Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Francis G. Caro

Second Advisor

Ellen A. Bruce

Third Advisor

Donna Haig Friedman


Critical to “aging in place” is a viable caregiver workforce. Homecare aides provide the backbone of that group. Many are hired by agencies. Others, independent aides, work directly for their elder clients, some publically subsidized, some privately paid. Without the structure and oversight provided by agencies, independent aides must arrange the substance and scope of their role directly with their clients. Few studies have focused on the private-pay independent aide operating in the gray market.

This qualitative study explored the differences in the negotiation experiences of agency and independent (subsidized participant/consumer-directed and private pay) home care aides. Through in-depth interviews they shared their perceptions of their negotiation interactions with their clients. The findings were framed by a conceptual model that described negotiation as a process with preconditions and consequences. Two overarching themes emerged from the narratives: managing boundaries and limiting precariousness. They were used as lenses through which to analyze the differences between agency and independent aides in negotiating their tasks, time, compensation and relationships.

Many independent aides felt that they had more autonomy and flexibility in setting their physical, temporal and emotional boundaries than agency aides. They did not have the restrictions that a formal organization imposes, but also did not have the safety of basic labor rights, time management, backup, and information/support resources. Independent aides had to negotiate compensation with their employers who were also their clients (or family members) with whom they wanted to establish caring relationships. Issues of rights, obligations, closeness, trust, loss and entrepreneurship were part of their narratives. Confirming the literature, many implied that to be successful on the job required communication and negotiation skills.

The findings point to the need for home care aides to have access to low-cost, time-intensive training in communication, emotion management and negotiation skills – interpersonal as well as physical skills. Providing skill information to the more invisible independent aides in the gray market may be possible through public media and informal mentoring in the home care setting. Further, regulatory protections are needed for this disenfranchised, independent group and their clients/families.


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