Background: Foreign home care services provided to frail older adults by individuals from the developing world are a global phenomenon. This study evaluated the challenges associated with live-in foreign home care from the perspective of older care recipients and their family members. Methods: Qualitative interviews were conducted with 23 family members and seven older care recipients. Interviews were analyzed thematically. Results: Three main themes were identified: (i) the intense fears associated with witnessing the decline of the older care recipient and the subsequent employment of a foreign home care worker; (ii) actual negative experiences within this caregiving setting; and (iii) the ways in which family members and older care recipients coped with these challenging experiences. Conclusions: The key to this caregiving arrangement is the establishment of trust. Yet, many care recipients experienced violations of trust that resulted in abuse and neglect, which served to further intensify fears and concerns about this caregiving arrangement. The same coping methods used to maintain this arrangement, despite fears and concerns, are the ones responsible for maintaining the older care recipient in an abusive situation. © 2009 International Psychogeriatric Association.

globalization Neglect Domestic care Long-term care frailty Abuse

abuse Life Style Frail Elderly Caregivers Israel Long-Term Care home care Home Nursing Developing Countries human middle aged Activities of Daily Living Aged Adaptation, Psychological Home Health Aides foreign worker Humans family Trust male Emigrants and Immigrants female Aged, 80 and over cost of illness clinical article Article experience Personnel Selection adult elder abuse Consumer Satisfaction normal human neglect Philippines Fear employment caregiver