Delivering home-care services: empathy and respect needed

The Bottom Line

  • Older adults want to maintain their autonomy and participate in decisions affecting their lives.
  • The importance of autonomy is often underestimated by those who provide daily home-care services.
  • Key factors to ensure the quality of home-care services include comfort and autonomy of older adults, respectful and compassionate attitudes of providers, and services aligned with the values and needs of older adults.

Older adults want to stay at home and be independent for as long as possible, but sometimes they require help and care. The aging population is expected to generate growing demands for high-quality home-care services.

Older adults also wish to participate actively in decisions that affect them, but they are sometimes vulnerable because of age or illnesses. Depending on others to carry out their daily activities or acknowledging the need for home-care services is not easy to accept. The delivery of home-care services should be done in accordance with the opinions and priorities of older adults. Unfortunately, governance and delivery arrangements for home-care services are often perceived as cumbersome, with little room for engaging clients to shape services based on their values and needs.

A systematic review identified 12 studies published from 2009 to 2014, which examined how older people perceive their participation in decisions about their daily home-care services (1).

What the research tells us

The systematic review revealed four major themes related to the autonomy and organization of home-care services. Studies show that for many older adults, the home is a personal space that allows them to make decisions and gives them a sense of control and comfort. They do not hesitate to review the organization of their home in order to remain independent for as long as possible, as well as to preserve their privacy and autonomy. Thus, since it may help them stay at home, many older adults accept the presence of assistive, medical and technological devices to meet their needs and facilitate their daily care at home, even if it affects their living environment.

Providers can greatly contribute to older adults’ comfort by paying attention to their opinions, priorities and ways of doing things in their home. However, in some cases, providers compromise older adults’ autonomy by acting rigidly and by not responding to the client’s needs and desires.

Several studies have found that administration systems related to daily home-care services often limit the ability of older adults to make autonomous decisions. For example, older adults feel they have little control over services offered or care provided, and often feel that they only have some degree of control over the sequence of services provided.

To improve the quality of life of older adults, let's listen to them! Keep in mind that they should be free to make decisions about their health and their lives, despite old age or illness. When you enter their home to provide care or services, do so with respect and empathy, adapting to their life context.

Older adults are sometimes caught up in the administrative structure of home-care services and struggle both to receive help and to keep control over their own lives. Current research evidence points to the need for more flexible policies, procedures and guidelines on the delivery of home-care services to allow older adults to have a say about their needs and how to meet them.

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Author Details


  1. Fjordside S. and Morville A. (2016) Factors influencing older people's experiences of participation in independent decisions concerning their daily care in their own homes: a review of the literature. International Journal of Older People Nursing 11, 284-297. doi: 10.1111 / opn.12116

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