On Your Terms: How to Set Professional Boundaries with Clients

Families of aging loved ones are often dealing with significant stress. Worries about a parent’s safety, medical condition, medications, physicians, mobility, cognitive functioning, caregivers—the list goes on and on. No wonder, when you are their Aging Life Care Manager®, and you bump into each other outside of your regularly scheduled meetings, that you get pummeled with questions.

Question is—should you answer? And if so, how?

Setting boundaries and managing client expectations is a crucial piece of maintaining an appropriate professional relationship. You got into this field because you want to help others, but no one can or should be expected to be on 24/7 call for every client. To do so is a certain path to burnout, which can have significant personal costs for you and doesn’t do anyone who depends on you a bit of good.

So, where to draw the line? (We know of one ALCM who found herself being asked for advice by her doctor during a gynecology exam! Definitely a bridge too far.)

Here are a few tips that we’ve found to be effective:

  1. Use a dedicated phone for your business, and DO NOT give clients your personal home phone or personal cell phone number. Many ALCMs find it useful to have a separate cell phone (and/or land line) for their professional use, even if it’s a bit cumbersome to be juggling two mobile phones. This will help you to establish a clear boundary in your own mind between your professional and private life, as well as spare you from unwanted work calls during off hours (or the middle of the night).
  2. Create an away message that sets clear expectations about how soon you will return a call (e.g. by the next business day). You can always call sooner, but give yourself some breathing room so that you can triage calls that truly demand your immediate attention.
  3. Avoid “friending” clients on personal social media. Understand the differences between various social media platforms. While you may have a professional business page on Facebook that you promote to clients as followers to build your business, you should stay away from friending clients on your personal Facebook page where you post pictures of family, friends, pets and maybe political views. If you choose to use Twitter to promote your business, limit your posts to professional issues and news. Understand that if you decide to tweet from a personal account, anyone can find you and follow you, so think twice about your comments. LinkedIn is a platform for making professional connections; the same guidelines apply.
  4. Arrange for coverage when you are away on vacation, dealing with your own medical issues or otherwise need time off. In our highly connected world, many people find that their bosses and coworkers expect responses to emails, voicemails and texts in real time. However, for many ALCMs with solo or small practices, it is up to each individual to set appropriate boundaries with clients. You may be able to work out an arrangement with another ALCM in your area to cover for each other when needed, following appropriate practices regarding client confidentiality (e.g. shredding any paperwork after it is shared with the professional you are covering, since these aren’t your clients).
  5. Set clear limits about accepting gifts from clients. This is a matter of personal judgment, especially when a client’s culture sensitivities would be hurt if you refuse a gift. However, it’s important to set boundaries, especially regarding expensive gifts or cash; avoid accepting any gift that could appear to compromise your professional integrity. If a client insists, one tactic is to thank them and explain that you are donating the gift to a worthy charity—and why.
  6. Be empathetic but assertive with clients who try to get a free consult when you meet at social events or other off-hours occasions. This one is a real balancing act between being compassionate as well as clear that there is a separate time and a place for the discussion. It’s especially touchy if your client belongs to your house of worship or another social circle where you might see each other more often than not. Language that both acknowledges their concern as well as defines how and when you might follow up with them—perhaps emphasizing that these are confidential issues best explored during a call or appointment—is one effective option. It’s also a good idea to set limits early in a conversation before you get hijacked simply because you didn’t want to interrupt or sound mean. Hand them a business card and ask them to call you during the workweek, and assure them you’ll be glad to address their concerns at that time.
  7. Be clear in your own mind what constitutes a true emergency and how you choose to respond. Some ALCMs elect to stay with clients during an emergency room visit until their situation stabilizes, while others set limits on their involvement. Some may give select clients whom they trust an option to call in the evening or on weekends if an emergency is evolving. Others treat all clients the same. This is your judgment call. Just be realistic about your own needs for downtime, sleep and quality time with your family and friends. Emergencies have a way of stacking up like planes circling an airport, and you can neither predict nor respond well to a state of constant crisis.

For best practices about professional boundaries, please refer to the Aging Life Care® Association’s Standards of Practice and Code of Ethics (which Deb helped to write).

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care Manager™. Drawing on more than 35 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsALCM.

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Adjusting to a Nursing Home Can Be Rocky—and That’s Normal

For many families, placing a loved one in a nursing home can be an excruciating decision, laced with guilt. But when medical needs and safety issues exceed your family’s ability to provide appropriate care, a nursing home may well be your loved one’s best living situation.

So what happens when you make that decision, move your aging parent into a good and appropriate nursing home setting, and she tells you she’s better off dead?

Hard as it is to hear your loved one say those words, and difficult as it is not to take them personally, it’s important to recognize that she’s expressing genuine grief. What may feel like a guilt trip that pricks all of your own misgivings about the move is more likely the beginning of your loved one’s natural and necessary process of grieving the loss of independence, privacy and comfort of living on her own.

Grieving is Not a Neat Process

Much has been written about the grieving process, drawing from the seminal work of psychiatrist Elizabeth Kubler-Ross, who defined five stages of grief and loss: denial, anger, bargaining, depression and acceptance. More recent research shows that the grieving process doesn’t necessarily follow such a neat path; rather, individuals come to terms with loss—of their health, a loved one, a home, a job—by following their own unique process. Some may skip steps, others may bounce back and forth, while still others may ride an emotional rollercoaster.

Regardless, people come to terms with grief and loss over time, and need permission—from themselves and others—to work through loss on their own terms (provided they do not engage in risky or injurious behavior for themselves or others). Inevitable denial and anger (I’m better off dead) ultimately leads to acceptance.

Here are some ways to help your loved one along that path—and to help yourself, too:

1. Listen without judging your loved one or yourself.

Listening by simply being present, without offering solutions or defending yourself, can be a very powerful way to help your aging parent process feelings. All too often we assume that we need to “fix” another’s sadness or grief. The act of accepting the legitimacy of those feelings, without passing judgment or accepting blame, can be healing for both of you as you come to understand each other more deeply.

2. Set boundaries.

That said, you don’t need to shoulder the full weight of your loved one’s grieving all by yourself. Neither should you tolerate abusive, blaming diatribes. If the conversation is too caustic, you may need to limit your time together. Be honest with yourself about your emotional needs and work with the nursing home social worker and other members of your loved one’s care team to ensure that he gets the support that you yourself cannot provide.

3. Give your loved one time to adjust to her new living situation.

The losses she is experiencing are real and profound. Grieving her change in status, health and ability; losing her privacy; adjusting to a smaller living space and unfamiliar surroundings—even when you’ve done your best to decorate her room with her favorite things from home—takes time to accept. It may take months, or even a year. We each have our own timetable for major life transitions, and your loved one’s needs should be respected.

4. Watch for signs of depression that may need medical attention.

While grieving is a normal process of coming to acceptance, if your loved one exhibits changes in behavior that indicate more serious mood shifts—a refusal to participate in social activities when he was always gregarious, or a pattern of self-isolation and refusing visitors when she always loved company, for example—it’s time to seek a professional evaluation from the care team. Medication may help, but is not always the answer. Explore non-pharmacological options, such as providing a personalized music playlist, to help your loved one feel more at home.

5. Ask for help.

A certified Aging Life Care Manager® can assist you and your loved one in evaluating best living options for your loved one; making the transition from home to an appropriate care setting; assessing when and what kind of additional support is needed; mediating between you, your loved one and other family members as necessary; and helping you to understand what your loved one is going through, as well as your own adjustment to this new phase in your relationship.

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care Manager™. Drawing on more than 35 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsALCM.

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Balancing Act: How to Help Your Loved One Without Helping Too Much

“I want to do it myself!” As a parent, at some point, you have to learn to let go. Kids must be allowed to try and fail, hard as it is to stand by and watch. Growing up is all about making mistakes and learning how to do better, next time.

But what do you do when the roles are reversed, and it’s your aging parent who insists on acting independently, when you think she really needs help and is refusing to acknowledge limitations? Who’s right? How do you know?

That conflict can become especially intense after your loved one has been hospitalized for surgery or another serious medical issue, and he’s been cleared by health professionals to go back home. How can they be so sure he’ll be fine recuperating on his own? After all, you’re the one on the ground who sees how he’s changed—perhaps becoming weaker, maybe more forgetful—post hospitalization!

Respecting Your Loved One’s Need for Independence

For older adults who have been living successfully on their own until a medical crisis, reclaiming their lives prior to whatever landed them in the hospital is a strong motivator. They may take longer to get going in the morning. They may sleep more and nap during the day as they recover. They may need time to make appropriate lifestyle adjustments that seem obvious to you.

But that doesn’t mean they won’t figure out the best, new combination for self-care and daily activities that enables them to remain independent. In this best-case scenario, your aging parent is just on a different timetable than you.

So how do you know when it’s appropriate to insist on helping or getting help for your parent after a significant medical episode? The answer depends on several factors, including observed risks to health and safety, as well as how much and what kind of risk you can tolerate out of respect for your parent’s right to self-determination.

Separating Real Risk from Presumed Risk

Let’s take the serious risks, first. If your parent is having trouble remembering to take medications on schedule, if she is too weak or unable to make meals, if he is unsteady walking or climbing stairs, if she no longer cares about personal hygiene, if he forgets to pay bills—significant changes in behavior with real health risks for a person who was always capable, organized and independent require professional assessment.

However, what to do when the changes are more subtle and worrisome, but not life-threatening, involves not only an impartial assessment of your loved one’s situation, but also an honest self-inventory of your own fears and concerns. For a parent who already feels diminished by the natural aging process, declining strength and agility, and an awareness that her mind is not as sharp as it used to be, your insistence on providing help may be well-meaning, but not truly necessary—and cost your loved one’s self-respect.

Understanding When Your Needs May Be the Issue, Not Your Loved One’s

Here are three key questions to ask yourself if you are walking the fine line between helping appropriately and helping too much:

  1. What can my loved one DO, as opposed to NOT DO? It’s all too easy to dwell on the negative. Reframe your assessment by focusing on capabilities, first.
  2. Does our disagreement over appropriate help echo old conflicts and power struggles in our relationship? This one is hard to determine on your own and may require an unbiased third party to sort out. But it’s important to differentiate between what is actually at risk and what is a trigger for arguments that may have nothing to do with the facts on the ground.
  3. How much risk can my loved one live with—and am I able to tolerate that choice? If your aging parent understands the situation and attendant risks, and is able to make reasonable judgments about safety and health, then there comes a point when you will need to let go. Whatever fear and guilt you may carry about the possibility of your loved one getting hurt or sick due to lack of help is your issue to work through, not your parent’s. This can be a tough path to travel, but it can also be freeing.

An Aging Life Care Manager® can provide an impartial, expert evaluation of your loved one’s status, help you to navigate the murky stretches of your journey together, and recommend next steps for appropriate assistance, home modifications and future care options. Remember, while these decisions may seem intractable, there is help and support available—for all of you.

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care Manager™. Drawing on more than 35 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsALCM.

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Deb’s Best Practices for Keeping Your Aging Loved One Safe

As our loved ones age, their safety becomes a top-of-the-mind concern. Should they still be driving? Are they able to handle a snow storm or a power outage? What if they fall and no one is there to hear or help?

Over the past few years, we’ve written many blog posts about how to ensure that your aging loved one lives in a safe, secure environment. Now we’ve compiled the best of those posts into a free eBook, For Safety’s Sake: How to Reduce the Risk of Accident or Injury for your Aging Loved One.

Among the topics:

  • How to assess whether your loved one is safe living alone;
  • What to expect in a home safety inspection and why it’s necessary;
  • 7 tips to reduce fall risks;
  • How to keep your loved one safe and comfortable in severe weather or power outages;
  • When is it time to take away the car keys;
  • How to help your aging parent travel safely.

To download your free copy, visit our eBook page here.

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care Manager™. Drawing on more than 35 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsALCM.

View Privacy Policy here.

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Winter Weather Advisory: How to Keep Your Aging Loved One Safe in a Blizzard

As we head into the new year, there hasn’t yet been much snow here in Southern New England. But, as anyone who lives here long enough knows, this is probably the calm before inevitable winter storms.

The National Oceanic and Atmospheric Administration (NOAA) annual winter outlook for 2018-2019 predicts a milder winter throughout much of the U.S., with a colder and wetter season in southern states—and possible extreme cold in the Northeast, depending on the movement of arctic air masses, known as the Arctic Oscillation.

Whatever we’re in for, it’s essential to have a good plan in place for your aging loved one before a major winter storm hits. Snow, ice and coastal flooding can wreak havoc on your or another caregiver’s ability to reach your loved one during a severe storm. Extreme cold poses serious risks for a fragile adult’s health.

Here are some tips to help you keep your loved one safe, whatever winter has in store:

Before a Winter Weather Event

  • Be informed. Sign up for local weather alerts.
  • Create and review an emergency plan for your loved one. How will they get medical treatment or home health care if you cannot leave your home or providers cannot get to them?
  • Assemble an emergency kit, including extra winter clothing and blankets.
  • Be sure that they have non-perishable food on hand and needed medications.
  • Know locations of nearby public shelters.
  • Prepare for possible power outages. Equip your loved one’s home with flashlights, spare batteries, a battery-powered or hand-cranked radio. Ask neighbors to check on their well-being. See more tips for power outages here.
  • Check that their heating system is in proper working condition and that fuel levels can last through the storm.

During the Storm

  • You and your loved one should minimize outdoor activities. Drive only if absolutely necessary and with appropriate equipment (snow tires, AWD, clean windshield and working wipers).
  • Keep pets safe.
  • Check in with your loved one to be certain they are wearing warm clothing and using heat (not trying to save money by keeping on the oven!)

After the Storm Passes

  • Continue to monitor weather conditions and your loved one’s safety.
  • Call 911 to report emergencies.
  • Take your loved one to a warming center or shelter, if needed. But stay off streets until cleared of snow and ice!
  • Clear exhaust vents to avoid carbon monoxide poisoning from furnaces and be sure any secondary heating systems are well-ventilated.

What to Do if Your Loved One Is Not Safe at Home Alone

  • Consider a respite stay, arranged in advance of the storm, at an assisted living or other community that has generators to maintain power.
  • Install a system that will notify you if temperature in their home drops below a certain point.
  • If your loved one already has private duty help, perhaps extend hours for the caregiver to live-in during the storm.
  • Notify police and fire (especially in smaller towns) to watch out for your loved one’s well being.
  • Arrange for snow removal with a reliable service. Make sure your loved one understands that it’s not a good idea to hire just anyone walking by, as they could get scammed.
  • Watch for warning signs of hypothermia, which can be life-threatening:
    • Cold feet and hands
    • Puffy or swollen face
    • Pale skin
    • Shivering (although not always)
    • Slow speech or slurring
    • Confusion
    • Shallow breathing

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care Manager™. Drawing on more than 35 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsALCM.

View Privacy Policy here.

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