Rebuilding Trust: Inside the Effort to Repair Family Relationships in Skilled Nursing Care

Cleveland, OH – When an elderly nursing home resident’s family loses trust in the care team, the fallout can extend far beyond tense phone calls or complaints — it can lead to unnecessary hospitalizations, fractured communication, and care that drifts away from a patient’s goals.

That dynamic was the focus of a recent case study presented by Luke Dogyun Kim, M.D., a geriatrician at Cleveland Clinic, during the 2025 Annual Meeting of the American Geriatrics Society. His presentation underscored how mistrust between families and nursing home providers can become a barrier to effective care — and how rebuilding that trust requires a coordinated, multidisciplinary approach.

The case centered on an 80-year-old man with multiple chronic conditions, including severe COPD, heart failure, vascular dementia, and anxiety. Despite worsening symptoms, the patient and his family hesitated to pursue palliative care, attributing his fatigue and confusion to medication side effects and sleep issues. When the patient was ultimately hospitalized, his family accused the nursing home of neglecting his care.

Kim said such breakdowns in confidence are not rare — and they often reflect systemic pressures rather than individual failings.

“In the current atmosphere, it’s very hard,” Kim told Skilled Nursing News. “We need better nurse ratios, more frequent provider visits, and clear care goals from the beginning — but all of that takes resources and engagement.”

The Roots of Mistrust

Kim pointed to several forces shaping the fragile trust dynamic between families and post-acute providers. Fewer older adults choose nursing homes after hospital discharge — only about 20% of Medicare patients, he noted — as most prefer to age in place. The AARP’s 2024 Home and Community Preferences Survey found that 75% of adults over 50 want to remain at home as they age.

Meanwhile, the pandemic era brought a wave of new regulations without equivalent funding, and the shift from nonprofit to for-profit ownership has altered many families’ perceptions of facility motives. Staffing shortages further amplify anxiety, as families worry whether their loved ones will receive prompt, appropriate care.

Medical misunderstandings compound the issue. Families often push for curative treatment when palliative care would offer better comfort and outcomes. Kim described common misconceptions — for example, when families equate radiation treatment with recovery rather than palliation.

“We sometimes see patients being ‘rehabbed to death,’” Kim said. “Families believe we can restore full function, but at some point, we’re prolonging suffering instead of improving quality of life.”

Building Communication Systems That Work

Rebuilding trust, Kim emphasized, begins with communication. Nursing home residents are often seen by physicians only once a week, making nurses the primary link between the family and the care team. Establishing structured, secure channels for updates and consistent messaging across all clinicians is essential.

“Most effective systems communicate clearly and circulate information quickly,” he said. “If something changes, it must be reported — and everyone, including families, should be on the same page.”

Leadership transparency also plays a role. Families notice when facility leaders or staff choose to place their own loved ones in the same community — or when they don’t. “That sends a message,” Kim said. “If staff don’t trust the system themselves, why should families?”

A Team-Based Path to Repair

In Kim’s case study, the patient’s care improved only after the nursing home assembled a multidisciplinary team: respiratory therapists refitted his BiPAP mask, pharmacists eliminated redundant medications, nurses received new education in morphine and lorazepam use, and a physical therapist designed a fall-prevention and gait program.

The coordinated effort not only stabilized the patient’s health but also renewed his family’s confidence. Their involvement in decision-making — and seeing tangible improvement — restored trust in the facility’s care team.

Kim said such turnarounds require clinicians to own their missteps, communicate honestly, and advocate for system-level changes that reduce burnout and turnover. When staff feel supported, he added, they’re more likely to notice early signs of decline and prevent avoidable hospital transfers.

“The simplest thing is how orders are carried out,” Kim said. “If nurses are just doing the job without caring, it shows. But when they’re engaged and supported, families feel it — and that’s when trust starts to return.”