Consumer-directed care and the relational triangle: Power, subordination and competing demands – a qualitative study

Following a recent government initiated change to a consumer-directed care model across the Australian community aged care sector, the purpose of this paper is to explore frontline home support workers’ perceptions of relational changes with clients in power and subordination within the triadic relationship between employer, employee and client.

Contextual interviews were held with managers (n=4), coordinators (n=10) and semi-structured face-to-face interviews with support workers (n=17) in three organizations. Interview transcripts were analyzed.

Some workers did not perceive a power change in their relationships with clients. Others perceived minimal change but were concerned about the incoming client generation (baby boomers) that were more aware of their rights. Others felt subordinated to the client, perceived a loss of control or that felt treated like an employee of the client. Consistent with the philosophy of consumer-directed care, senior staff encouraged clients to treat workers in this way.

Further research is recommended on worker and client perceptions of relationships within the context of a consumer or client focused model.

A clear and realistic understanding of the locus of power within a triadic relationship by all actors is important for positive workplace outcomes.

The increasing ageing population makes it essential that workers’ relationships with clients and with their organization are unambiguous.

This study makes a contribution to theories about change and power transfer in the implementation of consumer-directed care through the perceptions of support workers. Examination of power and subordination transfer through the perceptions of the actors of rather than through the prism of organizational policy deepens the understanding of frontline service work and relationships.