Negotiating worker-client relationships: a necessary step to providing quality home health care.

A qualitative study was conducted to investigate definitions of quality home health care and how good quality care was achieved from consumer and provider perspectives. Using semi-structured interviews, members of sixteen families and their home health aides described the skills required for good quality care. While able performance of essential tasks was considered part of quality care, relational skills of home health aides were crucial to good quality care. Relationships were negotiated between worker and client that were characterized as close and preserving of client autonomy. When such relationships were achieved, workers were frequently described as insiders in client families. High performing aides also undergo a process of intrapersonal negotiation in order to give meaning to their work. Implications for recruitment and training of home health aides and for measuring quality care in home health are discussed.