then YOU are crossing the professional boundaries. And setting yourself up for a lot of trouble.
* Have you ever spent off-duty time with a client/family?
* Do you keep secrets with clients/family?
* Do you become defensive when someone questions your interaction with a client/family?
* Have you ever given gifts to or received them from a client/family?
* Have you felt possessive of a client/family, thinking that only you could provide the care the client needs?
* Have you ever flirted with a client?
* Have you chosen sides with a client against his or her family and other staff?
If you find that you’re overly attached, how to manage that? It’s not easy. The first step is recognizing you have a problem. Then, it’s a matter of distancing yourself from the client. For some direct care staffs this is best done gradually. For others, a total cut off is appropriate. Many times, when the bosses see these problems, they’ll assign the direct care staff to another unit altogether, effectively ending the relationship. I don’t think this is a good way to do this.
A DSP can ask for a change with their assignment. Being open and honest about this will almost always result in getting the changes you seek. Part of being PROFESSIONAL means keeping staffing issues to yourself. The urge to tell the client, or the family, a change has taken place might be very high. It’s best to leave these discussions with the nurse. And, after the client and/or their family is informed, THEY will prod the DSP for information. Again, professional boundaries must take precedent over individual staff needs.
A note about being attached to client families.
It’s not as common as client-DSP friendships. But it’s much more dangerous. And, many times these relationships are initiated by the DSP.
Often times:
A family will block out all others in the home and depend upon the direct care staff for all communication. The direct care staff will be put into situations they are not trained and educated to handle. Every word the direct care staff speaks will be heard and recalled. If the direct care staff doesn’t have the right information, or misspeaks, a lot of trouble can arise, legally.
The direct care staff will become a spy, for the family. DSP’s are privy to some information that is private and confidential. The levels of care for other clients is an example. When we have over bearing families seeking information from direct care staffs who are all too willing to share, it creates huge management problems. It sets the stage for a turbulent relationship between the HOME and the family.
Some direct care staffs like to think families have some super power over a home. This is simply not true. Government regulation and oversight have “power”; as do legal standards.
Other direct care staffs will use the family in an effort to be assigned to the client they want. From my experience, these clients are almost always the ones who are considered “easy to do”– and the direct care staff is simply seeking a guarantee of being assigned to this client. There has been some evidence of direct care staffs seeking permanent assignment to certain clients in hopes of getting some monetary award. These situations are always unethical. The direct care staffs involved in this should be terminated from employment and barred from working as direct care staffs ever again. They are opportunists.
No matter whether a DSP is overly attached to a client or their family, it’s not usually healthy. Most times the only way to stop the problems associated with these relationships is to separate the direct care staff and client. Perhaps, consistent staffing would better serve all if the assignments changed every so often. A couple times a year and all direct care staffs would be required to change no matter what family requests are. We all want what is best for the clients. Sometimes though, in order to insure this is happening equally across the board, we have to make adjustments and changes.