Invisible Care: Understandings of Care Supports Among Older Adults and Staff In Nonprofit Homesharing Programs

Background and Purpose: Older adults are facing rising concerns in securing and maintaining affordable housing and care supports that facilitate aging in place. Among unhoused adults 50+ in California, about 41% experienced homelessness for the first time after the age of 50. An increase in health and caregiving needs can also compromise one’s ability to pay for housing and/or remain in their home. Nonprofit homeshare programs support older adults to age in place by facilitating shared living agreements with two unrelated people who mutually benefit from the exchange of rent and/or services and support from the nonprofit throughout the match. This study examines how homeshare participants and staff understand and make sense of care supports among homeshare participants in nonprofit homeshare programs in California.

Methods: This multi-method qualitative study incorporates semi-structured interviews from 24 homeshare participants and 19 staff and directors (n=43) and two 2-hour focus groups with eight directors from nonprofit homesharing organizations in California. We used a hybrid model of inductive and deductive coding for thematic data analysis.

Findings: We identified four themes in how participants and staff make sense of care supports among homeshare participants: vivid care, translucent care, obscured care, and invisible care. Vivid care reflects task exchanges that were readily identified in contracts in which care supports were acknowledged, primarily as instrumental activities of daily living (IADLs). Translucent care reflects tasks or supports that were occasionally recognized as care in certain contextual situations, but not others (e.g., recognizing transportation for someone with mobility issues to a doctor’s visit as “care” but not recognizing transportation to other locations as “care”). Obscured care was a common theme among homeshare staff, in which IADL support was explicitly redefined as “tasks” or “services” and the word “care” or “caregiving” was intentionally avoided. Invisible care comprises supports that participants recognized were important (and sometimes necessary) but that remained unacknowledged as care by staff and the participants providing or receiving the support.

Conclusions and Implications: “Care” and “caregiving” invoke certain values, stigma, and concerns about liability that can preclude homeshare participants and staff from using these particular words when describing homesharing. However, data from this study underscores the complexity of care in homesharing, and how participants and staff make sense of care supports in these programs. While nonprofit homesharing programs tended to limit their description of IADL and companion support as caregiving, the pervasiveness of care in these programs–regardless of whether participants or staff visibly saw care as occurring–suggests that these programs serve vital roles in caregiving to help older adults age in place. Policy and funding priorities for aging in place (and caregiving) may provide opportunities for homeshare organizations to expand their vision of care in homesharing.