“Family Members Do Give Hard Times”: Home Health Aides’ Perceptions of Worker–Family Dynamics in the Home Care Setting

Abstract

Paid and unpaid care in the home are closely intertwined, but a lack of outside supervision and support often forces paid and unpaid caregivers to negotiate care tasks, responsibilities, and boundaries alone, leading to role conflict and role ambiguity. This analysis draws on two existing qualitative studies of home health aides (S1 n = 27, S2 n = 26) to better understand aides’ perceptions of their relationships with family caregivers by exploring (1) aides’ perceptions of their caretaking role; (2) aides’ perceptions of co-producing care with family members; and (3) factors affecting these perceptions. Data were analyzed through grounded theory and thematic analysis. We found that aides viewed themselves and their clients as the core care “team” and identified three relationship dynamics with family caregivers: independent, where aides and families provided care separately; competitive, where aides and families struggled over control of care tasks; and carative, where aides considered family part of the unit of care. The authors propose strategies, suggested by our participants, for employer agencies to better support paid and unpaid caregivers in negotiating boundaries and co-producing care in the home care setting.