Gifts gone awry: Theft in the context of everyday exchange in paid home care of older adults

PURPOSE: Theft is an endemic problem in long term care settings (Harris & Benson 1998; Lindbloom et al 2007), and is of particular concern in home care (Payne 2006) where supervision is minimal and socioeconomic inequality is systemic. While wealthier older adults privately fund their own home care, low-income older adults can receive home care services funded by a combination of state and federal funds. Workers in both publicly and privately funded home care are generally paid just above the minimum wage (Yamada, 2002). This paper seeks to contextualize theft within the vast array of exchange behaviors that home care workers and older adults engage in, and which they consider intrinsic to the production of caring relationships that are embedded in socioeconomic disparities (Mauss 1990; Sahlins 1965).METHOD: Research was conducted in one privately funded and one publicly funded home care agency in Chicago, Illinois. Within each agency, a nested sample was constructed consisting of four worker-client pairs (n=16), older adults' family members (n=10) and agency supervisors (n=25). Data collection methods included eighteen months of structured observations in agency offices, worker training sessions and in client's homes, as well as life story interviews and a review of agency documents. Fieldnotes and transcripts were coded using HyperResearch© qualitative software. Following inductive qualitative research practice, data were continuously analyzed over the collection period to identify key themes and patterns. FINDINGS: In home care settings, theft occurs within an array of ongoing exchange practices between workers and older adults. The majority of behaviors that supervisors labeled as “theft” were earlier described as other forms of exchange such as “loans,” “gifts” and “favors” by workers or older adults. Examples of observed exchange behaviors include older adults signing workers' time sheets for missed workdays, giving workers discarded house wares, treating workers to fast food meals, and loaning workers cash. Older adults spoke of these kinds of exchanges as part of treating workers well, as a way of building stronger relationships with workers, and as an effort to help workers facing financial hardship. Frequently, exchanges are relabeled “theft,” and reported when workers fail to meet older adults' implicit expectations of reciprocity. Older adults who felt close to their workers were also reluctant to report problematic exchanges to agencies. Though the most extreme example of a problematic gift occurred at the privately funded agency, accusations of theft were more common at the publicly funded agency. IMPLICATIONS: Theft prevention efforts in the home care industry are currently limited to performing criminal background checks on workers. Though agencies frequently ban most forms of direct material exchange, such prohibitions are impractically disregard the ways that gift exchange is embedded in everyday life and can benefit home care relationships. Agencies should instead differentiate between acceptable and unacceptable forms of exchange and provide workers with ongoing training around the risks and benefits of exchange. Interventions which decrease socioeconomic disparities, such as a mandated living wage for home care workers, might also decrease the frequency of problematic exchanges.