Dispute Resolution in the Homecare Industry:the Triangle of Patient, Worker, and Manager

Submitted to

The Sociological Quarterly

Elizabeth A. Hoffmann

Department of Sociology and AnthropologyStone Hall

Purdue UniversityWest Lafayette, IN 47906

(765) 463-4947hoffmanne@cla.purdue.edu

approximate word count: 8,894 wordssuggested running head: Dispute Resolution in the Homecare Industry

Correspondence may be addressed to Elizabeth A. Hoffmann; Department of Sociology and Anthropology; Purdue University; 1365 Stone Hall; West Lafayette, IN 47907. hoffmanne@cla.purdue.edu. The author wishes to thank Jeni Loftus and Kirstin Paap for their comments on earlier drafts, and Mark C. Suchman, Lauren Edelman, Jane Collins, Howard Erlanger, and Myra Marx Ferree for their help and encouragement at earlier stages of this project. This research was supported by a National Science Foundation grant (SBR-9801948)

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TITLE: Dispute Resolution in the Homecare Industry: the Triangle of Patient, Worker, and

Manager

ABSTRACT

Drawing on data from three homecare businesses, each with a different organizational

configuration, I explore how the structure and culture of the homecare industry affects workplace

dispute resolution behavior. Rather than tolerating problems, raising formal grievances, or

exiting to avoid disputes – as do workers in other industries – the homecare workers resolved

their disputes informally. This specific behavior is homecare workers’ main dispute resolution

strategy because homecare involves caring for vulnerable clients who would be negatively

affected by some disputing strategies – particularly exiting and formal grievances. Managers and

employees both work to avoid these disruptions, thereby limiting the dispute resolution options

available to workers. Additionally, the culture of the industry allows for sufficiently successful

informal dispute resolution so that quiet toleration of disputes is not necessary.

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This study explores workplace dispute resolution strategies of homecare workers. Four

distinct dispute resolution strategies were examined; formal grievances, informal dispute

resolution, toleration, and exiting. This study demonstrates that the structure and culture of the

homecare industry produced a climate in which the majority of homecare workers relied only on

informal dispute resolution as a way they would address their workplace problems.

Like employees in other industries, homecare workers encountered various workplace

disputes. Sometimes these problems involved hours and scheduling: homecare workers have to

travel to the homes of their various patients and poor scheduling by managers could place them

in impossible situations of trying to travel across town in only a few minutes. Other times,

managers might schedule them for too few patients, leaving them without enough paid hours at

the end of the week to provide sufficient income. Other problems might arise over being paired

with difficult co-workers or assigned to hostile patients, both of which would make the workday

longer and the work more difficult.

Unlike in other industries, however, these homecare workers were unlikely to consider

formal grievances as potential options because of the unique triangular structure of the homecare

industry. In contrast to industries, in which workplace disputes involve only the employee and

the manager, in the homecare industry, disputes affect the patient as well as the worker and the

manager. Since formal grievances could potentially endanger their patient by disrupting

necessary home visits and care, homecare workers were reluctant to embrace this formal option.

Managers were aware of their employees loyalty to their patients and would occasionally utilize

these emotional ties to avoid any formal action by their workers.

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However, the homecare industry was also unlike other industries that focus on vulnerable

clients (e.g., childcare, nursing homes), which also avoid formal grievances out of concern for

harming their charges. Employees in these industries, unable or unwilling to raise formal

grievances, will often resort to exiting to escape workplace problems or will develop coping

mechanisms so that they can tolerate the un-raisable grievances. However, the culture of the

homecare industry created an environment in which flight and toleration were not necessary.

Instead, workers in all three businesses described informally resolving their workplace disputes.

Even though the interviewees were drawn from three very different homecare businesses – one

conventional, privately owned business; one run as a charity not-for-profit; and one worker

cooperative in which all employees were also co-owners – they all responded similarly, primarily

describing informal dispute resolution strategies and seldom mentioning exiting, toleration, or

formal grievance strategies. These workers could rely on informal dispute resolution, nearly

exclusively, because the homecare culture supports perceptions of procedural justice on the part

of management and emphasizes morality over legality, as I discuss below.

THEORETICAL CONTEXT AND PREVIOUS RESEARCH

Workplaces are often the site of conflict and, accordingly, much literature has examined

workplace dispute resolution. Although dispute resolution procedures are frequently “premised

on the harmony model of law that denies the unequal power of disputing parties,” in fact,

workplace disputes reflect the social and economic inequalities of greater society (Nader 2001:

19). Additionally, unlike formal adjudication, workplace dispute resolution procedures offer little

protection against abuses of power (Delgado et al. 1985). Moreover, parties in workplace

disputes must participate directly in the confrontations of the grievance procedure, lacking the

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buffer of professional representation that makes formal court hearings emotionally easier for the

participants (Grillo 1991). These elements make the formal workplace grievance even more

difficult than an actual law suit.

A critical factor in how a dispute will evolve is how it is named. Merry argues that “the

ability to name and interpret is … a central feature of the power exercised by those who handle

problems” (Merry 1990: 4). In her study of court mediators, Merry found that mediators and the

lower courts tried to reframe disputants’ problems away from the legal perspectives, and toward

moral and therapeutic frames, thus diverting them from the use of the courts (1990). Merry

distinguished three discourses: morality, legality, and therapy. A legalistic reframing is “a

discourse of property, of rights, of the protection of one’s self and one’s goods, of entitlement, of

facts and truth” (Merry 1990: 6). Moralistic discourses focus on relationships, obligations, and

responsibilities. Therapeutic discourses withhold judgment, but portray the offender as “lacking

full responsibility for himself;” hence, this orientation is compassionate, but disempowering

(Merry 1990: 8).

The party bringing the grievance, as well, may embrace various positions and may

choose to be more accommodating or less. Tyler and Lind assert that if disputants receive

procedural justice, they will be more flexible in accepting a wider range of distributive justice

outcomes (2000). In other words, if the grievant feels s/he was treated fairly, s/he is more likely

to accept an otherwise disagreeable outcome. Perceptions of procedural justice depend on

whether the disputant trusts the authorities handling the dispute (“trust”), whether the disputant

feels that s/he is seen by the authorities as having full status in the group or society (“standing”),

and whether the disputant believes that s/he received nondiscriminatory, neutral treatment

(“neutrality”) (Tyler and Lind 2000). According to Tyler and Lind, trust reflects the individual

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authority’s character, assures (or fails to assure) the disputant of the authority’s future behavior,

and is linked to inferences about the authority’s sincerity. A disputant being accorded full

standing in the group is strongly linked to her/his treatment; if s/he is poorly treated by the

authority, the implication is that the disputant is not a full member of the group (Tyler and Lind

2000). Neutrality involves “honesty, unbiased treatment, consistency, and factual decision-

making” and the perception of a “level playing field” (Tyler and Lind 2000: 76).

If people feel that authorities are fair in their decision-making, then they believe they can

obey authorities’ orders without fear of exploitation. In contrast, if authorities seem to act

unfairly, people will fear exploitation and their obedience becomes less likely. Tyler and Lind

explain that if people feel they are fairly treated (procedural justice), they enter “group mode,” in

which they are cooperative and establish behavior based on fairness rather than expected

outcomes. However, if they feel poorly treated, they enter “individual mode,” in which they act

primarily to maximize their own short-term outcomes, rather than focusing on fairness (Tyler

and Lind 2000).

Thus, the degree to which an organization’s authorities are trusted, respect members’

standing, and exercise neutrality affects how much its employees will trust in procedural justice.

In organizations that lack procedural justice, members will be self-centered and focus on their

own benefits, pay, and workloads. In organizations that achieve procedural justice, members will

be willing to work cooperatively with a sense of fairness towards the group.

Tyler and Lind assert that employees infer trustworthy motives when authorities act with

informal discretion, more so than when the authorities merely enforce formal rules. Informal

justice allows authorities to communicate their trustworthiness more than formality because

informal dispute resolution allows them to engage in more discretionary actions. Thus, in

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informal settings, authorities have more freedom and flexibility to communicate their

“benevolent motives and caring attitudes” towards disputants, and hence are seen as more

trustworthy (Tyler and Lind 2000: 85).

Tjosvold et al. found that employees and managers who see themselves “on the same

side,” working toward the same goals – what they call “cooperative interdependence” – were

often willing “to compromise, assist each other, and work for a successful resolution to

problems” (Tjosvold, Morishima and Belsheim 1999: 59). Managers and employees with

cooperative interdependence had shared understandings of issues, common objectives, and trust

that both sides want a solution for mutual benefit (Tjosvold, Morishima and Belsheim 1999).

Various researchers have compared male and female managers, finding distinctive styles

of dispute resolution among women managers (e.g., Calhoun and Smith 1999: 204; Court 1994;

Fletcher 1999; e.g., Kanter 1977; Kelly, Hale and Burgess 1991). For example, Kelly, Hale, and

Burgess, in their study of public administrators, assert that male managers are more competitive

and confrontational while female managers are more cooperative and accommodating (1991).

Court found that women managers were more supportive and explained that these women

managers took the caring and nurturing skills and values from their private lives and applied

them to their public lives of managing (Court 1994). The managers in Court’s study said they

didn’t want to be “selfish” and dictatorial, but to work toward the harmony, openness, and

teamwork with their subordinates. Calhoun and Smith report “that women tend to behave less

competitively and more cooperatively than men,” implying that both women workers and

women managers approach dispute resolution more cooperatively than is optimal for them to

fully benefit from the dispute process (1999: 204).

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Some scholars assert that women employees – the majority of the homecare workers –

are particularly disadvantaged in resolving workplace grievances (e.g., Bumiller 1988; Calhoun

and Smith 1999; Gwartney-Gibbs and Lach 1994a; e.g., Gwartney-Gibbs and Lach 1994b; Paap

1999). For example, Grillo asserts that women’s reluctance to embrace and utilize their anger

creates difficulties in raising grievances because they are unwilling to fight (1991). Additionally,

some scholars argue that women are more susceptible to reframing their disputes from

“legalistic” to “moralistic” issues, to use Merry’s typology from earlier in this section (1990).

These researchers argue that women perceive situations of conflict differently from men (e.g.,

Acker 1990; Calhoun and Smith 1999; e.g., Court 1994; Gilligan 1982; Lerner 1985; Major,

Bylsma and Cozzarelli 1989). Unlike men, who primarily tend to consider abstract rights and

justice with less consideration of individual relationships (i.e., legalistic), women focus more on

responsibilities to others and the needs that others have (i.e., moralistic). This further

disadvantages women in pursuing grievances. Major et al. report that women, in responding to

questions about justice at work, said that “it was important for them to give more than they

receive, whereas men on average reported that it was important for them to give and get in

approximately equal amounts” (Major, Bylsma and Cozzarelli 1989: 494).

Additionally, women are often blocked from various options of dispute resolution. For

example, Hoffmann found that women in predominantly male occupations were more likely to

use formal grievance procedures as their only option to resolve their disputes (2005). The women

in her study were blocked from resolving workplace disputes informally because they lacked

informal access to the managers and supervisors. Other scholars have found that women have

difficulty raising grievances at all – formally or informally. Bumiller found that women, in

resisting the label of “victim” were unable to address their discriminatory treatment by their

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supervisors (Bumiller 1988). Similarly, in their study of clerical and maintenance workers,

Gwartney-Gibbs and Lach found that gatekeepers of company grievance procedures deterred

women from resolving grievances, formally or informally, by being “insensitive to women’s

unique workplace disputes” (Gwartney-Gibbs and Lach 1994b: 614).

While scant extant research has examined workplace dispute resolution among homecare

workers, specifically, other researchers have studied this labor issue with nurses, teachers, and

nannies (e.g., Abel and Nelson 1990; Grimwood and Popplestone 1993; e.g., Marshall et al.

1991). This research has shown that managers often use the potential harm to the third parties –

the patients, the students, the children – to prevent disputes from occurring. In this way,

managers avoid workplace disputes by pitting the care giver against the care receiver.

SAMPLING AND METHODS

Sample

Homecare work refers to assistance in one’s home provided by non-medical staff.

Homecare workers usually work with people who have physical and/or mental disabilities. These

workers do not administer medicines or do any other sort of nursing, but, instead, help people do

what these clients would otherwise do themselves. The services include giving sponge and full

baths, cooking meals, cleaning, dressing, getting the person out of bed, assisting in toilet usage

and continence, shopping, and taking the person for walks.

I studied three different homecare agencies: (1) Private Homecare, which was owned by

two women and run for profit, (2) Charity Homecare, which was run as a local charity, not-for-

profit, and (3) Cooperative Homecare, which was collectively run and owned as a worker

cooperative for profit. All of the homecare businesses employed mostly women: Private

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Homecare: 91%, Charity Homecare: 90%, Cooperative Homecare: 82%. Although these

businesses were not all located in the same cities, their cities are quite similar: somewhat small

(approximately 300,000 population) with a diminished manufacturing economy and significant

unemployment (Langway 1997). Each of the businesses were quite small: Private Homecare: 44

workers, Charity Homecare: 51 workers, Cooperative Homecare: 45 workers.

The data in this study was also included in an earlier four-industry research design to

examine the impact of formal and informal power on disputing strategies. The focus of this paper

is different. Rather than looking at patterns that recur across industries, here, I explore how the

distinctive characteristics of a particular industry may affect the behavior of the employees

working therein. In this way, my analysis has shifted from individual-level power to industry-

wide patterns.

Data Collection

I conducted a total of 49 interviews with workers from these businesses: 14 at Private

Homecare, 10 at Charity Homecare, and 25 at Cooperative Homecare. The confidential

identification number for each interviewee is show in parentheses after each quote. I did not

identify a specific group of workers whom I knew to have had “disputes” but spoke to all

interviewees about their workplace experiences generally. I included a wide variety of

interviewees to maximize the range of problems and experiences as well as the variety of

solutions and expectations to be included in this study. My sample includes present and former

employees as well as managers and worker-managers. Interviewees also differed in terms of

length of employment, sex, race, age, level of education, and socioeconomic status. Through

careful sampling and the repetition of responses I encountered as interviewees spoke of similar

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themes, I have become confident that my findings are well triangulated and valid. Although these

interviewees are not statistically representative of all the workers at their individual

organizations, the diversity of this sample is helpful in developing conceptual models.

Methods

One of the key benefits of qualitative studies is the high validity possible: the researcher

can understand the greater context, obtain a large overview, and can triangulate the accounts of

differently situated interviewees with various bases of knowledge. In gathering data for this

study, I interviewed workers; observed behavior; read related documents and articles; and

attended companies’ business meetings.

Generally, I approached interviewees myself, rather than requesting volunteers to come

forward. Since a significant focus of this study is the raising of grievances, interviewing only those

inclined to step forward could create an unrepresentative sample of perspectives on grievance

behavior. The assertiveness and extroversion necessary to volunteer to be interviewed by a stranger

may be correlated with both attitudes on raising grievances and ability to resolve disputes. I

arranged certain interviews in advance with key people and workers from underrepresented groups

within the organization whom I wanted to be certain to include.

Most of the interviews were conducted in public places or in private spaces at the

companies themselves. The interviews ranged from twenty minutes to over five hours, with most

lasting between thirty and ninety minutes. At least one especially lengthy interview occurred at

each business.

All interviews were conducted in person, using a set of open-ended questions as initial

probes on a wide variety of work-related topics. Each interview and most site observations were

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tape-recorded and transcribed, so all quotes used here are direct quotes. The main focus of the

interviews was how the interviewee would handle potentially grievable circumstances.

Interviewees were asked mostly general, open-ended questions, but with some direct questions,

especially as follow-up inquiries. In discussing grievance resolution strategies respondents would

often draw on examples from their past experiences.

These data, interview transcripts and fieldnotes, were coded and analyzed for various

themes using the qualitative data software NVivo. Some of these themes were responses to

explicit questions (e.g., “In what ways is your job difficult?”). However, many others were

extracted from the responses of interviewees to broader questions (e.g., “How would you

describe your job?” “How would you recommend/criticize your job to another worker in the

same industry?” “What would you change about your job if you could just snap your fingers and

it would be different?”) or to follow-up questions to other responses. Thus, many codes, such as

“toleration,” were not the result of a direct question or set of questions intended to measure

loyalty, but were produced by careful analysis of interviewees’ responses to various questions.

RESULTS AND DISCUSSION

Rather than exiting to avoid disputes, developing toleration skills to cope with problems,

or raising formal grievances – as do workers in other industries (Hoffmann 2006) – the homecare

workers resolved their disputes exclusively through informal means. I argue that this dispute

resolution behavior results from the structure and culture of the homecare industry. Specifically,

because homecare involves caring for vulnerable clients who would be negatively affected by

some disputing strategies – particularly exiting and formal grievances – both managers and

employees work to avoid these disruptions, thus, limiting the dispute resolution options available

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to the workers. Additionally, the culture of the industry allows for sufficiently successful

informal dispute resolution so that toleration, rather than resolution, of disputes is not necessary.

Informal Dispute Processing

In the homecare industry, workers in the three different types of homecare businesses

preferred to resolve disputes informally rather than through formal grievance procedures. Their

statements were remarkably similar, as Table One shows.

Insert Table 1 about here

As did many workers at all three businesses, the following woman from Cooperative

Homecare explained that she resolved problems at work informally:

I just come to Ellen [one of the worker-managers], just ring in or come in and I

would say ‘I’m not happy with that,’ or ‘I’m not happy with this,’ and usually sort

it out. No problem. Not yelling. It was never anything drastic, if I didn’t

particularly like the person I was going into and I felt that they didn’t particularly

like me, or if they had a problem with people coming in, I used to come and say

and work it out. (111)

Echoing the emphasis on informal dispute processing, a woman at Private Homecare stated that

everyone has problems so one needs to be understanding. This is why, she explained, she always

tried to resolve issues informally.

[If a co-worker weren’t doing her/his share] I think I would say something.

Everybody has down and out days don’t they? Everybody is human that’s why

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sometimes everybody slacks off every now and again. You gotta understand a bit

I suppose. (066)

The workers from the Charity Cooperative also spoke about resolving disputes directly and

informally, such as this woman’s succinct strategy.

When we’d finished and we were outside, I would simply ask them what they

were playing at. (132)

Thus, their dispute resolution strategies were remarkably similar. Their workers consistently

mentioned informal dispute resolution as the main way to resolve disputes.

Workers often explained that they could resolve these issues informally with their

supervisors because they enjoyed good relations with them. Homecare workers at all three

businesses spoke of feeling well supported with easy access to their managers. For example, this

55-year-old woman at Cooperative Homecare contrasts how accessible her supervisors are at her

present homecare job with those at her previous non-homecare job.

[Here] you can just come in and have a good chat. You can just go talk to them,

just pop in and say, ‘Oh can I have a word with you, Ellen?’ [At my previous job]

you had to knock on the door, wouldn’t you. It’s more like a distance between

you, when you have to go at somebody’s office and knock on the door. You’d

have to ask him, ‘Is it convenient?’ It’s going to be more official rather than just

having a little chat. Different from when you just sort of like pop in and have a

cup of coffee with somebody. (083)

The easy access to her present supervisors made her feel that less formal interactions were more

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possible than at her previous job. Nearly all the homecare workers emphasized that the

encouraging and understanding manners of the supervisors contributed to their ability to rely so

heavily on the informal dispute processing.

Research on carework does emphasize the importance of managers’ supportiveness in

buffering the workloads and emotional demands of caregiving work (Tjosvold, Morishima and

Belsheim 1999). The nature of carework often demands that careworkers are accessible to clients

emotionally, physically, and intellectually. This can be very demanding and can create very

meaningful relationships between care givers and clients (Tjosvold, Morishima and Belsheim

1999: 59). Kahn reports that careworkers perform best when the employees receive the same

level of support and nurturance from the organization as they are expected to provide to clients

(1993). Similarly, workers “felt frustrated and angry when superiors inappropriately withheld

care” (Kahn 1993: 545).

Exit

Exiting was not an option regularly considered by the workers at the three homecare

businesses. When they did cite this as an option, it was generally voiced as a last resort. For

example, this member of Cooperative Homecare contemplated her hierarchy of options in

considering future grievances.

I think I’d try and work it out first with the cooperative. If I couldn’t get anywhere

then, and I just didn’t like the situation at all, I don’t know whether I would bring

[the union] into it. If I really felt necessary, I might. The very last option would be

to leave. But hopefully that wouldn’t happen. (005)

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At most, twenty percent of the homecare workers (at Charity Homecare) said they would

consider leaving as a response to a grievance (7% at Private Homecare and 12% at Cooperative

Homecare).

Toleration

Additionally, homecare workers at all three sites also seldom discussed grievance

strategies that included toleration (14% at Private Homecare, 20% at Charity Homecare, 16% at

Cooperative Homecare), emphasizing their preference for informal dispute processing.

Sometimes the strategies of toleration and informal dispute processing merged. The most

prevalent example of this was when a worker had an assignment s/he did not like, but no

substitute worker could be found to replace her/him immediately. In such situations, the worker

often discussed the situation with the manager(s) and reached an agreement to be switched as

soon as this was possible (informal resolution), but, until the worker was switched, s/he had to

cope with the arrangement temporarily (toleration). This description by a young woman from

Cooperative Homecare offers an example of this situation.

There was one place I particularly didn’t want to go back to. I came in and said

to [a worker-manager] I’m not that happy about going there, but [I then agreed

that] I’ll do it if you can’t get anyone, because I knew how bad it was to get

people, especially on short notice. (111)

However, workers at all three businesses emphasized that coping with an unpleasant situation

was rarely necessary because one could usually switch out of such situations easily. For example,

a woman at Private Homecare said:

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I would probably take myself off any assignment, if I was unhappy. I wouldn’t go

anywhere if I wasn’t happy because that’s not fair to the people you visit then. If

you went into somebody’s house and you never look forward to going, then that’s

really unfair to the person you go to visit. Because you’ve got to make it pleasant

for them. So, yes, I would just ask myself to be taken off it. (038)

Indeed, the managers of all three businesses emphasized that they made great efforts to quickly

move workers out of unpleasant situations, trying to facilitate workers liking their placements.

This was done not only out of concern for worker morale, but as a practical matter in order to

deliver quality service to the clients.

Formal Grievance

As with exiting and toleration, the homecare workers also did not anticipate using formal

procedures to resolve grievances (7% at Private Homecare, 20% at Charity Homecare, 12% at

Cooperative Homecare). Nevertheless, at each business they were aware that the formal

procedures existed as a possible option. A man at the cooperative homecare business described

how he and his co-workers can resolve problems informally, but emphasized that he’s glad the

formal procedure is available.

We have a whole formal procedure, but I don’t think anyone’s used it. We can all

talk together. We can work things out (informally). But it’s good to have the

formal procedure, just in case.

This appreciation of the formal grievance procedures as a back-up is similar to the sentiments

expressed by men in other studies (Hoffmann 2001; Hoffmann 2005). However, the homecare

workers in this study were not opposed to raising formal grievances, as a strategy in general.

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Indeed, approximately, one third of the interviewees responded that they had brought a

grievance, or been part of a grievance, at a previous non-homecare job. This is approximately the

same proportion found in earlier studies of other industries (___, submitted).

Characteristics of the Industry/Occupation

Homecare workers’ preference for informal dispute processing results from the

characteristics of the homecare occupation, specifically the structural and cultural aspects of the

industry.

Structure of the Homecare Industry: managers, workers, clients Grievances in these

homecare businesses are unlike other labor situations because of the triangular nature of the

structure of the industry. In the other industries, workplace conflict generally involves two

parties, the worker and the manager or the worker and another worker (see e.g., Hoffmann 2001;

Tjosvold, Morishima and Belsheim 1999). But labor issues in the homecare industry always

involve three parties: the worker, the manager, and the client. Unlike workers in other fields such

as coal (Hoffmann 2001), public service (Gwartney-Gibbs and Lach 1992), autoworkers (Gruber

and Bjorn 1982), and cab driving (Hoffmann 2003), the homecare workers could not take radical

action to pursue a grievance against management without potentially endangering their clients.

Indeed, research on nurses, teachers, and nannies (e.g., Abel and Nelson 1990; Grimwood and

Popplestone 1993; Marshall et al. 1991) indicates that managers often use the potential harm to

patients, students, or children to avert disputes from formal processes. With the formal grievance

options thwarted in this way, homecare workers only have informal means to resolve disputes.

Although other care-giving work, such as that in nursing homes, also has this triangular

structure, the triadic relations in the homecare industry are particularly acute. The individual

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caregiver-client relations in homecare are between individual workers and clients, rather than

being diffused across many caregivers and many patients in, for example, nursing home wards.

Thus, these homecare worker-client relations are more intense and can be more powerfully

exploited.

The Managerial Stress of Filling Shifts Managers and owners of homecare businesses

face staffing challenges that those in other industries I studied do not. These staffing pressures

compel managers to do whatever they can to ensure that all shifts are adequately filled. This

means that they must deter formal grievances and exiting, since these behaviors would disrupt

staffing the shifts.

As a care industry, homecare deals with people with time-sensitive needs. All three

homecare businesses offered 24/7 care, although most clients received only a few visits each day.

As a service industry, homecare businesses’ main stress, and main expense, is labor. Unlike other

industries such as the coal industry which focuses on mining coal (Hoffmann 2001), the auto

industry which focuses on producing cars (Gruber and Bjorn 1982), and even industries like cab

driving which has to both maintain and staff a sufficient number of cabs (Hoffmann 2003), the

main focus within homecare is having all shifts covered all the time.

Even in the similar business of nursing homes, staffing is a less frantic concern, since

workers can, and often do, take on additional “beds” during their shifts if a particular shift is

understaffed. Unlike nursing home workers, homecare workers have to transport themselves to

several sites each day, sometimes across town, in order to work their shifts. Pulling another

homecare worker to cover a missed shift requires more than the supervision of another hallway

of rooms on the part of the pulled worker, as it would in a nursing home. It requires that an

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already-busy worker must travel to yet another home, or several homes, which cannot be done

simultaneously with other home visits and might involve extensive travel time.

Moreover, in the event that a staffing problem should occur, the greatest risk is not low

coal output, fewer cars, or passengers left waiting at the airport. If a homecare business cannot

resolve staffing problems, it risks bodily, and possibly fatal, injury to its clients. For example,

elderly or disabled clients might fall trying to do for themselves what a care giver should have

been doing, such as bathing, cooking, or even getting out of bed. This severely intensifies the

anxiety for managers who risk missed shifts due to labor problems. As echoed by managers at

the other two businesses, the manager at Charity Homecare explained how stressful it is to

oversee sufficient staffing.

If it’s moving smoothly – because a lot of the care attendants have regular work

they do every day or every week, then it’s [only] a matter of covering those

[shifts]. But if somebody goes off sick at quarter to eight in the morning and they

should be doing a day’s work, then obviously that’s a real headache to arrange. At

the end of the day, you’ve got to cover it, because we’re going into vulnerable

people, often with either a long-term health problem or a disability.

It’s not like saying well, I won’t do that paperwork today, but I’ll do it

tomorrow. There’s somebody needs to be got out of bed or put to bed. Can’t leave

them to stay in bed all day, can you? It’s got to be done, even if I’ve got to go

and do it myself. (022)

She emphasized that keeping all shifts covered is vital by adding that she does the work herself

in emergency situations.

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One of the two owner/managers at Private Homecare described a recent situation where a

client’s scheduled visit was missed. As did other managers, she feared that such action could

result in injury or death.

The thing is, last night, a Mrs. [name] was missed. She was fine. Great. But that

person could have died because [she] didn’t have that call. Anything could have

happened. That person could have fallen downstairs from the top to the bottom

and be dead.

It really has to be brought home: it is a big, big responsibility that the staff

have. There’s no getting away with it. There’s not many jobs where you are so

responsible. To most staff it comes very, very natural. If you’re that type of

person that cares enough, everything comes natural. (071)

She concluded that the staff was generally capable of this high level of responsibility and caring.

Interestingly, this Private Homecare owner emphasized the responsibility of the care givers, not

the managers, unlike the Charity Homecare manager’s statement which focused on her own

responsibility. The Private Homecare owner even stated, as did other managers as well as

workers, that these homecare workers were “naturally” suited for this responsibility because they

seemingly cared enough.

This view, often shared by both labor and management, that homecare workers were

“extra special” because they “cared so much,” could easily be exploited. Some scholars have

argued that the combination of the intense pressure on management to have perfect staffing and

the potential to exploit the care givers’ ethic of responsibility can lead to a high level of

emotional manipulation by management in order to control labor. An important aspect of this

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emotional manipulation includes channeling all grievances to informal methods, specifically

avoiding formal grievances and abrupt exiting that could disrupt staffing shifts.

Although this emotional manipulation is not the sole dynamic, managers’ capitalizing on

workers’ emotions to lessen management difficulties is a key aspect of managing a homecare

business. This was seen at the three homecare businesses in this study. For example, one of the

worker-managers at Cooperative Homecare described how she appealed to workers’ sense of

“the big picture” when they want more money and more hours.

Much as they might be nice people, they still got their own agenda. As an

individual – and [since] it’s approaching Christmas – they want money. They got

pressures on them financially, ‘cause it’s not a well-paying job. And they see the

wrong circumstances and forget the bigger picture. I try to tell them about the

bigger picture. Sometimes it works. Sometimes it doesn’t. (069)

She explained that if Cooperative Homecare raised the wages it paid, even as a cooperative, they

would have to raise the rates they charge, resulting in losing government contracts and becoming

too expensive for clients who pay out-of-pocket. By reminding the co-workers of the importance

of their work to their care receivers, the managers could appeal to their sense of altruism – in the

above scenario, to work for less pay, or, in other situations, to resolve a dispute informally rather

than exiting or bringing a formal grievance.

Workers’ Emotional Bonds with Clients As appeals to “the big picture,” these reminders

about the needy clients who depend on their homecare workers have very powerful effects on

dispute resolution behavior, particularly in deterring formal grievances and exiting. Nearly all

homecare workers talked about their emotional attachment to their clients. For example, a

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woman at Private Homecare explained how she manages to not “go to pieces,” as she said, over

her clients.

You have to harden your heart. When you’ve nursed them for so many months, I

think then you get very attached to them. If you’ve nursed them for a while, I

think that’s when you do get so emotionally involved. (147)

While the literature talks about workers in all caring professions (e.g., teachers, nannies, and

nurses) developing emotional ties to their charges, some workers I interviewed felt that homecare

workers developed closer relationships with their clients than care givers who worked in

hospitals or residential homes. A woman at Charity Homecare explained that close bonding is

difficult in hospitals because one cares for so many patients at once.

In the hospital, you don’t build up a relationship with a ward with 30 people on it,

but here [in homecare] you go to people week in, week out, and you build a

rapport. (092)

Weaker bonds with patients in nursing homes is not surprising, since nursing home workers, like

hospital workers, interact with many more patients and spend less time with each patient, than

the average homecare worker.

Both managers and workers acknowledged that close ties could form between the cared-

for and care giver. For example, this woman from Charity Homecare described how fulfilled she

felt by working with a little girl with brain tumors.

I’ve got a little girl that I’m working with. They said she wouldn’t walk until

maybe she was four or five. She walked at two. They didn’t really think she’d get

any speech, because she has tumors of the brain, but she’s talking. So that’s been

a big achievement to me, because I’ve been going to her since she was about six

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months old, and she’s now four. That’s been nice, because I’ve actually helped to

prove – not necessary prove the doctors wrong, but helped her to progress earlier

then they said she would, so that’s really satisfying. (027)

Indeed, 80% of workers mentioned the emotional bonds with clients as part of the “good” in

their jobs. With these strong and highly valued emotional bonds, few workers were inclined to

engage in any behaviors that would jeopardize their clients’ welfare, such as formal grievances

or sudden exiting.

Loyalty to Clients Results in Self-Sacrifice These bonds often develop into strong senses

of loyalty on the part of workers, which can affect dispute resolution strategies by making some

dispute resolution options unappealing or even inconceivable. Illustrating the power of workers’

loyalty to clients, a woman at Cooperative Homecare explained that she came to her present

company because the client with whom she had been working changed agencies.

What happened was, I was looking after a client in this private agency. And, the

client wasn’t happy with [that agency], so he joined this homecare agency. Once

he transferred over, he wanted to keep me as a care giver. I liked this gentlemen

so much I decided to stay with him and move to [Cooperative Homecare] myself.

And, here I am. (068)

Rather than staying at her present job and getting new clients, she preferred to honor that bond

and change employers.

Echoing this same sentiment but with an opposite situation, a woman at Private

Homecare spoke of how she considered quitting and changing to another company where she

could make more money, but wouldn’t leave her clients.

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Because I started with Private Homecare [as opposed to another company] I’ve

got used to my clients. But really I’m cutting my nose off to spite my face.

Because, if I swapped over to the other company, I would get loads of work, loads

more money. (066)

Instead of taking the better paying job and leaving her clients, she remains at Private Homecare

so that she can continue to work with them.

Not only did loyalty to clients determine where workers were employed, this loyalty

would often motivate them to do work without pay. A woman at Private Homecare described

how she occasionally stays longer than she is paid to visit.

Sometimes I stay beyond my time because you can’t say no. You think to

yourself, there’s a few of them are on their own. They never see anybody.

There’ll be some that haven’t got any family. Just to chat with them keeps ‘em

going. Probably I feel sorry for them, sometimes. (030)

Similarly, a woman at Charity Homecare spoke of making extra visits when some clients could

not pay for them.

[Sometimes] somebody needs the service. And, the money isn’t there to give it.

And, you think, the money shouldn’t be involved, when it is. It’s the major part of

care. But, because like I’m the sort of person that do take things to heart, [it

becomes] a problem shared. But you’re important anyway, so you have to; that

all. (119)

The importance of her work, as well as her loyalty, motivated her to donate unpaid time.

A member of Cooperative Homecare described a client whom she drove to the doctor and

whose dog she watched when the client was hospitalized.

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I looked after her dog. I didn’t get paid, she paid us something but didn’t expect

anything and I treated her more like a friend. I used to go on my own time and

look after her dog and feed him when she was in the hospital. And I used to pick

her up from dialysis in my car for no extra cost or anything. (111)

For her, it was a point of pride that she did some work for no pay. She felt that this demonstrated

that she was a “good person,” who was not in the job only for the money.

Loyalty and this ethic of sacrifice also occasionally affected workers’ rights

consciousness directly. The man quoted below had been a miner before being laid off and

coming to Charity Homecare. Although he defined himself as a socialist, he said that, as a

homecare worker, he wouldn’t join their union because he didn’t want to take part of any formal

action.

You see, social services is quite a large organization and has a lot of people

working for them and everybody in that industry is represented by [union]. It’s

important that you are part of that, but [now], it really wouldn’t matter. I mean, if

I was in [union] and they decided, ‘Right, we’re going to have all of our members

on strike until we achieve a basic minimum wage of whatever.’ I mean, I’m not

going to go on strike here. [Because?] Because just wouldn’t do it. (082)

He emphasized that, although he was usually very in favor of collective action, he did not believe

in it within the homecare industry.

Thus, in the structure of the homecare industry, a formal grievance would be seen as not

simply between the individual worker and the manager, but would be a triangle, involving the

client as well. This triangular nature of potential grievances radically changes the nature of any

disputes. Any formal action could affect the care to clients. Neither the managers nor the workers

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want this; in many senses, this is their shared goal. Unlike in other industries – such as cab

driving where the managers may wish to cover shifts so that service users are not left waiting,

but the cab driver may hold no allegiance to the convenience or care of those service users (e.g.,

Hoffmann 2003) – in homecare, the managers are concerned about staffing shifts, and the

workers are similarly concerned that the clients receive timely and appropriate service. Some

argue that this transfers the balance in any labor disputes (Abel and Nelson 1990). Managers in

the care industries can exploit this concern by workers for their charges in order to avoid

potential formal disputes.

Industry Culture of Procedural Justice and Moralistic Relationships: Why “Toleration”

is Rare The presence of clients who are easily and directly impacted by most workplace

grievances creates a triangular industry structure that situates the care receiver between the

manager and the workers. The triangular structure of the homecare industry makes managers

concerned about keeping schedules filled, and motivates workers to make sacrifices in order to

ensure that their clients receive the care they need. This explains why so few homecare workers,

at any of the three businesses, mentioned formal grievances as ways to resolve disputes.

Additionally, few workers mentioned leaving as means of resolving disputes. This same dynamic

that prevented many formal grievances also deterred workers from quitting: managers need to

keep shifts filled, which is difficult if workers leave, and workers establish bonds with and

loyalty to their clients and so would be hesitant to leave them.

Yet, the rare mention of toleration as a dispute resolution strategy in the homecare

industry is particularly unique from the strategies found in many other industries in (e.g.,

Gwartney-Gibbs and Lach 1994b; Hoffmann 2003). These homecare workers seldom resorted to

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simply tolerating problems. Workers in other studies who, similarly, did not bring formal

grievances, instead chose either to quit or learned to tolerate problems (Gwartney-Gibbs and

Lach 1994b; Hoffmann 2005; Mansbridge 1982). In contrast, the workers in the homecare

businesses gained sufficient satisfaction through informal means so that very few employees felt

forced to learn coping skills in order to tolerate problems.

But why is this? The homecare managers could have capitalized on the workers’ concern

for their clients to simply thwart all grievances from being raised, formally or informally. Why

do these workers rely on informal grievances, but rarely talk about toleration and coping skills?

I argue that the structure of the homecare industry also produces an industry culture that

makes informal dispute resolution particularly satisfying for workers, so that toleration, exiting,

and formal procedures are not needed. The homecare culture supports perceptions of procedural

justice on the part of management and emphasizes morality over legality.

The literature on procedural justice helps explain this grievance behavior. Tyler and Lind

found that people are more flexible on accepting a wider range of distributive justice outcomes if

they feel they received procedural justice (2000). If the homecare workers felt that their

managers, worker-managers, and owners were engaged in procedural justice, informal dispute

resolution may have provided sufficiently successful grievance resolution to decrease the need

for much toleration of unresolved disputes. As mentioned above, Tyler and Lind assert that a

disputant will judge treatment as being procedurally just if the disputant (1) trusts the authorities

handling the problem (“trust”), (2) feels that s/he is seen by the authorities as a having full status

in the group (“standing”), and (3) believes that s/he received nondiscriminatory, neutral

treatment (“neutrality”).

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The data indicate that all three aspects of procedural justice (“trust,” “standing,” and

“neutrality” (Tyler and Lind 2000) were present in the homecare businesses. The workers trusted

the managers and cited many instances of managerial fairness and even of managers being “more

than fair.” For example, workers spoke of managers backing them up when faced with

unreasonable requests or complaints from clients, of managers considering extenuating personal

circumstances and making necessary allowances, and of managers putting in their own overtime,

such as sitting with them after the death of a client. The statement from one homecare worker

was typical of all the homecare workers: “I trust that if I go to Ellen, she’ll sort it all out.” (151).

The workers also felt that they had full standing. Workers at all three businesses spoke of

loyalty to the company and of feeling included in the enterprise. The homecare workers and

managers alike were seen as having full status in the group. The managers were seen as

comrades in the homecare effort. In this case, because all three businesses’ managers began as

rank-and-file workers in homecare, they easily accorded their workers full status and vice versa.

Because of this practical experience in the field, several workers spoke of the managers as

understanding what the workers were facing, rather than simply giving uninformed orders. This

empathy by the managers also made the workers feel more connected to them.

Additionally, the homecare workers saw the actions by the managers as being neutral and

fair. Unlike in other companies where a frequent complaint of workers was favoritism of others

by the managers/owners (e.g., Burawoy 1979; Hodson 1991; Hoffmann 2004; Paap 1999), I

heard no one at any of the homecare businesses express this complaint. The one complaint

indirectly along this theme was from some male homecare workers. They resented that some

female clients would only work with women workers, making for fewer available hours for male

workers. However, none of them blamed the managers for this. Rather, they saw it as the

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prejudice of personal taste and a result of the demographic of many of the clients: elderly women

who were uncomfortable being bathed and dressed by men.

Tyler and Lind emphasize that procedural justice is often more important than

distributive justice, i.e., how the outcome is reached is more important than the outcome of the

specific dispute itself (2000). When people experience procedural justice, they enter “group

mode,” in which they are cooperative and establish behavior based on fairness rather than

expected outcomes. Because the homecare workers perceived procedural justice from the

managers in all three businesses, their primary dispute resolution strategy was informal dispute

resolution, rather than formal grievances, exiting, and toleration skills.

Similarly, Tjosvold, Morishima, and Belsheim’s theory of “cooperative interdependence”

also explains the dispute strategies found in the homecare industry (1999). Tjosvold et al. found

that workers with aligned or cooperative goals could resolve disputes informally with mutually

satisfactory outcomes. The homecare workers and managers shared an understanding of the

primacy of client welfare, with quality and safe caregiving as their common goals. The

“cooperative interdependence” in the homecare businesses resulted in a reliance on informal

dispute resolution strategies.

This “cooperative interdependence” is similar to the “moralistic” discourse, rather than

the “legalistic” or “therapeutic” discourses, that Merry reported in her study of courts and court

mediators (1990). The homecare workers eschewed the “legalistic” approach to dispute

resolution, formal grievances; and yet directly confronted their problems, unlike the

nonconfrontational therapeutic perspective. Rather than embracing the legalistic or therapeutic,

they focused on relationships, obligations, and responsibilities, engaging in a moralistic

discourse that resulted in their emphasis on informal dispute resolution.

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However, homecare workers’ moralistic perspective was not accidental. Just as Merry’s

court mediators actively and intentionally reframed would-be litigants’ concerns from a legalistic

frame into a moralistic or therapeutic frame, in order to avoid formal dispute actions and the

subsequent difficulties in scheduling these would provoke, homecare managers try to reframe

workers’ concerns away from the legalistic and toward the moral. Legalistic disputes would be

appropriately settled through the quasi-legal forums of formal dispute resolution, which

managers would want to avoid. However, moralistic problems would be better addressed through

informal means. Therefore, homecare managers emphasized the morality of the job, such as the

quote from one of the Private Homecare owners. They also tried to refocus workers’ concerns

onto the greater businesses’ needs rather than on workers’ personal needs, as reflected in the

comment from the worker-manager at Cooperative Homecare regarding how she dealt with

workers’ desire for more money around the holidays. When this reframing is successful – that is,

when the workers, too, see their problems in moral terms – they are satisfied with informal

dispute resolution, not relying on coping skills, not exiting, not raising formal grievances.

CONCLUSIONS

The homecare workers in the three homecare businesses described informal dispute

resolution strategies, with little mention of formal processes, toleration, or exit. These results

have several important implications. One cannot assume that patterns of grievance behavior and

dispute strategies found in some industries will necessarily translate across industries. The care

industries, including homecare, have at least three parties potentially involved in any dispute: the

caregiver, the manager, and the client. The presence of the client in this triangle substantially

alters the disputing dynamic.

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Application to Extant Theory

The results also speak to the power of framing disputes into moralistic discourses. Other

studies (e.g., Merry 1990) have shown how moving disputes into moralistic discourses can

prevent those disputes from being brought into court. The results from the homecare industry

demonstrate how similar moralistic framing can prevent workplace issues from being raised as

formal actions. While some grievances might be able to be successfully resolved informally, the

lack of formal procedures implies that workers’ rights might be more easily trampled (e.g.,

Edelman, Erlanger and Lande 1993; Silbey and Sarat 1989). This is significant, especially when

one considers the many health and safety risks of homecare work. In addition, the risk to

vulnerable clients if grievances are not successfully resolved heightens this concern over

potentially undermined rights. The rights talk of care professionals, such as teachers and nurses,

often includes both the workers’ needs and the needs of their students and patients (e.g.,

Grimwood and Popplestone 1993). If homecare workers are not able to assert their rights through

formal grievance processes, then both they and their clients are at greater risk.

The homecare industry data also are linked with procedural justice. The homecare

workers perceived their managers as being procedurally just and so were willing to enter a

“group mode” in which they focused more on fairness and the best result for everyone involved,

rather than on their own needs and wants. As with the moralistic framing of disputes, entering

into a group mode mentality could permit workers’ rights to be circumvented under the guise of

procedural justice. Indeed, Tyler and Lind (2000) note that it is merely the perception of

procedural justice by the would-be grievant that affects grievance behavior – not the actual

presence of procedural justice. In fact, a degree of false consciousness regarding procedural

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justice on the part of the workers and managers would still produce a group mode, with all of its

cooperation and focus on the needs of others. The acceptance of a wider range of distributive

justice could leave workers very vulnerable and unable to raise potentially necessary formal

grievances. Since, as mentioned above, homecare grievances could protect workers’ and clients’

needs, blocked formal grievance avenues could result in harm to both groups.

Future Research

The results from the homecare industry raise many questions for future research. The

main area for future research is to compare the findings of this study to other similar industries.

In particular, the uniformity in workers’ dispute resolution strategies across all three homecare

businesses raises questions regarding whether similar responses would be found in other triadic

industries.

A fascinating direction for future research might be to study the dispute resolution

strategies of workers in a predominantly male industry with a similar triadic structure and culture

of care, as present in the homecare industry. Police and rescue workers might provide interesting

points of comparison, especially when these safety workers go on strike. However, homecare

establishes very dependent relationships between workers and individual clients, while police

and rescue workers do not form the close ties between worker and recipient. This makes their

comparisons with the homecare industry more difficult. However, if police and rescue workers

only have homecare’s triangular structure, but not its culture of caring, then perhaps future

research might investigate industries such as teaching, nursing, or nannying, instead. Yet, these

industries are all predominantly female industries, and so, while they might provide a useful

comparison, they do not offer the contrast of mostly-male to mostly-female industries.

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Table 1: Qualitative Patterns of Dispute Resolution Strategiesat Homecare Employees

Formal Processing

Informal Processing

Toleration Exit

Private Homecare 7% 100% 14% 7%

Charity Homecare 20% 90% 20% 20%

Cooperative Homecare 12% 84% 16% 16%

Percentages sum to greater than 100% because the categories are not exclusive; some interviewees mentioned more than one grievance resolution strategy. A “no response” category does not exist. All interviewees provided at least one strategy (formal processing, informal processing, toleration, or exit) that they anticipated trying to address workplace problems.

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