As a Personal Support Worker (PSW) or Homemaker (HMKR) at Circle of Care, you will be providing service in the homes of our diverse client population. It is within your duty to recognize and respect the unique cultural background of each client. By providing culturally sensitive care, you acknowledge the impact of culture on your client’s beliefs, values, customs, and lifestyle.

PSWs and Homemakers can provide culturally sensitive care by adopting the following habits:

• Learn about other cultures
• Avoid making assumptions and forming stereotypes
• Build trust and rapport
• Overcome language barriers
• Practice active listening
• Ask questions when you are unsure
• Accommodate the client’s preferences within safe and reasonable means
• Be curious about what the important things are to help clients’ live their lives to the fullest

Clients are referred to our Home Care services through:

• Home and Community Care Support Services (HCCSS),
• Private hire by the client themselves or their families
• Client’s doctor or other community professionals (e.g. social workers).

HCCSS, formerly known as CCAC or LHIN, is a Home Care Program funded by the Ontario Ministry of Health. The program collaborates with primary care providers (such as Circle of Care), hospitals, Ontario Health Teams, and many other health system partners to support high-quality, integrated care planning and delivery. The HCCSS Home Care Program delivers in-home and community-based services to support clients’ health and well-being and funds the services of a large percentage of the clients at Circle of Care. Care Coordinators at HCCSS determine client eligibility, the number of hours of service to be provided, and the primary care agency that will receive the contract, in addition to contractual obligations with primary care providers.

To be eligible for Homemaking assistance, clients must require help with personal care. In cases where a cognitively impaired person is being cared for by a relative or friend, caregiver relief may be provided.

Support for Holocaust survivors requires special understanding, knowledge, and sensitivity. Our specially trained staff offers a range of services for Holocaust survivors (conditions apply). These services are funded by the Conference on Jewish Material Claims against Germany and include Personal care and homemaking, Respite care, Kosher Meals on Wheels, Transportation, Managing Care, and Counselling and support.

Any request to increase or decrease the level of care would need to be authorized by the funder of service.

Client’s Rights

• All clients have the right to good health care and good treatment.
• They have the right to be treated with consideration and respect
• They have the right to be treated as individuals and to participate in their care plans.
• They have the right to be informed about their care in terms that they can understand so that they can consent to or refuse care.
• They have the right to freedom from physical, mental, and emotional abuse.
• They have the right to complain about the care that they feel is inadequate.
• They have the right to privacy and confidentiality. Only care team providers directly involved in their care need to know information about their condition, treatment, or lifestyle.

Client’s Responsibilities

• The client must treat the Personal Support Worker or Homemaker with respect and courtesy.
• The client must respect the limits of the Personal Support Worker/Homemaker job.
• The client must be at home to receive service.
• The client must inform Circle of Care if they will not be at home when service is scheduled
• The client must refrain from smoking inside the home for at least 2-hours prior to their scheduled PSW or Homemaker visit.
• The client must secure pets before their scheduled visit to prevent pets from getting in the way of the client’s care or causing injury to the Personal Support Worker/Homemaker.
• The client must endeavor to support a safe, harassment-free, and judgment-free environment for the Personal Support Worker/Homemaker.

Circle of Care strives to uphold the highest level of therapeutic boundaries between employees and clients in any care or service we provide. Personal Support Workers (PSWs) and Homemakers work in an unregulated profession, but they too have a responsibility to maintain therapeutic boundaries while providing safe, effective, and ethical care to clients. The therapeutic boundaries at Circle of Care are aligned with the components established by the College of Nurses of Ontario (CNO); trust, respect, empathy, professional intimacy, and power:

1. Trust – Being reliable, genuine, and honest. In the Worker-Client relationship, trust is important because the client is in a vulnerable position and depends on the Worker.
2. Respect – The recognition and acknowledgement of a client’s dignity, self-worth, and uniqueness regardless of socio-economic status, personal attributes, ethnicity, religion, and the nature of the health problem.
3. Empathy – The expression of understanding, validating, and resonating with meaning that the health care experience holds for the client. Empathy includes an appropriate emotional distance from the client to ensure objectivity and an appropriate professional response.
4. Professional intimacy – Natural in the type of care and services that Personal Support Workers/Homemakers provide. It relates to physical activities such as bathing and can involve psychological, spiritual, and social elements that are identified in the plan of care. Access to the client’s personal information also contributes to professional intimacy.
5. Power – The Personal Support Worker/Homemaker has specialized knowledge, access to privileged information, and the ability to advocate for the client. The appropriate use of power in a caring manner enables the PSW/Homemaker to partner with the client and other caregivers of the client to meet the client’s needs. A misuse of power is considered abuse.

PSWs/Homemakers are liable for setting appropriate boundaries for their relationship with the client and can do so by following the CNO’s four standard statements, which describe the Workers accountabilities in the worker-client relationship. These standards are therapeutic communication, client-centered care, maintaining boundaries, and protecting clients from abuse. They are practiced by all staff at Circle of Care.  The four standards are explained below to help Workers understand how they can achieve therapeutic worker-client relationships.

Standard 1: Therapeutic Communication

PSWs/Homemakers must practice effective communication strategies and interpersonal skills to appropriately establish and maintain worker-client relationships.

Here is how the PSW/Homemaker can meet this standard:

1. Introduce yourself to the client by sharing your name, job title, and the purpose of your visit:
2. Address the client by their preferred name, title, or pronoun;
3. Actively listen to the client by giving them time and opportunity to express themselves;
4. Be aware of your own verbal and non-verbal communication style and how clients might perceive it;
5. Modify your communication style, when needed, to meet the needs of the client (For example, to accommodate a different language, literacy level, developmental stage, or cognitive status);
6. Consider the client’s preferences when encouraging the client to advocate on his/her own behalf, or advocating on the client’s behalf;
7. Promote client choice and enable clients to make informed decisions;
8. Recognize that all behaviour has meaning and seek to understand the cause of the client’s unusual comment, attitude, or behaviour
9. Listen to understand and respect the client’s values, opinions, needs, and beliefs, and integrate these elements into the care;
10. Recognize that all behaviour has meaning and seek to understand the cause of a client’s unusual comment, attitude, or behaviour (For example, exploring a client’s refusal to eat and finding that it’s based on the client’s cultural or religious observations);
11. Listen to the concerns of the family and significant others and report those concerns to your Client Services Supervisor (CSS);
12. Refrain from discussing the client’s personal matters with individuals outside of the client’s care team;
13. Reflect on your interactions with a client and invest time and effort to continuously improve your communication skills.

Standard 2: Client-Centered Care

When working with clients, PSWs/Homemakers must ensure that all professional behaviours and actions meet the therapeutic needs of the client.

Here is how the PSW/Homemaker can meet this standard:

• Actively include the client as a partner in care by allowing the client to participate in their care, make decisions and choices, and respect the client’s wishes and preferences;
• Have an understanding of the client’s abilities, limitations, and needs related to the client’s health condition and the care duties;
• Know your role, the client’s role, as well as the roles of family and significant others in achieving the goals identified in the care plan as established by your Supervisor (CSS);
• Recognize that the client’s well-being is affected by your ability to effectively establish and maintain a therapeutic relationship;
• Acknowledge your own biases and feelings that have developed through life experiences, and be aware that these attitudes could affect the worker-client relationship;
• Reflect on how stress can affect the worker-client relationship, and appropriately manage the cause of the stress so the therapeutic relationship is not affected;
• Demonstrate sensitivity and respect for the client’s choices, which stem from the client’s individual values and beliefs, including cultural and/or religious beliefs;
• Consult with your Supervisor (CSS) when there is difficulty establishing a therapeutic relationship with a client;
• Maintain your commitment to being available to the client for the duration of care within the employment boundaries and role context;

Standard 3: Maintaining Boundaries

PSWs and homemakers are responsible for effectively establishing and maintaining the limits or boundaries in the therapeutic worker-client relationship.

Here is how the PSW/Homemaker can meet this standard:

• Set and maintain the appropriate boundaries within the relationship, and help clients understand when their requests are beyond the limits of the therapeutic relationship:
• Follow the comprehensive care plan that aims to meet the client’s needs (and notify your Supervisor (CSS) if no care plan is available for the client);
• Consult with your Supervisor (CSS) if you are unsure if a particular approach or activity could be perceived as a boundary crossing;
• Recognize that there may be an increased need for awareness in maintaining professionalism and boundaries, particularly when care is provided in a client’s home; a PSW/Homemaker may become involved in the family’s private life and need to recognize when their behaviour is crossing the boundaries of the worker-client relationship;
• Do not interfere with the client’s personal relationships;
• Abstain from disclosing personal information about yourself or other clients, as this can make client feel like their problems/feelings are being diminished too or that the client needs to provide help to the PSW/Homemaker;
• Regularly clarify your role in situations in which the client may become unclear about the boundaries and limits of the worker-client relationship:
• Ensure that co-existing relationships do not affect judgment and objectivity in the therapeutic worker-client relationship (for example, if you have been assigned to provide service for your neighbour, be aware of the potential effect the dual relationship has on the service you are tasked to provide). Disclose conflicts of interest or if you have friends or family receiving services provided by CofC to your Supervisor (CSS);
• Abstain from engaging in financial transactions unrelated to the provision of care and services as specified in the client’s care plan;
• Document client-specific information in the “ALC Checklist” of your Mobile App or by calling the Call Centre to report instances in which:
  • It is necessary to consult with your Supervisor (CSS),
  • You are uncertain of a particular situation,
  • You witnessed a concerning incident with the client,
  • You observed notable changes to client’s health and functional capabilities.
• Do not give gifts to the client or family, and do not accept gifts. Consult with your Supervisor (CSS) in any situation in which it is unclear whether a behaviour may cross the boundary of therapeutic relationship;
• Accepting gifts from clients or their families:
  • Do not accept individual gifts from clients;
  • If the refusal of a gift will harm the worker-client relationship, consult with your Supervisor (CSS);
  • Before accepting an individual or team gift from a client, your Supervisor (CSS) must consider the following:
    • That the gift was not solicited by the PSW/Homemaker,
    • That the client is mentally competent,
    • The client’s intent and expectation in offering the gift,
    • The appropriateness of the timing (for example, on discharge of services versus Valentine’s Day),
    • The potential for negative feelings on the part of other clients who may not be able to, or choose not to, give gifts,
    • The monetary value and appropriateness of the gift
• Giving gifts to clients:
  • Do not give gifts to clients or client’s families,
  • Any gift giving to a client should be done by the agency/corporation (i.e. Circle of Care) after the Client Services Supervisor (CSS) and Client Services Manager (CSM) have determined the following:
    • The client is clear that the PSW/Homemaker does not expect a gift in return;
    • It does not change the dynamics of the therapeutic relationship;
    • There is no potential for negative feelings on the part of other clients or toward other members of the health care team.

Standard 4: Protecting Client From Abuse

PSWs and Homemakers protect the client from harm by ensuring that abuse is prevented, stopped and reported.

Here is how the PSW/Homemaker can meet this standard:

• When appropriate, intervene and report incidents of verbal and non-verbal behaviours that demonstrate disrespect for the client;
• Intervene and report behaviours toward a client that may be perceived by the client and/or others to be violent, threatening, or intended to inflict physical harm;
• Intervene and report a health care provider’s behaviours or remarks toward a client that may reasonably be perceived to be romantic, sexually suggestive, exploitive, and/or sexually abusive;
• Do not enter into a friendship, or a romantic, sexual, or other personal relationship with a client when a therapeutic relationship exists;
• Do not engage in behaviours toward a client that may be perceived by the client and/or others to be violent, threatening, or intending to inflict physical harm;
• Do not engage in behaviours with a client or make remarks that may reasonably be perceived by others to be romantic, sexually suggestive, exploitive, and/or sexually abusive (for example, spending extra time together outside of the client’s care plan);
• Do not exhibit physical, verbal, and non-verbal behaviours toward a client that demonstrate disrespect for the client and/or are perceived by the client and/or others as abusive;
• Do not neglect a client by failing to meet or withholding their basic assessed needs;
• Do not engage in activities that could result in monetary, personal, or other material benefit, gain or profit for the PSW/Homemaker and/or their family and/or friends, or result in monetary or personal loss for the client;
• Do not accept the position of power of attorney for personal care or property for anyone who is or has been a client, with the exception of those clients who are direct family members of the PSW/Homemaker. Should a person for whom the PSW/Homemaker has been named  as a power of attorney become a client, the PSW/Homemaker must declare to the Client Services Supervisor (CSS) that he/she is the client’s power of attorney and decline the client assignment.

Warning Signs

To know if you or a colleague is crossing therapeutic boundaries, PSWs and Homemakers should reflect on the situation to determine if one or more warning signs are present:

• Spending extra time with one client beyond their scheduled visit;
• Changing client assignments to give care to one client beyond the care established in the client’s care plan and outside of the PSW’s or Homemaker’s scope;
• Feeling that other members of the team do not understand a specific client as well as you do;
• Disclosing personal information to a specific client;
• Dressing differently when seeing a specific client;
• Frequently thinking about a client when away from work;
• Feeling guarded or defensive when someone questions your interactions with a client;
• Spending off-duty time with a client;
• Ignoring Circle of Care’s policies when working with a client;
• Keeping secrets with the client and apart from the health care team (For example, not reporting relevant discussions with the client to the Supervisor [CSS]);
• Giving a client your personal contact information;
• A client is willing to speak only with you and refuses to speak with other staff members.

Colleagues who Cross Therapeutic Boundaries

If a PSW or Homemaker witnesses their colleague crossing a therapeutic boundary, the PSW/Homemaker must report these concerns to their Supervisor (CSS).

Clients of Circle of Care have the right to let us know how they feel about our services. On a regular basis, a survey is sent randomly to clients of the agency. We see this as an opportunity to understand how clients feel about the quality of our services and it allows us to see what we can do to improve.

Whether a client receives a survey or not, Circle of Care invites any client at any time to call and share any feedback through our Call Centre. All feedback is then escalated to the most appropriate department or staff member.

If the client registers a compliment or complaint about a PSW or Homemaker it is escalated to the Client Services Supervisor (CSS). When a compliment is received about a PSW or Homemaker, it is shared with them and entered in Applause where they are nominated as a Champion of Care. If a complaint is received from a client about a PSW or Homemaker, this is escalated to the CSS for investigation and follow-up. The CSS gathers all the necessary details regarding client’s complaint after which, the CSS contacts the PSW or Homemaker involved in the complaint to inform the PSW or Homemaker that a complaint has been lodged against them. The CSS gives the PSW or Homemaker a chance to share their perspective and at times, the CSS may be required to review Circle of Care’s practice expectations or take disciplinary actions. All complaints are kept confidential and dealt with in a sensitive manner.

Our agency is committed to meeting client needs and providing quality services through recognizing staff when they demonstrate the Circle of Care standards in their work and offering coaching and guidance to those who need it.