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Bureaucrats and old clients: dependence, stigma, and negative sentiment in the service relationship

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Bureaucrats and old clients: dependence, stigma, and negative sentiment in the service relationship

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Content BUREAUCRATS AND OLD CLIENTS : DEPENDENCE, STIGMA, AND NEGATIVE SENTIMENT IN THE SERVICE RELATIONSHIP by Stephen Robert McConnell A Dissertation Presented to the FACULTY OF THE GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of- the Requirements for the Degree DOCTOR OF PHILOSOPHY (Sociology) August 19 77 UMl Number: DP31784 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. Dlssertalien PÜMisMng UMl DP31784 Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106- 1346 U N IV E R S IT Y O F S O U T H E R N C A L IF O R N IA T H E G R A D U A T E S C H O O L U N IV E R S IT Y P A R K LO S A N G E L E S . C A L IF O R N IA 9 0 0 0 7 So ' 7 ? M This dissertation, written by S TEPHE N. .ROBE RT. McCON^ LL....... under the direction of /z.is... Dissertation Com mittee, and approved by all its members, has been presented to and accepted by The Graduate School, in partial fulfillment of requirements of the degree of D O C T O R O F P H IL O S O P H Y Dean Date. DISSERTATION COMMITTER Chairman ACKNOWLEDGMENTS I would like to dedicate this dissertation to all i jthe Gray Panthers who have filled my life with comedy, ^enthusiasm, and a respect for growing old. I j Gray Panthers have been relatively recent additions to my life; others have been instrumental in my development for much longer. The most important of these is my friend 'and lover Shirley Fiske. Besides offering me the stability ! of love, she planted and carefully nurtured the seed of I icerebral development that has been a source of growing * ! [satisfaction. Another is David Haber, who has been like a brother, leading the way, creatively challenging stale , ideas, and teaching me about life through his own struggles I I also thank my mentor, Herman Turk, whose intensity jfor life and the world of ideas is contagious. It was his jprodding, coaxing, and simple disregard for the word I I"can't" that was most instrumental in my academic develop- I Iment. Gratitude is also extended to Jim Lincoln, a true 11 intellectual with a competitive drive that extends from academia to parallel parking; to Rich Sundeen, a pillar of mellowness in a swamp of frenetic activity; to Bill Davis' |humor, gaiety, and invaluable help with the computer; to Lamar Empey for opening the door to gerontology; and to Vern Bengtson for keeping it open by providing encouragement and financial support for my journey therein. I wish to i I Ithank Ray Steinberg, who unknowingly provided a role-model jfor bridging the gap between academe and the "world out there." And appreciation is extended to Edna Bell, a multitalented mother, model, student, and rider of the RTD. Finally, my parents are gratefully acknowledged for their unadulterated love and guidance over the last 2 9 years. Their teachings of cooperativeness and brotherly ilove have provided a life goal, perhaps unattainable, but jwell worth the effort. ! This dissertation was supported in part by a grant Ifrom the Administration on Aging, Department of Health, I Education, and Welfare. Data reported here are from the ! :University of Southern California's Social and Cultural I jContexts of Aging research project (V. L. Bengtson, 111 Principal Investigator) supported by a grant from the National Science Foundation's RANN program (#Apr 75-21178), Researchers undertaking such projects are encouraged to 'express freely their professional judgment. Therefore, points of view or opinions stated in this document do not necessarily represent the official position or policy of I jthe Department of Health, Education, and Welfare or the t [National Science Foundation. iv_ , TABLE OF CONTENTS I Page ' acknowledgments.......................................... ii I liST of t a b l e s .............................................vii List of illustrations................................... ix 'Chapter j I. CLIENT-ORGANIZATION RELATIONS .................. 1 ! The Topic Importance of the Topic Conceptual Framework A Note on Terminology The Unique Nature of Client- Organization Relations Asymmetry in Client-Organization Relations Organizational Structure and Client-Organization Relations Role Expectations of Clients and Officials Summary II. THE VIEW FROM ABOVE ; OFFICIALS' SENTIMENTS TOWARD ELDERLY CLIENTS ...................... 54 Review of Previous Research Theoretical Orientation Research Procedure Organizational Roles and Negative Sentiment V Chapter Page III Positive Evaluations of Elderly Clients Summary THE VIEW FROM BELOW: OLD CLIENTS' ATTITUDES TOWARD GOVERNMENT AGENCIES ............. 115 Theoretical Rationale Hypotheses Aging and the Stigma of Dependency The Effects of Stigma Research Procedure Research Results S ummary IV SUMMARY AND CONCLUSION 161 Practical Implications Limitations of the Study APPENDIXES I ! Appendix A: Appendix B : Appendix C: I Appendix D: i Appendix E : Appendix F : BIBLIOGRAPHY Zero-Order Correlation Matrixes for Organizational Officials . 180 Description of Sampling Procedure for Organizational Officials ........... 184 The Four Hierarchical Levels of Organizational Officials by Job Title and Organizational Affiliation . . 188 Survey Items Asked of Organizational Officials ........................... Survey Items Asked of Elderly Clients 196 199 Zero-Order Correlation Matrixes for Elderly Clients (Chapter III) ......... 20 3 206 vx I LIST OF TABLES I 'Table Page I I 1. Factor Loadings (Varimax Solution) on Attitudes toward Elderly Clients i Among Organizational Officials ................ 64 2. Correlates of Officials' Negative Sentiment toward Elderly Clients ........................ 74 3. Interaction Effects of Low Hierarchical Level and Frequent Client Contact on Officials' Negative Sentiment toward i Elderly Clients ............................... 82 : 4. Effects of Officials' Role Orientation, Client Contact, and Level in the Organiza tional Hierarchy on Negative Sentiment ■ toward Elderly Clients ............. .... 90 j 5. Main and Interaction Effects of Officials' I Role Orientation, Client Contact, and Hierarchical Level on Negative Sentiments toward Clients ........................... 93. ! 6. The Effects of Hierarchical Level, Client Contact, and Breadth of Client- Organi zation Relationships on Officials' Negative Sentiment toward Elderly Clients . . 9 7 ' 7. Interaction Effects of Hierarchical Level, Client Contact, and Breadth of Client- Organi zation Relationships on Officials' Negative Sentiment toward Elderly Clients . . 9 8 VI1 Table Pagej I j 8. Triple Interaction Effects of Hierarchical Level, Client Contact, and Breadth of Client-Organization Relationships on Officials' Negative Sentiment toward Elderly Clients ............................... 100 9, Correlates of Officials' Positive Evaluations of Elderly Clients.......................... 10 7 10. Regression Coefficients for Dependency, Embarrassment, and Anger Measures (Males) . . 142 11. Regression Coefficients for Dependency, Embarrassment, and Anger Measures (Females) . 14 4 12. Correlation Matrix for All Negative Sentiment and Positive Evaluation Items ............... 180 13. Zero-Order Correlation Matrix, Organization Officials........................................ 181 14. Zero-Order Correlation Matrix, Organizational i Officials........................................ 182' 15. Correlation Matrix, Elderly Male Clients .... 203 16. Correlation Matrix, Elderly Female Clients . . . 204 viii LIST OF ILLUSTRATIONS Figure Page 1. Examples of Constraints on Officials and Clients at Both Societal and Organiza tional Levels of Analysis.................... 10 2. Relationship between Perceived Instrumen tality of Client and Role-Orientation of Service W o r k e r ............................ 8S 3. Scale of Organizational Types Based on the Breadth of Client-Organization Linkage........................................ 9 5 4. Path Model of Causal Relations Among i Background Variables, Perceived Dependence, and Elderly Clients' Per ceived Relations with Government Agencies...........................................135 XX CHAPTER I CLIENT-ORGANIZATION RELATIONS The Topic Persons live major parts of their lives today as members, beneficiaries, supporters, or targets of organi zations. Notable among these organizational relations is that which occurs between an organization's representatives | I and its clients. Considering the ubiquity of such rela- i tionships, it is curious that they have been slighted by research. Our interest here lies in the members of a socially deprived client group, the elderly, who are heavily dependent for their existence on those organizations called service bureaucracies. In this research— a rare instance in which clients and bureaucrats are studied within a common framework— we emphasize the structural roots of the solidarity-inhibiting aspects of interaction between incumbents of these two roles. We develop conceptually the constraints placed upon the bureaucrat that require impersonal and imperative treatment of the client and which, in turn, foster noxious feelings of dependency and consequent embarrassment or anger in the client. We consider equally important, and also develop, the client's need for personalized treatment and respect that cause strains for the constrained bureaucrat and consequently engender negative sentiment toward the client. Findings are to be presented which indicate that, although the broader social structure affects client responses to organizations, there is little evidence that I I considerations outside the organization itself have much to I do with how the bureaucrat reacts to the client. Importance of the Topic Most people have experienced some form of frustra tion, anger or embarrassment in their dealings with service bureaucracies. Either the organization is inefficient and sluggish, or it is so impersonal and efficient one feels | personally "ripped-off." While the claim has been made that criticisms of bureaucracy have declined in recent < ' I :years due to an increased acceptance and familiarity with i [bureaucratic procedures (Hofstadter, 1964), there is little jevidence that this has happened for the more deprived > i ^ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ J -----3i groups in society who must rely on public bureaucracies for ; their existence. One such deprived group is the elderly. Growing bid in modern society is increasingly associated with grow- , ing more dependent on a plethora of service bureaucracies. Reaching the age of 62 qualifies a person for, and fre- iquently forces him/her to rely on, the social security bureaucracy and/or some other private or public pension organization. Advancing age carries increased health I (problems and with them an increased use of health services. i |Furthermore, there is a boom in government services for the 'elderly ranging from public social services, such as medi caid, food stamps, and rent supplements, to home-help services, senior centers, legal services, physical and men - 'tal rehabilitation, information and referral, friendly [visitors, day care . . . the list goes on ad infinitum. ! Despite this growing concern for the elderly within I ;the service sector of American society, comparable atten tion has not been paid to the relationship between elderly jclients and representatives of the various service bureau- | I icracies. There is some evidence that the elderly under- | jUtilize services (Shanas and Maddox, 1976; Powers and Bul- jtena, 1974). It is possible that this underutilization is j related to problems in perceived or actual relations with j I service bureaucracies? For example, are the elderly dis- j criminated against by bureaucrats? There some evidence | that the stereotypes of professionals and service agency j ! I I I 'representatives are no less negative than those which exist I jin the wider society (Troll and Schlossberg, 1970; Cyrus- Lutz and Gaitz, 1972; Campbell, 1971; Spence and Feigenbaum, 1968; Kosberg, et al,, 1972). Do the elderly fee1 stig matized dealing with service agencies? There are indica tions that older people are embarrassed as welfare clients (Welle, 1973) and feel that admission of illness or need is a sign of weakness (Shanas and Maddox, 1976). Do the elderly lack knowledge about services and how to deal with bureaucracies? The elderly have been described as suffer ing from "bureaucratic deprivation" (Kent and Matson, 1972). The results of this study have both theoretical and practical implications for the sociology of organizations jand the sociology of aging. While there is increasing jattention being paid to the client-organization relation- ! % ship by organizational sociologists, there is still a paucity of research in which the respective orientations ! of clients and officials are conceptually linked to one janother. Also, most studies of client-official relations are of the case-study variety analyzing a single welfare agency, employment agency, hospital or prison, mental hos- ipital or customs office, school or police department. By examining more than one organization we can determine the I [extent to which organizational factors, providing they are j I limportant at all, are relevant across types of organizations representing a variety of sectors. Furthermore, this study ; is a replication of previous research which found that | properties of the organization itseIf--its structure, goals,! and norms— affect client-organization relations (Katz and I Danet, 1966; Blau, 1960, 1964; Seeman and Evans, 1961; | Rosenberg and Pearlin, 1962). Finally, a contribution is | made to the sociology of organizations based on comparisons I ! bf organizational, personal, social psychological, and i j professional properties as they relate to the client-organi-; zation relationship. j A contribution is made to the sociology of aging in i two ways. First, a limited amount of research in aging has considered the perspectives of practitioners, professionals,» I and administrators toward aged clients. But with only very I jfew exceptions, previous research has relied on analyses of ; I I personal factors, such as age, education, and professional | jsocialization, as they purportedly affect officials' 6 attitudes and perceptions. As a result, large amounts of data have been amassed showing, for example, that negative stereotypes increase with age (Thorson, et al., 1974), (decrease with age (Borges and Dutton, 1976; Newfield, 1971), i land show a curvilinear effect with age (Kilty and Feld, ! I ■ 1976). At best, these studies rely on a loose conceptual i I framework regarding one's location, in a social structure , and the effects of this location on attitudes. But seldom | j are these results linked to sociological or social-psycho- j logical theory. This study provides such a linkage. Second, if we accept the assumption that the mean - i ing of old age in modern society is socially constructed (cf. Estes and Freeman, 1976), gathering knowledge about the perspectives of the many bureaucrats and professionals who play a large part in defining this reality for the elderly is a worthy endeavor. Frequently, the elderly are arbitrarily forced into dependency and, therefore, must rely I jon service bureaucracies for much of what the "under 65" ipopulation gets from private sector economic organizations. Although these service bureaucrats are more powerful than , most of the elderly they serve and therefore, their con tributions to the reality of old age is probably of greaterj importance, an analysis of the twin perspectives of clients and officials is crucial for understanding the ultimate reality of old age. Why study elderly clients? Some may argue that a client group is a client group and that what is important 'is the universal contingencies affecting client-official I (relationships. But the elderly are particularly worthy of I study not only because their rapidly increasing numbers | I prophesizes increasing demand for social services (Bengtson,! / et al., 1974) but also because of their unique position in society. Most of the elderly who in old age are dependent i on government agencies had previously been independent, j productive, and autonomous members of society for most of ; Itheir lives. Furthermore, the status of the elderly in I ! jsociety is such that they are caught in a cross-fire of 'negative and positive stereotypes, though admittedly the i ' I I I [negative view tends to prevail. Because some people view | j I jthe elderly as bitchy, rigid, and wise, how will this affect jthe relationship between an official and his/her elderly i jclient? Will societal stereotypes prevail over the effects jof the organization or of professional socialization? Might ! i (the fact that the elderly are a relatively visible and | (Specific target population, if for no other reason than jthat they are retired and receiving social security. 8 influence the perceptions of service bureaucrats toward them? What affect does the image of the elderly as a legitimate welfare group (Hoshino, 197 3; McDonald and Mar tin, 1972) have on dealings with service bureaucrats? Conceptual Framework ' We begin by assuming that the orientations of social; actors are functions of both their structural locations and ; normative exposures. Social structures consist of config- | I jurations of social relations which are important above and j jbeyond the specific characteristics of individual actors j [which make them up. These configurations are enduring and i i ! tend to place external constraints upon individual choices i and behavior in the form of role expectations. While these | role expectations are not immutable, role occupants tend to , view themselves and others in terms of their relative posi- j tions in structured relationships and according to norma- | tive patterns. Furthermore, we assume, along with Merton, | . . . that it is fundamental, not incidental, to the | paradigm of structural analysis that social structures , generate social conflict [emphasis his ] by being differentiated, in historically differing extent j and kind, into interlocking arrays of social statuses, i strata, organizations, and communities which have | their own and therefore potentially conflicting as | well as common interests and values. (Merton, 1975: ; 35) 9| The social structure of client-organization rela- | I 1 tionships is based on a division of labor, interdependence, ' and asymmetry. The relationship differs from non-service organizational relationships in that the client is more intimately involved in the output; clients of service organizations are both consumers and, in part, producers of a given service. The closer involvement of clients in the service relationship, combined with an absence of other mechanisms of accountability, requires a minimum of shared orientations between clients and officials for the service relationship to be carried out effectively. But there are structural and normative factors in the service relation ship which conflict and thereby inhibit or enhance shared orientations by affecting the respective sentiments of officials and clients toward one another. The structural and normative constraints which impinge on the client-organization relationship can be categorized into three levels : societal, organizational, and situational (Katz and Danet, 1973). Given the limita tions in scope of this analysis, only the societal and organizational levels will be examined. Thus, we will examine structural and normative constraints at both socie tal and organizational levels (see Figure 1) as they 10 1 affect the sentiments of clients and officials. j 1 ! Level of Analysis 1 1 Constraints on Clients and Officials j Structural 1 Normative ' Societal Organizational status hierarchy expectation ; of independence hierarchy of authority bureaucratic I role orientation [ Figure 1.— Examples of constraints on officials and | clients at both societal and organizational levels of analysis. An important structural arrangement affecting clients and officials, for example, is the asymmetry which | I characterizes their relationship to each other. At a soci- ; etal level this asymmetry is manifested in their differing I social statuses; officials are generally middle class while | I their clients, especially if they are old or are clients ' I of public service bureaucracies, are drawn from lower class j backgrounds. Asymmetry at the organizational level is best . irepresented by the difference in authority between clients \ I . ! I and officials, a difference which affects the definition i of the service situation, the ability to generate rapport, or the development of feelings of powerlessness in the ! ^ ^ client-organization relationship. Examples of the norma- | tive counterparts of these two levels of analysis are, ! I [respectively, societal emphasis on independence but bureau- ; i I Icratic emphasis on adhering to rules. I i I The emphasis in this research centers around those i : (structural and normative constraints which contribute to conflict among clients and officials. Limitations of data ! prohibit looking at specific relationships between bureau- , crats and clients. Therefore, such relational properties I as conflict and solidarity cannot be operationalized. How ever, conflict plays a central role in this research and will be used as a hypothetical construct to interpret observed relationships between social structural, normative jor personal variables, and negative sentiments, embarrass ment, and anger. i Three specific sources of conflict are examined in i jthis study: (1) unequal exchange relations among officials : 1 I jând clients due to asymmetry in resources, status, know- jledge, and authority; (2) bureaucratic role constraints which contribute to role strain among low level officials who are in constant contact with clients ; and (3) competing expectations from the organization and society which affect : I clients' perceptions of self vis-a-vis the service j ■' ' 121 organization. Further elaboration of these sources of con - i flict draws upon four theoretical approaches ; client- ' jorganization relations, exchange theory, bureaucratic I ; [theory, and s^^mibolic in ter act ion ism/role theory. A brief 'sketch is provided below of the value of each theoretical [orientation for understanding conflict in the service relationship and the sentiments of clients and officials I {toward one another. Following this sketch, the remainder of the chapter is designed to flesh-out these conceptual issues, some of which are examined empirically in the remaining chapters. I Theories of client-organization relations alert us to the structure of the relationship between clients and organizations as this affects the potential for conflict and negative sentiment among clients and officials. One important structural component is the breadth of the rela- I jtionship, i.e., the extent to which the "whole client" is I considered organizationally relevant. The more aspects of I the client that must be served by the organization, the I greater are the problems of compliance (Lefton and Rosen- gren, 1965). These compliance problems may create strains for officials who are charged with enforcing compliance, I which^ in the presence of other conflicting expectations, | 131 I may contribute to negative sentiment toward clients. | I I Although it is not examined in this study, breadth may also I 'be associated with client-resentment over encroachments on | their privacy by the all-encompassing organization. I Interdependence and asymmetry in the client-organi- j zation relationship suggest the value of applying an ex- j I change theoretic approach. clients and officials enter i into a service relationship with differing levels of I resources which can be exchanged. The greater resources ; and power of the organization provide the official with the ability to contribute unequally to the definition of the j (Service situation and to extract compliance from clients who are "dependent" and in possession of relatively few resources. The extraction of compliance can have an affect on conflict between clients and the organization. For example, the client may experience resentment if he/she I |feels the norms of fair exchange are broken. This is most [likely among clients who feel the organization is taking more than it has a right to and among those who feel they I 'are in control of sufficient resources that they should not have to submit to the compliance demands of the organiza tion . I Resentment and anger may be projected onto the ' 14! organization by clients resulting in conflict and strain : i between officials and clients. However, if the client legitimates either the organization or the official, resent-- ! ment and anger are less likely to occur (or, they may be j i directed toward self) and the potential for conflict between client and official is thereby reduced. Thus, the princi- Iples of exchange theory are useful for predicting conflict in the service relationship. ; Bureaucratic theory is useful in isolating sources \ of conflict which result from the structural and normative i jarrangements of the organization itself. Organizations are | I Icharacterized by formal rules, a hierarchical authority j I i 'Structure, and norms of affective neutrality. The lowest ! Ilevels in the organizational hierarchy are allowed the least I 'flexibility in role performance and are monitored more Iclosely than higher levels. While the lower level offi cials are responsible for directly meeting clients' needs, - I rewards emanate from higher organizational levels rather ! than from the clients themselves. Consequently, when | clients make demands which are outside the lower level | i lofficial's tightly drawn role constraints, role strain may | I i (occur which in turn may lead to negative sentiment toward i I jclients. J 15 Symbolic interactionism and its counterpart, role theory, help us to understand clients' reactions to bureau cratic demands. From the client's perspective, the organi zation is the source of two kinds of conflict. The first Isource of conflict results from the organization's require- I ments that clients play a dependent role. But dependency is i stigmatizing and is in direct contradiction to the broader societal norms for independence and autonomy. Therefore, the client is caught between the conflicting expectations of organizational and societal norms. clients' reactions to these conflicting expectations vary according to percep tions of self. If the client sees him/herself as dependent and thereby accepts the implied stigma, embarrassment is likely to result. But if the client deems the stigma of dependency to be inappropriately applied, anger or resent ment is likely to result. The second source of conflict for the client is the organizational norms of affective neutrality, specificity, and universalism. clients are individuals with unique problems and concerns. Yet, the organization treats them as jif they are undifferentiated units in a narrowly defined I jcategory. Demands by clients which exceed the boundaries jof the organization's definition of service are met with 16 what appears to the client to be bureaucratic rigidity and indifference. Clients who are unwilling to tolerate this perceived indifference become angry and may challenge the organization to treat them more diffusely. While these ^challenges may generate an increased sense of efficacy 'among clients and may even achieve results from the organi zation, they are a further source of conflict in the service relationship. In sum, conflict between clients and officials develops over competing expectations based on organizational and societal norms. The power of the organization allows jit to define the role of the person as client, which in cludes expectations of dependency. But attributes of the client as person, i.e., individual client needs for inde pendence, may conflict with the client role defined by the i 'organization. This conflict may generate negative senti- i ment toward clients among officials. Furthermore, the I organization's expectation of client dependency implies I stigmatization. clients who accept the stigma of depen dency are likely to experience embarrassment, while those who deem it to be inappropriately applied are likely to become angry. ït] A Note on Terminology | I Throughout this chapter several terms are used | which need clarification. First, the major variables we j are attempting to explain in this research are attitudinal. ;More specifically, we are concerned with the attitudes of ! I bureaucrats toward elderly clients and with the attitudes I I I of elderly clients toward their relationships with govern - I ment agencies. But the term attitude will not appear in i I this study except when discussing previous research. i Rather, the terms "negative sentiment" and "positive evalua tions" will be used to describe the attitudes of officials i toward elderly clients ; "embarrassment" and "anger" will be used to represent the attitudes of elderly clients toward the service agency. Second, the terms solidarity and conflict are used ' in this chapter to describe in very general terms the extent; to which clients and officials share expectations, orienta- ; tions, or values. As we noted above, neither solidarity nor conflict are operationalized in this study. But we i I assume, and it will be supported in greater detail below, ; ! that conflict contributes to negative sentiment, anger or embarrassment, while solidarity tends to inhibit these. Thus, by demonstrating the theoretical relationships between 18] I conflict and organizational, personal and societal factors, we can cull several testable hypotheses which enable us to explain officials' negative sentiment and clients' anger or ! Iembarrassment. Finally, the remainder of this chapter is a review of a very disparate literature on client-organization rela- , I tions. Based on this review and our theoretical framework i stated above, we will derive propositions and hypotheses. ; Propositions, as the term is used here, state a relationship between two or more properties, at least one of which is a i hypothetical construct and will not be operationalized in j this research. Hypotheses, on the other hand, refer only to relationships between two or more properties that are : I operationalized and tested in the following chapters. j I What follows is a detailed discussion of the struc- j tural and normative constraints on organization-client | i relations. Following a brief discussion of the uniqueness j of service organizations vis-à-vis other types of organiza- : tions, the discussion turns to the structural components of j asymmetry which characterize the service relationship. ! Next we turn to the organization itself and discuss the ' I effects of hierarchical authority relations on clients and t officials. Moving closer to the actual relationship between Î 9 | I clients and officials, we then examine the effects of | asymmetrical resource distribution on the definition of the ' I service situation, the official's ability to establish | rapport, and clients' feelings of powerlessness. Finally, we turn in the last section to the specific normative con- i I Istraints, both organizational and societal, which influence the service relationship. ! I The Unicfue Nature of Client-Organization j Relations j How do service organizations differ from their j economic counterparts? What are the unique characteristics j of service organizations that make them worthy of study in their own right? ' According to Hasenfeld and English (1974), three characteristics differentiate service organizations from other types of formal organizations. The first is that the I outcome of the organization is largely dependent on the ! nature of the client-organization relationship. The second ; is that clients are often more dependent on any given ser- j vice organization due to the lack of alternatives from which j to choose. The third is that the client is both recipient | of service and object which the organization attempts to ! change. 20, Perhaps the*most important difference between service vis-à-vis other types of organizations is based on the extent to which the client is incorporated into the process of producing and delivering the service (befton and i Rosengren, 1966; Parsons, 1970). Economic organizations produce goods which clients either purchase or ignore ; at best, the relationship is distant. Service organizations, jon the other hand, rely to varying degrees on the partici pation of the client in the actual production of service. I For example, schools cannot simply place education on a Ishelf and expect people to purchase it. The client, i.e., student, must participate with the school in producing I"education." Similarly, patients as hospital clients must I in some way help produce "health" by responding physically ■to treatment. Therefore, officials of service organiza- I tions and their clients must share certain values and expec- i jtations regarding service (Parsons, 1970). , The mere fact that clients and officials of the service relationship share certain minimal values and expectations does not imply that solidarity exists among j I them. In fact, conflict may be more prevalent in service . relationships than in other types. 2 1 1 Buyers and sellers of services, especially in , the quinary sector, are more closely bound together j than buyers and sellers of tangible goods. The closer and more enduring relationship entails a | potential for more sustained and intense antagonism j than exists in the impersonal and fleeting encoun- I ters of the tangible goods market. (Gersuny and I Rosengren, 1973:131) I I . Thus, the issue of solidarity among members of the service collectivity becomes problematic (Parsons, 1970). The i relationship can be characterized by "freedom and constraint^ I repulsion and attraction, conflict and consensus" (Gersuny and Rosengren, 1973:124). Client-official relations are based on interdepen - ! dence, reciprocity, and a division of labor, each of which contributes to the development of either compatible or conflicting orientations. But perhaps the most important component of the relationship is asymmetry. Simply, clients; are in possession of fewer resources, less knowledge, less ' I authority, and lower overall status vis-à-vis the official. i However, like interdependence and reciprocity, asymmetry in ; relations can also lead to varying degrees of solidarity or : conflict. j i The division of labor and interdependence between j clients and officials is not clear-cut. As mentioned above,; the production and consumption of services, in part, inhere , _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ I I in the same individual as clients and officials alike are expected to contribute to the production of the relevant outcome. Furthermore, the existence of a division of labor and interdependence set the stage for conflict because the I [interests of clients and officials are often divergent. ,Clients need the services provided by the official and to j varying degrees the official needs clients for revenue and j legitimacy. But officials, especially in the public sec- i I tor, are responsive to the employing organization, to | elected officials, often to anything but the client. There-! I I fore, the asymmetry in orientations or interests of clients j and officials may contribute to conflict. ^ Conflict is not inevitable in client-official rela- | I I tions because like other relationships based on a division i of labor, there is some form of social contract which j I governs the activities of participants. The social contract I between officials and clients is one of exchange. Both I parties in exchange relationships incur certain costs and ■ receive certain rewards and the process is governed by norms of fairness or reciprocity (cf. Homans, 1961; Blau, 1964). If one party to the exchange perceives a departure from the norms of fair exchange, resentment and anger are likely to result. 23! i As will become obvious in the following section, ' clients are not equal partners in their relationship with officials. The mere fact that a client approaches a ser vice organization seeking services implies that he lacks self-sufficiency. This lack of self-sufficiency combined with the subordinate role of clients and the obligations incurred as a recipient of services places the client at a disadvantage to the more powerful service provider. Fur thermore, the constraints on elites which serve to maintain accountability in other asymmetrical relationships— disci plines of the "market," the coercive power of the vote, or jadministrative authority— are not operative in the service I j jrelationship (Parsons, 1970). Therefore, accountability is,j ! ' : in part, maintained via the mechanism of trust or confi- I jdence on the part of the client and trustworthiness on the i part of the official. While the issues of trust and trustworthiness cannot! ! be empirically analyzed in this study, they are mentioned ' here because they point up the importance of compatible I expectations in effective service relationships. For j I ! I example, if clients are committed to a service relationship| this may neutralize the potential conflict over being cast in a dependent position, of being "on the dole," of being forced to comply with organizational demands. A good j I example of the power of trust in overcoming the potential ; I stigma of being a welfare recipient, is that associated j with Social Security. The fact that Social Security is a [redistributive program, thus making it a form of welfare, I : is a well-kept secret (Hollister, 1974). If the secret were to become widely known the program might be jeopardized. | The insurance concept is extremely important for the legit imation of Social Security because the American public, particularly the older segment, is reluctant to participate in "welfare" programs. Therefore, Social Security functions because of the trust on the part of both contributors and recipients. In sum, service organizations differ from other types of organizations because of the unique nature of client-organization relationships. Clients and officials of ! service organizations are members of an asymmetrical, inter dependent social relationship governed by rules of exchange. Asymmetry and interdependence in turn set the stage for the (emergence of conflict or solidarity and, by definition, [ I (contribute to varying amounts of negative sentiment, anger ' ! I lor embarrassment. The next section describes the major j I structural elements of asymmetry in client-official j relations. Asymmetry in Client-Organization RelaLlous Client-organization relations are essentially asymmetrical. Asymmetry exists in terms of: (1) differen- j tial control of tangible resources; (2) different statuses; ^ (3) incongruent knowledge; and (4) differing amounts of authority. In the broadest sense, the bases of asymmetry fall within the broad category of differential control of resources. Thus, the imagery of social economics applies to the relationship and has been rather eloquently applied j I by Rosengren (1970). Drawing upon Rosengren's analysis, I then, this section is a review of the differential resources available to members of the client-organization relation - ! ship. I Tangible resources It has been suggested that professional services were bureaucratized in order to distribute resources more evenly (May, 1976). However, the process of bureaucrati zation carries its own demands for survival which inhibit its ability to redistribute resources. In the case of ser vices to the poor and deprived, necessary resources flow into the organization from sources other than the clients 26 themselves. This factor alone reduces the amount of con trol that any client can exercise over the delivery of services (Moore, 1970:205). Thus, clients who are receiving} i services from bureaucracies funded by the government or from charitable funds are especially lacking in means for controlling the service relationship. To whom is the organization responsible if not the client? If funds come from private sources the organiza tion must be responsive to the values of the donors. Fre quently these donors are members of the middle and upper jclasses and their benevolence may not extend beyond pater- Inalistic tokenism. If funds derive from government sources |the organization must be responsive to election-conscious politicians who are concerned with short-term, highly jvisible projects that result in immediate pay-off (Binstock 1 [and Levin, 1976). The source of bureaucratic revenue, then, limits the kinds of services which are provided and the types of clients the organization serves. Due to a variety of self-maintenance needs, bureau- jcratic service organizations frequently have been found "to neglect those in greatest need of their services" (McKinlay, jl972: 132). A good example of this process is provided in a study of welfare agencies serving the blind (Scott, 1967). 27 A careful analysis of demographics and of available ser vices uncovered the fact that 90 percent of services for the blind are provided for 30 percent of the blind popula tion. This was not the result of mistakes or a simple jshortage of resources. Rather, there are strong societal forces which structure this situation. It turns out that ■ I I 70 percent of all blind people are old; old people are ! devalued in American society; resources for agencies dealing with blind emanate from the private sector which is inte rested in getting more "bang for the buck"; therefore, 90 I percent of the services are provided for blind children I despite the fact that they comprise only 30 percent of the ; blind population. In sum, organizations select clients on | I the basis of survival considerations. If these considéra- j tions are not within the control of the clients themselves ' i organizational decisions will be made on other than client- I I centered criteria. j i Clients are often left with limited power because | organizations can traffic in more than one market, i.e., with clients and with other organizations, but clients cannot (Rosengren, 1970). For a variety of reasons the client is more dependent on the organization than vice versa. This problem is particularly acute in the case of public social services. When poor clients do not have a choice of welfare bureaucracies, the single agency that exists in a community has a virtual monopoly over all clients. Furthermore, the bureaucracy can, and often must, Iexchange resources with other organizations as well as with I clients. This reduces the absolute amount of control clients can exercise over the agency. In sum, asymmetry in tangible resources and the ability to operate in more than one market give the organi zation the edge in power over clients. This asymmetry sets the stage for frustrations and a sense of powerlessness among clients and under certain conditions may lead to con - | flict between clients and the organization. j I Differential status I A second source of asymmetry is the different sta tuses of clients and officials. Most officials are drawn from middle-class backgrounds while most of their clients 2 come from less privileged status groups. This difference in status levels is indicative of differing life experi ences and socialization patterns that can give rise to mis understandings and conflict between clients and bureaucrats Differences in status have been found to be responsible for 291 unsuccessful service relationships when, for example, a | middle class therapist's expectation of service as "talk" I conflicts with the lower class client's expectations that he receive something more tangible (Overall and Aronson, 1965). Furthermore, low social status may inhibit the client's ability to comprehend and deal effectively with the service bureaucracy. Low social status clients have less experience in bureaucratic modes of operation. There is a tendency for lower social classes to expect affectivity and diffuseness in relationships both of which are contrary to the norms of bureaucratic organization (Gans, 1965). It has been posited that lower social classes are less con strained in their belief systems, less politically sophis ticated and less able to conceptualize abstract issues (see Converse, 1964). This may prevent a lower class client from understanding the segmental and specific relationships of bureaucracies. Similarly, low social status of client implies differing world views between client and provider which may inhibit the provider's ability to understand the client. Therefore, one effect of social status differences between clients and officials is the obstacle it creates in communication. Additional problems related to status differences 3 0' have emerged in the literature. These are summarized by McKinlay (1972): 1. The values, norms and life-styles of middle class service providers inhibit their sensitivity ! and understanding of the problems and orientations I of lower class recipients; I 2. Lower class clients project needs, inter- j action styles and patterns of acting which are dif- ! ferent than the middle class providers; 3. Lower class clients receive differential treatment which is related to the degree of simi larity in backgrounds between provider and client. In short, when lower class clients confront middle class bureaucrats, a variety of problems in communication and understanding may generate conflict between officials and clients. lAuthority and knowledge Two additional sources of asymmetry between clients and service bureaucracies are authority and knowledge. If jthe client accepts the superiority of the provider's posi- I ition of authority and expertise, conflict is unlikely. The . medical profession is organized around preserving its I I [exclusive hold on knowledge and authority in the health i . I icare field. Similarly, professional associations are a | means of maintaining the legitimacy of expertise for ser- |vice professionals. Superior knowledge in combination with 3Ï1 I bureaucratic organization, which is designed to establish j clear lines of authority based on position rather than on ! personal attributes, place the client in a clearly subordi nate position and can generate either conflict or compati bility in the service relationship. I Differential knowledge, and the providers' need to I maintain exclusive rights to this knowledge, will generate conflict if the client tries to gain access to this privi- | leged information(Haug and Sussman, 1959). For example, if I a patient tries to do his/her own diagnosis the physician ' 1 I may become defensive. Physicians go to great lengths to ! preserve their autonomy by using jargon to describe common ! sense diseases and by withholding information from the pub- jlic. In fact, the biggest criticism patients have of the ; I I I medical treatment they receive is that doctors do not give i them enough information (Cartwright, 1964; Duff and Hol^ | linshead, 1968). Power resources always favor the official but there | are variations in this power based on the official's rela- | tive position in the stratification system of the larger society. Thus, physicians often are able to coerce patients into behaving "appropriately" while social workers and less prestigious professionals are less able to do so (Bidwell, 32| I 1970). For example, doctors have been described as "aposto lic" because of their attempts to convince patients that they have the disease the doctor thinks they have (Balint, 1968). Asymmetry and conflict The superior power of both the organization and its ' representatives place the client at a definite disadvantage in terms of defining the service situation. While the ex pectations of both officials and clients are relevant to the situation, the clients' ability to define the situation pale in comparison to the officials' because "... the capacity I to convey effectively a definition of the situation may be of little use if one is not in a position to give example, ’ exchange, punishment, etc," (Goffman, 1959:241). clients, ! I particularly those who are elderly, retired, and poor, are I I dependent on official definitions of the service relation- j ship because compliance may be their last remaining resource^ I which can be exchanged (Dowd, 1975). ' I i Differing definitions of the situation by clients j and officials generate antagonisms and strain. One common I [problem results when the client defines his/her problem as ; I an emergency but the official sees it as routine (Gersuny i 33 and Rosengren, 1973). These mismatched definitions of the | I I situation often result in intense frustration for clients j and officials alike. | I There is some indication that clients are beginning I ito organize and to demand greater participation in defining , their relationships with service bureaucracies (Tripi, 1974;; I Haug and Sussman, 1969). Also, Goffman has written about | the "underlife" in public institutions which inevitably | develops to subvert the development of complete bureaucrati-j i zation (Goffman, 1961). However, despite these noble r : | efforts by clients, the evidence still favors the organiza- | jtion as having most of the power in defining its relation- [ ships with clients (Rosengren, 1970). j If the greater power, knowledge or expertise of the I official is legitimized as prestige it may enhance solidar- ; ! ity in the relationship. It can be argiied that the gap ' between client and official is similar to that between ' administrative and service delivery levels within the organization: "both are based on special competence and authority" (Parsons, 1970:5). Solidarity between these I levels operates on the basis of influence. Prestige, according to Parsons, is the "code component" of the influ ence system in organization-client relations. It follows. 3^ then, that the more prestigious the official, the less the conflict between officials and clients. i Regardless of the prestige of the official, a necessary component of compatibility in the service rela tionship hinges on client voluntarism (Parsons, 1970). Voluntarism is particularly relevant to older clients because the elderly are frequently cast into a dependence on public service organizations as a result of mandatory retirement, declines in income, health problems, and nega tive societal stereotypes. When the relationship between I client and official is perceived to be involuntary by the client, other factors must come into play to establish ' solidarity. These other factors relate to the profes- j sional's reputations, perceived competence, or status in ; the larger society, or to the client's perceived absence of I alternatives. If both voluntarism and all other factors j I are absent, client commitment to the relationship is prob- | i I lematic. I I I It is important to note that the absence of volun tarism may also lead to the opposite reaction by dependent clients ; resignation. Simply, if there is no other choice, why bother being mistrustful? This has lead Bidwell (1970) to suggest that the greater the dependence of the client - _ . ^ - 351 (specifically, the less knowledgeable he is) the more abso- . lute must be his/her trust in the service relationship (Bidwell, 1970:40). I The above discussion suggests that .involuntarism canj (lead either to greater or lesser client commitment to the Iservice relationship. A possible resolution to this appar- I ■ ent dilemma resides in the client's definition of his/her problem. To the extent that the client views his/her I problems as personal, i.e., not the result of some external ; cause, he/she is more likely to legitimate the power or knowledge of the official and to accept the inevitability of an involuntary relationship. But if the client views the blame as externally rooted, e.g., discrimination, there jis less chance that he/she will accept involuntary servi tude regardless of the status of the Official. 1 I In sum, the above discussion of asymmetry in rela- jtions between clients and service organizations leads to one conclusion : all client-organization relations embody jthe potential for conflict or solidarity due to differences between officials and clients in terms of social status, control of tangible resources, authority, and knowledge. , : I 'Asymmetry in resources, then, is the predominate charac- | jteristic which runs through all client-organization rela- I I tionships. I 36! Five propositions are implicit in the previous dis cussion : 1. The greater the asymmetry between clients and officials, the greater the likelihood of miscommu nication between them; 2. The greater the miscommunication between clients and officials, the greater the conflict; 3. The less responsive is the organization to its clients, the greater the conflict between officials : and clients; i 4. The greater the involuntarism among clients-- j providing the client does not accept the blame for | his/her own problems— the greater the conflict between officials and clients; 5. The greater the authority, prestige, or legiti- j mized expertise of the official, the less likely j the conflict between clients and officials. I Assuming that conflict is predictive of negative , I sentiment we can state the following hypothesis based on | I I proposition number five: j The greater the authority, prestige, or ligiti- ; mized expertise of the official, the less the nega tive sentiment toward clients. Organizational Structure and Client- Organization Relations Interaction between officials and clients occurs 37] within the confines of organizational boundaries and regard-| less of the personal or professional characteristics of | individuals the structure of the bureaucracy will have an impact on the form and outcome of interaction. The argument is that organizations structure the experiences of organi zational representatives and clients in ways very similar to those of stratification systems in society, by limiting experiences and patterns of interaction. Therefore, the characteristics of an organization, as well as the structure of the linkage between organization and client, will in turn structure the perceptions and attitudes held by organi-i zational representatives and clients. But before linking organizational characteristics to individual perceptions, it' I ; ;is necessary to discuss the formal structure of bureaucra- I I I tic organization. I The classic Weberian model of bureaucratic organi- ! I zation posits six characteristics of formal bureaucracies. I I i The most important of these are that bureaucracies are based; I on formal rules and that control is vested in a hierarchy ; of authority. Relationships among personnel within the organization, including official-client relations, are, therefore, patterned on the basis of a formal hierarchy of authority. For example, a strict hierarchy tends to limit 38| r the communication among staff and between staff and clients (Seeman and Evans, 1961). Also, high level officials tend to be more knowledgeable about substantive issues (i.e., issues of general concern to the community) while lower level officials are more knowledgeable about client-specific 1 issues (Janowitz and Delaney, 1957). | Hierarchical authority among organizational staff also has several important ramifications for the relation - ! ship between officials and clients. Blau (1955), in a study, of employment agencies, found that client conflict and ! punitive treatment of clients was enhanced by the demands of supervisors who emphasized statistical records of produc-[ tivity. But in a division of the same agency where human j [relations rather than statistical productivity were demanded] Blau found less punitive treatment of clients but there were signs of discrimination against certain clients and favori - | I tism toward others. Thus, a strict adherence to formal | bureaucratic structure in terms of rigid hierarchical authority may increase prejudice, as evidenced by the atti- | tudes of low level bureaucrats toward clients, but it may also inhibit actual discrimination via the application of j I [norms of universalism (Katz and Danet, 197 3; 167). | In addition to the internal authority patterns, the 391 organization structures the linkage between itself and I clients. one of the most important components of organi- I zation-client relations is the "breadth" of the relation- iship.^ In simplest terms, breadth means the extent to which the organization considers the "whole" person in its [dealings with clients. For example, a senior center has j greater breadth in its relationships with the elderly than jthe Social Security office. A senior center deals with the j physical (recreational, social), psychological (counseling), and political (advocacy) needs of clients, whereas the i social security office is almost exclusively oriented | toward clients' economic needs. In sum, breadth refers to ' the organization's "interest in the client's biographical space, ranging from a focus upon a limited aspect of the client . . . to a broad interest in who the client is as a person" (Lefton, 1970; 17). Therefore, the greater the ! breadth of organization-client relations, the more the "whole" client is organizationally relevant. The induction of the "whole person" into the client-, I organization relationship creates a servile condition for I the client. "Subordination of the whole person rather than I the performance of specific subordinate role is the essence of servitude" (Gersuny and Rosengren, 1973:137). Prisons ■■ '401 and nursing homes are examples of broad client-organization relationships which coerce the client into a servile and powerless position. While the problem for the client in a ! : jbroad relationship is servitude, the organization's problem | lis one of enforcement of client conformity to rules (Lefton I land Rosengren, 1966). Thus, broad relationships generate compliance problems for both clients and the service organi zation . To summarize, organizations establish rules, hier- ' archical authority patterns, and the breadth of organiza tion -client relations. The following propositions can be stated: i ‘ I 1. The more bureaucratic and formal the organize- j tion, the more likely are authority relations among I its members to be characterized by a hierarchical t ! structure; 2. The greater the breadth of client-organization relations, the more the whole client is organiza tionally relevant; 3. The more the whole client is organizationally relevant, the greater the compliance problems for officials and clients ; : I 4. The greater the compliance problems for offi- : cials and clients, the greater the conflict between : them. 41; I The above two sections have described the structure of client-organization relations in terms of asymmetry and organizational characteristics. The next section draws upon these structural factors and develops the normative I constraints which impinge on clients and officials and which directly affect negative sentiments, anger, and embarrassment. Role Expectations of Clients and Officials ! Roles are the interface between the structural ' ! dimensions of the organization and the behavior of indivi duals. Organization theory specifies three norms of formal organizations which are pertinent to client-official rela tions ; universalism, affective neutrality, and specifi- ! 4 : city. Universalism means that all clients will be treated ! equally to the extent that they have the attributes deemed , I relevant by the organization. Specificity means that inter action between clients and officials must stay within the relatively narrow boundaries defined by organizational rules. Affective neutrality means that officia1-client ' relationships are to be "businesslike" and dispassionate. ! I Each of these norms contributes in its own way to smooth | effective relationships between clients and officials, or 42 to disruption, disappointment, and conflict. Organizations vary in the extent to which these norms are applied in dealings with clients. The internal Istructure of the organization often determines the appli- I jcation of bureaucratic norms. For example, organizations 1 iwhich are dominated by professionals, such as hospitals, are generally less bureaucratic in form and are less speci fic and neutral in their dealings with clients (Rosengren 5 and Lefton, 1969). Professionals are generally more responsive to professional norms than to those of the orga nization. Professional norms frequently emphasize the ! preeminence of the client. For example, in studies of "homes for the aged" the professional staff was found to be i I more supportive of the rehabilitation potential of patients î than were non-professional staff (Kahana and Coe, 1969; ' iKosberg and Gorman, 1975). While organizational norms of neutrality, specifi city, and universalism operate to constrain the behavior of | Î officials and clients alike, they are not immutable. There i I . I jare both societal and situational expectations which alter jthese organizational constraints. Sometimes these alterna- jtive expectations are in conflict. For example, one source bf conflict is that between the oversocialized bureaucrat 43 and the undersocialized client. Blau and Scott (1962) discuss the bureaucrat's dilemma over sticking rigidly to organizational procedure versus becoming "captives of their clientele." The problem is reduced when clients understand their role vis-à-vis the bureaucracy. But regardless of the extent of client socialization the bureaucrat remains in need of defense mechanisms for protecting himself from the demands of clients (Bar-Yosef and Schild, 1966). Moving now to specific role expectations of both elderly clients and the officials who service them, we can I examine how the expectations of each may produce conflict ! and strain in the relationship. First, we will examine the i expectations of a "person as client" which are implied by his/her relationship with a service organization. Next it ; will be shown how these organizational expectations of i clients conflict with societal expectations for "clients as * persons." Following this, we will review the expectations ' which attend the official's role in the organization and ! how these may conflict with demands by clients, thereby producing strain for the official and for the relationship with clients. 44! Norms of dependence The predominant value of the service organization is that ". . . the delivery of a service constitutes a correction of a perceived defect in values carried by clients" (Rosengren, 1970;221). The implications of this definition for clients is that they are expected to be faulty or defective. Thus, the client must view him/herself in terms of this defect before even approaching the service agency. The idea that clients are defective is further [supported by societal values pertaining to acquisition of jservice. The stages in "help-seeking" are as follows I I(bandy, 1965); 1. client must view him/herself as handicapped vis-a-vis significant others; 2. client must face the prospect that others will view him/her as dependent and culturally disadvan taged; 3. client must be willing to admit to the official that he/she has failed as a person; 4. client must be willing to surrender autonomy and submit to a dependent position. Consequently, both the organization and society place a Ilabel "dependent" or "faulty" on the client as he/she enters I [the service organization. The impact of this label relates I to the extent of the defect and its relationship to the 45 client's ability to remain independent and autonomous. ' The definition of clients as dependent may be personally traumatizing for the individual because it con flicts with societal norms for independence and often carries the potential for stigma. (Dependence and stigma will be discussed in detail in Chapter III.) The effects of stigma have been found among elderly clients (Wells, 1973) and among lower class clients, particularly those who are acquiring financial help from service agencies (Mayer and Timms, 1970; Stuart, 1975). Furthermore, older people are thought to be reluctant to actually use services even though they claim to need them, in part, because of the stigma of being on the "dole" (Powers and Bultena, 1974) The feelings of being stigmatized are not limited merely to clients' views of self. Stigma is also related to clients' perceptions that the service they received was not adequate or that they were discriminated against by an official (Stuart, 1975). Furthermore, Mayer and Timms (1970) report that many people are unwilling to participate in public social programs because the agency personnel are perceived to be moralistic and punitive, and perhaps more importantly, that they would ask embarrassing questions. "46j The following account of one potential client illustrates this point: "Well, I thought, honest to the Gospel, that [the official] would check on every part of my life--the ins and outs of everything. I thought they'd pry-- do I drink, do I smoke, how many women have I divorced. . . . I imagined people coming to my address, saying. Does he live here? Is the light off? Try the switches. . . . That was one of the things that stalled me off. I thought to myself, I can't go through all that— everyone's entitled to a bit of privacy." (Mayer and Timms, 1970;103) Thus, the clients' needs as a person, i.e., his/her needs to be an "independent" member of society, are often in con flict with the role expectations, perceived or real, which accompany his/her relationship with a service organization. | This problem has led some critics to claim that the welfare | bureaucracy may destroy the clients it is supposed to aid (Putney, 1972). The dependency and compliance demands imposed by the organization may create role strain for certain clients.| I I While we might expect lower status clients to be the most | abused and to experience the greatest communication prob- : lems with officials, it may be the upper status clients who experience the greatest strain over dependency requirements In anticipation of unexpected findings presented in chapter III, the higher status clients are likely to feel that 47i i norms of fair exchange are broken by the costly demands of compliance made by the organization in exchange for ser vice. Upper status clients are most likely to reject the stigma of dependency and to become angry at being forced to comply with organizational demands. The strain of dependence on the part of clients may I lead to anger and open conflict with the organization. | 1 There is evidence of a growing client revolt against the i autonomy and authority of service professionals and agency ! officials (Tripi, 1974; Haug and Sussman, 1969). In some | cases clients are banding together to challenge the tradi- ; tional authority of service organizations. In other cases, , there is simply a growing discontent among clients over the claims of expertise by professionals, the defective delivery system, the supposed altruism of professionals, and the , alienating efficiency needs of the organization (Haug and i Sussman, 1969). | Challenges by clients of the"authority of officials ! is often confronted by organizational rigidity. Lower i level officials are tightly constrained by the rules and I norms of the organization (Etzioni, 1968; Cyert and McCrin- ; non, 1968). When confronted by client demands that exceed the boundaries of their defined role, officials often 48! experience role strain, resulting from the impossibility of meeting expectations. Since the official receives rewards from above, i.e., from superiors and from the 'organisation itself, there is a tendency for the official |to opt for fulfilling expectations placed on him/her by the I ' I I I organization rather than comply with those demanded by the client (Blau, 1960). The bureaucrat's behavior, like that of clients, is not simply a knee-jerk response to the expectations of his/ her role. First, bureaucrats interpret their roles dif ferently: some are oriented more toward the client than to the organization ; others are oriented toward professional | [norms (Rothman, 197^; Turk, 1963; Gilbert, 1968). The role | i [orientation of the official will mediate the potential con flict between organizational and client expectations. ! Second, the job tenure of the official is related to the-.degree of internalization of organizational norms I (Blau, 196 0). Contrary to what might be assumed, Blau found that in an employment agency it was not the old-timers who [were most rigid and bureaucratic in their dealings with I iclients. Rather, it was the newcomers who were most rigid I I ias they learned the organization's rules. Thus, lower level ! lofficials who also have a bureaucratic rather than 49 i I professional or client orientation, and who are not old- I timers of the organization are the most likely to experience role strain over client versus organizational expectations. Summarizing this section on role expectations, then, we see how the organizational and official expecta tions for client dependency are in potential conflict with societal expectations of independence and autonomy. This conflict results in stigmatization of dependent clients. Those who accept this stigma are likely to be embarrassed by it. But clients who are unwilling to passively "play" a i dependent role, i.e., high status clients, may become angry j and challenge the bureaucracy to treat- them more equitably. | This challenge, in combination with client needs that ex- j tend beyond the resources or norms of the organization, will I generate the potential for role strain among lower level I bureaucratically-oriented officials. Without appropriate i i means of mediating these strains and conflicts, the j organization-client relationship may be strained. [ Summary j We began this chapter with a theoretical framework | ! I ‘ I :that emphasized that individual behavior and attitudes | I I I derive from structural and normative arrangements. Two ' 50, levels of structural and normative effects on client- j organization relations were posited: those emanating from the organization, and those of the broader societal con text. It was assumed that both conflict and solidarity are I 'inherent in all social relationships due to the shared and icompeting interests and expectations of participants. Client-officia1 relations were further characterized as having a high potential for both conflict and solidarity due to the unique division of labor, interdependence, and asymmetry in resources which define the client-organization relationship. The theme of conflicting and shared interests and ; expectations was carried into a discussion of the asymmetry | I of client-official relations. Based on the assumption that j a minimum of shared orientations is a necessary component j of effective service relationships, attention was directed | toward sources of conflict which serve to highlight rele - I I vant structural and normative components of client - ! organization relations. Conflict between clients and officials stems from several sources: differences in sta- j tus which indicates differing world-views; differences in control of tangible resources which provide the organiza tion with an edge in defining the service relationship; SI differences in authority, knowledge and expertise; and the absence of client voluntarism which can generate conflict between officials and clients unless the client is inclined to define his/her problems as personal rather than exter nally caused. Given this asymmetry, principles of exchange suggest that the client will be less in control of the j relationship than the official; therefore, unless the client legitimates the relationship, either out of necessity or i because of adherence to some overriding value, he/she will be less likely to offer commitment to the relationship which in turn increases the potential for conflict. Client-official relations occur within and are structured by organizations. The organization places cer- | I [tain limits on members due to its authority structure, role I ! constraints and the breadth of relations with clients. I Bureaucracies are founded on norms of affective neutrality, I j specificity and universalism, each of which contributes to ; I the potential for conflict with clients. Furthermore, the ; structural and normative constraints of organizations bear most heavily on lower level officials who are themselves i most likely to have to deal with client demands. Role i strain is likely to result for low level officials over the | I divergent expectations of clients and the organization. | 52 And, role strain may be greatest when client-organization relations are broad, since more of the client becomes organizationally relevant under these conditions and com pliance problems are increased* I Finally, conflict is created for the client in the i form of competing expectations from the organization and j from society. The client's role, as defined by the organi- ; zation, is one of dependency. Yet, societal norms require ; independence and autonomy. The stigmatizing effect of i I dependency creates strains for the client which result in ' hostility toward the organization or toward self. | The next two chapters provide empirical analyses of ! the themes discussed in this chapter. Specifically, Chapter; II examines officials' negative sentiments and positive ' i evaluations regarding elderly clients, while Chapter III ; examines the responses of elderly clients to the service organization. In Chapter II we explore the relative effects of organizational versus personal or professional socializa-| tion factors on officials' orientations toward clients. In ' Chapter III the theme of dependency and its stigmatizing effects are used to explain clients' embarrassed or angry reactions to government service agencies. I NOTES FOR CHAPTER I I I ^Two recent edited volumes have appeared dealing 'exclusively with human service organization and client- organization relations (see Katz and Danet, 1973; and Hasenfeld and English, 1974). 2 Only 5 percent of the sample of bureaucrats to be ianalyzed in Chapter II did not attend college (the majority lhave some graduate education) while the median educational [level of the community sample of older people analyzed in [Chapter III is roughly eight years with wide variation by - ethnicity. I 3 I Lefton and Rosengren (1966) refer to breadth as I"laterality," a term which they ardently defend but which seems to be unnecessarily esoteric. 4 I "Organization theory" is a composite of perspec tives most of which have their roots in the writings of Max Weber (e.g., Gerth and Mills, 1946). ^Eliot Freidson (1970) has argued rather cogently that the traditional distinctions drawn between so-called [professional and bureaucratic organizations are inaccurate. iFreidson claims that the absolute domination by physicians Iin the professionally-oriented health care field tends to [structure relationships in ways that are very similar to traditional, bureaucratic settings. (See also Ritzer, 1975, [for a similar argument.) 6 j Underutilization of services, particularly health services, by the elderly may actually be a sign of "healthy" behavior (cf. Schneiderman, 1965). 53 CHAPTER II THE VIEW FROM ABOVE: OFFICIALS' SENTIMENTS TOWARD ELDERLY CLIENTS Large-scale organizations, with rules, regulations, and impersonal standards, all too often approach the service needs of older individuals and their families in a stereotypical and bureaucratic manner. Yet, the limited gerontological research available identifies that the aging processes increasingly differentiate persons of the same chronological age from one another as they grow older. (Beattie, | 1976:629) Perhaps the most consistent and dominant theme I throughout the literature on service organizations and their clients is that of bureaucratic indifference versus inva- * sions of privacy (see Katz and Danet, 1973; Rosengren and Lefton, 1970). Bureaucratic organizations are established i on the principles of affective neutrality and universalism. : But the people they serve are unique and have individual needs which demand a more particularistic in-depth approach.I If bureaucracies adhere to the norms of neutrality, they .5Æ 55 are accused of being impersonal and ineffective. But if organizations become too intimate with clients, cries of "invasion of privacy" are likely to be heard. Therefore, [the establishment of a fine line between too much and too little indifference or intimacy is a major problem of ser vice bureaucracies. It is fundamental for developing soli darity between clients and service providers and may be the essential ingredient in effectively delivering services to | the public. j I This chapter approaches the relationship between I clients and organizational officials by exploring the orga- | nizational roots of officials' negative sentiments and posi-' jtive evaluations of elderly clients. Two questions are | [asked. First, are the negative sentiments of officials ; toward old people a function of organizational factors and j I :the nature of organization-client relations? Or, are these j I I jnegative sentiments more directly related to the officials' | : I ilocation in the broader social structure? Second, are ! I I I ' l o f f i c i a l s ' p o s i t i v e e v a l u a t i o n s o f t h e e l d e r l y a s i n d e p e n - I I |dent and productive members of society a function of organi- izational factors or are they derived from some other source? |Thus, negative sentiments and positive evaluations toward I I ’ j e l d e r l y c l i e n t s a r e a n a l y z e d s e p a r a t e l y f r o m a n J 56 ' lorganizational perspective. R e v ie w of Previous Research ' Previous research on sentiments and evaluations regarding the elderly has been classified under the rubric ' "attitudes toward aging." Since the early 1950's, a number ‘ [of studies on attitudes toward aging have emerged (for reviews see McTavish, 1971; Bennett and Eckman, 1973; Mor- I I !gan and Bengtson, 1976). In more recent years researchers lhave begun to focus on the attitudes of service providers and administrators toward elderly clients (e.g.. Troll and Schlossberg, 1970; Cyrus-Lutz and Gaitz, 1972; Spence and Feigenbaum, 1968; Keith, 1977). Although these studies ;have analyzed the attitudes of a broad spectrum of people, [results have been inconsistent. Attitudes toward the aged [are generally found to be negative but great variation I Iexists in the correlates of this negativism and findings I conflict more often than they agree. I Most research on the attitudes of service providers *has concentrated on professionals ; physicians, psychia trists, and social workers. This focus assumes that due to declining health the aged are most dependent on medically- 'Oriented service providers. Perhaps most important, though. 5 7 1 is that much of this research has been performed by medi- I cal professionals themselves. This results in findings that! are frequently only descriptive. To the extent that these researchers draw on sociological variables there is little, if any, theory attached. The overriding intent of research on professionals' ! j attitudes has been to locate stereotyping of the aged and, j in some cases, to determine which groups are most likely to ! have a negative bias toward the elderly. In general, the | I i ! [attitudes of professionals toward the aged have been found | jto be negative (Coe, 1967; Troll and Schlossberg, 1970; j 'Cyrus-Lutz and Gaitz, 1972; Spence and Feigenbaum, 1968). I [social workers, nurses, physical therapists, dentists, and jphysicians tend to view the aged as rigid, inadaptable, and I [slow to respond to treatment (Coe, 1967). Medical students are more likely to express negative stereotypes toward the ja^d than to ethnic minorities (Spence and Fiegenbaum, |1968). Psychiatrists have been found to discriminate 'against the elderly by holding the view that the aged differ, I ' Ifrom others in terms of hopes, fears, and needs, despite j ireports to the contrary by the aged clients themselves | !(Cyrus-Lutz and Gaitz, 1972). I ; Not all professionals, however, are equal in their 58 negativism toward the aged. In fact, Kahana and Coe (1969) found that staff members in a home for the aged held pre dominately positive attitudes. It is difficult to compare studies because the instruments used and sample selection procedures are so different. But some studies were in them-| selves comparative. For example, employers differ from i employees in their attitudes toward older workers (Kirchner, 1957); professional staff differs from nonprofessional staff in homes for the aged (Kahana and Coe, 1969; Kosberg and I Gorman, 1975; Cyrus-Lutz and Gaitz, 1972). The most consis- I tent finding of these comparative studies is that differ ences among professionals do exist, although evidence on 1 ithe direction of differences is often conflicting. j I I i There are only a few studies which have analyzed j I I [the effects of organizational characteristics on officials' j I evaluations and sentiments toward elderly clients. Perhaps j the best among these is a recent study which found organiza-1 I tional characteristics (size, client occupancy ratio, com- i 'munity size, and level of technical care) to be less important in predicting nursing home administrators' nega- i I 'tive sentiments toward clients than were client and admin- i istrator characteristics (Keith, 1977). Unfortunately, the organizational characteristics selected for study were I without theoretical justification or even previous empiri- | cal support. For example, why should we expect "community j size" to have an effect on administrators' attitudes? It is| I I little wonder, then, that what the author labelled "organi- j I jzational characteristics" were not more predictive of ad- ; ministrators' sentiments toward nursing home patients. i In sum, previous research analyzing attitudes towardj i ] aging among service providers, administrators, and pro fessionals has been relatively atheoretical. This may explain why results have been inconsistent and even con flicting. Perhaps the most glaring omission in previous research is an absence of analyses which relate organize- | tional characteristics to officials' attitudes. This study is a step toward correcting that omission. Theoretical Orientation Organizations are collectivités having specific ; goals and functions, a normative order based on affective | neutrality and instrumentalism, and hierarchically arranged , roles based on differential authority and flexibility. The i I . j irelevant attributes of clients are defined by organizational! ! I jgoals and functions. Clients bring attributes into their | relationships with organizations which, when in conflict 6 0 with the norms and role expectations of the organization, result in role strain for organizational officials and negative sentiment toward clients. This implies the follow-- ing: 1. The lower the level in the organizational hier archy, the less flexible the role constraints; I The less flexible the role constraints, the more likely the role strain when dealing with clients; i The more likely the role strain when dealing j with clients, the more negative the sentiment toward clien ts. Hypothesis 1; Therefore, the lower the level in the organizational hierarchy, the more negative the ^ sentiment toward clients. [ 2. The greater the prestige of the officials, the | less likely the conflict between clients and offi- i T I oral; The less likely the conflict between clients and officials, the less the negative sentiment toward clients. Hypothesis 2: Therefore, the greater the prestige of the official, the less the negative sentiment toward the clients. Each of the above propositions and hypotheses is [discussed in greater detail in the following pages and i jtested using data from a survey described below. I_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 61! i Research Procedure | i I t he sample I j I I I The analysis uses existing data drawn from inter- jviews with a purposive sample of 143 administrative and jservice delivery personnel representing six Los Angeles [county based service sectors; health, nursing homes, employment, senior affairs, income maintenance, and other (recreation, transportation, housing). The sample is 54 percent male and 35 percent ethnic minority. The average educational level is 16.6 years, with 41 percent holding post-graduate degrees. The average age is 48 years and job I tenure ranges from one month to 28 years with the average [being four years. (For further details on sampling proce- j dure and organizations represented, see Appendix B.) I These organizational officials represent a portion | 1 of a sample of 316 decision-makers selected for a survey on | 1 the general climate of decision-making affecting the elderly! ! As a result, questions were not asked regarding specific ; clients or client-organization relationships. We must assume, therefore, that officials' sentiments and evalua tions toward "the elderly" reflect, in large part, their sentiments and evaluations toward "elderly clients." This .J 62 limitation should provide a conservative bias in our analysis of organizational effects on officials' sentiments and evaluations. 'Operational definitions of variables Dependent variables.— The two major dependent Î variables used in this analysis were developed from nine [ items, each measured on a four-point, bikert Scale ranging ; ( from strongly agree to strongly disagree. These nine items , {were selected from a list of 20 "attitude" items asked of | [officials because they dealt specifically with negative feelings toward and positive evaluations of old people.^ A relatively consistent finding in previous research on aging is that attitudes toward old people tend to fall on two separate and unrelated dimensions; one negative, the other positive (Kilty and Feld, 1972; Morgan and Bengtson, 1976; McConnell and Verdugo, 1976; Brubaker and Powers, 1976). ; jAs predicted, a principal components varimax rotated factor analysis of these data substantiated earlier findings by i disclosing two unrelated factors, one composed of four items ! representing negative sentiments toward personal traits of the elderly and the other composed of five items pertaining 63! to positive evaluations of the productive potential and I social worth of older people (see Table 1). In all, the twoj factors explained one-half of the covariation among the nine items. I Two factor scales were created using the relative | I I weights of the nine items on each scale as determined by ^ I the loadings in the above factor analysis. The first scale | to be analyzed below will be that based on the "negative | i sentiment" items. The "positive evaluation" scale will be j analyzed in a later section. I I Hierarchical level.— The original sampling proce dure selected from two levels within the organizational I I hierarchy; administrative and service delivery. Using role 1 : descriptions and job titles, these two levels were each I I divided again by the investigator according to the degree i and scope of authority over other organizational members. i (See Appendix C for complete listing of positions by level.); The top level in the hierarchy consists of directors or deputy directors of regional level organizations; the sec- [ [ I I ond highest level consists of program directors within thesel same organizations; the third level is composed of super- j I visory personnel within the departments of service 6 ^ TABLE 1 FACTOR LOADINGS (VARIMAX SOLUTION) ON ATTITUDES TOWARD ELDERLY CLIENTS AMONG ORGANIZATIONAL OFFICIALS (N=143)^ Items 1 1 Factor Positive Evaluations Loadings Negative; Sentiment! |1. Most older people are set in their ways and unable to change. -.261 .508 2. Older people are apt to complain. -.009 1 .508 3. Older people are often against needed reforms in our society because they want to hang on to the past. -.015 i .612 4. Most older people spend too much time prying into the affairs of others. -. 171 . 648 5. Older people can learn new things just as well as younger people can. .452 1 -.326 6. People become wiser with the coming of old age. .554 -.036 1 7. Most older people can do a job as well as younger persons, but are not given an opportunity to ®how what they can do. .642 1 i -.146 1 8. There should be no required retirement age ; older people should be allowed to work as long as they want to and are able to. .593 1 .003 i 9. In most jobs, older people can perform as well as younger people. . 580 -.145 1 Explained Variance 32% 18% ; I See Appendix A for complete correlation matrix of all variables in this table. 1 I _ _ _ _ _ _ _ _ _ _ _ _ _ _ I 65 organizations; and, the lowest level is made up of direct line service delivery personnel with little or no super visory authority. Sample sizes within each level are roughly equivalent and each o f the sectors is represented |in each level, with one exception; income maintenance is ! mot represented in the lowest hierarchical level. There is moderate empirical validation for hier- I archical level as defined. First, a significant inverse correlation (-.20) exists between hierarchical level and contact with elderly clients, indicating the lowest levels are the most likely to deal directly with clients and less likely to be in supervisory or administrative positions. ! Also, the highest levels are significantly more accurate in ' their knowledge about the older population taken as a whole. For example, the higher the level, the more accurate are jthe estimates of rates of institutionalization among the I elderly (r=.33, ct=.001) and rates of elderly poor (r-.15, ' a=.05). This suggests along with other research (cf. Jano- ^ witz and Delaney, 1957) that the upper levels in the organi-: i zational hierarchy are connected to other organizations and * 2 I to technical sources of information more than to specific j client interactions. j I 6^ i Sector.— Sector consists of six dummy-coded vari- \ I ables representing the service areas of health, nursing ' homes, employment, elderly affairs, income maintenance, and | other (housing, recreation, education, and transportation). I j i"Other" serves as the baseline variable and is not allowed ! i I [to enter the regression equations, in part, because it is j I a composite category of several organizational types and i because dummy variable multiple regression requires that one categoric variable remain out of the equation. Thus, five of the six sectors are analyzed in terms of their rela- 1 I jtive contribution to explaining officials' negative senti- | ments and positive evaluations. j I Frequency of client contact.— In the context of j asking officials about their information sources concerning ! the needs and problems of older Americans, one question was i asked which pertains to officials' direct contact with older people; "would you say you use 'contact with older j I people themselves' as an information source often, sometimes; or never?" (See Appendix D for exact wording.) j I Centrality of aged clients.— This was measured by a ! ! single item asking officials whether the "problems of the | aged” constitute "the major focus of your position." This 6 7 1 is a self-rating and varies by sector location : "elderly affairs" has the highest score (88 percent rate the aged high in centrality) and "health" has the lowest (only 9 percent rate the aged as high in centrality). Interpreted as a social psychological variable centrality indicates "salience" of elderly clients. As an organizational vari able it indicates the number of competing interests the organizational representative must deal with when serving aged clients: the higher the centrality, the fewer the competing interests. It may, in part, indicate the fre- I quency with which the representative comes into contact with' aged clients (correlation with "contact" = .34). It may : also indicate the dependence of the organization on the aged j for its survival. Personal characteristics.— Previous research has found that attitudes toward aging vary by educational level | I (Merrill and Guntner, 1969; Thorson, 1974; Troll and j SChiossberg, 1970) and by age of respondent (Borges and ! button, Newfield, 1971; Kilty and Feld, 1976; Thorson, I 197 5). As such, these variables are measures of a person's ilocation in the social structure. Contrary to other 'research, however, these variables are included here as 68 controls rather than as theoretically relevant predictors. Also, ethnicity is included as a control variable coded as minority/non -^minority. I Professional socialization.— Based on officials' I I Idesignated college major and degree received, professional I socialization was coded into three categoric variables : (1) registered nurses ; (2) social welfare professionals — those who have a Master's degree in social welfare; and (3) physicians— M.D. 's. Organizational Roles and Negative Sentiment j Following a discussion of organizational roles and j role strain which spells out more clearly our discussion in ; Chapter I, we will empirically examine the effects of these ! variables on officials' negative sentiments and positive i evaluations. j I Organizational roles ‘ I A central concept in understanding the perspectives of organizational officials is that of organizational ! I I roles. Roles designate the relative positions of organiza- | tional members and establish the expectations for behavior ' which accompany these positions. Organizational roles are 6 9 i c a r e f u l l y s p e c i f i e d i n o r d e r t o e n a b l e t h e o r g a n i z a t i o n t o m a i n t a i n s t a b i l i t y a n d r o u t i n e o v e r t i m e a n d i n d e p e n d e n t l y o f s p e c i f i c r o l e o c c u p a n t s . T h u s , i t i s t h e r o l e , L a t h e r t h a n t h e o r g a n i z a t i o n ' s g o a l s , w h i c h g e n e r a t e t h e { g r e a t e s t p o t e n t i a l s t r a i n f o r o r g a n i z a t i o n m e m b e r s ( C y e r t i j a n d M c C r i n n o n , 1968). | ! I while it is true that both the organization and the | I role occupant must adjust to each other, i.e., roles are 1 not so rigidly defined as to be inflexible (Haga, 1974), | too much flexibility can cause problems for the organiza- i tion's stability. Consequently, the organization maintains ; tight control over its role occupants via the processes of selection, training, and monitoring (Cyert and McCrinnon, 1968). First, the selection process for role occupants is carefully conducted in order to insure maximal fit between role prescriptions and personal attributes of occupants. i Second, organizations enhance the fit between role and I occupant through a process of on-the-job training whereby , t the individual is socialized by direct exposure to organiza-j I itional rules or indirectly by exposure to organizational I [norms. Finally, organizational role occupants are continu ously monitored to insure ongoing activities do not deviate far from role expectations. The lowest levels in the 7 0 organization are more closely monitored than upper levels. ‘ Roles establish both programmed and discretionary behavior of occupants. Programmed behavior is that which ■ the organization requires of role occupants in order to barry out its goals and functions. Discretionary behavior ! Is the flexibility allowable within the role. As with [ I i 'monitoring of role occupants, the organization allows I ; [greater flexibility and discretionary behavior at the upper : ' I levels, in part, because the goals of these upper level ; jpositions are more vague than those at lower levels I |(Etzioni, 1968; Cyert and McCrinnon, 1968). I I Authority is perhaps the most important component of organizations. Authority is the control over rewards and punishments and constitutes the major means of control jWithin the organization. Those occupying the highest levels ! |in the organization control greater facilities for the [administration of rewards and punishments than those at the ■ lowest levels. Therefore, organizational rewards flow from top to bottom. In sum, organizational roles define the expecta- ( ! tions for behavior and the relative positions of organiza- ; tional members. Lower level roles and those requiring the | [least skill levels are more tightly monitored, are allowed j 71 less flexibility, are given less discretionary control and 1 less control of rewards and punishments than upper level roles. Thus, the lower the level in the organizational I hierarchy the less flexibility in role expectations. Role strain ; Role strain occurs when a role occupant confronts j I I difficulties in meeting role expectations. The problem of role strain is particularly acute among organizational [ officials who must deal with uncertain environments. The specific demands of the role, particularly for lower level [personnel, are often at odds with the unspecific and chang- ;ing needs of environments. Officials of human service organizations are especially likely to confront problems of i ;role strain due to conflict over individual needs of clients I I jand organizational norms of universalism (Rothman, et al., |l976; Gilbert, 1958; Krause, 1965). , j I ; Organized clients have begun to challenge welfare i t bureaucracies to demand services and rights (Tripi, 1974; ; Laug and Sussman, 1969).^ This is a manifestation of a ; ! wider social process in which clients are increasinqly ' i I less willing to be passive. These demands, while raising I I ;the level of efficacy for clients, tend to produce strains i i I J for lower level bureaucrats who are caught between competing| I and conflicting expectations made by supervisors and clients.| Human service workers often find themselves caught up in a "cross-fire" of differing expectations regarding their work roles. Their own assessment of desirable goals may vary from those of supervisors, board members, community leaders, public officials, and others. Within the agency system different con stituencies may have different views of a particular practitioner's roles. (Rothman, et al., 1976:134) Thus, inflexible role expectations in service organizations will be associated with a high potential for role strain among rôle occupants who deal with client issues Role strain and negative sentiments In the presence of role strain, lower level organi- j zational officials will tend to direct anger and hostility downward toward clients. This occurs for two reasons. i First, as discussed above the organizational reward struc- i ture is such that rewards emanate from the top and flow j downward. clients, especially those of public service bur eaucracies, are not in control of the necessary rewards to control officials. Consequently, clients become a dispen- isible commodity as the official directs his/her attention upward toward the source of rewards. 73: Second, the success or failure of each level in the , organizational hierarchy is, in part, dependent on the per- iformance of subordinates (Dubin, 1974). Clients are the I I '"subordinates" for lower level officials and may therefore | be the recipients of blame for organizational failures. Blame for role strain may be directed toward powerless, dispensible clients. This may explain the finding that low ' I I (level non-professional service providers are more negative ; iin their sentiments toward aged clients than other personnel in homes for the aged (Kahana and Coe, 1969; Kosberg and jcorman, 1975; Cyrus-Lutz and Gaitz, 1972). I Therefore, the greater the role strain over dealing with clients, the more negative the sentiment directed (toward clients. Combining the above effects of organizational level, roles, role strain, and negative sentiments, we have derived I Hypothesis 1: The lower the level in the organizational (hierarchy, the more negative the sentiment toward clients. I ; Table 2 presents the results of a regression analy sis in which negative sentiment of organizational officials « was regressed on all predictor variables. The results of this analysis indicate support for the hypothesis that lower I level officials are more negative toward clients than are i . C N f d o ' 1 —I C T j M J 0 5 1 W I E h I H EH g W iJ < H u H k k O k O W g I o + J 1 — 1 o c 0 0 o 03 CM o o 1 P G A 03 * H 1 — 1 CM G 0 0 CO M o o • • -p c (Ü . § -p c (Ü w Q) > ' H - P f d tn (D p u -P 0 3 G G N o 0 3 -H -H -H TS 0 3 U A P 0 3 M o fd 0 3 ip C O T3 P ip « G tP 0 3 1 fd 0 3 O + j O] u p o ■p u - p T3 (D P eu o o o . o o o o o I —I o CN m o cr> ro o u VD i n o 00 CO CN O r H o O I —I O O I —I r * * r r CN o M O O C M O O O I—I r r CO o v£) CM O CO I— I O I —1 I — I O I — I r * t * I * r o Ü < r > ^ CO M O O Ü Ü ^ LO CM CM r r Ü CM C T > O CO CM 0^: -P Ü 0 3 > . ü G r— 4 0 3 ' fd O 0 3 p 1 —1 p 0 3 1 —1 M P o 0 3 G U fd P 0 3 p U 0 3 O M M fd rX G Ü 0 3 U 0 3 P u N P c G S U P 0 3 M M 0 3 O ü G G p G M P 1 —1 0 3 X •H O , 1 —1 0 3 fd G 0 3 P 1 —1 P >1 fd 0 3 ■H P *P 0 3 P G 0 3 M 0 3 fd O P M P 0 3 •H P > 0 3 M 0 3 •H M P M •H u G P G G M 0 3 0 3 fd ■P 1 —i U ü u P p o C fd 0 3 C p C P I g M G u fd M O o w p 0^ -H CP O -P M •H P p P G U 1 —1 0 3 &4 0 3 •p 1 I—1 P Î G fd fd p O fd P G M 1 —1 0 3 0 3 G «C 0 3 ; fd 0 3 g o x; O O e fd P fd 1 —1 0 3 O P g > 1 >, u •H G 0 3 •H 0 3 O m ' G >1 M 0 3 >i p P P u 0 P 1 —1 O 0 3 O O ■ -p •H O P g ü -H 1 —1 O fd •H M 0 3 fd M C / 3 « . 1 Ü M 0 3 1 -1 0 3 O G 1 —1 fd ü G 0 3 M •H 0 3 G p u p P fd P g, T5 O 0 3 fd G 0 3 G .G 0 3 CPo >1 fd O 0 3 G g r-4 G G p o CP P 0 3 0 3 o X: i P ■P ffi S M H M O j^ p 0 3 < H H P [ / ] 04 0 3 u 0 3 G P O M 0 3 P 0 3 0 3 P W P L J U C M e u 74 I T3 Q ) ( 1) b M O 03 Q) Q) P tP Q ) ' T3 P O M T3 <D ■ P Ü Q ) P • P X o •H U P - P 03 fd Q ) S 03 ( Ü n o - p M c ■p ( Ü fd p M fd 0 3 Ot p P G O *H u CM 0 3 Pij - P 0 3 r - 4 • A M g 0 3 O > 0 3 75 upper level officials. Hierarchical level is inversely I related to negative sentiment net of other factors. Parti- ( cularly noteworthy in this finding is the significance of | hierarchical level even when frequency of client contact is j controlled. This suggests that strains inhere in low level : bureaucratic roles which generate negative sentiment toward clients independently of the frequency with which officials come into contact with clients. Also, frequency of client contact shows no independent or zero-order relationship to (negative sentiment. i Age of official is significantly and positively (related to negative sentiment but educational level is unrelated to negative sentiments. Previous research based on non-organizational samples has generally found the oppo- jsite effect, that negative sentiments decrease with age !(Nardi, 1973; Borges and Dutton, 1976; Newfield, 1971) and I I leducational level (Merrill and (Guntner, 1969; Thorson, 1974). But age has also been found to be non-linearly I 'related to negative sentiments (Kilty and Feld, 1976) and to be unrelated as well (Thorson, 1975; Troll and Schlossberg, 1970). Unfortunately, chronological age is a "grab-bag" :for a variety of normative and behavioral factors which are : I . ; jcompounded by the difficulties of sorting out environmental,| 76 developmental and cohort effects. Therefore, it would be presumptuous to offer a simple explanation for the signifi- ; |cance of age without more detailed analysis. But noting | i I the strength of its effect on negative sentiment among I organizational officials suggests a topic for future 'research. The issue may relate to a more generic one: the [effects of social distance between clients and officials I(based on similarities in personal characteristics) on the [ i ! [service relationship. The absence of an effect associated I ! [with educational level may, in part, be a function of the I I homogeneity of the present sample on that variable. The results in Table 2 also indicate partial sup port for Hypothesis 2, that the higher the prestige of the official, the less negative the sentiment toward clients. Both social workers and nurses are significantly less nega tive than other officials toward elderly clients. But I 'physicians are neither more nor less negative. While the [relative prestige of nurses and professional social workers I may inhibit conflict between clients and officials and thereby reduce the liklihood of negative sentiment, the socialization experiences of physicians may serve to neu tralize this effects. Previous research has uncovered strong negative stereotypes about the elderly among medical 77; students (Spence and Feigenbaum, 1968). Also, medical training is such that medical students only have contact with those elderly who are suffering the effects of illness I I and degeneration (Butler, 1976). | I The effects of organizational sectors on negative | sentiment were essentially negligible. It is worth noting, ‘ however, that with the exception of nursing homes, all sec- I tors tended to be inversely, albeit minimally, related to (negative sentiment. Nursing home personnel, on the other I 1 (hand, tend to be slightly more negative toward elderly {Clients than other sectors, even when the effects of organi zational and personal factors have been removed. : This finding may be related to the nature of organi- I zational power found in nursing homes. Etzioni (1961:31) 'argues that nursing homes and homes for the aged are coer- 'cive organizations, along with prisons and some mental I [hospitals, because their main objective is to detain per- i |sons. while it is true that roughly 60 percent of nursing [home patients are allowed to leave the nursing home after I a period of "rehabilitation," the orientation of staff members, particularly the lowest level staff members, is that patients are not capable of being rehabilitated (Kos- 1 berg and Gorman, 1975). Etzioni argues further that while 78 youth and insanity tend to mitigate punitive treatment, old , age may work in the opposite direction and actually exacer- t jbate the punitive orientation of staff members in coercive | ! I I , organizations. Young and insane people are generally given { i 'more rehabilitative treatment than are old people (Etzioni, ,1961) . Table 2 also compares the relative contribution of J leach of five sets of variables included in the previous I j i [regression analysis. Personal characteristics of officials i i(age, education, ethnicity) explains 3 percent (1 percent {corrected) of the total variance in negative sentiment, and | Î (professional socialization (registered nurses, social wel- [fare professionals, and physicians) explains 6 percent (4 percent corrected). But the major organizational variable ' I(hierarchical level) makes the most significant contribu- I ition (F=12.391, significance > .001), explaining 8 percent 'of the variance. Sector contributes 3 percent (0 percent corrected) to explained variance, in part, due to the [effects of nursing homes discussed earlier. In sum, both organizational, personal, and pro- 1 Ifessional factors explain negative sentiments of officials | , toward elderly clients, but organizational effects are the i I ' most important. Strong confirmation was found for the | 79 hypothesized relationship between hierarchical level and negative sentiment. But only partial confirmation obtained for the hypothesis that prestige (professional status) of [ ' official is inversely related to negative sentiment. j ! : (Interaction effects of hier- l archical level and client j Contact ; ! ( j Implicit in the theoretical argument of this chapter is the idea that role strain among low level officials, j I : , which presumably accounts for the observed inverse relation- I (ship between hierarchical level and negative sentiment, is ! I iexacerbated by direct client contact. Low level bureau- I !crats are highly constrained by rules and norms which [designate specific duties to be performed impartially in relation to clients. But clients' needs and demands do not ( [always conform to the neatly defined rules of the organiza- ; ition. Furthermore, clients often feel their needs are urgent, whereas officials see them as routine. In short, ( the potential for conflict in the service relationship is enhanced when client and low level officials confront one I another directly, A large body of social psychological research offers (further support for the prediction that bureaucratic " ' ■ 80 [constraints will interact with frequent client contact to produce greater negativism toward clients. First, there is consistent evidence which suggests that while frequent con tact with an object may not change attitudes toward that object, it does tend to intensify attitudes (McGuire, 1968). Second, direct contact with an object will lead to in- Icreased positive (or decreased negative) affect only if I (contact is: (1) long-term, (2) based on an equal status relationship, and (3) between persons with similar belief systems (McGuire, 196 8). Since clients and low level [officiais meet in a highly asymmetrical relationship, it I 'is doubtful that frequent contact between them will decrease negative sentiment. In fact, given the precondition of i bureaucratic role constraints for producing negative senti ment, we should expect that frequent client contact will interact with the effects of being a low level bureaucrat Ito produce even greater negative sentiment toward clients. In order to test the interactive effects of hier- ^archical level and client contact, level was dichotomized linto lowest = 1, and all others = Û. An interaction term (was then created by multiplying level by the already dichotomous variable . client contact. 81 The results in Table 3 indicate support for the i hypothesized interaction effect. The lowest level offi- ' jcials who also have frequent contact with elderly clients Iare significantly more negative than other officials toward | elderly clients. Thus, under conditions of frequent client ( contact, low level bureaucrats are very likely to develop [negative sentiment toward clients. The interaction of low I jhierarchical level and frequent client contact has an effect I [above and beyond the main effects of those two variables lacting alone. Despite the rather convincing evidence above that (low hierarchical level in combination with frequent client icontact indicates potential role strain and thereby predicts; negative sentiments, there is still some question as to the i (actual causal relationship between level and negative senti- I ment since we have not assessed role strain directly. Role [strain is a subjective variable encompassing the individual (role occupant's response to conflicting role expectations. [Therefore, an assessment of subjective role orientation, [i.e., how the role occupant views his/her own role, is (important. Following a discussion of role orientation and , |its effects on attitudes, the role orientations of the two [^lowest levels in our sample are operationalized and a | C / 3 iG < H U M a P p o k O G ^ (N 1 — 1 G 5 h tH o C M G O • t t P en E h G U T5 C a P o O O ir> a U -P o O C • u E h 0 3 ' —' G ÎZ « — 1 e a M 1 1 •H ro u H ÎZ -P V D G iG — C O p C J 0 3 • p C / 3 C / 3 o g g 0 3 II o w w > C M G D M -H a G O iG -p G M U G G g : tn U a X: pp > H 0 3 0 3 c c a iG iz; N o 0 3 c Q Cïî •H "H ‘H G G IZi W U 0 3 U 1 — 1 1 — 1 P ro C Q p 0 3 -H ro C D un G a G 0 3 a • • • CI4 p L i a H U P a 1 1 a H c en G C a > p G G 0 •H c w a a p:; C J E H a < c /3 C M 15 a a o < G E h O M E h r— 1 1 — 1 a S G G U M > > a S G G C H 1 — l 1 — l a E h W S G G H H U ü ÎG C / 3 C C G G 12 H U U Q > •p "p a H a a a E h r— 1 C 3 •P "P P < G G c c O O > a en en G c •p "P C /3 § a o G G E h p u C J o 1 — 1 rP ir> W a G a 0 0 P ü ü c • • P -H •H G G P M u iG -P G U M IG p P C J O p G H P a E h G c U ■H G C M < ® & a e r X H ^ G 0 P M a p — H 821 o t 0 3 0 3 U : ' ■ ■ ■“” "85 [further analysis is provided of the effects of role strain |on officials' negative sentiment toward clients. ! Role orientation ( ■ I Three major role orientations have emerged in the | (literature on workers in service bureaucracies. These are: ; (1) professional orientations, (2) bureaucratic orienta- jtions, and (3) client orientations (Rothman, 1974:83-84). 'A professional orientation is associated with a high degree I I of concern for professional standards and values, attitudi- ; nal commitment to affective and political neutrality, and a i ; belief that the professional's definition of client's needs I bs superior to the client's definition of those needs (Roth man, 1974:99). I A bureaucratic orientation indicates a preoccupation ,with bureaucratic standards and norms (Turk, 1963). The Iclassie example of the social worker who spends most of his/ (her (creative) energy filling out forms in order to receive rewards from the organization and his/her superiors rather I (than focusing on the client, is an example of a bureaucratic orientation. For reasons related to the organizational reward structure and professional training, social workers (tend to be more bureaucratically oriented than other 84' professions, such as professors and lawyers (Billingsley, | I 1964; Epstein, 1970). , A client orientation involves a primary concern for [ (the needs of those served by the agency or organization I (Rothman, 1974). Presumably, a client-oriented professional 'will subjugate professional and bureaucratic role demands ' 1 \ to those of the client if these demands are contradictory ! i ( jor competing. The language of role theory (cf. Shaw and ' I iCostanzo, 1970; Biddle and Thomas, 1966) sensitizes us to ! I ! ! ■ I"reference groups" and "role expectations" as two important - I components of role orientations. Relating this to the above discussion of role orientations, then, a professional orientation will include as its primary reference group the behaviors and expectations of other professionals; a bureau- Icratic orientation signals an emphasis on others in the ! Iorganization or agency as the primary reference group; and a client orientation suggests clients are the important reference group. -If we think of role expectations and reference ’ groups as determining the behavioral goals of a role occu- i pant, their relationship with attitudes can be discussed. i A person's "... attitude toward an object is defined as a composite of the perceived instrumentality of that object j 85 to the person's goals, weighted by his evaluation of those goals" (McGuire, 1968:153). Applying this to the role relationship of service worker and client, the "perceived linstrumentality" of the client will vary according to the Iworker's role orientation. Figure 2 juxtaposes the varia- i jbles "role orientation" and "perceived instrumentality of jclient." The congruence between these two variables is ! jhighest in the marked cells and presumably lower in the jremaining cells. In short, it is expected that attitudes i jtoward clients will reflect the congruities and incongrui ties in role expectations, reference groups, and the per ceived instrumentality of clients. i Perceived Ins trumentality ; of Client Role Orientation Professional Bureaucratic Client Hi 1 X Med X ; Low X Figure 2.— Relationship between perceived instru- jmentality of client and role-orientation of service worker j I _________________________________________________________________ 80 Cognitive dissonance theory posits that attitudes I are a cathartic means of acting out inner tensions; that j jattitudes are used to justify behavior. If, for example, | I ,a service worker is oriented toward the norms and rules of ( I I !the employing organization but must contend with the needs ,of clients, many of whom may not fit neatly within the rigid structure of the agency, then the worker will develop nega- I jtive attitudes toward the client to justify his/her behav ior. Thus, the reduction of dissonance may be a useful ! jmeans of coping with role strain. The above discussion leads to the following predic- ' I Ition. All other things equal: officials with a bureau- 'cratic role orientation are likely to experience greater ;role strain when dealing with clients than those with a 1 jclient or professional orientation. Adding this to our 1 ipartially confirmed hypothesis that the greater the role j strain when dealing with clients, the more negative the sentiment toward clients, we can state the following hypo- jthesis: The more bureaucratic the role orientation, the I ^ ^---- more negative the sentiment toward clients. Role orientation and negative sentiment: A test j Based on brief descriptions of major job I 87’ responsibilities provided by officials, two judges acting | independently coded officials into three role categories — client, professional, and bureaucratic. The criteria used for coding role descriptions were as follows; (1) client oriented— official demonstrates primary concern for client needs ; (2) bureaucratic orientation--official's first pri- I : I ority is the operation of the organization, supervising,- regulations, or other bureaucratic tasks ; (3) professional ' I jorientation--official is primarily oriented to professional lvalues, e.g., teaching health care principles. Examples of ; I leach type of role description are provided below. Client-Orientation: ; "... to be aware of physical and emotional problems; ! to give adequate nursing care to those who are infirmed; and to provide a healthy and happy atmos- I phere for my patients. Also, to supervise all care i given to the patients." (#3411, Head Nurse, Home for ; j the Aged) I I ! Professiona1-Orientation: "... to improve and teach health care and princi ples; and to find and use resources and also to tell the older people of the different services that are available and encourage them to use them." (#3070, j Clinic Manager, Family and Adult Care Clinic) | Bureaucratic-Orientation; | "Seeing as a supervisor that the people understand j me correctly and interpret and apply the provisions j 88 of the Social Security Act." (#3520, Operations Supervisor, Social Security Administration) Perhaps the best example of the difference between i 'a client versus bureaucratically oriented official is provided by the role descriptions of two operations super visors in a Social Security Office; ’ : "Supervise employees engaged in taking claims for j health insurance, old age, disability insurance, and I SSI claims for diabled, blind, and aged." (#3470) 1 I ' "Service to the public, I mean getting their checks j on time, getting proofs for them, process their ! claims." (#3480) i : The first official's role description emphasizes supervision of staff and the more formal aspects of carrying out his/ her job, while the second emphasizes his/her clients above ! all else . I I J Only the lowest two levels were codeable because i I ,the upper level officials were considerably more vague than i lower levels in describing their roles. This probably | results from the vague role expectations accompanying upper , [level positions in organizations, which was discussed earlier- However, among the lower levels, role descriptions were ' i relatively clear-cut. inter-rater agreement reflected this (Gamma=.74) as 38 percent were coded bureaucratic, 38 i i 89 percent as client-oriented, 16 percent professional, and 8 percent other. In line with our stated hypothesis regard ing the effects of a bureaucratic role orientation on nega- | ,tive sentiment, role orientation was recoded into a dichoto-j 'mous variable: bureaucratic versus all others. Using a .subsample composed of only the two lowest hierarchical levels,(supervisory and service delivery personnel), a test jof the hypothesis--the more bureaucratic the role orienta- I • I Ition, the more negative the sentiment toward clients— was 1 ! ; performed. | i ; I The results in Table 4 offer mild support for the i independent effects of a bureaucratic role orientation on officials' negative sentiment toward clients. Among super- visory and service delivery officials in the service bur - jeaucracy, a bureaucratic role orientation, frequent con - Itact with clients and low level in the hierarchy each con- jtributes; about equally to negative sentiment. (Each vari- jable explains approximately 4 percent of the total variance.) jTwo things are worthy of further comment. First, it will |be remembered that frequent client contact did not produce I I I 'a strong indpendent or zero-order effect on negative senti- jment in the total sample of bureaucrats (see Table 2). But among the lower level officials, client contact is s P Q g g O H § ÜfO o (N VO L _ . E h C O M Eh !2i W H H > H u > H Q P : ^ < Q 3 E h M U < Q cn < O IS U o E4 E h Î2i W H W i-q S U H M O C O M E h cq < H g E4 W < M O Pi o w O o - o m p^ a c < p^ H w u H H ffi h k O til O C O u H h k H ''t < T > m U t - -1 rP o U + J C O c L O ( D o e • •H -P " C (T\ ( Ü C O C O O ( Ü > I I •H -P (N nj Pi tn T5 -P C Ü 0 C C N O 0 •H *H *H T5 W O A U 0 -H m I - - o fd 0 p (N C N C N T5 P P « . * • C 0 fd 0 O -M Pi u C O c p o 1 — 1 Ü •H 0 0 p > P 0 0 C p p A 0 c 0 U 0 p 1 — 1 ■ H Ü 0 P P "H Ü C o T5 *H 0 0 A •H Ü P a I — •H CM p o p 0 0 P p P 0 c Ü *H 0 0 K p j 0 0 1 5 0 P 0 p 0 A h CQ 90' n j i T5 • 0 X 0 •H P p P p 0 P g o c w o 0 -H 0 p p 0 tn rP 0 0 T5 P P P 0 O Ü P 0 T5 p 0 0 P I — 1 Ü a, • 0 g I—1 P o 0 P Ü > 0 0 Ü p I — 1 o w p 0 0 Ü w < c 0 0 x i X o p *H •H c T5 P 0 C ■H p 0 C 0 A tn PU C U •H < C Q G 0 O 0 1 — 1 C N C O • P Ü 91: moderately predictive of negative sentiment. This further confirms the prediction of an interaction effect (see Table * i3). Second, a bureaucratic role orientation does not show j 1 'a significant zero-order effect but does indicate a mild to | moderate independent effect when hierarchical level and client contact are controlled. 1 The critical test remaining is to determine the I !interaction effects of hierarchical level, bureaucratic I role orientation, and frequent client contact on negative i I ; 'sentiments These three factors should interact to produce 'greater negativism toward clients than the effects of any ' one factor taken alone. We have already discussed and demonstrated empirically the interaction effects of low hierarchical level and frequent client contact. Similarly, a bureaucratic role orientation should interact with client ■ I ^contact to produce conflict and negative sentiment. A ! bureaucratic role orientation implies that the organiza tion's rules and procedures are a higher priority for the bureaucrat than are client needs. Given this orientation, ifrequent contact with clients, and having to deal with their, idiosyncratic needs, will be frustrating for the official. j For reasons discussed earlier, this will lead to increased | : I negative sentiment. Moreover, a bureaucratic orientation j 92 among low level officials, who are already stressed by rigid role constraints, will enhance negative sentiment toward clients. i Table 5 offers further confirmation for our earlier j finding that the lowest level officials who also must con front clients often, are most negative toward those clients.' The interaction of a bureaucratic orientation and either low level or frequent client contact produces negligible effects on negative sentiment. The set of interaction terms contributes an additional 4 percent to the explained vari ance above that explained by the main effects. However, when this is corrected for the attendant increase in the standard error the increment due to interaction terms is nil. Thus, among the supervisory and service delivery personnel the best predictors of negative sentiment are the : simple additive effects of bureaucratic role orientation, frequent client contact, and lowest hierarchical level. (The triple interaction effect could not be calculated due to extreme co1linearity.) Breadth of client-orqanization i relations and negative ■ sentiment : A test i — ——— I I i As stated in Chapter I, the breadth of client- ! J i n 3 m g E h U O n i U vO H H tn En U H H ig A o u H ^ o c q/ Eh S H g g H E h P O CO J p M - S C O W n i C O <C H H U > H J H P EH P C O o p o g C O £h U P P P P > P P P P g ü U p p < g g H H II •H P C N 0 P C r > A P 0 0 G G P N O 0 •H •H t H T l C Q Ü p P 1 — 1 C O )4 C Q -H p O (N O O 0 0 P * » « • • • T l U P 1 1 G tP 0 0 0 O P P U P G P O * 1 — 1 U P 0 0 P > p 0 0 c P M p o G 0 u 0 P 1 — 1 •H Ü 0 p ÎH •H u G O T3 •H 0 0 A •H O 5 h U P •H P J - 4 C J P 0 0 u P M 0 0 G U -— ' '— ' -— ' •H 0 G C N m en K G 0 Œ 0 X X X 3 0 ÎH O ÎM G 1 — 1 C N 1 — 1 P P m P •H U 0 0 G P P P O U 0 g 0 U p X 0 o p 0 G t3 b g 0 o P b 0 0 p 0 G U U p p 0 p U o 0 0 A 0 0 P u O en G 0 b b P ÎH G o O p U b w 0 p p u u 0 0 p kl p kl 0 o u G O 0 •H 0 p m ü 0 0 A U P 0 C p 0 G kl P 0 P U 0 1 — 1 G P U P P J - 4 C N Ê h p 93' ( ü 94j organization relations will affect the extent to which the whole client is organizationally relevant: The broader the client-organization relationship, the more the whole client is organizationally rele vant^ The more the whole client is organizationally rele- ' i vant, the greater the compliance problems for both , officials and clients; j Therefore, the broader the client-organization rela tionship, the greater the compliance problems for i 1 both officials and clients. Presumably, compliance problems will create stresses and ; I strains for organizational officials who are responsible for enforcing the rules of the organization in the face of jclient demands. Furthermore, broad relations with clients |will engender greater diffuseness which encourages greater jexchange of affectivity, both negative and positive, within the client-official relationship. Drawing on examples provided by Lefton and Rosengren i ;(1966) service organizations in this sample were coded !into ten ordinal categories breadth (see Figure 3) and then I Icollapsed at the mid-point into a dichotomous variable i (broad = 1, narrow = 0). 95' Broad Mid-point Narrow Elderly Affairs Nursing Homes V.A. Hospitals Mental Health Clinics Employment Agencies General Hospitals Health Clinics Social Security Administration Public Employment Boards Other (recreation, transportation, housing) ; Figure 3.— Scale of organizational types based on Ithe breadth of client-organization linkage. Organizational and personal characteristics which were found to be related to officials' negative sentiment I jin the previous analysis were evenly distributed between the two categories of breadth. However, as might be , expected, breadth did show significant positive correlation , with "centrality of clients" (r=.30). ] : In order to examine the effects of breadth of client' i I -organization relationship on negative sentiment, we | i I regressed negative sentiment on breadth controlling for low , i I hierarchical level and frequent client contact. : I - • - - -gÿ The results in Table 6 indicate that officials who | must deal with clients in terms of broadly defined needs land problems, does not in itself generate negative senti- | I ! ment toward clients * As wc pointed out in Chapter I, a ; broadly defined relationship may be more satisfying for clients (unless it occurs in a coercive organizational , setting, such as a nursing home) than a narrowly defined lone. Therefore, broad relations may generate less conflict | , between clients and officials, all other things equal. For I •officials, however, we might predict that the breadth of ' I I jthe relationship is a contextual variable which enhances the effects of other strain (or solidarity) producing fac- [tors. In other words, the compliance problems which arise ,for clients and officials alike, may generate hostility and [negative sentiment toward clients among officials only i jWhen other variables, such as frequent client contact or I low hierarchical level, are present. The results in Table 7 indicate a significant inter- ! jaction effect of broad relations and frequent client con - tact. This occurs in addition to the already substantiated I 'interaction effect attributed to frequent client contact Iamong the lowest level officials. However, breadth does ' Inot show a strong interaction effect with low hierarchical VD g g o S o H E H < N H 13 O I I P G ? “ Ej W W f e i H W O ë i - q O 5 f f i P B H Q Q <C 1 - 1 w w p m Q 13 § c o E H E^ E h O P C g ^ H S | g œ w w H > h! H :- i g œ iP 1 - 1 ( < ; < H u o H H P P U p p o < c _ p 1 3 M O H M C / 3 P O S C / 3 S E H O O I — I W t H È 3 H H P P G I P G 0 C / 3 0 > •H P 0 e n ! 3 T3 0 P G G N I O 0 •H -H -H T î 0 U k l 0 P 0 0 P T J k l P G en 0 0 0 O PPL) m 97 ' s t * 1 —I C N O 0 LO p p o O g G O p • r H I — H 0 P 0 0 0 > p N 0 G • r H u 1 - 1 O G o U 0 p I — H en 0 0 P k l p 0 C o 13 "H 0 T 0 • r H P 0 k l 0 i - H G C P k l C J 0 O 0 P -H k l p P P 0 G C J 0 ■H 0 1 -I m G 13 0 er 0 P 0 O o k l k l 1 - 1 p m A P O 00 C N O C N P P 0 > 0 0 0 G 0 0 -H P •H G e n -r4 0 o 1 —I 0 0 A 0 0 k l p p o 0 0 0 k l e n 0 A u o p A 0 P 0 0 k l k l O 0 0 0 0 0 A P G 0 U 0 Pa G • r H CN EH 13 P a u p o Q P < EH IS Q O < Eh H P Eh m P P Q P M <C P Eh W a !3 H O Eh O < - — - Ü o g g r - H H I I H - P^ p œ u P C W H EH p U p p H p > P M p P p p O U p P l > H < o p u p 1 — 4 p p p M q u P p P P p I I ip -H -P C N ip 0 P O C n d -P 0 0 C C 0 P N O 0 0 ■ H •H -H 0 0 0 0 1 3 W 0 ID H m C N P C T > p P 0 *H rH C N en en O en 0 0 M - l • • • • • • 0 1 3 U 1 1 1 I t C C r > 0 0 0 O p -P P U o P m t 0 -p 0 • 0 1 — 1 p > o 0 0 H 0 0 0 0 0 G 0 0 X G 0 -p O •rH G 4J ■H LP 0 1 — 1 0 -P •H P 0 0 0 G 0 > -P N en P U 0 G ■H •H P P O G 0 C O U 0 •H -P fH Î7 > P u 0 ■ P P O C N •H 0 G O • P •H 0 1 0 P 0 X i -H +J 0 P 0 r-H G G P U u 0 O 0 •H r4 kt p 1 — 1 -p 0 G o G . —' « —- < ■ — • •H 0 H C N en en P G 13 0 0^ 0 P X X X 0 O O P U 1 — 1 C N 1 — 1 P P P 99 level. These findings taken together suggest that broad client-organization relations tend to generate negative ; ^ i jsentiment toward clients only when officials are required j i Ito deal with clients directly and frequently* j ! I The final test of the contextual effects of breadth in generating negative sentiment toward clients is an | [examination of the three-way interaction term (see Table 8). While the three-way interaction of breadth, client contact, ; and hierarchical level is not significant, it is in the 'predicted direction and adds an additional 1 percent to j jvariance explained by our two-way interaction terms. Thus, Ithe strains and negative sentiment which already exist among low level officials who are in frequent contact with clients, is greater when client-organization relations are broad than when they are narrow. I These findings are admittedly only tentative. But ithey take on added significance when considered next to the jresults of a well designed but not yet published study of the attitudes of nursing personnel toward the "typical" middle-aged and elderly patient in a Veteran's Administra- ■ I •tion hospital (Shirley, et al., 1977). The V.A. study I I Iclearly demonstrated that long-term care personnel (i.e., I broad and long-term relations with clients) were 00 g m g E h 1 3 M H M U M O ffi E h Q < H M F H M M Q ë Î3 M < E h i3 M E h 0 3 U < g H O E h U C ^ ^ O O M 1 3 r P H I I H - 1 3 M 0 3 O M < 0 3 M E h M O % H H M M H H M M M O U g p p g < o u H eu w s s g P P M < 13 ^ P O P H H M H Eh ® a g M H E h O P P !3 g s H E H M i< M N H H 1 3 !3 O g H P Eh o U I I S p H g -P S .§ - P C 0 p 0 > ■ r H - P 0 Î J 1 0 !3 T3 0 N • r H - P G 0 -H b 0 u p 0 *p 0 0 0 > 0 M 0 0 •H d Ü P 0 P 0 ■ H M 1 - P u 0 -p G O U - P G 0 •H r — I U ■ P G 0 & 0 P M G O • r - i p 0 N •P G 0 U « P ? - P G 0 ■ P r P 4 J en X U 0 ^ — V " - — s . ^ - - - r — 1 'ü 0 C N P O P O C N 0 M O X X X X P r — 1 C N 1 — 1 1 — 1 m '— '— ip O 0 0 0 p en 0 A P O < 4 - 4 0 -p u 0 P P O U 0 0 0 0 d - P G 0 P 0 PU G •P CN M I — I 0 > 0 0 U § u • r H m •rH & •P 0 p o 0 g ' 0 1 P I JP- .J [■' ' ^ ■ 101 jsignificantly more negative in their attitudes toward the ! ! "personal acceptability" of both middle-aged and elderly clients than were the general medicine and surgery group | ; I I (i.e., narrow- and short-term carc relations). The authors I I 'drew the tentative and rather uninteresting conclusion that ■ [long-term care patients must actually be less acceptable [personally than other patients in the V.A. hospital. How ever, a more theoretically interesting and, I think, more [plausible explanation, is that the nature of the client- jorganization relationship in long-term care settings tends |to produce greater stresses and strains among low level I jnursing personnel who are in constant contact with clients, ! jthan do the shorter more narrowly defined relationships in ^surgery and general medicine. This interpretation gains , further credibility as we look at the items used to measure I [personal credibility in the V.A. study. This scale assessed i 'nurses' attitudes toward patients in terms of their being ugly, selfish, rigid, untidy, intolerant, etc. These are hardly items which one could easily label as objective 'characteristics of patients. Rather, they are reflections j I of what we refer to as negative sentiment and presumably , ithey derive from sources similar to those described in this : I [chapter. I 102| In sum, tentative support was found for the predic tion that the structure of client-organization relations [specifies the relationship between organizational variables i ' I [and officials' negative sentiment toward clients. The | 'results described above suggest that it is not only the organization's rules, hierarchy, and role constraints which ; ^contribute to role strain among low level officials who must jdeal with clients, but also the nature of the client-organi- ' i zation relationship itself. The findings presented here [suggest that frequent client contact under broad client- I lorganization relations, though it may be less stressful for ithe client, may produce greater strain for officials than I iWhen the relationship is narrowly defined. ; Positive Evaluations of Elderly Clients The factor analysis of attitude items presented in jTable 1 indicates two orthogonal factors, one consisting of ■ negative sentiment items and the other an evaluative scale regarding positive evaluations of the elderly. We turn now 1 |to the positive evaluations. The items in the positive evaluation scale relate ' t I to the ability of older people to work and learn. It is 1 ! argued here that work and learning abilities are closely \ 103 'tied to a person's independence and productivity in society. Therefore, the positive evaluation scale will be treated as a rough indicator of officials' perceptions of I 4 Ielderly clients along a continuum of dependency. By doing ' Iso we are able to relate these evaluations to our earlier (discussion of the organization's definition of "persons as jclients" in terms of the required dependent role of clients. [ If we assume that evaluations of independence and I [productivity of the elderly are critical to their defined [ role as clients of the bureaucracy as noted in Chapter I, we I should expect that attributes of the service organization [itself will be important in determining officials' positive evaluations of clients. If, on the other hand, we treat these evaluations as societal stereotypes of the elderly, [then we should expect personal characteristics of the official (i.e., his/her location in the larger social structure) to be most predictive of evaluations of the independence and productivity of elderly clients. Thus, we begin this discussion with two competing orientations which are based on the conceptual scheme stated in Chapter I; that there are both societal and organizational effects on atti- ,tudes and behavior. i I Interpreting the effects of organizational sector onj ïo3 officials’ positive evaluations of the elderly requires that we look at aspects of the organizational definition of [ persons as clients. It was posited in chapter I that the 1 'predominant role definition for clients in service agencies j is one of dependency. But we should expect that organiza tional requirements for dependency will vary according to a variety of organizational characteristics, such as goals, i [control structure, sources of revenue, and the type of I ' clients served. Before discussing the specific organize- ; tional characteristics which might affect officials' évalua-^ jtions, it is first necessary to describe the different ' [aspects of clients which are relevant to organizations. Clients embody three broad types of characteristics , , which influence the service relationship: qualifying or [ primary characteristics ; related or secondary characteris - Itics; and extraneous characteristics (Lefton, 1970). Pri- .mary characteristics are those which are considered to be necessary and sufficient for entering the relationship with ■ jthe organization. For example, the primary characteristics of clients of the Social Security bureaucracy include being i 'at least 6 2 years of age, not currently earning more than [ "x" dollars per month in any given quarter, and having con - tributed to the Social Security fund (or be married to I someone who has) during one's work career. Secondary char- acteristics are related to primary characteristics and often affect the particular service offered. For example, ! I age is a secondary characteristic which does not have a | direct bearing on a person's ability to become a hospital patient but does affect the treatment administered in hos pitals. Sudnow (1967) found that age was strongly related to perceived moral character of patients and the amount of effort expended in emergency care. The elderly and alco holics were the two groups given the least consideration by , emergency staff. Finally, extraneous characteristics are those which are not directly relevant to the organization jbut which nonetheless affect the client's relationship with I the organization. Ethnic variations affecting the use of services or knowledge of bureaucracies has long been an extraneous characteristic of service organizations. Organizations both define the relevant character istics of clients and are affected by those characteristics. : The effects of clients on the organization depend on the salience of client characteristics to the organization | (Lefton and Rosengren, 1966). The next question is how does the client characteristic of independence and productivity relate to the given organizational sectors in this analysis?. 1061 I The results in Table 9 show three of the five jsectors and centrality of clients to be significantly [related to officials' positive evaluations of elderly | iclients. Personal characteristics of officials were unre- j 1 I lated to evaluations as were contact with clients and the officials' level in the organizational hierarchy. Finally, while the regression coefficients for professional sociali-' I 5 ization are relatively large, none are significant. i , The results in Table 9 also demonstrate clearly that jthe only variables in our regression equation which explain I ia sizeable amount of variance in positive evaluations are I ,the five sectors. (The increment attributable to SECTOR is significant at the .05 level, F=2.6.) All other influences explain only minimal variance, especially when we consider jthe increases in standard error associated with their inclu- i [sion in the regression equation. It should be remembered i [throughout the remainder of this section that the observed ^effects of the five sector variables are in relation to the I jmissing category "other" which is not included in the 1 equation. Earlier we provided partial justification for , ! excluding "other" based on its being a composite category. i 'While it is not really further justification, the absence i I I ( ' lOf a zero-order relationship between positive evaluations | ' c r > i M m ■g o I —I & M 5 U g g 9 H M O W Î3 0 H E h 1 i Eh H W O PM M g U H I M 0 œ H g 1 U w G O ■ H - P 0 G rH 0 > M 0 > ■ H • P ■ P 0 Q A 0 ^ -N ^ -' s 00 .-- P o 00 O ro 1 —1 CN c o 00 o 1 —1 o o 0CN » o o O » o g A 1 • « ■ t 1 • 0 P G 0 "p o m o c r > 1 —1 G o 1 —1 o 1 —1 o CN 4P o 1 —i o o o O • • • • • * T S P 0 G G N O 0 • P ■ P • p T 3 0 0 P 0 - P 1 —1 0 0 p o T 3 P P » G en 0 0 0 O P A U CO U Q -P O •P b 0 P A 00 iH ro VD a> o o rp I —I I —I r r r * r c r > ip CM o VD O O O 0 CM m o VD C O CM O O O « » * I I —I CM A 00 m r~ o r~ o I —I I —I I —I o I —I o r- CN o o o <y\ vD ro I I G 0 0 0 rH -H P P 0 0 p 0 0 ■ P "P 0 X 0 0 P 0 N p P p 0 ■ P •P 0 G G -H P P 0 1 — 1 0 O 0 p 1 — 1 P >1 0 0 0 P U •P 0 0 0 P "P P 0 > 0 •P 1 — 1 p •P -H 0 G p 0 0 0 P U 0 0 p p O G 0 A g P G 0 ■ P o o C O p 0 P P 0 p P P G b rH 0 1 — 1 X G 0 •P 0 0 P G ■ H 1 — 1 0 0 G 0 0 1 - -1 X 0 O g 0 P 0 0 O n g >1 C) C . ) ■ P C (!) ■ P "P G >1 P p P 0 O P 1 — 1 0 P: P •P O P P •P 1 — 1 o 0 ■ P ■ P 0 0 ■P 0 P 0 1 — 1 0 G 1 — 1 0 0 G 0 ■ P •P 0 p P 0 P 0 0 G 0 G X 0 en 0 > i 0 O 0 G g 1 - -1 G P 0 en P 0 0 O .G P p m 3 H H e y ’ P 0 < W M P A C O A 0 0 0 G P O ■ P 0 p 0 0 p M C O M O A A 107 8 Ü i p î o 0 0 0 p en 0 TS P O m b 0 -p 0 0 p p o 0 0 0 0 0 .G - P G 0 P 0 P U G ■ P N A 0 0 0 > > > 0 0 0 0 0 0 0 0 0 G G G 0 0 0 0 0 0 ■ P * P -P < P I P I P ■ P -P -P G G C On en en •P " P " P 0 0 0 I —I O LO O .P O 0 A 0 I 108 land "other" (r=-.06) provides some assurance that we are : I I jnot overlooking important effects by leaving "other" out of jthe equation . I Two of the sectors— employment and nursing homes— t 'are concerned with the issues of independence and produc tivity as a primary characteristic of their clients. [Employment agencies must assess the productive abilities of [older persons as part of the routine of finding jobs for [them; while nursing homes are primarily concerned with elderly clients who cannot live independently any longer. iThe issue of independence and productivity is of primary ! [importance to both nursing homes and employment agencies, I but the officials in these two settings hold opposing evaluations. Employment officials are significantly more , likely than not to evaluate elderly clients as independent and productive, while nursing homes tend to evaluate them as much less so. This adds further confirmation to previous findings that nursing home personnel are often unsupportive of the rehabilitative potential of elderly clients (Kos- i berg and Gorman, 1975). Furthermore, the goal of nursing | I homes is to detain clients while the goal of employment 'agencies is to find them jobs and a productive role. i I Elderly affairs officials are more likely than I ; 109! [those from the income maintenance sector to evaluate the I elderly as independent and productive. The issue of inde- jpendence as a client characteristic is only of secondary | i ! importance in both sectors. While the issues of indepen- | 'dence and productivity are not necessary characteristics for becoming a client in a senior center or a department of aging, elderly affairs organizations are frequently cast ' in the role of advocates for clients and issues of inde- jpendence are salient in shaping policies which affect the [elderly. Income maintenance officials, on the other hand, may downgrade the productive potential of elderly clients jas a means of self-justification. Simply, the raison d'etre of income maintenance organizations is providing income for older clients who are no longer working. While the ability of a client to work is not of critical importance in de- [fining client status, it undoubtedly becomes part of the I [organizational fiction that the elderly are in fact not capable of working. I I Finally, the issue of independence and productivity ; are only extraneous characteristics for clients dealing with health agencies. Health problems occur regardless of one's . j potential for independence. Thus, health sector personnel |are neither more nor less likely than other officials to j j 110 'evaluate the elderly as independent and productive. The one non-organizational variable which affects evaluations of the elderly is the centrality of clients to | Ithe official's job. There are several possible interpréta - | tions of this finding. If centrality is taken as an indi cator of the degree to which officials must deal with com- ; ,peting interests, it is plausible that those who only deal ! with elderly clients will view them in less stereotyped jways. There is evidence that the greater the density of clients, the more stereotyping of clients (Shuval, 1962; I Keith, 1977), Diversity of clients may have the same effect as density in forcing officials to gloss over the 'unique aspects of clients and resort to societal stereo- Itypes. This may influence officials who deal with elderly jclients as only one of many client groups. Summary The major theme of this chapter, for which we have garnered reasonable support, is that characteristics of the I organization and the client-organization relationship are important in predicting the views of officials toward the elderly, specifically elderly clients. The major finding reported here is that the hierarchical role structure in Ill organizations tends to generate negative sentiment toward clients. The organizational role structure is such that those who occupy lower level roles are more constrained, monitored, and confronted with conflicting expectations, ! 'all of which contribute to role strain. Given the nature of the reward structure in the organization, clients, |Particularly those with limited resources, must bear the jbrunt of this strain in the form of negative reactions by [officials. I While clients must bear the brunt of negativism, Ithey are themselves a source of strain for officials. Thus,: low level officials' negativism toward clients is signi ficantly enhanced the more frequently the official is in I .contact with clients. This is consistent with social Ipsychological research which indicates that contact with an 'object or person tends to intensify rather than change the direction of attitudes. Additionally, if a lower level [bureaucrat is oriented to enforcing the rules and regula- jtions of the organization this will further enhance his/her begativism toward clients. [ A most interesting finding in this chapter was that ithe structure of the client-organization relationship also jintensifies the effects of other factors in producing | I 112; pegative sentiment toward clients. Low level bureaucrats I who have frequent contact with elderly clients and who must , [deal with a variety of client needs, tend to be the most I negative toward those clients. Thus, the role strains j which exist for lower level bureaucrats are amplified the more the whole client becomes organizationally relevant. , Finally, the organization itself tends to determine jthe extent to which bureaucrats view their elderly clients I !in terms of productivity, independence, and social value. [Positive evaluations of elderly clients were related to [organizational sector but not to personal or professional I I characteristics of officials. Employment and elderly I affairs sectors were more positive than nursing homes, income maintenance, and health organizations. Nursing homes were least positive, a function of their coercive nature or, perhaps, the type of clients they treat. NOTES FOR CHAPTER II ! 1 I Of the remaining 11 items two dealt with positive or negative feelings toward the elderly but their distri butions were so highly skewed they were excluded from this .analysis. The remaining nine items not used here dealt with issues of discimination, family relations or prescriptions bbout old age. j i 2 ! I Higher levels in this sample are more likely than [lower levels to use technical (though not necessarily [ jscientific) sources of information. Correlation of level [ with use of government reports is .34 (cx=.001) and with ! legislative hearings is .17 (a=.05). Correlation with use of scientific research was .06 (N.S.). . I ' 3 ' This trend is probably less pronounced among aged clients than among younger cohorts due to generation-speci- . Ific socialization patterns which trained the current older cohorts to hold relatively low expectations for collective services, particularly those provided by government. The recent growth of political associations and programs and lincreased coalition activity between old age organizations land others may mark a shift toward greater efficacy among [older people leading to increased demands on service agen cies. (See also Jenkins and Perrow, 1977.) 4 A significant inverse correlation between offi cials' definitions of client's problems as personal and high evaluations of independence and productivity offers further confirmation for our interpretation of the evaluative scale. ,Thus, if the elderly are perceived to be suffering from per- 'sonal deficiencies they are also viewed as less productive and viable as independent members of society. : i I 113 i 114 ; 5 i The size of these coefficients reflects collinea- rity with other variables. (Nearly half of the variance of ; leach of the professional socialization variables is ex plained by other variables in the equation.) When sector lis removed from the equation the effects of professional socialization are reduced; but when professional socializa- , tion variables are removed the effects of sector are vir- | tually unaltered. C H A P T E R I I I I THE VIEW FROM BELOW; OLD CLIENTS' ATTITUDES ' TOWARD GOVERNMENT AGENCIES "The confusion between the interest which a person himself has or takes, and the interest which a sec ond person has or takes in him, is one of the pit- , falls of parentage, teaching, religion, and all the I varied forms of professed benevolence. In order to I discover whether professed benevolence is really independent benevolence, ask the beneficiary rather than the benefactor." (R. B. Perry, Realms of I Value, cited in Mayer and Timms, 1970; face page) i The relationship between clients and officials entails mutual attitudes, expectations, and orientations. iChapter II examined the social structural and organizational iroots of attitudes toward elderly clients held by officials. This chapter deals with the complementary perspective: the 'aged client's perceptions of their relations with formal organizations--in this case, government agencies. Specifi- jcally, what factors contribute to clients' feelings of embarrassment and anger over dealing with government agen cies? 1 1 5 f --------------------------------- ---------- T16 : I j It is assumed that clients' perceptions of their relations with government agencies are at least in part I affected by their perceptions of self. The self in turn is ' a product of social interaction. Through a process of j '"imaginative reconstruction" the self is projected to others--in this case, the agency--and is thereby defined by: (1) an imagination of how self appears to others, (2) I an estimate of what others’ judgments of self will be, and i I(3) how ego feels about self (Cooley, 1902). Thus, the client's image of self, of the agency, and of the self in I the context of the agency are taken to be the essential i .sources of embarrassment and/or anger over client-agency I ;relations.^ I Theoretical Rationale ' The argument presented in this chapter has four major components. First, growing old in American society brings increasing dependency. Second, dependency, though {often a normal aspect of social life, is considered patho- ' logical and thereby carries the potential for stigma. Third, the client's ability to control information or ten sion regarding stigma is diminished in the face of the more powerful and intruding government agency. Therefore, 117 ! clients interacting with agencies are exposed to the outside world as stigmatized and the resultant response by the client is embarrassment where s(he) accepts the stigma and ; anger where s(he) does not, | I Hypotheses I The following propositions and hypotheses are j ! implied by the above rationale; i Proposition 1; The greater the perceived depen dency, the more stigmatized the client feels; Proposition 2; The more stigmatized the client feels--assuming acceptance of stigma— the more likely the embarrassment; Hypothesis 1: Therefore, the greater the per ceived dependency of the client, the more likely the embarrassment. Proposition 3: The less the client's power, the more coerced the client; Proposition 4; The more coerced the client, the more angry the client; Hypothesis 2; Therefore, the less the client's power, the more angry the client. 118 Aging and the Stigma of Dependency jDependency and aging Dependence is reliance on others for support and sustenance. As social beings we are undeniably interdepen- ! dent, yet in American society dependency has acquired a pathological connotation and frequently indicates "covert ■moral weakness" (Clark, 1969:60). "Only by being indepen - I jdent can an American be truly a person, self-respecting, j [worthy of concern and the esteem of others" (Clark, 1969: j 59). ^ The elderly in American society are uniquely caught in a cross-fire of competing cultural expectations for in dependence and social, physical, and economic conditions which increasingly generate dependence. Some have argued !that the dependencies of old age are "normal." These dependencies, which include the economic changeover from producer to consumer, physical declines in muscle strength, ' reflexes, and energy levels, mental alterations due to (Changes in the central nervous system, and the social loss of important’ others (Blenkner, 1969), may be normal in that | they are more of less universal, but in the face of a youth- I - : 'oriented culture that favors competitive productivity and 119 individualism, they are often considered to be no more nor mal than are homosexuals to Anita Bryant. The conflict between the dominant societal values of independence and the aged's increasing dependence ere - ates a personal confliet for the individual older person. Parents teach their children the virtues of independence and autonomy and the evils of dependence. But as they them selves grow old they are confronted with increasing depen dence. This tension has rather severe effects on life satisfaction, morale, and self-esteem. For example, the significant relationship between declines in financial and health status and diminished self esteem and life satisfac tion (Edwards and Klemmack, 197 3) are in large part due to the negation of self accompanying dependency. The elderly are often "frantic" in expressing a need for independence, citing it as the most important component of self-esteem (Clark, 1969). The contradiction between normal dependen cies and a cultural obsession with individual autonomy jforces a "war between the self and the superego" (Clark, |l969). I j pependence as stigma Stigma is a deeply discrediting attribute that 120 represents a discrepancy between "virtual" and "actual" social identity (Goffman, 1963). Virtual identity is that imputed by others to an individual member of a general social category, e.g., the expectation of independence and IseIf-support accompanying adulthood in American society. I lActual identity, on the other hand, consists of the attri butes a person can be proved to possess. An adult who is unable to care for him/herself due to physical, emotional, or social handicap is considered to possess a deeply dis crediting attribute. The discrepancy, then, between the expectations of independence accompanying adulthood and the iproven attribute "dependence" thus constitutes a stigma. ! I There are numerous categories of people who are ! Idependent, but not all dependent persons are stigmatized. Infants and children, women in late stages of pregnancy and during childbirth, and the temporarily ill are examples of jdependents who are given societal exemptions from stigma. IBut even these exemptions are bounded by strict temporal ^boundaries such that if a person remains ill too long he/she 'acquires the stigmatized label "invalid," or if a person i does not "grow up" and become self-supporting within a reasonable period of time negative sanctions are applied. Given a cultural preoccupation with independence it r 2 ' r is readily apparent why those who are dependent are also stigmatized. The norms of society dictate that adult mem bers' virtual and actual identity should be based on the individual's ability to be wholly self-sustaining; if proven otherwise, one's social identity is discredited and stigma Is clamped on. Thus, the greater the dependency, the more stigma tized the client feels (Proposition 1). 'The management of stigma I Stigma is meaningful only in social relationships. [That is, a person's virtual identity can be discredited only by an audience of others who are considered "normal," i.e., |Without discrediting attributes. This does not mean that bne's stigma suddenly disappears when in the presence of jother stigmatized individuals, for the inescapable societal norms of normalcy are ever present. Rather, stigmatization as a process and product of social interaction. I I Given the preeminence of an audience in defining what is normal and what is discrediting, there are two cate gories of stigma that are relevant to client-agency rela- I étions: (1) those who are discredited, i.e., visibly and outwardly deficient, and (2) those who are discreditable. 122 i.e., possessors of a discrediting attribute that is not readily visible to the casual observer but which can be uncovered by varying amounts of probing. The cripple con fined to a wheelchair is discredited because his handicap is immediately visible. But the hemophiliac is only dis creditable, until his/her disease is made known to others, because hemophilia is not an immediately apparent condition Thus, the visibility of one's discrediting attribute is critical to its impact on the individual and his/her audi ence . Whether one is discredited or merely discreditable has important implications for one's responses to stigma in social situations. Goffman (1963) points out that the prob lem for the discredited is that of "tension management," dealing with his/her own and others' discomfort or embar rassment over the discrepant identity, while for the dis creditable it is a problem of "information management," more commonly referred to as "passing" by concealing as much as possible any discrediting attributes. j Success in managing tension or information is a I [function of the degree of stigma, the skills of the stig- I imatized, and the knowledge, power, and empathie qualities of the audience. Those who are only mildly discredited can 123 more easily manage the situation than those with severe or radical stigmas. In this age of liberation many previously severe stigmas, such as homosexuality, are now only mildly jstigmatizing. Stigmatization is managed also by the skills lof the individual that enable either a cover-up of a nega- I jtive attribute--the rich elderly woman who can deny her age via expensive face, hip, breast, and thigh modifications-- or a softening of the blow of a stigma to self and others. Finally, the audience itself is important in managing Jstigma. Among friends the stigmatized-.are able either to feel comfortable or to "pass" since friends are committed |to a smooth-flowing social situation. However, in a more j [hostile or indifferent environment, such as in the presence ! jof a caseworker representing the welfare bureaucracy, the management of tension and/or information is more difficult. : Stigma and government agencies I I The clash between societal expectations of inde- I I ipendence and the individual's dependence is embodied in the [client-agency relationship. The older person may attempt jto conceal his/her dependence, via information management, ■by portraying an image of independence to the outside world. In contrast, the societal response to the dependence of the 124 elderly is to establish welfare bureaucracies that in effect^ "expose" the individual as dependent. For example, a per sonal means of dealing with stigma is to devote inordinate [amounts of energy to areas that are supposed to be closed [due to the person's condition (Goffman, 1963). The follow- i ling personal experience illustrates this point : A 76-year-old friend of mine, shortly after coming out of the hospital for a serious illness, worked very hard at getting dressed-up to attend a meeting of her "activist" peers and friends. Arriving late she caused a minor commotion as people greeted her in amazement that she looked so good despite her recent illness. With great pride and boastfulness she brushed aside the offer of a chair claiming she could easily sit on the floor. As a further show of her health and independence, she offered time after time during the meeting to do this task and that task until after an hour or so she quietly turned to a friend and asked if she could be given a ride home . . . she was very very tired. It was only at this point that her social identity became discredited. However, her great amounts of "face-work" had bought an hour of independence and strength and a much- I {valued social identity. In short, she had "passed" success fully for a brief period. But the societal response to dependence makes pass ing more difficult. Among the societal responses to depen - Idency is the development of a vast array of publicly funded social services, many with a covert mandate to sort out the 125 dependent from the less dependent clients. These services include such things as Medicaid and Medicare, Social Secur ity and SSI, food stamps and meal programs, rent supple ments, transportation and escort services, senior centers, and legal and protective services. All, including Social Security, are a form of welfare. Despite the fact that the elderly are a more legitimate population for social inter vention than other groups (Hoshino, 1973; McDonald and Mar - ing, 1972), the "residual" approach to social welfare in America, whereby welfare is administered only in cases of extreme and demonstrable need rather than as a right of citizenship (Latz, 1965), leaves the elderly recipient in the midst of a dilemma. The dilemma is over needs for sus tenance versus self-related needs for independence. The dilemma of sustenance versus self is apparent as the individual's strongly socialized need for indepen dence clashes with the residual definition of welfare ; that one must be extremely needy to participate. In line with a residual approach to welfare is the image of welfare reci pients as personally deficient. Data from a national opin ion survey of adults over the age of 18 indicate that most people believe "welfare recipients find themselves in reci pient status because of lack of skills and/or ability to 126 cope with contemporary society" (Carter, 1973:8). A focus on the individual's deficiencies in contemporary welfare imagery increases the pressure on welfare recipients to [demonstrate their need (read: dependence) in order to I I qualify for service. As a result, all efforts at concealing [one's discreditability are futile in the face of the service bureaucracy. In short, the older person's most discrediting attribute, dependence, is laid bare in the face of the service bureaucracy and the attached stigma thereby becomes public. The Effects of Stigma Stigma and client embarrassment If imagined or real interaction with government service bureaucracies exposes one's discreditability and increases stigmatization, we should expect clients to react accordingly. One such reaction is to avoid contact with i I service agencies altogether. The elderly do, in fact, lunderutilize services despite an "objective" level of need and an expressed willingness to use them (Powers and Bul- jtena, 1974). The fear of stigmatization over dealing with I service agencies may explain the lack of consistency be tween an expressed willingness to use services by the aged ITT] I and their subsequent low usage. But low usage may also be explained by lack of knowledge of services, or a limited life space that makes it too difficult to travel the neces sary distances to obtain services (Kent and Matson, 1972) . Assuming the client interacts with the agency and accepts the stigma of dependence, embarrassment is one pos- jsible response of clients in the face of the service bureau cracy. Embarrassment is a personal response to the projec- jtion of incompatible definitions of self to an audience. IThis incompatibility, like that which gives rise to stigma, jimplies an audience whose attention is focused on the per- Iformer (Goffman, 1959). Through the process of imaginative I {reconstruction discussed earlier, the self is projected to I :the agency and based on one's own perceptions and on others' responses the client evaluates his/her self. i I When an elderly, low status, dependent client reflects these attributes of self onto a government agency, I the reflection is often resoundingly negative. But given I the role of the agency, i.e., correcting defects in the I lvalues of the client (see Chapter I), the reflection of self off the agengy may be negative regardless of the attri- : butes and perceptions of self. In brief anonymous service relations, servers become ' skilled at detecting what they see as affectation. However, since their own position is made clear by their service role they cannot easily return affec tation with affectation. At the same time, customers ! who are what they claim to be sense that the server may not appreciate this. The customer may then feel ashamed because he feels as he would feel were he as false as he appears to be. (Goffman, 1959: 22Iff.) Perhaps the most embarrassing of dependencies is ] poverty or financial insecurity. Money is the key to inde- | pendence in American society and without it one is surely i dependent on others. It is no accident that a major die- ; i tionary definition of embarrassment includes an involvement ] in "financial difficulties" (Merriam-Webster, 1961). The I embarrassment of financial dependency in the face of a government agency is described in the following excerpt ! from a study of lower-class clients: ; Clients in search of material, rather than interper sonal, help were a good deal more resistant about [ coming to the agency. Moreover, if we are to make sense of their later reactions to treatment, we must thoroughly understand the source and nature of their antipathy to seeking help. These clients antici pated that the treatment experience would be punish ing. For one thing, they were ashamed of their financial dependency and to expose their plight to others would only increase their humiliation. Sec- i ondly, a sympathetic response was the very last thing | they expected from the agency. It was anticipated : that the worker would be harsh and abrupt; in all ; likelihood he would be contemptuous of their plight; ; and he might well imagine they were only there to j "cadge" what they get. There is not the slightest j 129 doubt that these individuals dreaded the prospect of becoming clients. (Mayer and Timms, 1970:139) Embarrassment, then, is distress over one's per ceived falseness, of not living up to the dominant values ,of the society, of being discredited before an audience. I Thus, the more stigmatized the client feels— assuming acceptance of stigma— the more likely the embarrassment (Proposition 2). Stigma and client anger Another reaction to stigma and dependence is anger. Anger is an expression of displeasure over an impropriety or injustice. Chapter I presented the components that ' underlie asymmetry between clients and the agency. These ; are: asymmetry in tangible resources, differential sta- { tuses, incongruent knowledge, and imbalanced authority. j Assuming that client-agency interaction is based on prin- | ciples of exchange, each of these factors of asymmetry con - ; i tributes to an imbalance in the resources that each member can exchange in the relationship. This imbalance carries , ithe potential for disruption of the norms of "fair exchange"| j I land anger may be the likely result. ; i I i Of all the systems of exchange, compliance is the | jmost costly (Elau, 1964). Those who lack the necessary 130 ! I requisites of power in exchange relations are least able to j resist giving compliance in.exchange for needed services. In order to avoid giving compliance in exchange for service,| the client must be able either to give something valuable in return, to do without the service, or to seek services | I elsewhere. In client-agency relations, then, the organize- | tion can ' exert more coercive power than the client can and this fact tends to be translated by the organization into the presumption that its values and products I are more reasonable, more honorable, more legal, and j technologically more plausible than are those of the client. (Rosengren, 1970:205) I ’ Thus, the imbalance in power leads to a form of organiza tional chauvinism. j Organizational chauvinism and the ability to coerce I clients at will suggest that the less the power of the I client, the more coerced the client (Proposition 3). I I j Surrounding all exchange relationships is a norm of ; jreciprocity (Blau, 1964). This norm develops through inter4 [action and over-time becomes institutionalized such that a ■fate of fair exchange is established across a broad range j 1 I I I I of social relationships. These norms of fair exchange j I ■ i j"specify the proper proportion of rewards to costs and | investments" (Turner, 1974:269). If one party to an 1311 exchange extracts too much from his/her partner for what is j given in return, the norms of fair exchange will be broken j and anger will result. The presence of the norm of fair exchange in client- jagency interaction makes it apparent that if the agency Iextracts too much compliance for too little service the I ; jclient is likely to become angry. Bearing in mind the | I j social costs of stigma attached to clients' dependence on ! j government agencies, coupled with the imbalance in power | resources available to, the client in relation to the agency, it is likely that the most coerced clients will similarly | be the most angry (Proposition 4). Drawing on Propositions 1-4 above, the following [ section provides an empirical test of the following hypoth eses : 1. The greater the perceived dependency of the client, the more likely the embarrassment. 2. The less the client's power, the more angry the client. ■ Embarrassment as a jcause of anger I I While the above discussion and hypotheses have dealt with the predictors of anger and embarrassment, noth ing has been mentioned to this point about the relationship 132 [between these two variables. There is, however, a logical connection between them which has been implied in our dis cussion. Supplementing this logical link with the elusive but suggestive psychological concept of projection, we will argue that the greater the embarrassment over one's per ceived relations with government agencies, the greater will be the anger. The causal relation is from embarrassment to anger and not the reverse. Embarrassment results from the acceptance of stigma --in this case acceptance of dependent status (perception | of self as old, in poor health, financially declining, | declining in general, and blaming oneself rather than the system for one's noxious state). The acceptance of this , stigma of dependency is a function of being old, having low j social status, and being retired. Thus, these social attri - j butes have but an indirect causal connection with embar- , i rassment. On the other hand, we have already posited direct; [relationships of these objective characteristics with anger ! i ' [because of the treatment they occasion on the part of ser- ;vice providers. To this we add embarrassment as a direct j Icause of anger, for three reasons. First, embarrassment m a y j [be a cost of dependent interaction that goes beyond the | i ! Inorm of fair exchange. Second, embarrassment--conceived as j I 133' I ! anger against the self--may be painful and therefore pro- j I jected as anger against the other. Third, embarrassed [ I clients might be the ones who are most obsequious and there fore invoke denigrating responses to self on the part of both self and bureaucrat that cause anger. ! The processes through which embarrassment is trans lated into anger are aptly described in the summary of a study of lower class clients seeking both financial and interpersonal help: ". . . [clients ] sought to ingratiate themselves with the worker. To some extent they did things ' they did not want to do in order to appear deserv- ■ ing. Efforts of this type are apt to be stressful More significantly, they are apt to generate feel ings of self-disgust, which in time become converted into anger and resentment toward those ’responsible’ for their self-contempt." (Mayer and Timms, 19 70 :133) Thus, in the above study, the more reprehensible the client felt, the more ingratiating was his/her behavior ‘ i lin the face of the agency. Ingratiation in turn tended to I ' igenerate mistrust and further questioning on the part of the service worker which tended to increase the ingratiating behavior and eventually led to anger and resentment toward the projected source of mistrust and stigma. To argue the reverse--that embarrassment is caused by anger is far less tenable. Anger is the result of 1341 rejecting stigma, not the cause of a feeling that is engen- ’ dered by the acceptance of stigma. | Therefore, the greater the embarrassment, the greater the anger. The causal relationships between low power, perceived dependency, embarrassment, and anger are presented in the path model below (Figure 4). Research Procedure The sample The analysis was performed using existing data drawn | from interviews with 334 Black, Mexican-American, and White | 65 to 74 year-old residents of Los Angeles County. The | sample design used an area probability method with stratifi-; i cation on the bases of age, ethnicity, and socio-economic | status. The statistical process of weighting takes into | i account the probability of each respondent's having been sampled and provides an estimation of a representative sample for the three ethnic groups in Los Angeles County. Dummy variable regression was used to test the hypotheses. Analyses were performed for men and women sepa rately, because the issue of dependency has a different I I meaning for the two sexes. Simply, the problems associated j I with dependency, such as its stigmatizing effects, are j C O H p œ H is O o is H M w w o 3 < H M K P » CO u H Q 6 4 § CO P H o P Pi W o E 4 C ) o < (U ■p > p “ H m Ü ■H Ê H ( D c -p (U M P Ü p fd fd +J w P M o c iH w o w (U o •p ( Ü >1 p p P p p p CO W P 8 c o n -p ( U fd p o ■ i H P +J ( U n ( U C n H P < T5 (U > -r H (U u u (U ip C O (U • r H C O A (U fd •H -H Ü p C fd (U > îm fd n d c -p d G O (D P B tn c P p Ü (D fd > rQ o U1 C r» c O +J ■H r3 C O C O C G o O • p ■rH -p -p fd fd r H r H (D (D p P rH Td fd (U C O > p ■rH fd (U Ü Ü p M H (D o Pa rH _ (D C O nd +J O G B ( Ü •H jd r H -p Ü fd P >1 1 1—1 1 P « C L ) r ) r H Q ) 0 P P C r» C •H f X ) fd 0 0 G 0 G 0 P4 0 Id 1351 136 {presumed to be greater among men than among women. In American society men are expected to perform independent roles, to be employed, to be head of household, and general provider for family members. Those men who are incapable !of performing this role are often stigmatized as deficient. For this reason, men who are forced to negotiate an exis tence from government service agencies are likely to react negatively to this situation. Women, on the other hand, are often socialized into dependent roles by the dominant culture and, therefore, may be less likely to react nega tively to dependency requirements of service agencies. Tentative confirmation for this notion comes from a previous analysis of embarrassment among elderly clients of welfare agencies which uncovered major differences among men and women (Wells, 1973). Operational definitions of variables I I I The variables identified in the path model are I joperationalized below. Exact wording of each item as it was asked of respondents is provided in Appendix F. Each [variable was dichotomized. While this tends to cause some problems in interpreting statistical significance levels, Iwe are interested in the relative contribution of variables 137j and, therefore, pay more attention to the magnitude of standardized regression coefficients than to significance per se. Dependent variables.— The two dependent variables, clients' embarrassment or anger over dealing with govern ment agencies, are operationalized with the following two- part question. "In dealing with a government agency, have you yourself ever had any of the following experiences: (a) Did people treat you rudely? (b) Did you find it embar rassing?" On first blush, face validity for the embarrass - | ment item (b) is perhaps greater than for that which we are calling anger (a). However, given our theoretical orientation and the social psychological nature of the data,! we must treat clients' reactions to agencies in terms of ; self-perceptions. Thus, when a client perceives that he/ i she has been treated rudely we interpret this as the client : j directing blame for abusive or coercive treatment outward i I onto the agency. Outward directed blame, then, is inter - ' preted as anger over a perceived injustice, while embarrass- j ment is viewed as inward directed shame over the projec- | tion of discrepant identities. Perceived old.— Given the negative stereotypes of 138; old age which exist in American society (cf. Bennett and I Eckman, 1973; McTavish, 1971) one's self-identification as i old in many cases equates with a resignation to diminished or dependent status. Poor health.--Perceived health and perceived finan cial condition are consistently found to be the best predic tors of life satisfaction among the elderly (Edwards and Klemmack, 1973; Spreitzer and Snyder, 1974). These social psychological variables are better predictors of well-being i than functional health or income measures. Thus, we expect ^ I I that the lower the perceived health status, the greater the feelings of dependence. Financial decline.--As discussed earlier, one's j I independence is closely tied to financial security. On the | i average, a person's income is reduced by roughly 50 percent | I upon retirement, a factor which severely limits the options j available to many retired people. Therefore, a perceived | decline in finances is associated with increased limits on ! one's independence and ability to purchase goods and ser- j I vices necessary for playing an autonomous role in society. ; I I Relative decline.--The perception that one has i 139! I experienced greater decline in one's overall condition than j was expected is taken as a summary measure of general deprivation. This operational definition includes not only the experience of dependence but also indicates potential i Ifrustration that dependence relative to others, or to one's | I ! ' ; Iown standards, has exceeded expectations. This relative ' I I I decline in general status, like its counterpart relative ! deprivation, may be associated with greater personal dis satisfaction over one's dependent status than would simpler measures of "absolute" dependence. System blame.--System blame relates to the indivi- i i jdual's willingness to accept responsibility for his/her own i plight as opposed to directing it outward. The definition I of one's problems as personal rather than system related is considered to be relevant to the development of client- trust toward the service practitioner: the more problems are defined as personal, the more absolute the trust (Bid- well, 1970). The corollary to the above proposition, then, , is that the more the individual blames the system for his/ {her problems the more tenuous the trust between client and I : practitioner. System blame is operationalized by the degree; to which clients define their major problems in terms of I 140 discrimination, transportation, medical care, neighborhood problems or housing— -versus personal health and morale (see Appendix F for details on coding of system blame). Education.--It is assumed that power is the ability jto exercise one’s own will against the counter-pressures of i jOthers. However, simply perceiving oneself as powerful is jnot enough to actually exercise one's own will. In order I to exercise power a person needs the necessary resources. I These resources are closely aligned with objective social position. One indicator of social position is educational I level. Educational level is associated with level of in - ;come, which in itself is a source of power and may allow | the client to resist bureaucratic attempts to extract com- j pliance for service. Furthermore, those with higher levels , I of education are considered to be more experienced in bur- I eaucratic relationships and therefore better able to defend ' I I jthemselves against encroachments by the bureaucracy. I Age.— Chronological age does not necessarily equate, ! i with lowered status. However, there is strong evidence that; ; i (the older a person is beyond retirement the fewer the re- ] Isources. Age may indicate decrements in health and i ! I 141 financial status as well as the increased obsolescence of skills as defined by the wider society. It has been j argued that old people are at a distinct disadvantage to | i others in society in terms of available power resources j ! (Dowd, 1975). I i Retirement status.--Retirement, like old age and I educational levels, may signal a decline in financial health! and overall status. Work is a major form of status in | American society especially for male members of older co- | horts. Work provides not only financial resources but also ; I a position within the productive sector of society from which to exercise power and control over one's life. An i ■absence of the work role, then, is associated with the {absence of a significant source of power resources. i I Research Results Objective status and perceived dependence I Educational level proved to affect perceptions of I 1 {self (see Tables 10 and 11). Objective social status appears to be the best predictor of perceived dependency. iFor both males and females, low social status is strongly i related to perceptions of oneself as old, to be in poor en I S E h 2 en s 1 <C CN W 1 —1 I I > 4 2 u 2 M œ Q 0 ) 2 1 —1 W jd Oj S H Q Pi O k en E h 2 M H U H C m P h W O u 2 O H en en H i S ro LO en ■H ro un o œ •H rH ■H O • r H • r H I f ) ro • r H R CN ro O ro O ro i f ) CN I f ) o m m o o • r H • r H •H •H -H • r H •H 1 4 2 T3 0 •S -P g I I S 5 1 4 3 LO CN ro CN o o 1 —4 ■H CN 1 — 4 •r4 1 — 4 00 ro -r4 c r » 00 ro CN CN •H -r4 1 — 4 1 — 4 -r4 -r 4 r— 4 CD CN CN CN 1 — 4 CT » CN < y \ 00 ro to I — 1 CD CN 00 ^ ro I—I CN ■H 00 CD O CD CN I —1 •r4 1 — 4 00 CN I—I to in CN 1 — 4 ■H I—Il—Il—1 CN 1 — 4 1 — 4 1 — 4 1 4 0 1 — 4 S ■H 00. a 0 3 i 03 C i H Q EH g 03 i < w « s i * KD II Z >H U " § 8 Q iH § CD g a c c ; g 03 EH i g § § M 03 03 i a 1 4 4 ro O ID O •H CN O ID CN ■H ■H •H •H I —I CN •H O O ID § •H ■rH ro ro ro 03 O 03 ID O O O 00 o CN CN CN O O O r—I • i H •iH • i H rH •iH •H • i H •iH ■H •H M I —I ID 'O s •H ■P 8 I I a 145 m o ro 04 o o •H I—I •H •H •H •H en o •H CN I —I LO •H •H 1 —1 00 00 LO •H •H en en o CN LO o CN o 00 CN ro o •H •H CN 00 ro CN O •H I —I I —I CN LO 1 —1 O o •H 00 146 health, and to have experienced more decline than expected (relative decline). Low social status also is associated with financial declines and a tendency not to blame the system among females, but not among males. Advancing age Itends to be a better predictor for males than for females of financial declines and of a tendency not to blame the system. In general then, low status and age are associated with self-perception as dependent. Yet, some of the specif ics differ between men and women. For men, advancing age is associated with the feel ing that one's health is poor and that finances are dwind ling. Also, as noted above, only the youngest of elderly men are likely to blame the system rather then themselves i |for their troubles. Women, on the other hand, are more I _ . ! likely than men to equate subjective age with chronological , age; the oldest women, in turn perceive themselves as old. ! I The fact that advancing chronological age does not pre- ; jdict subjective age for men is not surprising given the numerous sources of status available to men which allow them to deny old age. One obvious source of status available j i _ I ito men, but not women (especially of this older cohort) is , employment. Men who are retired are likely to view them- j jselves as old. Therefore, retirement status predicts J 147 subjective age identification for men but not women. A curious finding reported in Table 11 is that advancing age has a positive influence on stability of perceived financial status among women. This contradicts [expectation. We should expect, for example, that older women are more likely to be widowed and widowhood often I j b r i n g s a n i n c r e a s i n g t h r e a t o f p o v e r t y . W i d o w h o o d o c c u r s a t a g e 56 o n t h e a v e r a g e ( K a l i s h , 1975) a n d o v e r 45 p e r c e n t o f w i d o w e d , s i n g l e o r d i v o r c e d f e m a l e s l i v e b e l o w p o v e r t y ( B e n g t s o n , e t a l . , 1976). I n c o n t r a s t t o s u b j e c t i v e a g e , I I t h e n , p e r c e i v e d f i n a n c i a l s t a t u s a p p e a r s t o o p e r a t e i n t h e | o p p o s i t e d i r e c t i o n f r o m w h a t w e w o u l d p r e d i c t k n o w i n g t h e [ c o n s e q u e n c e s o f c h r o n o l o g i c a l a g e a m o n g e l d e r l y w o m e n . I t ! I : m a y b e t h a t o l d e r w o m e n w h o h a v e s u r v i v e d t h e i r h u s b a n d s ! ' I . I l a n d w h o f o r t h e f i r s t t i m e a r e r e s p o n s i b l e f o r f i n a n c i a l | 1 matters, may perceive greater stability simply because these' L a t t e r s h a v e b e c o m e m o r e v i s i b l e . ! ! A s e x p e c t e d , r e t i r e m e n t s t a t u s i s a s t r o n g p r e d i c t o r o f s u b j e c t i v e d e p e n d e n c y a m o n g m e n b u t h a s n o e f f e c t o n |women. Men who are retired (or unemployed) are considerably! I I m o r e l i k e l y t o v i e w t h e m s e l v e s a s o l d , i n p o o r h e a l t h , a n d g e n e r a l l y w o r s e o f f t h e n e x p e c t e d . R e t i r e m e n t f t o m t h e 1 valued work role tends to mark the onslaught of old age i 148| (thus, the use of age 55 as a widely accepted marker of old ! age) and, on the average, brings with it an often unexpected: I and drastic reduction in income levels. Similarly, health , problems arc frequently associated with retirement, often | being the cause of retirement. Retirement for women, on the other hand, is considered to be less traumatic because many older women have already retired from a valuable role i at the onset of the "empty nest" (Bengtson, et al., 1976). In sum, the objective status of older people, in ! terms of chronological age, education, and retirement, > generally predicts perceived levels of dependency. Low j social status (low education) is perhaps the best and most consistent predictor of dependency for men and women. Chro nological age and retirement status have different effects on men than on women. Turning now to our hypotheses we can | [examine the relative effects of subjective dependency and j objective status on older clients' perceived relations with | I I government agencies. I I The remainder of the analysis section will proceed ' j as follows : in the next section we will examine the causes { I I I !of embarrassment for elderly men, followed by an analysis ! . I jof embarrassment among elderly women. The final section I will follow the same format, looking first at causes of I anger among elderly men followed by a discussion of anger | among elderly women. ! Perceived dependency and lembarrassment ; Elderly men.— The results in Table 10 indicate | ! : jsupport for the hypothesis among male clients that per- , j j Iceived increases in dependency predict a greater likelihood i ! I of embarrassment. Three of five measures of perceived | I dependency show significant independent relationships with j I embarrassment. The strongest among these is the perception | I I that one's finances have worsened over the past decade, thus offering tentative support for the strong stigmatizing potential of financial dependency among male clients of I service agencies. Also important in causing embarrassment i among older males is the perception that one is old and that, [things are generally worse than expected (relative decline). j I To perceive oneself as old is to identify with what is ; I : lessentially a devalued class of people in American society i I . . . . ' and to experience frustrating declines in general well-being ! I jis to feel increasingly helpless. Devalued status and I ; helplessness along with financial dependency generate feel- ^ ings of shame when confronting the all-seeing eyes of the | 150 government service agency. Two of the perceived dependency measures, however, I I were not significantly related to feelings of embarrassment.| These are poor health and system blame. First the effects of poor health appear to be absorbed by relative declines : I i |in overall status (note residual correlation ^tv in Table 10). Also, declining health and chronic ailments are condi-l I tions faced by most older people and may, therefore, take | on a character of normalcy. Moreover, people are often | given an exemption from stigma for health related dependency,' especially if the health problem is short-term and if it I I jean be concealed, and this may neutralize feelings of embarrassment. , i : 1 The effect of system blame, on the other hand, is j I in the predicted direction but not significant. That is, j I jthe less likely a person is to project blame for dependency 1 I I outward, the more likely the embarrassment. ; ' ‘ Despite the strong relationships between objective I I 'status and perceived dependence discussed earlier, none of j the objective measures show a direct relationship with I ; I embarrassment. Nor did we expect one. Our earlier assump- ■ fion that embarrassment depends on the acceptance of stigma : I I gains tentative support by this finding in conjunction with 15 1 1 the finding that perceived dependency is by-and-large I predictive of embarrassment. Therefore, emong elderly ! i males we conclude moderate support for the hypothesis that perceived dependency among clients of government agencies [Contributes to feelings of embarrassment among them. i : i Elderly women.--The results in Table 11 indicate a pattern of causes of embarrassment among women which is very i different from the men discussed above. First, none of the ] perceived dependency measures are significantly related to ] embarrassment. In fact, the only variable which signifi- ! I cantly predicts embarrassment is retirement status ; women who are retired tend to be embarrassed. On the surface, the absence of a significant rela- jtionship between perceived dependence and embarrassment for jolder women may appear to be contrary to our theory that dependency is stigmatizing and therefore embarrassing. But ' I the societal norms of independence are differentially applied to men and women. Women, especially those of older ; cohorts, are given an exemption from the stigmatizing [ effects of dependence since they are frequently relegated to| I I a legitimate dependent role vis-a-vis their husbands. For | i this reason, then, perceived dependency does not predict , I stigma and embarrassment for older women while it is j I strongly predictive for older men. Moreover, women in this ' i sample were only one-third as likely as men to be embar- j rassed over dealing with government agencies, and there is j Isome question as to the reliability of multivariate analyses. ! : jin which the dependent variable is so markedly skewed. The significance of retirement status for embar- j rassment among women may be related to the fact that previ- | ously employed women may have developed expectations of in- | dependence similar to those of men. Therefore, the loss I of independence which accompanies retirement for these | jWomen generates embarrassment despite the general exemption ! [from the stigma of dependence allowed for women in American ; I . ! society. [ low social status, embarrassment, | and anger I i I Elderly men.--Looking first at the hypothesis that low social status (i.e., low power resources) predict anger j I among clients, we find the results in Table 10 to be in j I contradiction to our predictions. old age, high status, I ;and being employed all are significantly related to anger. With the exception of old age, it appears that anger is 153 positively associated with high status. This finding suggests several revisions to our earlier stated theory. The theory as it was stated at the beginning of this chapter posited that low status clients have fewer power resources to exchange in social relationships. There fore, they must submit to greater amounts of coercion and mistreatment, both of which lead to anger. Given this theoretical orientation, and the findings above, it would appear that older clients are more coerced, mistreated, and angry. This may be true in that older clients have fewer power resources to exchange in any social relation ship which forces them to offer compliance, the most costly j of all rewards, in exchange for service. If these older | clients also feel unjustly stigmatized as a result of their dependence and forced reliance on the government "dole," the ! extraction of compliance by the agency may exceed the norms | I of fair exchange, thus causing anger. older clients may also experience direct discrimination from low level prac- , titioners who tend to hold negative sentiments toward ; j elderly clients (see Chapter II). Thus, limited resources may combine with old age to produce coercive and abusive treatment of clients, all of which results in anger among clients. 154| I However, exchange theory, as we have stated it, is j I cast into doubt by the finding that non-retired high status | male clients are more likely to be angry than low status j retired male clients. One interpretation of this finding | j is that the employed and high social status clients are less! likely to accept any symbols of stigma, such as coercive, paternalistic or callous treatment. Therefore, they are | more likely to be angry. Furthermore, those who are high ; i status will be less likely to tolerate the implied depen- | dence and stigma of dealing with government agencies. | A refinement of our earlier stated exchange theory | may actually be a more accurate interpretation of the ! exchange theory as formulated by Blau (1964), Under the | new formulation we would expect that high status clients ! I who are subjected to the dependent role required by the | service agency (cf. Landy, 1965), and who must offer com pliance when they have other less costly resources available to them, are likely to perceive that the norms of fair j 'exchange are broken in their relations with government j I agencies. Simply, high status clients, especially those j ' I I , who are still occupying valued roles in the productive sec- « ; , I tor of society, will be most angry over the expectations ! I I !for compliance foisted upon them by the agency. Thus, as a 155: I qualification to our predictions, it appears that rather ; I than coercive and abusive treatment of low status clients leading to anger, it may be forced compliance demands made | Ion high status clients that causes anger. An interpretation! !of the relationship between old age and anger in this light , I would suggest that the older the client, the more dependent ' I _ I |on government agencies; the more dependent the client is on ' government agencies--given a background of independence-- I I the more likely the anger or resentment. 1 The above interpretation is further supported by the- I significant effects of perceived relative decline and systemi jblame on anger. Those who have declined in their old age ; more than they expected and who tend to blame the system for| I | t h e i r c u r r e n t p r o b l e m s a r e m o s t l i k e l y t o b e a n g r y a t I i ' I I dealing with government agencies. j Turning now to the effects of perceived dependency | on client anger, we find that system blame is significantly i I I I I related to anger. This finding, in combination with the ! i |earlier observed non-significant but nonetheless, negative relationship between system blame and embarrassment, indi- i cates partial support for the idea that anger is outward directed blame, while embarrassment is inward directed s hame. 156] An unexpected finding is the strength of "relative overall decline" in predicting both anger and embarrassment It may be that overall decline in one's condition is a jgeneral measure of both low self-esteem and mistreatment by bureaucrats which may give rise to a generalized complaint (anger and embarrassment) about many aspects of growing old Furthermore, the experience of declines in status which exceed expectations are at once a sign of impending depen- dency as well as irritating frustrations that life did not turn out the way it should have. Therefore, we might expect! I this measure to be related strongly to both embarrassment j and anger. Finally, as predicted, embarrassment is a strong . predictor of anger. Thus, in addition to high social status, system blame and the frustrations of relatively larger declines than expected being causes of anger, embar- I i rassment over dealing with an agency also contributes to j anger. Apparently some clients are angry because they feel ; the norms of reciprocity are violated by the expectations the agency demands in exchange for service. But other clients are angry because they are acting obsequiously or I are projecting their feelings of embarrassment onto the j I agency and are accurately or inaccurately perceiving abusive 157| I treatment in return. j I The feelings of embarrassment and resentment ' I experienced by financially dependent clients described in | I the study of lower class clients by Mayer and Timms (1970) | I I [appear to be replicated here. We find that perceived i I f inancial decline has the strongest effect on embarrassment ' I i among elderly men, and while it also shows a strong zero- j I order relationship to anger (r=.314) this effect on anger j disappears when embarrassment itself is controlled. In sum, high social status--especially being I employed--old age, the frustrations of unexpected declines, a tendency to blame the system rather than oneself, and ,embarrassment all are significant causes of anger among I [elderly male clients of government service bureaucracies. Our argument tends to be supported. EIderly women.--As with embarrassment, the results in Table 11 indicate a unique pattern of relationships between anger and both objective and subjective status. With the one exception that embarrassment is positively related to anger, all other predicted causes of anger demon strate a trend which is opposite to that found among men. It appears here that our initial argument about low status holds. Women might well react more to the treatment that | their low status calls forth than to any injustice, accus- | tomed as they are to dependency. Women who are financially stable (i.e., reject the stigma of dependency) or those I [who are embarrassed are most likely to be angry over dealing j i w i t h g o v e r n m e n t a g e n c i e s ; h e r e t h e y b e h a v e m o r e l i k e t h e I [ j men. But again, extreme skewness in the dependent variable of anger (5 percent to 95 percent) leave the reliability of these results in question. Summary We began this chapter with the theoretical rationale that dependency carries the potential for stigma which is further enhanced or exposed in the face of the domineering | service bureaucracy. It was argued that clients who are exposed as stigmatized become embarrassed where stigma is accepted, and angry where stigma is rejected. | The results of analyses of 142 older men and 164 | ! older women (aged 6 5-74) were generally consistent with the , theory, though much more so for men than for women. Spe cifically, it was found that elderly males who perceived | i themselves as dependent were more likely to feel embar- j I rassed when dealing with government agencies, while men i who were high in status were more likely to feel anger, perhaps because they did not feel compelled to comply with the organization's demands for compliance and its implied stigma. Perceived dependency did not predict embarrassment or anger among women in this sample, in part because women are given an exemption from the stigma of dependency, but also because neither anger nor embarrassment were as prob lematic for women, a factor which caused extreme skewness , in the dependent variables and unreliability in the regres- j sion estimates. ' It is an admitted, though unintended, bias of this j study that the theoretical model--as in much social thought ' and social structure in general— is oriented more to men I than women. The nature of the problem was such that the I ! major focus was dependency. But, as we noted above, depen - ; dency per se does not appear to be as big a problem for j I women as it is for men, because it has traditionally been ad I axis of sex role differentiation. In the future, we might . begin to orient our theories around the issues which cross - ; I cut the sexes or which attend more carefully to the unique ! ; I [problems and concerns of women. N O T E S F O R C H A P T E R I I I 1 ^ The assumption that clients' perceptions of rela- Itions with government agencies are solely a product of self- [Perceptions obviously ignores other important factors, such | as organizational, situational, and environmental influ- ' [ences on specific client-agency relationships. However, I an exclusive focus on the client enables an in-depth analy- [ sis of the social psychological factors which influence perceptions about the agency, factors which might be over looked by focusing on interaction only. This, combined with the agency officials' perceptions analyzed in Chapter II i will flesh out the broad perspectives of both client and i agency official as they approach the interaction situation. * 16 0 CHAPTER IV SUMMARY AND CONCLUSION . . . and, so, who cares about all that's gone before? (McConnell, 1977) In Chapter I we posited three sources of conflict in client-organization relations stemming from: (1) unequal exchange relations among officials and clients due to asymmetry in control of tangible resources, status, know ledge, and authority; (2) bureaucratic role constraints which contribute to role strain among low level officials who are in frequent contact with clients; and (3) competing | expectations from the organization and society which affect clients' perceptions of self vis-a-vis the service organi zation. Further elaboration of these sources of conflict drew upon the four theoretical approaches of client - organization relations, exchange theory, bureaucratic theory and symbolic interactionism/role theory. , I The relationship between clients and service ! .16.1. 16 2! j organizations is asymmetrical and is based on interdepen dence and a division of labor. The relationship differs from non-service organizational relationships in that the client is more intimately involved in the organizational output; clients of service organizations are both consumers land producers of service. The closer involvement of clientsi ! I in the service relationship, combined with an absence of I i other mechanisms of accountability, requires the develop- j I I ment of solidarity, i.e., commitment on the part of clients j and trustworthiness on the part of organizational officials,; in order for the relationship to be carried out effectively.| The development of solidarity in client-organization; relations is problematic and is, in part, dependent upon j I principles of exchange relations. client and officials I I enter into the service relationship with differing levels , I of resources which can be exchanged. The greater resources ! i and power of the organization provide officials with the i ability to contribute unequally to the definition of the service situation and to extract compliance from clients ! who are dependent and in possession of fewer resources. If I 'the client legitimates the organization's power, solidarity is more likely to develop. However, if the client feels thej j organization is extracting more than the norms of fair J 1631 i exchange allow, resentment and anger will result and con- | I flict rather than solidarity will characterize the rela- | tionship. Conflict also arises as a result of the structural land normative arrangements of the organization itself. I IOrganizetions are characterized by formal rules, a hierar- i ! i chical authority structure and norms of affective neutral- I I I ity. The lowest levels in the organizational hierarchy are [ allowed the least flexibility in role performance and are ' monitored more closely than higher levels. While the lower level officials are responsible for directly meeting clients' needs, rewards emanate from higher organizational levels | rather than from the clients themselves. Consequently, when I I clients make demands which are outside the lower level I I official's tightly drawn role contraints, role strain may j ! occur which in turn leads to negative sentiment toward I clients. I I i From the client's perspective, the organization is | ] I the source of two kinds of conflict. The first source of conflict results from the organization's requirements that ' I clients play a dependent role. But dependency is stigma- | i tizing and directly contradicts the broader societal norms calling for independence and autonomy. Therefore, the 164 client is caught between the conflicting expectations of organizational versus societal demands. Clients' reactions to these conflicting expectations vary according to their perceptions of self. I Î The second source of conflict for the client is the I : organizational norms of affective neutrality, specificity, I and universalism. Clients are individuals with unique prob- I 1 lems and concerns. Yet, the organization treats them as if i they are undifferentiated units in a narrowly defined cate gory. Demands by clients which exceed the boundaries of | the organization's definition of service are met with what appears to the client to be bureaucratic rigidity and indif-; ference. clients who are unwilling to tolerate this per ceived indifference become angry and may challenge the i organization to treat them more diffusely. While these challenges tend to generate an increased sense of efficacy | among clients and may even achieve desired results from the j organization, they are a further source of conflict in the | service relationship due to the role strain they create among low level officials. In sum, conflict between clients and officials develops over competing expectations stemming from organi zational and societal norms. The power of the organization Ï65] allows it to define the role of the person as client, which includes expectations of dependency and a client-official [relationship based on neutrality, specificity, and univer- I Isalism. But attributes of the client as person, i.e., indi vidual client needs for diffuseness and independence, may iconflict with the client role defined by the organization. This conflict, in addition to other bureaucratic constraints tends to generate role strain for low level officials and embarrassment or anger for clients. Four hypotheses were derived from the above theore- ! I tical orientation ; i 1. The lower the level in the organizational hier archy, the more negative the sentiments toward clients. i 2. The greater the prestige of the official, the | less the negative sentiment toward clients. | 3. The greater the perceived dependency of the ; client, the more likely the client embarrassment. I 4. The less the client's power, the more angry the | client. I I Each of these hypotheses was tested using multi- ^ Ivariate analyses of data from two existing data sets. The | ifirst data set consisted of interviews with 143 organiza tional officials representing six Los Angeles County based 166 service sectors— health, employment, nursing homes, income maintenance, elderly affairs, and other (recreation, trans portation, and housing). The second consisted of interviews with 334 elderly (ages 65 to 74) Black, Mexican-Amerlean, land White residents of Los Angeles County. ! Support was found for the first hypothesis, that lower level officials are more negative than upper levels i in their sentiment toward elderly clients, presumably due | I to increased role strain over dealing with clients within i I narrowly defined and rigidly enforced bureaucratic role ! I constraints. Additional analyses revealed significant j interaction effects on officials' negative sentiment. Low level officials who have both frequent direct contact with , clients and a bureaucratic role orientation, were most ; negative toward clients. i I A most interesting finding was that the structure of the client-organization relationship also intensified the effects of other factors in producing negative sentiment ^ toward clients. Low level bureaucrats who had frequent ' 1 contact with elderly clients and who were required to deal j with a variety of client needs, tended to be the most nega tive toward those clients. Thus, the role strains which i exist for lower level bureaucrats are amplified the more 16 7 1 I the whole client becomes organizationally relevant. ! I I Other significant predictors of negative sentiment i I toward elderly clients included professional socialization and age of official. Registered nurses and social workers were less negative toward elderly clients due either to the I greater commitment they engender from clients, because of their prestige, or due to professional socialization experi ences which encourage these officials to manifest a client- centered versus bureaucratic orientation toward clients. Age of official was positively associated with negative I sentiment toward elderly clients. One possible explanation ! for this finding is that older officials may be closer to their elderly clients, in terms of social distance, a factorj which may pose a threat to them in their role as affectively neutral bureaucrats. The best predictors of negative sentiment toward [ elderly clients, then, were organizational in nature. While; I personal and professional characteristics of officials had . I some affect on negative sentiments, the only significant contribution to explaining these sentiments came from the [ official's position in the organizational hierarchy. The | i negative sentiments associated with low hierarchical level were in turn specified by frequent client contact and Ï68l broad client-organization relations. ! I Although no specific a priori hypotheses were Î stated regarding the predictors of officials' positive [ evaluations of clients as independent and productive it was [nonetheless assumed that organizational factors would struc-| I I iture officials' perceptions in this area. Organizational i I sector and centrality of aged clients to the official's job| were the only significant predictors of officials' positive ] ! evaluations of clients. This offers support for the notion j I that the degree of client dependence is an organizationally i defined role which varies in intensity according to the ; specific goals and functions of the organization. Nursing | ihome and income maintenance officials evaluated elderly j clients least positively in terms of independence and pro- : ductivity, while employment and elderly affairs officials viewed them most positively. Health officials were inter mediate between the other organizational sectors in évalua- j I tions of independence and productivity. Furthermore, the fewer the competing demands on officials from other than elderly clients, the more were elderly clients viewed i positively as independent and productive. j I Despite the observed variations in officials' posi- I tive evaluations of the independence and productivity of 169 clients, the predominant role of clients in service organi zations is one of dependency. This results in part from the asymmetry in resources between clients and officials ; Iclients need the organization more than vice versa. The 'greater power of the official allows him/her to extract the most costly of resources-— compliance--from clients, I especially from those who occupy low status positions in the broader society. But perceived dependency also results f from the negative societal value judgement placed on red - | i Ipients of public services. Therefore, clients are often i labelled as dependent and stigmatized. This negative label | is most harshly applied to those who suffer from financial dependency. Assuming that stigma is a constant factor which attends recipients of service organizations, elderly clients, I Were found to respond to this label in different ways j I I [depending on their view of self and their objective status j lin society. Support was found among elderly males for the ' I hypothesis that the more dependent the client perceives him/herself to be, the more likely the embarrassment over ; 'dealing with government agencies. Elderly males who per ceived themselves as old, financially dependent, and rela tively more deprived than expected, were, in turn, more 1701 likely to experience embarrassment over dealing with govern - i ment agencies. Also, those who tended to blame themselves ! for current problems, rather than blame external or sys- ! i jtemic factors, were more likely to be embarrassed. Pre- j ' I , I jsumably the stigmatizing effects of dependence on government' I services, where accepted, interacts with and further exposes one's perception of self as dependent resulting in inward directed shame or embarrassment. No support was found, however, for the hypothesis that clients with low power would be more likely to experi ence anger over dealing with government agencies. On the contrary, it was the higher status non-retired and older males who were most likely to be angry. Also, males who blamed the system and who had experienced greater overall decrements than expected, were more likely to be angry. [Therefore, the stigmatizing effects of being dependent on a government agency are externalized in the form of anger by clients who occupy socially valued positions in the broader society. Furthermore, except for the frustrations of [unexpected declines in overall status, perceived dependence does not directly affect clients' angry reactions to stigma. Rather, perceived dependency has an indirect effect on anger only through embarrassment; the greater the embarrassment. 171 the greater the anger. Given the positive association between high social [status, employment, and embarrassment on the one hand, and ; i . : îanger on the other, it is apparent that outward directed { blame or anger hinges on the possession of objective re ssources. Without these resources elderly male clients are ; ! forced to quietly and passively accept organizational demands for dependency and the stigma that comes with them. . i I The result, in this case, is embarrassment. However, if I jthe client possesses high social status and a position in I jthe productive sector, the implied stigma is rejected and .anger results. These findings are consistent with our revised interpretation of exchange theory which posits that an unwarranted extraction of compliance in exchange for .service violates the norms of fair exchange and results in ' I anger or resentment. I I Neither embarrassment nor anger are as likely among ’ elderly women as among men. Nor are the variables associ- jated with anger and embarrassment for men related to these [same reactions for women. There is no relationship, for example, between perceived dependency and embarrassment among women. This is taken as confirmation for the differ- ; I iential effects of stigma on clients of government agencies ! j 172 I •which are based on sex roles. Simply, the fact that women are often perceived to be legitimately dependent on their husbands for much of their lives, releases them, at least !in their own minds, from the stigmatizing effects of depen- t 'dency. While the conclusions drawn from these empirical ' i findings must be treated as tentative, there is general i [confirmation among them for the broad theoretical orienta- jtion that what is required by the service organization, in ; I ' [terms of compliance and dependency, creates strain for the [client, while what is required by the client, in terms of a ^ I /iffuse relationship and personal independence, creates strain for the organization. Furthermore, these findings offer tentative support for the theoretical importance of organizational variables fin predicting sentiments and evaluations toward older peo- :ple, an approach which does not eliminate the effects of ' other variables but which appears to be more sound both con- iceptually and practically than previous conceptual schemes. Practical Implications i I We can only speculate about the practical implica ptions of these findings; previous research offers little j ! ! 173' help in this area. We noted in Chapter I that bureaucrats' perceptions i of the elderly are important in defining the "social ^ I , ^reality" of old age in American society. Organizational ( factors contribute to both negative sentiments and positive [evaluations toward older people.. These attitudes may play ja critical role in the actual provision of services to i lelderly clients. Negative sentiment and dependent evalua- ; I itions of elderly clients may contribute to paternalistic ! i jtreatment of elderly clients. This may in turn contribute [to a negative self-image and increased dependency and stigma [which operates in a kind of "viscious circle" to produce even greater negativism and dependency. In order to break the viscious circle of negativism ■and stigma in the service relationship, both clients and f bureaucrats might benefit from training programs which j ■ [would encourage taking the role of the other. Bureaucrats [would do well to put themselves in the shoes of clients and jto experience the devastating effects on self-esteem of the organization's demands for dependency and compliance. An [ experience such as this might encourage them to be more flexible in their demands on clients, to understand clients' [individual needs for independence and autonomy, and to be I 174! I more sensitive to the unique position of the elderly as victims of forced dependency on service organizations. [Clients, on the other hand, might learn more about the role [ [constraints of the organization which constrain the bureau- j I crat and limit his/her ability to relate to individual client needs. This may help clients to be more tolerant of ; the service bureaucracy and rather than simply directing I I [hostility toward it, to learn to work cooperatively with i [bureaucrats to manipulate the organization for better ser vice . i Another implication of these findings has to do with the relationship between officials' evaluations of the 'elderly and their subsequent policy orientations regarding the provision of services. For example, those officials analyzed in this sample who are least supportive of the Iindependence and productivity of elderly clients are also more likely to define the problems of the elderly as pri marily personal (i.e., personal health, loneliness, depres- |Sion) rather than structural (i.e., problems with the trans- ! I portation, medical or health-care systems). In a previous ■ ‘study of elites, which also included the officials in this study, the author found greater support for an income-based , [subsidy program for the elderly among elites who defined j r - - - 1 7 5 the needs of the elderly as primarily structural than among those who saw mostly personal problems (McConnell and Kass- jchau, 1977). Thus, perceptions of the overall independence I [of the elderly may be relevant to social policy decisions, many of which are affected by agency bureaucrats who deal 'directly with aged clients . I I In terms of the stigmatizing effects of government agencies, future programs that are designed for the elderly might do best by operating as non-bureaucratic agencies. This might take the form of direct federal grants to grass roots community groups or programs that emphasize the Existing personal networks of the elderly. It is possible, las we stated earlier, that welfare bureaucracies, due to i [rigid role constraints, paternalism, and requirements for [dependency and compliance, destroy the clients they are I I supposed to aid. The confrontation between service as an ideology and service as an organizational instrument of manipulation and control (Etzioni, 1961) may lie at the I [heart of the matter of dependence, stigma, and negative Isentiment in the service relationship. Limitations of ttie Study The limitations of this study are similar to others ! 'involving secondary data analysis. Here, officials* I 176: attitudes toward the elderly could not be matched to speci fic elderly clients nor could the elderly's perceptions of 'government agencies be matched* with specific agencies, 'despite our wish that this had been possible. As a result, | we limited study to the necessary first step of respective orientations of clients and officials without being able to undertake the next step of mutual orientations. Future research should analyze officials and clients who are in contact with one another to more thoroughly explore issues of mutuality and coorientation. This study was a necessary first step toward this. To avoid tangents, numerous assumptions were made about organizational structure and normative arrangements which ignored subtle differences among types of organiza tions. officials were stratified according to what appeared to be a hierarchy of authority but we could not analyze authority relations between any pair of officials. Future research should sample from all levels within the same organizations to further control for subtle variations among types of organizations. We should also mention that we claimed only face yalidity for the dependent variables, embarrassment and anger. While our interpretations make sound intuitive sensej I---------- 1771 I I it would have been desirable, had the possibility existed, I to have examined their meanings relative to other indicators! jof the same or similar perceptions. ! I Despite these provisos, the findings reported here j 'should have both theoretical and practical utility. Fur thermore, the results should have generalizability beyond the individuals who comprise the respective samples. The | [sample of elderly clients was statistically weighted such , ; {that its members represent Black, White, and Mexican-Ameri- ' jean elderly (ages 65 to 74) in Los Angeles County. Los Angeles County has one of the largest concentrations of elderly in the United States and those between the ages of ! 65-74 comprise roughly 60 percent of this group. The [organizational officials were not sampled according to [statistical probability but were purposively selected so as ; j to represent all the major service sectors that deal with i elderly clients. Finally, the results are generalizable beyond these samples because they are intimately tied to previous aca demic research and, most importantly, to sociological the ory. A P P E N D I X E S 178 A P P E N D I X A ZERO-ORDER CORRELATION MATRIXES FOR ORGANIZATIONAL OFFICIALS (CHAPTER II) 179 180 TABLE 12 CORRELATION MATRIX FOR ALL NEGATIVE SENTIMENT AND POSITIVE EVALUATION ITEMS (Pearsonian Correlation Coefficients, decimal points omitted, N=14 3) ,T. Most older people are set in I their ways and unable to change. |2. Older people are apt to I complain. 19 >3. Older people are often against needed reforms in our society because they want to hang on to the past. 38 26 '4. Most old people spend too much time prying into the I affairs of others. 38 42 34 I j 5 . Older people can le am new ; things just as well as I younger people can. -29 -18 -30 -21 6. People become wiser with the coming of old age. -10 00 -05 -12 38 7. Most older people can do a j job as well as younger I persons, but are not j given an opportunity to show what they can do. —25 -08 -09 —24 24 29 I ,8. There should be no required 1 retirement age; older I people should be allowed j to work as long as they 1 want to and are able to. -25 00 08 -10 31 32 40 I 9. In most jobs, older people 1 can perform as well as ; younger people. -17 -11 -09 -21 2 8 35 49 25 5 3 3 3 181 a m g oa & œ c H u H k k O J ê 0 M E h C N H Î 2 ! 1 T3 Q ) +J -P •H § 0 ] - p C •H • N O X C L , H B4 ÎZi O H Eh W 0 u 1 o 0< w N I -P u ( U Q MD lO ro C N 182 o 00 o I C N o cn I — 1 C N 00 C\ 00 I CO \D C N c n C N I O 00 00 CO \D 00 I O CO C N C N CO O C N 00 C N < T > -P C X X 0 G •H c c O 4 -> 1 — 1 0 o T —\ •H O U -H •H Q ) -P P + J -P > fd -P -P 0 Q ) -P C C + J P » - p P ) c O 0 c c c (U O P 0 0 ( U 1 —1 • H & •H -P •H g fd P -P 0 P o P •H u O C P o 0 O -P ■p 0 P m -p c x; U -H u n U ( U Ü ■ H w — 1 X -H o •H œ u -P u + J u -P fd fd 1 — 1 0 0 1 — 1 Q ) u u + J 0 p -p P 0 > Q ) u c > + J o n u > •H •H p 0 0 O p 0 p 0 -P fd P PI 0 0 d 0 PI fd 0 0^ + J 0 0 tn u 0 ^ c p 0 P ( U o P U O O p p P o !zi PI C Q P m PI u C Q P m C Q P I 1 — 1 C N oo lO UO A P P E N D I X B DESCRIPTION OF SAMPLING PROCEDURE FOR ORGANIZATIONAL OFFICIALS 183 APPENDIX B ' I I. Administrative Agency and Program Heads in Govern- I t ment Social Service Sectors (final sample size = ' 70; pool of eligibles = 94; response rate = 85.4 percent) The first problem in defining this subsample was to ! [identify the service sectors we wished to include in our 'sample among the vast number of sectors that channel govern - ! : ments' social service provisions to various client groups i jin this country. The service sectors elected as having I \ jthe most involvement in determining programs and policies |for the aging segments of the population were: 1. Health care services 2. Transportation 3. Housing 4. Nursing homes 5. Income maintenance 1 6. Employment I 7. Leisure, recreation, and education I 8. Elderly affairs Having identified each of these service sectors, an attempt was made to sample vertically within each of them from the local government agencies up through the federal agency representatives. Thus, in health, housing, trans portation, etc., interviews were conducted with the heads of the appropriate local (city or county) departments, the ! 184 I 185, heads of the appropriate state departments, and the California or Southern California representatives of the appropriate federal agencies. To illustrate with an exam- ^ pie: the heads of the Los Angeles City and Los Angeles ( County Housing Authorities, the director of the California | State Department of Housing and Urban Development, and the ' Federal Housing and Urban Development Southern California regional administrator were all included in the sample list. At a somewhat lower level within these government , bureaucracies, a sample was selected among the program heads who supervised programs directly relevant to aging clien- Itele or target groups. Thus, in the housing bureaucracy, I 'the head of the Community Redevelopment Agency which pro vides leased housing for older persons was interviewed. II. Service Delivery Personnel in Government Social Service Bureaucracies (final sample size = 70; pool of eligibles = 95; response rate = 88.6 percent) Within each of the service bureaucracies identi- jfied above, service delivery personnel were sampled who are . actually engaged in directly translating policies into pro gram benefits and services to aging persons. There was a dual criteria for an individual's inclu- ision in this sample, regardless of the substantive area bureaucracy. First, the individual must be in daily or at [least frequent contact with elderly persons in the role of actually administering program benefits or services to those aging persons. Second, the individual must have acquired some seniority in his/her service position and thus have accumulated at least a minimal supervisory responsibility . over other service delivery personnel who are similarly | - I [dispensing services to aging persons. However, there is great variability in the sample on this last criterion; Lome service delivery personnel had no supervisory responsi bilities; others had extensive supervisory duties. The above sampling description, with only minor | changes, was provided by Patricia L, Kasschau, Ph.D., who | as project director of the Decision-Maker Survey from which , 'these data were taken, designed and implemented the study. A P P E N D I X C THE FOUR HIERARCHICAL LEVELS OF ORGANIZATIONAL OFFICIALS BY JOB TITLE AND ORGANIZATIONAL AFFILIATION I 187 APPENDIX C LEVEL I. Director, Deputy Director Regional Level Agency/ Organization or Department of Government (N=47) 2010 - 2020- :2030- I I2O4O- 12050- I2O6O- I 1 2080- 2160- [2170- ! i2180- ' 2 19 0- 2200- 2210 - 2230- 3 010- HEALTH Dir., Mental Health Svcs., LA Cty Dept. Health Deputy Dir., LA Cty. Health Services Admin., Martin Luther King Hospital Admin., LB Gen'l Hosp. Admin Rancho Los 2450- Amigos Hospital Admin., John Wesley Hosp. Acting Regional Chief, 2 5 0 O- E. LA Mental Health E. LA Community Mental Health Center Reg. Chief, West LA Mental Health Center Reg. chief, S.E. Comm. Mental Health Ctr. Reg. Chief, S.E. Comm. Mental Health ctr. Acting Director, VA Hospital Dir., VA Hospital Reg. Dir., VA Chief Medicare Officer of 9 Counties, Occi dental Life Insurance NURSING HOMES 2310- Dir., Adult Care Fac. Stds., Bur. of Social Services 2321- Acting Supvr., Adult 1 Care Fac. Stds. , 2330- Exec. Officer, Office of Nursing Home Admin - ! istrator 1 EMPLOYMENT Special Ass't. to Mayor Dir. of Manpower, Dir. j of Urban Affrs., Man power Prog., LA City Mgr., Employment Svcs. Office, State Employ ment Development Dept. , 2550- Dist. Dir., (U.S. Small Bus. Admin.) 2 571- Ass't. Dir., Manpower Admin. (U.S. Dept, of Labor) 2620- So. Cal. Prog., Prog. Officer, A.C.T.I.O.N. 6120- Western Reg. Coord., Acting for Indp. Matur ity (Pre-retirement Counseling) 188 LEVEL I (cont'd) 1891 1 ELDERLY AFFAIRS 2 012“ Mgr., Prog. Implemen- I tation, Div., State Office on Aging 2630- Admin. Coord., Aging ^ Prog. Office of Mayor 2650- Dir., LA Cty. Dept. S.C. Affairs 26 71- Acting Deputy Director Cal. Office on Aging 1 26 80- Reg. Mgr., Office on Aging 2 7 00- Deputy Dir., LA Cnty. S.C. Affairs I 1 INCOME MAINTENANCE j 2 36 0- Area Dir., Social Security Admin. (Local) 2370- Area Dir., Social Security Admin. I 2380- Dist. Mgr., SS Admin. 2400- Dist. Mgr., SS Admin. 2410- Dist. Mgr., SS Admin. 2420- Board Sec'y., LA City 2430- Mgr., Retirement Sys tem, LA City Brd. of Retirement 2440- Mgr., LA Area, Public Empl. Retirement Sys tem 2491- Dist. Mgr., US RR Retirement OTHER (cont'd) 2270- Exec. Dir., LA County Housing Authority 2280- Dir., State Dept, of Housing & Comm. Devel. 2291- Dir., HUD in Sacra mento 2300- Admin., Comm. Redevel. Agency 2072- Gen'l. Mgr., Public Utilities & Transpor tation 2240- General Manager, Southern Calif. RTD 2610- Gerontology, Special ist, Los Angeles | Schools 2340- Div. Chief, Protective Services— Dept, of Public Social Services OTHER 2250- Exec. Dir., LA City Planning 19a LEVEL II. Director, Deputy Director of Program Within Agency> * Organization or Department of Government (N=35) 2 09 0- 2100 - I 2110 - 2120 - 213 0- 2140- 1 2150- 2220 - 3620- HEALTH District Health Officer 2470- S.E. LA Health Center EMPLOYMENT (cont'd) Dir., Voc. Training 3191 3370 District Health Cntr. E. LA Health Center District Health Officer Hollywood-Wilshire Health Center Dist. Health Officer, Glendale Health Center Dist. Health Officer, South Health Center Dist. Health Officer, LA County Dept, of Health Chief Physician District Health Supvr. Alhambra Health Dist. Dir., Outpatient Clinic VA Hospital Executive Director, Stroke Program NURSING HOMES President, country Villa Service Corp. Exec. Dir., Calfornia Home for the Aged 3380- Admin., Conval^ Cntr. 3391- Dir Mgr Part-owner 2460- Retirement Hotels EMPLOYMENT S.C. Coord., Greater LA Comm. Action Agency 2480- Project Director, Snr | Comm. Svc. Proj. Dir. j 2510- Mgr., Employment Services Offices 2520- Mgr., Employment Services Offices 253 0- Mgr., Employment Services Offices 2540- Mgr., Employment Services Offices 256 0- Mgr., LA Area (State Employee Development Center) 2580- Management Assistance Officer, S.C.O.R.E. 3600- Director, Volunteer Action Center 3610- Director, Foster Grandparent Program ELDERLY AFFAIRS 2640- S.C. Coordinator, Mayor's office 2690- Planning Supervisor, Dept., S.C. Affairs INCOME MAINTENANCE 2390- Social Insurance Admin. E. LA, SS Office ' 3490- Ass't. District Mgr., SS Admin. 191 LEVEL II (cont'd) OTHER 2250- Ass't. Mgr., Surface Planning— Southern ! California RTD j3340- Project Director, ; Dial-a-Ride, East Los Angeles, C.I.A. 2590- Recreation Supervisor, ’ S.C. Section, City of I Los Angeles j2600- Supervisor, S.C. Activities, LA County I Parks and Recreation '3661- Director, Rec. Center 12350- Program Department, ' Homemaker Chore Svcs. Dept. Pub. Soc. Svcs. |3360- Exec. Dir., Retired I Housing Foundation 19 2 LEVEL III Supervisor Within Program, Organization or Agency (N=38) i HEALTH '3020- Clinical Supervisor Wadsworth VA Hospital 3 03 0- Head Nurse, Intern Ward VA Hospital 3 050- Supervisor & Public Health Nurse, Health Center 3070- Clinic Manager, Family & Adult Care Clinic 13080- Supervisor, Public I Health Nurse, Comm. ! Health Services 3110- Supervisor, Public Health Nursing, Family Ambulatory Care Clinic Central District 3120- Public Health Social Worker, Alhambra Health Center 3220- Supervising Psychiatric Social Worker, S. Cen tral Mental Health Cntr |3240- Supervisor Psychiatric Social Worker, E.LA Men 1 tal Health Center ‘ 3 27 0- Senior Mental Health ' Counselor, RN, E. LA I . Mental Health Center 3280- Medical Social Work Supervisor, Martin Luther King Hosp. 3290- Supervisor Staff Nurse, Martin Luther King ; Hospital HEALTH (cont'd) 3300- Supervisor Staff Nurse 2, L.B. General Hosp. I 3310- Supervisor-Director of Medical Social Work, John Weslely Hosp. Co., Agency 3320- Dir. of Nursing, LA County, John Wesley Hospital 3330- Supervisor Staff Nurse j 2, John Wesley Hosp. NURSING HOMES 3400- Head Nurse, Retirement Home 3411- Head of Nursing, Home of Aged 3422- Director of Nursing, Nursing Home 3442- Director of Nursing Convalescent Hospital 3450- Acting Supervisor, Cen tral Register of Adult Care Facility EMPLOYMENT 3550- Employment Svc. Super - ' visor, Avalon-Florence ; Employment I 3580- Supervising Employee Counselor State Employ ment Development Center r - - * * — - - ~ 1 9 3 ^ LEVEL III (cont'd) i , ELDERLY AFFAIRS OTHER (cont'd) 3650- Director, E. LA S.C. 3680- Recreational Supervi- Center, Will Rogers Park sor, LA City Prks. & ■ I Center Rec. Dept. : I 6 070- Director, S.C. Center, 3690- Recreational Supervi- | Watts sor. III, Will Rogers _ ^ ^ ^ ^ _ Park Center 6160- Rec. Supervisor for S.C. , Centers and clubs, Los 3700- Recreational Supervi- ; Angeles city sor, #3, LA City Prks. , 6 240- Director, Hotel for ^ Rec. Dept. I Seniors I INCOME MAINTENANCE j 3460- Administrative Assistant i City Empl. System , Retirement 3470- Operations SS Admin. Supervisor, 3480- Operations SS Admin. Supervisor, 3500- Operations SS Admin. Supervisor, 3510- Operations SS Admin. Supervisor, 3520- Operations SS Admin. Supervisor, 3530- Operations Supervisor, SS Admin. OTHER 3670- Recreational Supervisor, II, Rec. Center, Plum mer Park i 194 ; LEVEL IV. Little or No Supervisory Duties (N=25) I HEALTH HEALTH (cont'd) , 3010- S.C. Social Worker, E;^_/ 3250- Psychiatric Social j I LA Health Clinic Worker, E. LA Mental 3 040- Public Health Nurse, Health Center | Glendale Health Center 326 0- Mental Health Counselor E. LA Community Mental Health Center NURSING HOMES 3060- Clinic Nurse, Flor ence Firestone Health Center 3430- Administrator, Board & , Nurse, E.LA Health Cntr Care for Aged ',3100- S.C. Clinic Social I Worker, E. LA Health EMPLOYMENT : Clinic for S.C. 3540- Job Development Aid 13130- Clinic Nurse, Adult Am- LA Comm. Action Agency bulatory Clinic, Alham- ' bra Health Center 3140- Clinic Nurse, Huntington Park Health Center 3570- Older Worker Specialist, South Gate Employment 3590- Empl. Coord., C.E.A.R. '3150- Mental Health Counselor, ELDERLY AFFAIRS i West Community Mental Health Center 3560- Community Service Dept. S.C. Affairs 316 0- Psychiatric Social worker, lA Health Svcs. ®^30- Senior Co^unity Aid ; Dept, of S.C. Affairs 317 0- Mental Health Counselor ' S.E. Comm. Mental Health OTHER Center 3350- Tenant Relations Ass't 3180- Psychiatric Social LA City Housing Auth. Worker, S.E. Comm. Men tal Health Center 3 210- Mental Health Counselor S.E. comm. Mental Health Center 3230- Acting Senior Mental Health counselor, S.E. Comm. Mental Health I Center 3630- Recreation Director, La Fayette Center ^ 3640- Recreation Director, ; Watts, S.C. Center : 3201- Instructor, Gerontology Banning Adult School A P P E N D I X D SURVEY ITEMS ASKED OF ORGANIZATIONAL OFFICIALS I 19.5____ J APPENDIX D BACKGROUND INFORMATION T.D. # NAME; TITLE OR POSITION: LENGTH OF TIME IN PRESENT CAPACITY: AGENCY: What is your educational background? l ( IF COLLEGE MENTIONED) DEGREE______ MAJOR 55. Compared to other issues you deal with in your posi- ■ tion, would you say that the problems of the aged: ! are the major focus in your position........... 1 I are important, but not central to your I position .................................... 2 concern only a part of your position, or . . . 3 that your position rarely, if ever, deals with t h e m ? ............. 4 A. Can you give me a brief description of your major responsibilities in this position? I (RECORD VERBATIM) ;49. Would you say you use each of these sources of inf or- j mation often, sometimes, or never? ; SOME- ' OFTEN TIMES NEVER F. Contact with older people themselves? 4 5 6 I 6 0. This last section has a series of statements about aging. For each one, I would like you to circle the number that best indicates your stand on the state ment. Please circle the number key given below. 196 B I. N Q STRONGLY MILDLY MILDLY DISAGREE DISAGREE AGREE 197 STRONGLY AGREE , Older people are ^ apt to complain. Older people can learn new things ^ just as well as younger people can. People become wiser with the coming of 1 oId age. Older people are often against needed reforms in our soci- 1 ety because they want to hang on to the past. Most older people can do a job as well as younger persons, but ^ are not given an op portunity to show what they can do. Most older people are set in their ways and 1 unable to change. Most older people spend too much time prying ^ into the affairs of others. In most jobs, older people can perform as 1 well as younger people. There should be no re quired retirement age; older people should be 1 allowed to work as long as they are able to. J A P P E N D I X E SURVEY ITEMS ASKED OF ELDERLY CLIENTS 198 r' I APPENDIX E Now, I would like to ask a few questions on a different sub- jject. There are many different government agencies such as iSocial Security, Department of Motor Vehicles, Unemployment, Welfare, and the Vetetahs Administration. i '14. In dealing with a government agency, have you yourself ’ ever had any of the following experiences ; DOES NOT YES NO APPLY I b. Did people treat you j rudely? 1 2 3 t c. Did you find it embar- I rassing? 1 2 3 I |85. What was the highest grade in school you completed? j 00 01 02 03 04 05 06 07 08 09 10 1 11 12 ; college/other post high school schooling 13 14 15 16 POST GRADUATE SCHOOL 17 18 19 20 or more EDUCATED OUTSIDE OF U.S. Specify; # Years___________ 2 5. What is your current employment status? Are you : working full time working part time retired, working . . retired, not working keeping house . . . unemployed, or . . . something else? . . SPECIFY: ASK A .......................1 ASK A .......................2 ASK A .......................3 SKIP TO Q 2 6 ................4 SKIP TO Q 2 6 ................5 SKIP TO Q 2 6 ................6 SKIP TO Q 2 6 ................7 jFinally, I would like to ask you something about yourself: ,82. What year were you born? YEAR OF DIRTII: 199 2001 81. We'd like to know how you think of yourself as far as age goes--do you think of yourself as . . . j middle aged................ 1 young.......................2 i I elderly, or ...... . 3 ' I o l d ? ....................... 4 j I OTHER .................... 5 S P E C I F Y : ________ i I'd now like to ask you a few questions about health. | 65. In general, would you say your health is: very good.................. 1 g o o d .......................2 f a i r 3 j poor, o r .................. 4 ; very p o o r ? ................ 5 9 0. Would you say you are better off financially, about the I same, or worse off than you were 10 years ago? BETTER O F F ................ 1 I ABOUT THE S A M E ............ 2 ; WORSE O F F ...................3 78. As you get older, would you say things are better, about the same, or worse than you thought they would be? j B E T T E R..................... 1 I j ABOUT THE S A M E ............2 I WORSE .................... 3 ! DIDN'T THINK ABOUT FUTURE 4 I I Now, I would like to ask you for your opinion on some other questions. 11. What would you say are the three greatest problesm you I are facing these days? (RECORD FIRST 3 RESPONSES) 1. — -------------------------------------------------------------- — ...............— -------------- --------------------------------------------------------------------------------- -— ----------------------------------------- — I 2. I 201' Responses to this question were coded into two categories; . i ; I a. Personal Blame— personal health problems, I loneliness, interpersonal relationships, morale,^ life satisfaction, boredom, b. System Blame=“problems with medical care, age ! discrimination, race discrimination, neighbor hood crime, housing problems, problems with police, political situation. (Note : A third category, financial problems, was also coded but not used in the present analysis.) A P P E N D I X F ZERO-ORDER CORRELATION MATRIXES FOR ELDERLY CLIENTS (CHAPTER III) 202 m a CQ g CN I—I W w I —I ' — ij ^ u ( U -p H -P 1 - 4 -H g ë s ^ c H -H 9 S • N f C j X g H *H C K : u Eh CÜ < Û 0 H E h S H 1 O o r-4 C M c r * in o œ o 1 I — 1 I — 1 C O o r - I — 1 C M C M o 00 00 P V £ > ro o C O 00 Id C M C M C O 00 L O I — 1 O 1 — 1 o o C O 1 — 1 C M I — 1 C M C M C M o 1 in C O Id O in ro C M CO o 1 I — 1 o 1 O 1 C M 1 C M cn ro i-H in cn I — 1 O J O o C M CO o I — 1 1 Ip C M in in C M m o I — 1 1 — 1 C M I — 1 C N 1 o t CO 1 I — 1 1 Y o 1 p 1 O ( U c C D ■p C I — 1 r4 Ü p H I — 1 C D u C D o n Q C D P "d -p Q fd C D c "d r— 1 I — 1 I — 1 0 3 o C D f O (Ü C D m 0 3 -I-I > 0 ) •p > fd +J < D ■ H K u •P g P fd u C D G ■ P C D P } -l u ■ H Ü P fd fd -p f d C D P Q ) •P P o G I — 1 0 3 A tn tp C D C D o •P C D > i g C H C 0^ fl4 p L l C O H C , , — i C N CO m lO C O o I — 1 — _ — - --— --- - - — - ■ -■—— ■ -- -----------— ---------- 203 a CQ g Id I —I C O I 3 U ^ 0) s -p -p •H w o c n -P c Pfi 'H H O O CM t - 4 H P f d X . § H U P d , ( U Eh Q % O H E h 3 W o u o rH 00 Id LO m CM vd o C M LO o C M C M I 00 O C T t CO I 00 O O P I C T » C O I LO O o C M I o C M I C T t C M C O P I 8 I O I C M C M I CM P I C M O C M O r - o I o o I c r > o p C O o I o I o I LO r —I I C M Ld o I C M P C T > LO l> Q 00 O I P I C T i O I C M r-4 I o o C M O 0) C ( D •H G rH •P T5 Ü P P 0) u ( U O s : Q ( D Ë p Q fu ( U c T O p p 1 — 1 w o fd fd C D C Q CO •H T5 > 0) p > fd ■p ( Ü p K Ü P g p fd U Q ) c P ( Ü p p u •H O U fd fd P fd (U d < D P U Q c p m rQ tn T5 tn 0) Q ) O •P ( D > ) g G w < D : ^ C M 04 p L , CO < , , , , , , p CM CO ID Ld 00 O B I B L I O G R A P H Y 205 BIBLIOGRAPHY Books Balint, M. 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Gerontological Society Annual Meeting, San Juan, I Puerto Rico, 19 72. ! |Morgan, L. A., and Bengtson, V. L. "Measuring Perceptions I of Aging Across Social Strata." Paper presented at ! the Gerontological Society Annual Meeting, New York, October 15 ^ 19 76 . jShirley, K, W .; Kosin, E. H.; and Stewart, M. "Attitudes I of Nursing Personnel toward Older Veteran Patients." I Paper presented at the Western Gerontological I Society Annual Meeting, March 21, 1977.

Abstract (if available)

Abstract Persons live major parts of their lives today as members, beneficiaries, supporters, or targets of organizations. Notable among these organizational relations is that which occurs between an organization's representatives and its clients. Considering the ubiquity of such relationships, it is curious that they have been slighted by research. Our interest here lies in the members of a socially deprived client group, the elderly, who are heavily dependent for their existence on those organizations called service bureaucracies.

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Asset Metadata

Creator McConnell, Stephen Robert (author)

Core Title Bureaucrats and old clients: dependence, stigma, and negative sentiment in the service relationship

School Graduate School

Degree Doctor of Philosophy

Degree Program Sociology

Degree Conferral Date 1977-08

Tag OAI-PMH Harvest

Advisor Turk, Herman (committee chair), Bengtson, Vern L. (committee member), Lincoln, James R. (committee member), Sundeen, Richard A. (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC11256263

Unique identifier UC11256263

Legacy Identifier DP31784

Document Type Dissertation