"Who's the Boss": The Relationship between Older Adults and their Caregivers in a Consumer Directed Model of Care

The focus on consumer driven care in the US is part of the larger “aging in place” movement that emphasizes independence for older adults. However, there is limited research on how older adults who need home-based care recruit and hire non-family paid caregivers and manage their care. Drawing on a sample of qualitative interviews from a study of California older adults, who qualify for publically financed in-home supportive services (IHSS), this paper examines the relationships between older adults and their paid caregivers. Data were collected over a one year-period on older adults (age 65 and over) who are consumers of public programs that provide long-term in-home care services and supports. In-depth, face-to-face interviews were conducted with the older adult and their paid caregiver. Data were independently coded by two researchers. The results of thematic analyses suggest that in a consumer-driven model, some older adults had significant difficulties finding and interviewing non-family caregivers, and negotiating the care that they needed. Additionally, it was discovered that the nature of relationship had a significant impact on consumer satisfaction. For example, some older adults needed the care, and especially intimate personal care, to be framed in the discourse of familial ties such as “she is like a daughter to me.” Others felt much more at ease with a clear employer-employee relationship. More often than not, in successful consumer-caregiver relationships, it was a mix of these two understandings that created the best quality of life and an enhanced sense of independence for the older adult.