A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).
Many older adults may have disabilities that can make it difficult to care for themselves and their homes. These individuals may hire home healthcare providers to assist them with personal activities such as bathing, moving into and out of a wheelchair, and managing medications. They also may need assistance with household activities such as cooking, laundry, or housekeeping. As a component of high-quality care, it is important for individuals and home care providers to develop good relationships, and trust may be a key facet of these relationships. An individual must be able to trust the person who will be providing care, especially at vulnerable moments. In a recent NIDILRR-funded study, researchers interviewed older adults who were currently receiving care, such as home healthcare or assistance with household activities, to find out what factors encouraged or discouraged their trust in care providers. They wanted to find out what provider characteristics enhance their willingness to trust a care provider to help them with daily living tasks.
Researchers at the Rehabilitation and Engineering Research Center on Technologies to Support Successful Aging with Disability interviewed 24 older adults who received at least 4 days of caregiving each week. Half of the participants lived in independent living facilities, such as senior living communities, and had hired individual care providers, while the other half lived in assisted living facilities that normally provided supportive services. All of the participants received housekeeping assistance, and at least half of them received assistance with laundry, meal preparation, medications, or bathing.
During the interviews, each participant was asked to consider four caregiving scenarios when a person with a disability might require assistance from a care provider: bathing, transferring from bed to a wheelchair, managing medications, and household tasks such as cooking and laundry. For each scenario, the participant was asked to put themselves in that situation and consider what factors would allow them to trust the care provider most, and about any factors that could cause them to lose trust in the care provider.
The researchers found that the participants described three main factors that influenced their trust in care providers: professional skills, personal traits, and communication.
- Professional skills: The participants described being able to trust care providers who knew how to perform care tasks and who performed consistently, precisely, and safely. For example, the participants described trusting care providers who would follow a consistent routine for bathing and transfers. The participants also said that they could trust providers more if the providers performed tasks such as housecleaning in the same way that the participants used to do the task themselves before they required caregiving. Another aspect of professionalism mentioned was the care provider’s attitude. The participants felt that they could trust care providers who showed willingness to provide care, and those who did not complain about doing the tasks.
- Personal traits: The participants felt they could trust care providers who were honest, kind, caring about their well-being, and who held the same personal values that they held. The participants also wanted care providers to be well-groomed and dressed appropriately for the job. These traits were considered most important for providers who helped with bathing and household tasks.
- Communication: The participants described being able to trust providers who communicated well about the tasks they were doing, such as explaining what they were about to do next. The participants said they could trust care providers who were engaging and responsive to their needs. For bathing and transfers, the participants also said they could trust a provider more if they were willing to engage in conversation about personal topics, such as family life.
Based on the feedback from the participants in this study, the authors noted some recommendations for care providers to foster trust. These include:
- Show that they have skill and experience in completing home tasks such as cooking and laundry.
- Ask the care recipient for input on how they prefer a task to be performed. For example, do they prefer that vacuuming is done before dusting, or vice versa?
- Perform tasks in the same way each time, whenever possible.
- Dress professionally and keep themselves well-groomed.
- Be friendly and conversational.
- Explain what they are doing or about to do.
- Listen to the care recipient and ask questions to show concern for their well-being.
According to the authors, trust is what allows a recipient to accept care from a provider, even when they are vulnerable. Consistency, professionalism, and communication are keys to establishing trust between care providers and recipients. Failing to establish trust could lead to ineffective care. By understanding how to support trust in the home care relationship, providers and recipients can ensure proper comfort, care, and safety of older adults with disabilities.
To Learn More
The Northwest Spinal Cord Injury Center hosts regular forums with SCI survivors and clinicians, and has covered the topic of home healthcare in Managing Personal Caregivers: A Panel Discussion and Caregivers: Perspectives from Those Providing Care.
To Learn More About this Study
Stuck, R.E. and Rogers, W.A. (2019) Supporting trust in home healthcare providers: Insights into care recipients’ perspectives. Home Health Care Services Quarterly. This article is available from the NARIC Collection under Accession Number J81796.