Public care for disabled persons is in Denmark to a large and growing extent, provided through direct payment. In such organisation of care, the user of help selects and/or employs his or hers personal helpers privately. The work contract is governed by a dominant discourse of empowerment of disabled: help is to be given on the terms of the user. Within this discourse and the de-institutionalisation of help, the perception of work is transformed from being care to being service. The lack of guiding rules and regulations in these individualized help arrangements, leads to a large array of differing practical, social, emotional and sexual demands on helpers and their work performance. How do helpers cope under such flexible, volatile and boundless working conditions? Four focus groups, covering a total of twenty four Danish care workers from the attendant-care-sector, were conducted in winter 2005-6. A discourse analysis of their discussions shows that Exit is recognised as the only coping strategy when user/employer's demands are boundless or stressful. Hirschman's (1970) theory of Exit, Voice or Loyalty as the range of responses of customers/members to organisational decline is discussed as options for attendant care workers. Loyalty to give help at the terms of the user, combined with working under the head of the user, tend to drive helpers beyond healthy limits in their work performance. When facing excessive practical, social, emotional or sexual demands helpers turn to Exit. In discussions on experiences of burn-out, the favourite explanation is that one has stayed too long in the job. Problems in the psycho-social working environment is thus solved by the mechanisms of a free market of supply and demand of Loyal helpers. Care workers are the commodity of this market, and by favouring Exit as coping mechanism, they accept the premise of a free market care system. To improve working conditions and working environment, and to develop best practice in care work, Voice is necessary. We present the helpers experiences and discuss the limitations in their strategies and their opportunities for Voice. The case calls for institutional changes.
omsorgsarbejde; fleksibilitet; exit; midlertidigt arbejde; turn-over; care work; working life
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13th European Congress on Work and Organizational Psychology: Sustainable work., 2007