Bringing trust research to residential aged care

Introduction
This article aims to bring the field of trust research into dialogue with studies of residential
aged care. Very broadly, trust research is a broad and growing field which examines the
conditions through which trust is established and maintained, and the consequences of lack
of trust or breaches of trust (Bachmann & Zaheer, 2006). The field includes a range of
different theoretical and methodological approaches and spans several disciplines. One of
the most extensively studied areas of trust research has been empirical and conceptual
studies of trust in healthcare services and healthcare encounters (Gilson, 2003; Hall, Dugan,
Zheng, & Mishra, 2003). Researchers have examined the importance of clinical interactions
in mediating trust for health systems (Brown, 2008; Calnan & Sanford, 2004; Legido-Quigley,
McKee, & Green, 2014), in the choice (or lack of) between different types of health services
(Brown & Meyer, 2015; Ward et al., 2015), and patients’ acceptance of medical judgements
and decisions (Brown, de Graaf, Hillen, Smets, & van Laarhoven, 2015; Gilbert, Antoniades,
& Brijnath, 2019). From these studies, trust has been shown to be a pivotal concept for
understanding the functioning of human services and care provision, which incorporates
both micro- and macro-level sociological analysis (Ward, 2019). Curiously, there has been
little attempt to bring the to role of trust in aged care. Particularly salient now because
recent scandals in the media suggest there might be a “crisis of trust” in aged care system.
This article therefore reviews some of theoretical advances in trust research, and reframes
them in relations to their applicability to aged care. It then provides some commentary on
the ostensible “crisis of trust” facing the sector.

A crisis of trust in aged care?

In September 2018 Australian Prime Minister Scott Morrison announced his government
was launching a Royal Commission into the aged care industry, stating: “Australians must be
able to trust that their loved ones will be cared for appropriately and the community should
have confidence in the system” (Hasham, 2018). The Royal Commission was announced to
pre-empt an investigative report by the ABC television program Four Corners which stated
that the Australian aged care industry was “in crisis”, and documented disturbing incidents
of neglect and abuse faced by residents of aged care facilities, as well as broader
dysfunction in the regulation and quality assurance processes of the aged care industry. The
report argued that “every day stories of neglect and inattention, poor quality food, lack of
personal care, boredom and heart-breaking loneliness” were typical for much of the
industry, and drew on crowd-sourced stories from members of the Australian public as
evidence (Connolly, 2018). Now launched, the Royal Commission into Aged Care Quality and
Safety has called for further stories from the public, through hearings and submissions, and
these have prompted more media reports of incidents of abuse, neglect, mismanagement
and systemic failure.
The current Royal Commission is the latest in a long line of government and independent
probes into the quality of Australia’s aged care industry (Productivity Commission, 2011;
Smith, 2019). In another highly publicized incident in 2017, the Oakden nursing home in
South Australia was shut down by the State Government after a review by the South
Australian Chief Psychiatrist revealed disturbing incidents of assault, over-medication, and
clinical neglect involving residents with dementia and Parkinson’s disease had failed to be
recognized by regulators (Gage, Donnellan, & Harmsen, 2017). The incident prompted the
Federal Minister for Aged Care Hon Ken Wyatt to commission a review of quality in the aged
care system as a whole, which argued that regulations were overly focused on processes or
“box-ticking”, with poor engagement with consumers needs and expectations, and that
providers are focusing on remaining accredited at the expense of providing quality care
(Carnell & Paterson, 2017).
Australia’s aged care industry is one of the most tightly regulated in the world. The
Australian Aged Care Quality Agency (AACQA) was established in 2014 as body that
determines the accreditation and ratings of aged care providers in accordance with the
quality of care standards specified by the Aged Care Act 1997. This was followed by the
appointment of an Aged Care Complaints Commissioner (ACCC) in 2016 to independently
review and mediate individual complaints against care providers. Accreditation ratings of
aged care providers are published on the Department of Health’s My Aged Care website and
are intended to afford consumers a method of reviewing and comparing aged care options.
Public scandals have a damaging impact on the public’s trust in the implicated institutions
(Alaszewski, 2003; Gille, Smith, & Mays, 2017; Gilson, 2003). The AACQA and ACCC were
established both to address shortfalls in public trust in the aged care industry, by overseeing
the evaluation of care facilities and independently administrating the complaints process.
Yet both of these bodies came under criticisms in the Four Corners report for failing to act
on complaints, and for retaining 100% accreditation ratings for aged care providers after
incidents of assault in their facilities had been exposed, and members of those facilities care
staff had been criminally convicted.
There are clearly problems of trust in Australia’s aged care industry, yet years of reforms
have not resolved them. In what follows I suggest that trust research can offer a
sophisticated perspective with which to tease out the multifaceted dynamics of trust...

Researching trust
Scholars in sociology and organizational studies have been researching trust for decades and
have developed a complex repertoire of conceptual and methodological tools (Gilson). Yet
there has been little, if any, application of these tools to aged care systems. The term trust is
often mentioned in research on aged care quality and nursing practices, but it has been used
in a vernacular sense or upheld as an ethical imperative, rather than applied as an analytic
framework. In this section, I briefly introduce the analytic of trust and demonstrate its
relevance to questions concerning contemporary aged care.
Trust has been defined in various ways, but a succinct and widely accepted definition is “the
optimistic acceptance of a vulnerable situation in which the truster believes the trustee will
care for the truster's interests” (Hall 2001, p.615). Referring to optimism here does not
mean trusting is about assuming that things are going well, rather it is a narrow optimism
that applies solely to future of the relation between the trustee and truster. This implies
that there is a degree of risk in the truster’s relation to the trustee, a risk that cannot be
eliminated because other’s intentions and what influences them are not fully transparent to
us, and they “fundamental freedom” Kroegerpossess .
Vulnerability
Corporeality
Personal and institutional trust
Orgnaizational trust – important because regulatory bodies designed to oversee
organizations, and inform choices between them

Luhmann (1988, p.95) argues that trust is “a solution to the specific problem of risk" . we
Sociological theories of trust have tended to distinguish between interpersonal and
institutional levels of trust, with the former grounded

Care, trust and dependency

This section explains why trust is of central importance to residential aged care. This latter
term refers to care in modern societies that is mediated through economic and/or
institutional arrangements. In terms of aged care, this includes residential care, community
care, respite care, daytime care, and can even be extended to the state subsidization of
family home carers. This definition is preferred here over other distinctions like formal vs
informal care, or public vs private care. The opposite of organized care would be “non-
organized care”, where there are no organizations involved at all in the provision of care. In
Australia, aged care is predominantly “semi-organized care”, which is any configuration
involving both non-paid (but perhaps financially supported) care and formal services (Smith,
2019). The point is that once organizations (including state organizations) become somehow
involved in providing care, complex pathways of organizational and systemic accountability
are implicated which extend the possibilities of trust beyond phenomena that emerge from
non-organized family or interpersonal ties.

Defining care
Care is a tricky concept to define because it connects a broad semantic repertoire (Gilbert,
2019), and can variously be taken to mean a type of instrumental task, an emotion, a type of
human relationship, institutional arrangements, or an ethical orientation (Fine, 2006). There
has been a wide-ranging debate about the meaning of care taking place across the
humanities and social sciences over the last few decades which cannot be summarized here.
Yet underlining it is a historical trend: a disruption of the normative assumption that
caregiving ought to be handled in the domestic sphere, with the expectation that caregiving
should take place privately in the home and performed predominantly by women family
members of a person requiring care. These traditional gendered expectations about care
have been challenged (but not replaced) by the emerging possibilities of organized care.
Traditionally organized care meant institutionalization, with the threat of “structured
dependency” where people are re-socialised into becoming docile and compliant
dependants (Townsend, 1981).
However, a shift in emphasis is underway from notions of care as a social or familial burden,
towards care as a range of services consumers can choose from . This broadens what we
mean by care relations, as they are not solely encapsulated by the dyadic relationships
between carer and cared for, but also involve health and social professionals (Fine, 2004). It
has also brought greater attention to the perspective of the care recipient, with care figured
as a service that is foremost undertaken in order to maintain their dignity and quality of life
rather than as an altruistic act or gendered obligation of the caregiver.
New arrangements of managed care reduce this normative load – allow a more transactive
appreciation of care. Far from being alienating, it takes the perspective of the person
receiving care more seriously. Care providers are involved in an exchange and therefore
obliged to follow standards, offer services, care recipient also has more choice. Logic of
choice has in turn been criticized because it individualizes care and attributes responsibility
to the person receiving it, who must make the choices and must bear the consequences.
Not a realistic appreciation of dependency, both biological and socially constructed (kittay).
Person-centred care.
Division between instrumental understandings of care which focus on tasks of maintaining
clean, healthy, and calm bodies, and the relational
Svendsen, Navne, Gjødsbøl, and Dam (2018) have cut through a lot of the debate by
defining care as “substitution”. To substitute means to perform acts on another person’s
behalf in a way that either sustains or establishes the conditions for them living well. They
argue for a context-dependant and relational notion of personhood and suggest that the
substitution efforts of those performing care are contribute to the maintenance of a care
recipient’s social self. Substitution can be a transactional or ethical action. It is not
necessarily benign, and it can be imposed upon or willed by the participant. It may
encompass instrumental tasks such as bathing, dressing, cooking, cleaning, transporting,
communicating, and so on. Yet it may also involve more complex or abstract matters like
supporting someone to begin or sustain relationships, or facilitating the maintenance of a
person’s particular identity through memory work, or supporting their participation in
markets and institutions, and more.
Crucial to this idea of substitution is that it acknowledges an assumption which is of central
importance in theorising managed care in the contemporary Western world: In an ideal
situation, substitution would not occur. Idea that ideally people should be autonomous
individuals, able to perform these things themselves. But in reality and in various different
ways, people do not have this autonomy and therefore require the substitutions of others
to perform of their behalf. Notion of autonomous individual may itself be unrealistic – does
not apply to children, and may only apply to an employed adult, traditionally a man but
nowadays almost as likely to be a woman. Various commentators have pointed out that this
normative ideal of autonomous individual is unrealistic for most people, or perhaps anyone.
Autonomy seems like a vexed idea. But the whole point of a normative ideal is that it does
not have to be either clear or plausibly correspond to current realities in order to still be
culturally influential. Western notions of managed care centred around this: Ideally people
should be autonomous individuals who maintain conditions of their own lives themselves,
but sometimes they cannot and there are people, organizations and systems which can
substitute for those aspects of their life they cannot perform autonomously. As life
expectancies increase it is increasingly likely that we will make used of these services in
older age. Cannot rely on the care work of women in the family to do this anymore, because
of the feminization of labour (Fine). There has been the growth of government, not-for-
profit and private services which perform this substitution. Consisting of people like care
staff, managers, etc; organizations like aged care homes, ACAT services, etc,; larger
institutional “couplings” like funding, regulation, training, etc. Taken together all these
things comprise of the aged care system
Define the fourth age as opposed to the third age . Point out that third age associated with
autonomy, choice, pleasure, freedom from the constraints of the labour market. Opposed to
fourth age which is associated with frailty, abjection, and the need for care. If the third age
is culmination of autonomous individualism, the fourth age is cancellation of it. Organized
care is inevitably asymmetrical, as its function is defined by situations where the care
recipient is less able to look after themselves than the person providing care (Gilleard &
Higgs, 2018).
Defining trust
Trust is crucial to this system because people, organizations, and institutions are non-
transparent and complex. Non-transparency and complexity is not the consequence of a
concealment of information, it is an inevitable effect of things performing their role. The
future is unpredictable, and you can’t account for every possibility. A man cannot be
absolutely certain that tomorrow the staff in the residential care home he lives in will
support him to get ready in time for outing he has planned. But the assumption they will is
trust. Decision to book tickets depended on this trust in the first place. Interpersonal,
organizational, systemic. Trust that other people have an interest in his well being out of an
interpersonal acquaintance and desire to maintain a positive relationship, and therefore will
ensure the substitution work is performed. Trust that the organization has a both an interest
in its reputation, as well as internal procedures that operate to ensure his needs are met.
Trust that he is situated in a context defined by legislation, regulation, etc. which standards
are ensured and breaches penalized. Staff are educated, etc. When we view the aged care
system from the outside, as members of the public, and doubt that it is fulfilling these
function in line with interests or users or others we are talking about a lack of public trust.
Luhmann’s phenomenological theory of trust holds that it is a way of managing world
complexity. There are two interconnected aspects of complexity: the simultaneity of time,
and the non-triviality of agents. The first means that complexity is fundamentally a problem
of time rather than of the amount of information. Events that affect you are happening
simultaneously to your immediate present, and beyond your ability to pay first-hand
attention to them. Since it is impossible to keep track of every event which could possibly be
of concern to us, we have to trust by “bracketing” them out and holding expectations about
what will happen despite our inability to attend to them directly. We will only know whether
these expectations were fulfilled at that point in the future when they become directly
apparent to us. In the present we hold to these assumptions nonetheless because to not do
so in a modern society, where your life is profoundly interconnected with things beyond
your immediate control, just results in being paralysed by uncertainty. The non-triviality of
others just means that the actions of other people, and to some organizations and systems,
are endowed with agency and therefore behave in ways that cannot be fully determined.
These non-trivial agents also exist in time, meaning that changes in their social relations –
changes you cannot attend to owing to simultaneity – can affect their behaviour in ways you
cannot anticipate. Trust
Recent calls for cameras in aged care homes. Clear illustration of a lack of trust. Simultaneity
and suspicion of intentions.
It is only about our capacity to understand or retain information insofar as doing so would
consume time, so we trust others (such as doctors) who deploy symbols (such as
qualifications, displays of expertise, or an authoritative tone) suggesting they have
dedicated their time to specializing. A residential aged care home is a good example of
complexity because unlike popular perceptions of medicine, individual events within it may
not seem complex in of themselves, but when we consider their simultaneity and their
relational interdependence, we can see why trust is necessary.
Unfortunately, Anthony Giddens introduced some ambiguity into trust research when he
argued that trust is a result of childhood development, and particularly the warmth of
relations between mother and child. This implies that trust is foremost a psychological
phenomenon, and therefore that there are types of people who are more trusting than
other types by virtue of their psychological development. The psychological dimension of
trust is of course important. After all, trust is not just about calculating one’s interest in light
of the future, and can be worth it for its own sake. Psychologists find that people feel better
about themselves when they are trusted, and are happier when they confer trust to others.
Conversely, often the emotional feeling of a betrayal of trust is worse than any extrinsic
losses that resulted from it. Nonetheless, the developmental aspect is not the main thrust of
the sociological understanding of trust outlined here. We are focusing here on how trust
shapes and is shaped by social relations.

Best interests
“Best interests” is another tricky concept. Care as substitution in a way that supports the
conditions of living well… is the same as substitution is in ones best interests. Substitution
be divided into three considerations. Instrumental, guardianship, conservatory. We don’t
just trust to enact our best interests, as if these are self-evident, but also trust that their
definition of best interests is commensurate with our own. Mol explores this in relation to
care where best interests cannot be reduced to maximising choice. Trusting in medicine
means assuming that the doctor is in a better position to judge best interests than we are.
Conservatory – sustaining the conditions for human flourishing, allowing a person to make
the most of their capacities for relationships and meaningful activities. Jennings (2001)
distinguishes two goals of conservatory care: semantic agency and moral personhood.
Person-centred care. Comes into conflict with guardianship – increased fall risk where PCC
implemented. Either can be interpreted as a breach of trust – related to attitude, and not a
“rational” idea.

Types of trust
We can distinguish between three different types of trust which refer respectively to micro,
meso and macro levels of sociological analysis (Morgner, 2018): interpersonal trust,
organizational trust, and institutional trust. The relationships between these types of trust
are complex. They can substitute or complement each other (Kroeger, 2016, 2019), or
alternatively efforts to enhance one type of trust can end up eroding others (Brown, 2008).
We will discuss how all three types of trust are relevant to the aged care system.
Interpersonal trust refers to the relations formed between people, which are based on
perceptions of self-presentation and reputation, as well as the history of interactions
between them. People build interpersonal trust by becoming familiar with one another, and
performing in ways that symbolise to each other they are
“individually credible” (Kroeger, 2016, p. 506). Becoming familiar with someone does not, of
course, guarantee trust, and mistrust occurs when people actively avoid being vulnerable to
another based on experience or the way the other present themselves (Kroeger, 2019;
Luhmann, 2017). In aged care settings, interpersonal trust relations criss-cross the context,
factoring into the interactions between care staff, residents, family members, members of
management, and others. Interpersonal trust is most often raised important in relations
between residents and staff. Most residents place a high value on staff members who
demonstrate familiarity with their circumstances and needs, and who demonstrate an
interest in supporting them to live a high quality of life (Bradshaw, Playford, & Riazi, 2012;
Minney & Ranzijn, 2016). Interpersonal interactions like this demonstrate not only a
commitment to the resident, but also a positive commitment to the values and purposes of
the organization they work for and the institutional function of aged care more generally.
Giddens (1990) and Kroeger (2016) refer to this aspect of trust as “facework”, where front-
line staff are the “face” of organizations and institutions that define their role. Successful
facework not only establishes the individual trustworthiness of the staff member, but also
reinforces the perceived trustworthiness of organizations and institutions. Kroeger (2019)
calls this a “virtuous cycle”, where different forms of trust reciprocally reinforce each other.
Conversely, a “vicious cycle” can result when care staff are over-worked and time-poor. Staff
may feel they are unable to demonstrate their commitments to care values when
instrumental or bureaucratic aspects of their work take precedence, and there is insufficient
time afforded to interpersonal and affective facework (Tuckett, 2007). The inability to form
interpersonal trust with residents can contribute to low morale and high workforce
turnover, as care workers’ perceive that they are not trusted by residents and their families,
and are employed in a lowly and disrespectful industry (Tuckett, Parker, Eley, & Hegney,
2009).

My Aged Care system not trusted because it failed to paint organizations in a negative light
when they are committed breaches of trust.

of personal commitment “reduce the complexity” of living in

Symbols of trust can be problematic where people from different cultural backgrounds are
interacting. Aged care has an ethnic minority workforce, and

Residents value having staff who are familiar with their individual needs and circumstances,
and who show a positive attitude towards their work. Qualitative studies also suggest that
life satisfaction of aged care resident is strongly related to residents’ acceptance of their
situation, and their acceptance of being reliant on others for daily functioning (Bradshaw et
al., 2012; Minney & Ranzijn, 2016). This suggests that the quality of a person’s life while in
care may, to some degree, depend on their own disposition rather than solely
environmental factors. In institutional contexts like aged care homes, building interpersonal
trust typically depends on “supererogatory performances” where staff members show a
personal level of concern for the resident, which goes beyond the mere performance of
routine duties.

Survey research has shown that many aged care residents place a high value on staff
members who address them by their name, are aware of their interests and life story, and
express concern with their well-being and their preferences.

Institutional trust refers to positive expectations about the social rules, routines and
practices that are reproduced through and definitive of much social interaction. Aged care is
an institution of contemporary society, insofar as it refers to a broad range of practices,
relations, and organizational arrangements which are defined by a common social function.
Institutions are generalized expectations and patterns of behaviour which both emerge from
and shape social interactions. social rules, routines and practices. Institutional trust refers to

We exercise interpersonal trust insofar as we expect other’s behaviour will conform to what we
know of their personality. This kind of trust is necessary because human beings are also agents
capable of making decisions, and are therefore capable of deciding to do what we do not expect of
them. Trust involves excluding this possibility, or at least acting as if it has been excluded (Luhmann
T&P 43). Yet because people can exercise some control over the way they present their personalities
to others, there can be some independence of trust from intentions. In contrast, institutional trust
refers to

Organizations are also entities subject to self-presentation (e.g. branding, public relations) and
reputation. However, organizations are also

Both people and organizations appear to us as particular entities, and this means that
placing trust in entails forming a judgment about the characteristics or properties they
(self)present us with. In contrast, institutional are not perceived as

stand apart from all other entities. Interpersonal and organizational trust Systems have no
address, because their reality is processual rather than ontological. Interpersonal trust
refers to the expectations people form about each other as personalities In this section, we

Interpersonal trust
Facework
 Aged care users prefer familiar staff
 Staff concerned that there is insufficient time to build relationships
 Person centred care
Cultural differences in the concept of care
 Care is symbolically mediated.
 Differenences in culturally appropriate care
Decision making
 Family member and care staff conflicts
 Transitions often shaped by difficulty in trusting outsiders to the family system

Organizational trust

System trust

Media coverage and public trust

Miller and colleges examined the media portrayal of aged care in American newspapers and
concluded that a prevalence of negative perceptions about aged care among the American
public can be partially attributable to the mostly negative representations of nursing homes
and nursing home residents within the news media, with comparatively little coverage of
positive aged care stories or experiences (Miller, Livingstone, & Ronneberg, 2017; Miller,
Tyler, & Mor, 2013). Moreover, newspapers routinely “objectify” care-recipients as
problems that must be managed, especially those receiving state subsidized care (Rozanova,
Miller, & Wetle, 2016). These kinds of perceptions can influence people’s decisions about
seeking care for themselves or their family members (Mebane, 2001), and may constitute an
erosion of what has also been termed “public trust” in the aged care system (Gille, Smith, &
Mays, 2016). Similarly, a British study used multimodal discourse analysis to examine the
way people with dementia are represented in news (Brookes, Harvey, Chadborn, & Dening,
2017). They found a predominance of negative imagery, which invokes connotations with
death and frailty, as well as social isolation and dependency within aged care settings.
In a recent survey by an independent consulting firm in Australia, only 18% of respondents
reported that they had “a high degree of trust” in organized aged care services (Faster
Horses, 2018). In another survey, the national director of UnitingCare Australia – a large
non-profit aged care provider – reported that some respondents claimed that they would
“rather be dead” than live in residential aged care (The Guardian, 2019). When we speak of
public trust, we are speaking of these general perceptions that people have of aged care
organizations and the system when they view it from a distance and are not closely involved
in the internal processes. Media portrayals are dictated by what is newsworthy rather than
what is an accurate depiction of realities (Gilleard & Higgs, 2018). Consequently, what
people see in the news will tend to be the most scandalous incidents rather than the
mundane daily realities of life inside aged care homes.
Interestingly, the Faster Horses survey found that when respondents had a family member
who using aged care services, slightly more (25%) of them reported “a high degree of trust”.
A hypothesis for this is a proximity effect. As people become more proximate to social
systems, such as the aged care system, their relations with it become more complex. Asking
members of the public from all ages what they think about aged care is likely to garner
responses from people who have stereotypically negative views, have cultural anxieties, and
less first-hand knowledge. Also less awareness of the day to day bodily experience of living
with frailty or disability, the kinds of things that aged care substitutes for. The emotional
complexities of caregiving for families. Exposure to aged care through health professionals,
peers, marketing, etc. The facework of the system. Hence, qualitative studies showing that
people are relieved to receive care as it increases their sense of security.
Proximity – practical and existential. In the former sense, as people age or their family
members age, they come into contact with the aged care system. Meet individuals working
in that system, visit the organizations of the system and pay closer attention to their
branding, services, what differentiates them from one another, and they become more
familiar with the regulatory context… the My Aged Care system, the ways in which quality is
evaluated, etc. Also the processes internal and what is required. Interpersonal,
organizational, and system trust come to replace the media stereotypes. Nusem et al have
argued that if we want to improve quality, people should be in contact with services earlier,
mediated by wellness services and social workers. Trust formed earlier less likely to be a
“forced choice” where people are channelled into care. Generational: Biggs and Lowenstein
point out that as we age our life-course priorities change, and this is a collective
generational experience. The life course priorities of middle-aged people are dominated by
the ideal of the autonomous individual mentioned earlier. Prospect of substitution is a
direct threat to the achievement of this ideal. But as generations age, they enter retirement,
members experience frailty and death, etc. a mature understanding of human co-
dependence develops. Care is seen no longer as a threat to the self, but as its preservation.
Changes in the cultural symbolism of trust, but culture linked to life course stages.
Biggs and Lowenstein argue that dominant culture is inflected with the life course priorities
of Middle age, which tend to be defined by autonomous individualism. As we age, best
interests shift, people are more likely to see substitution not as an erasure of their own
agency but as the facilitation of it as we come to recognise finitude. Statements like “id
rather be dead” demonstrate Lack of generational intelligence, or the ability to put yourself
into the position of another age group and understand their different historical experiences,
life chances and life priorities relative to age. Expectations that in old age people remain
productive and active, dependency represents failure. Age otherness and depictions in the
media.
Higgs and Gilleard argue that fear of fourth age is not just a consequence of malignant
ideologies or discourses (which could be reversed), but a manifestation of “existential and
ontological dimensions of human corporality and its physical limitations” (Higgs & Gilleard,
2019, p. 11) which long predate contemporary ideologies.

Australia’s aged care system into what it is today, such as the Quality Commission, which
were subject to critique in the Four Corners documentary. Reaction to scandals is often to
increase regulation and surveillance, the assumption that front line workers are culpable
and if they are managed better by the authorities, then consumers will trust the system
more. But Brown suggests the opposite is the case, as management incursions into day to
day practices colonizes the spaces of interaction between workers and consumers, eroding
their ability to cultivate interpersonal trust relations. Given all this, there is an urgent need
to apply the conceptual tools of trust research to the formal aged care sector.
The aim of this paper is to tease out the ways in which trust research can be applied to
contemporary issues facing the aged care sector.
A deficit of trust in aged care services has significant implications for the uptake of services,
the well-being of users and their families, the morale of the workforce, and the operations
of service providers, regulators, and social policy.

Social proximity

Conclusion
Community care is interesting because it often involves inviting someone into your home
with a vulnerable relative, without the degrees of routinization and oversight residential
facilities

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