Building trust in elderly care

Why is trust important in elderly care?

Trust lies at the heart of good care. When older people feel safe, respected and understood, everyday life becomes more comfortable and meaningful. 

In England, around 559,000 older people received publicly funded long-term social care in 2023/24, highlighting how many rely on relationships with carers for their well-being. Carers are a lifeline for people living with frailty, cognitive change or emotional vulnerability, making trust crucial. It often becomes the difference between cooperation and resistance.

A strong care relationship does more than facilitate daily life and make tasks easier. It supports safety: people who trust their carers are more likely to speak up about pain or new symptoms, enabling early intervention. It underpins accurate assessment and richer conversations about preferences – care that is truly person-centred. And most importantly, it upholds dignity: older adults who feel seen, heard and valued retain a sense of self-worth and control.

This article explores practical ways to build that trust – through clear communication, predictable routines, attention to personal preferences, inclusive environments and respectful boundaries. When carers see each person as an individual and continuously reflect on their approach, they can help older adults feel truly supported, valued and in control.

Understanding age-related changes and their impact

As people age, they experience changes that can influence how they move, communicate and take part in daily life. These shifts vary from person to person, as no two people are the same at any given age. However, awareness of these changes and common challenges helps family members and carers understand behaviours and preferences without making assumptions.

Physical changes

Some older adults experience reduced strength and stiff joints. Their physical reactions may also slow down. Getting up from a chair, navigating steps or walking longer distances may take more time or effort. These changes can affect confidence in unfamiliar spaces and shape how someone chooses to move through their day.

Cognitive and emotional changes

Cognitive changes can include slower recall or difficulty tracking information in fast conversations. Early dementia may bring challenges with memory, orientation or problem-solving. These shifts can sometimes lead to uncertainty or frustration, particularly when routines change and people or environments feel unfamiliar.

Sensory changes

As humans, we rely on our senses to get through daily life. Older adults often experience changes in their vision and hearing that make it difficult to interpret the world around them.

Sensitivity to glare or difficulty following speech in busy rooms can make everyday communication more demanding. It’s easier to miss small cues, and group conversations may feel tiring or harder to keep up with. This can create a sense of isolation.

Effective communication – verbal and non-verbal cues

Clear, compassionate communication is the bedrock of trust. As a carer, both what you say and how you say it shape an older person’s experience of care.

Verbal cues

A few simple choices in speech can make conversations easier and more reassuring.

• Tone and pace – a warm, steady tone helps set a calm atmosphere. Speaking too quickly can be overwhelming, while a slower pace gives the person time to take in information and respond comfortably.
• Simple language – everyday wording avoids confusion and keeps messages streamlined.
• Affirmation – gentle acknowledgement, such as “You’re doing well” or “Thank you for sharing that”, recognises effort and encourages ongoing dialogue.

Non-verbal cues

As a carer or someone interacting with an older person, your non-verbal communication matters just as much as your words.

• Eye contact – steady, respectful eye contact shows you are paying attention and are interested in what’s being said. For those with hearing loss, seeing the speaker’s face clearly can make it easier to follow along.
• Body language – an open posture, relaxed shoulders and turning fully towards the person signal that they have your focus. This helps conversations feel more respectful and grounded.
• Facial expression – a calm, steady expression can help reduce uncertainty, particularly during personal or sensitive tasks.
• Touch – with permission, a light touch on the hand or arm can offer reassurance. Checking first – “Is it alright if I tuck your blanket around your legs?” – supports personal boundaries and choice.

When verbal and non-verbal cues work together, communication feels clearer and more respectful, laying a foundation for trust.

Active listening and empathy in practice

Genuine listening helps conversations feel calmer and more balanced. When an older person senses that you’re not rushing or distracted and that you’re genuinely taking in what they say, it becomes easier for them to share how they are feeling.

Here are some simple active listening techniques:

• Reflective responses – restating key points shows you have understood and invites clarification if needed. For example, “So you’re feeling chilly after our walk?” lets the person confirm or adjust your understanding.
• Open-ended questions – prompts, such as “Can you tell me more about how that feels?”, encourage fuller expression and help the person share experiences at their own pace.
• Minimal encouragers – gentle acknowledgements like “I see” or “Mmm hmm” signal you’re paying attention without breaking the speaker’s flow.

Showing empathy in what you say and how you say it is also important. It’s about noticing how someone feels and responding in a way that shows you understand.

For example, when an older person in a care facility shares that they feel sad about being away from home, a gentle reply, such as, “It sounds like you’re really missing familiar surroundings. Let’s think about what can help you feel more settled here”, acknowledges their emotion and opens space for conversation. This recognition helps the person feel heard.

Empathy also includes showing interest in a person’s past. Asking about what they used to do for work, their favourite hobbies or family milestones can be grounding. Returning to these details later signals that you have listened carefully and value their individual story, helping to build a steady, respectful connection.

Consistency and routine

Predictability helps many people who are older feel more at ease. When care follows a familiar pattern, daily life feels stable and easier to navigate.

Establishing reliable routines

Clear routines help the person know what to expect and when.

• Fixed schedules – keeping regular times for waking up, meals, personal care and bedtime can make the day feel more predictable and settled.
• Visible schedules – a daily timetable, printed in large text or supported with pictograms, gives a simple overview of what will happen next, helping the person feel in control.
• Advance notice of changes – when routines need to shift, gentle explanation beforehand – “Tomorrow we’ll have lunch at 12.30 because your GP is visiting” – helps the person prepare and reduces worry.

Communicating transition

Moving from one activity to another can be confusing, especially if the person is tired or in a new environment. A brief verbal cue, such as “In five minutes, I’ll help you wash your hands for lunch,” offers time to adjust. Small visual signals, like preparing the sink or putting on an apron, reinforce what will happen next.

These simple forms of preparation make care feel considered and respectful, supporting a sense of safety.

Personalised care plans – putting the person first

Trust grows when care reflects someone’s preferences, history and personality rather than a one-size-fits-all routine.

Comprehensive assessment

Begin with an unhurried conversation with the older person – and, with consent, their family – to learn more about what matters day to day. This information provides a starting point for tailoring support. You might ask about the following:

• Daily routines and hobbies – usual wake times, preferred morning habits, interests such as gardening, reading or enjoying a quiet cup of tea
• Food and drink preferences – favourite meals, dietary needs, well-loved snacks or particular treats
• Cultural and religious practices – prayer routines, dietary laws or observances that shape daily rhythms

Co-produced care planning

Invite the person to help shape their care plan. Simple questions, such as “What matters most to you today?” or “What helps you feel most comfortable?”, open up meaningful discussion. Record their responses and revisit them regularly, adjusting the plan as their needs shift. This approach keeps the person’s voice at the centre of planning.

Flexibility within structure

Consistency helps, but plans need room to change. On days when energy is low, quieter one-to-one time may be a better fit than group activities. A lie-in or an extra cup of tea can be a small but welcome adjustment.

Creating a comfortable environment

The physical setting says a great deal about safety and respect. A welcoming, accessible environment helps people feel that their comfort and dignity matter.

Accessibility and safety

Thoughtful design reduces risk and helps people move around with confidence.

• Clear pathways – remove clutter, secure loose rugs and ensure floors are non-slip to lower the risk of falls.
• Adequate lighting – use bright, glare-free lighting in corridors and shared areas. Night-lights help with safe movement after dark.
• Handrails and grab bars – place supporting rails/bars by toilets, in bathrooms and along corridors to help people move through their environment safely.

Personalised touches

Small, familiar details help new environments, like care homes, or shared spaces, like wards, feel more like home.

• Familiar objects – photographs, treasured ornaments or a favourite quilt can help shared spaces feel more personal.
• Sensory comfort – provide blankets, cushions and preferred lighting levels. A choice of chairs at different heights and firmness supports comfort and ease.
• Calming colours and artwork – soft, muted tones and familiar scenes, such as landscapes or nature prints, can create a soothing atmosphere.

By bringing together safety features with personal detail, care settings can feel both practical and reassuring.

Engaging activities to build connection

Meaningful activities help nurture relationships and add interest to daily life. They also provide natural moments for conversation, reflection and skill-building.

Reminiscence therapy

Reminiscence therapy invites older people to revisit meaningful moments from their past, encouraging them to share memories in their own words.

Discussing family celebrations, career highlights or significant events can help people reconnect with familiar experiences. Photo albums, old music or heritage objects – such as vintage telephones or tools – can prompt stories and create a sense of continuity. This approach acknowledges personal history and helps strengthen identity.

Creative and recreational pursuits

Creative and light physical activities give people different, enjoyable ways to spend time together. Arts and crafts – such as painting, collage or simple textile projects – offer a calm space for creative expression. It’s not about the outcome but the process, which should be enjoyable and flexible. These moments can encourage natural conversation and help people feel more at ease.

Gentle movement can also support well-being. Chair yoga, seated tai chi or short walks in the garden help maintain mobility and boost energy without placing pressure on ability. These sessions often work best when relaxed and social, giving people time to chat as they move.

Music adds another way to connect. Hymns, folk songs or familiar favourites can evoke memories and lift the mood in shared spaces. Even listening quietly together creates a sense of community, helping people feel included and present.

One-to-one shared interests

Pair carers with older adults over individual hobbies – reading newspaper articles together, baking traditional recipes or tending plants. These personalised interactions build trust through shared attention and mutual enjoyment.

Maintaining professional boundaries

Clear boundaries protect both the caregiver and the person receiving support. They help keep expectations open and honest, reduce the chance of misunderstandings and support relationships built on mutual respect.

Defining roles

Being clear about your role from the start helps everyone understand what support is available and what you’re there to do. A simple explanation of your responsibilities – for example, assisting with personal care, medication and daily routines – provides clarity. If tasks fall outside of this scope, such as managing money or arranging transport, acknowledge the request and talk together about other options.

A consistent approach across staff members prevents mixed messages and reinforces trust.

Respect and confidentiality

Boundaries also relate to personal information and private space. Protecting privacy during intimate or sensitive tasks shows care and respect. Closing the door, drawing curtains and seeking permission before entering a room help the person feel at ease.

When discussing health or other confidential matters, explain who will have access to the information and for what purpose. This transparency reassures the person that their details are treated with care and shared only when necessary.

Emotional boundaries

Warmth and empathy are central to good care, yet it’s still important to have emotional boundaries. A supportive relationship doesn’t mean becoming a confidant for every personal concern.

When conversations move into deeper emotional territory, it can help to acknowledge the person’s feelings while suggesting they involve family or a suitable professional, such as a counsellor. This keeps care focused and supports the person to build a broader network of support.

Involving families and friends in the care pathway

Families and friends are important partners in building trust. Their involvement offers continuity, reinforces the individual’s sense of identity and reassures them.

Open communication channels

Regular contact helps everyone feel informed and included when it comes to decisions about care.

Short weekly or monthly calls or meetings give relatives a clear sense of how their loved one is doing and let them use the opportunity to raise questions or concerns. Some settings keep a simple shared care log, on paper or digitally, which notes mood, appetite and small day-to-day moments. Families can read it and contribute to it themselves.

Family participation

Inviting families into planning conversations ensures support reflects what matters most to the person. Joint care-planning meetings allow relatives to share insight about the person’s preferences, experiences, routines or concerns, helping shape goals that feel personal and realistic.

Celebrations and familiar rituals also play a part. Families might bring in a home-cooked dish for a special occasion or help decorate for birthdays and anniversaries, keeping traditions alive within the care setting.

Volunteer befriending programmes

Regular social time can make a meaningful difference, especially when family members live far away or have limited time to visit.

Befriending programmes match older people with trained volunteers who visit for a cup of tea and conversation. They can also involve shared activities, like painting, cooking or gardening. These visits broaden social networks and offer another steady point of connection.

Addressing cultural and individual preferences

Respecting cultural backgrounds and personal histories is central to building trust. When care reflects what matters to the person, relationships feel more grounded and inclusive.

Cultural competence training

Training helps care teams recognise and respond to diverse needs.

• Dietary laws and preferences – halal, kosher or vegetarian meals
• Religious observances – prayer times, festival celebrations (Diwali, Eid, Easter)
• Language considerations – translation services or bilingual staff where needed

Life-story work

It’s important that carers don’t view older people as recipients of care but instead as unique individuals who have lived full lives.

Compiling a “This is Me” booklet – common in dementia care – brings together key details such as birthplace, favourite songs, nicknames and past professions. Keeping this information visible, for example, on a bedroom door, helps staff use preferred names and initiate conversation around familiar, meaningful topics.

Individual communication styles

Older people receiving care have different ways of communicating, and noting their preferences makes a difference.

Some people may prefer a formal address (“Mr Patel”) when they first meet, while others are more comfortable with first names. Adapting to these preferences shows respect for identity and helps interactions feel more natural.

Building trust again after a breakdown or incident

Even in thoughtful, well-run care environments, misunderstandings or mistakes can occur. What matters most is how people respond in the moment and what’s done to prevent it from happening again.

Acknowledging and apologising

A direct, honest response shows respect for the person affected.

When an incident occurs – such as a missed medication dose or a lapse in communication – address it promptly:

• Acknowledge – “I’m aware we didn’t get your pills to you on time this morning”
• Apologise – “I’m very sorry this happened”
• Explain – offer a brief reason for what went wrong, without deflecting responsibility
• Remedy – “Here’s your medication now, and I will help you understand the new schedule”

This simple structure demonstrates accountability and care.

Reflective investigation

Looking at what happened in an open, non-punitive way helps everyone learn. A brief review with the care team – and, where appropriate, the person and their family – can clarify why the incident occurred and what might prevent a repeat.

Making helpful adjustments to systems and practices shows that the concern has been taken seriously rather than swept under the rug. Sharing these changes helps rebuild trust.

Restorative practices

If a situation has strained relationships, a restorative conversation can help everyone reset. With support from a trained facilitator, those involved can express how the incident affected them, acknowledge harm and agree on next steps that feel fair and constructive. This approach upholds dignity and helps both sides move forward with confidence.

Continuous reflection and feedback loops

Trust grows when teams slow down, look closely at their practice and stay open to learning from the people they care for.

Reflective practice

Setting aside time – either alone or with colleagues – to think about recent interactions helps carers become aware of patterns and consider measures to improve care.

You might ask:

• What went well?
• What could have been handled differently?
• Which approaches created the most positive responses?

Recording these thoughts briefly in a journal or talking them through in team huddles helps good practice become embedded and shared.

Feedback mechanisms

Hearing directly from older adults and their families keeps care grounded in what daily life actually feels like.

• Formal surveys – simple paper or tablet questionnaires gather views on comfort, respect and communication
• Informal check-ins – quick questions, such as “How was your breakfast today?”, offer real-time insight
• Family feedback – relatives can share suggestions on care routines or the living environment

These conversations – however small – show that opinions matter and that the team genuinely wants to get things right.

Quality improvement cycles

The plan-do-study-act (PDSA) framework offers a simple way to test ideas and build on what works.

• Plan – identify an area for improvement, such as reducing wait times for personal care.
• Do – try out a small change, like staggering care schedules.
• Study – gather feedback and observe what difference it made.
• Act – adjust the approach or expand it if successful.

Repeating this cycle helps care settings respond to changing needs and preferences.

Summing up

Building trust in elderly care depends on thoughtful communication with the individual and their family, genuine empathy, predictable routines and environments that feel safe and comfortable. 

When things go wrong, prompt acknowledgement, open conversation and clear improvements can help repair confidence and make the older person feel respected.

Through ongoing reflection and feedback, care teams keep learning and adapting, making sure people feel listened to. In this kind of setting, trust becomes a shared foundation that supports dignity, safety and a feeling of ease in daily life.