Negotiating Identity in Care Work

Introduction

Community care is built upon relationships, trust, and intimacy. Unlike many other professions, care workers enter people's homes, support individuals during moments of vulnerability, and often provide highly personal care. As a result, care is not simply a set of practical tasks but a relational practice in which the identities of both the person receiving support and the care worker become significant. While person-centred care emphasises respecting the preferences, dignity, and autonomy of those receiving support, considerably less attention has been given to how care workers negotiate their own identities within these intimate care relationships. This is a notable gap, given that gender identity has increasingly been theorised as relational and contextually constituted rather than fixed (Suhomlinova, O'Shea, & Boncori, 2024).

For care workers who identify as lesbian, gay, bisexual, transgender, or gender diverse, professional practice may involve balancing authenticity with the expectations of colleagues, organisations, and the people they support. Decisions about whether to disclose one's identity, respond to assumptions, or navigate prejudice become intertwined with the everyday delivery of care. Consequently, identity itself can become part of the work, requiring care workers to continually negotiate who they are while simultaneously supporting others.

This article explores the lived experiences of care workers employed within Equal Care1, a platform care cooperative offering relationship-centred community care. Equal Care describes its mission as putting power in the hands of those who matter most: the people giving and receiving care. Caregiving, in this model, is framed as a relationship between equals; carer and care receiver choose one another and each retains control over what matters most to them, in contrast to the top-down, agency-style arrangements that shape much of the sector. It is this emphasis on mutual choice and lasting, trusted relationships that makes Equal Care a particularly revealing setting in which to examine how identity is negotiated in everyday care.

Through participants' narratives, the article examines how gender identity and sexual orientation shape experiences of care work beyond conventional discussions of workplace discrimination. Rather than presenting identity solely as a source of exclusion, it shows how care workers actively negotiate disclosure, authenticity, emotional wellbeing, and professional boundaries within everyday practice.

First, the article highlights negotiating identity during care, with participants continually making decisions about when, how, and whether aspects of their gender identity or sexuality should be disclosed within caring relationships. Secondly, it explores the emotional labour of identity, revealing that, alongside caring for others, participants frequently managed prejudice, challenged stereotypes, and educated colleagues and those receiving support. Finally, it examines the tension between person-centred care and worker dignity, illustrating how participants balanced the preferences of those receiving support with their own right to safety, authenticity, and professional respect. Together, these findings suggest that identity is not simply a characteristic that care workers bring into the workplace; rather, it becomes an integral part of the labour of care itself.

Negotiating Identity During Care

Unlike many professions where personal identity can remain separate from professional responsibilities, community care places workers in intimate, relationship-based environments where gender identity and sexual orientation become highly visible. Participants described how decisions about whether to disclose, conceal, or adapt aspects of their identity were shaped by the needs of the people they supported, the context of care, and concerns for their own wellbeing. Rather than viewing identity as fixed, participants demonstrated that identity was continually negotiated according to each care relationship.

Participants emphasised that identity disclosure should remain under the control of the care worker. Rather than simply asking staff what pronouns they use, one participant argued that organisations should recognise that identity is contextual and that workers should have greater agency over when and where aspects of their identity are shared.

"Instead of asking what pronouns would you like us to use. It would be... when would you like to use a pronoun for... when you are with people who are receiving support, what pronouns would you like us to introduce you? Do you want us to have an introductory conversation before you meet them?... Do you want the staff to know your identity and if so, when and where is appropriate for staff to kind of refer to you as these things?"

Rather than treating identity disclosure as a one-time decision, this participant framed it as an ongoing process that should remain under the worker's control. Identity within care settings was therefore not simply about recognition but about maintaining autonomy in situations where relationships are built upon trust and vulnerability.

The intimate nature of personal care further complicated this process. One participant explained that discussing gender identity whilst providing personal care could undermine the dignity of both the worker and the person receiving support.

"It becomes a very strange thing to kind of have like a coming out... whilst giving someone personal care... It's a very vulnerable thing to share in such a vulnerable space."

This demonstrates how identity negotiations within care differ from many other workplaces. Conversations surrounding gender identity and sexuality occur within highly personal environments, making disclosure not only a question of authenticity but also of timing, appropriateness, and emotional safety. This resonates with O'Shea's (2019) autoethnographic account of disclosure as an embodied and precarious act, in which sharing one's identity within vulnerable spaces carries its own emotional risk.

Participants also recognised that identity disclosure was not always necessary or beneficial. Reflecting on supporting people living with dementia, one participant explained:

"Working with some folk who have dementia... I wouldn't take the same approach of kind of desperately trying to make them understand my identity."

Rather than viewing this as denying their identity, the participant described it as an exercise of professional judgement in which the needs of the person receiving support took precedence. Identity therefore became flexible according to the circumstances of care, reflecting the relational nature of support work.

Similar experiences were described by other participants, particularly in relation to sexual orientation. One participant explained that despite being open about their sexuality, this sometimes affected whether they were accepted by people receiving support, recalling being told outright that some clients did not want a gay woman providing their personal care. Another participant described a related experience in which their sexual orientation directly affected their ability to continue supporting someone, after a person they supported objected to receiving personal care from them because they were gay; an episode discussed further, in the participant's own words, in the following section.

These accounts demonstrate that decisions surrounding identity were not always made by the care worker alone. Instead, identity became something negotiated within the care relationship, influenced by the attitudes and preferences of those receiving support.

Participants also reflected on how gender expression shaped perceptions of their professional identity. One participant recalled that people often struggled to believe she was a woman, and that on learning she was a care worker, colleagues and clients alike would remark that she "didn't look like a care worker" a comment explored further below in relation to the emotional labour it created.

This highlights how expectations surrounding care work continue to be gendered. Participants were not only negotiating their sexual orientation or gender identity but also broader assumptions about what a care worker should look like and who is perceived as suitable to provide care. Such reactions echo O'Shea's (2018) discussion of how transgender subjects can be dehumanised through everyday assumptions about appearance and legitimacy, which position certain bodies as inherently incongruous with particular professional roles.

Across all conversations with participants, identity was not presented as something that was either hidden or openly expressed. Instead, participants described identity as something continually negotiated according to the individual receiving support, the nature of the caring relationship, and the wider organisational context. These negotiations reflected ongoing attempts to balance authenticity with professionalism while preserving the dignity of both the care worker and the person receiving support. Rather than existing separately from caregiving, identity became embedded within the everyday practice of care itself, requiring workers to make continual judgements about disclosure, visibility, and self-presentation in order to maintain trusting, person-centred relationships.

Identity as Emotional Labour

Beyond the practical responsibilities of providing care, participants described the additional emotional labour associated with managing their identities within professional settings. While care work is widely recognised as emotionally demanding, these accounts revealed an additional layer of work that involved responding to prejudice, managing assumptions, educating others, and continually assessing how identity might influence relationships with the people they supported. Rather than being separate from caring, participants described identity management as becoming embedded within their everyday practice, echoing wider scholarship on the body as a site through which organisational meaning, vulnerability and resistance are enacted (Boncori, Brewis, Sicca, & Smith, 2019).

One of the strongest examples of this emotional labour was the expectation that LGBTQ+ care workers should educate colleagues and organisations about their identities. Participants described situations in which they became the default source of knowledge simply because of who they were, rather than because this formed part of their professional role. Reflecting on their experiences of joining the organisation, one participant explained:

"People can get a little bit lost in the idea of asking the trans person to do the thing... Then misunderstanding that it's not necessarily their labour."

Although willing to contribute towards improving organisational practices, the participant questioned the assumption that responsibility for inclusion should fall upon the individual whose identity was being discussed. This distinction highlights that inclusion requires organisational commitment rather than relying upon minority workers to provide continual education.

The participant further described how these expectations emerged almost immediately after joining the organisation.

"They were like, 'Oh, we've not... do you think we should put pronouns on the badges or not?'... I do have that knowledge and I was able to give some good suggestions, but it's not a particularly comfortable initiation to be sat and immediately asked, 'What do we do about you?'"

Although these conversations reflected positive intentions, they also placed responsibility upon the individual to solve organisational issues before being fully integrated into the workplace. The emotional labour therefore extended beyond providing care to managing the uncertainty of colleagues and contributing to organisational learning.

Participants also reflected on the ongoing emotional effort required to respond to curiosity from colleagues. While many recognised these questions were well intentioned, they nevertheless highlighted the burden of continually explaining their identities.

"I do worry other trans people would get subjected to a lot of questioning... I'm happy to help, but at the same time that's not really up to them."

Another example illustrated this point further.

"I've had conversations with colleagues that have said, 'Well, I've got these grandkids... how do I explain to them if someone's a they?' I'm happy to help, but at the same time that's not a normal thing to ask someone immediately."

These reflections demonstrate that emotional labour is not always the result of overt discrimination. Instead, it can arise through repeated expectations to educate others, answer deeply personal questions, and reduce uncertainty surrounding identities that remain unfamiliar to some colleagues.

Participants also described the emotional impact of confronting stereotypes and prejudice from the people they supported. As noted in the previous section, one participant recalled having to withdraw from supporting an individual after being told, "I don't want to receive Personal Care from you because you're gay." Reflecting further on this experience, she described having to actively defend her professionalism against the assumptions underlying that rejection:

"I said, 'I'm not a predator.'"

This account illustrates how prejudice extends beyond rejection itself. The participant was compelled to defend her identity against harmful stereotypes before even being recognised as a professional care worker. Such experiences required emotional resilience while simultaneously maintaining professionalism.

Similarly, another participant reflected on the broader impact of being judged because of her appearance and identity, describing again how people struggled to believe she was a woman, let alone a care worker. These comments reveal that assumptions surrounding who is considered an appropriate care worker continue to be shaped by gendered expectations. Participants therefore carried the additional burden of continually negotiating perceptions that questioned both their identity and professional legitimacy.

Emotional labour also extended beyond the workplace into participants' personal lives. One participant reflected on the internal challenges associated with accepting their sexuality following a strict religious upbringing.

"It goes more to show... the challenges I have to face in my own sexuality and also the guilt and the emotions that come with that... Having to deal with a large amount of society that have a thought process of a certain way and having to push against that is very, very challenging."

This illustrates that identity-related emotional labour is cumulative, shaped not only by workplace experiences but also by wider social, cultural and religious expectations. Participants therefore entered professional settings already carrying experiences of exclusion, self-reflection and resilience that influenced how they navigated care work.

Despite these challenges, participants consistently distinguished between individuals who were willing to learn and those who were unwilling to question their own assumptions. As one participant observed:

"I think a lot of people make a lot of judgments on stuff that they don't understand and I think that if they're not willing to understand then that's an embarrassment of what they are as a person more than anything."

Rather than focusing solely on experiences of discrimination, participants repeatedly emphasised the importance of education, openness and dialogue. However, they also argued that responsibility for fostering inclusive environments should not rest solely upon LGBTQ+ workers themselves.

Collectively, these findings demonstrate that emotional labour in care extends far beyond supporting people during illness, disability or vulnerability. Participants described continually managing their own identities through explaining, defending, educating and adapting within professional relationships. Identity therefore became an additional form of labour that accompanied the practical and emotional responsibilities already associated with care work, highlighting that inclusion requires more than acceptance alone; it requires organisations to recognise and reduce the invisible work carried by minority staff, consistent with calls for organisations to attend more closely to the embodied and often unspoken dimensions of employees' identity work (Boncori, Brewis, Mandalaki, & van Amsterdam, 2024).

Balancing Client Choice, Worker Dignity and the Role of Equal Care

Lastly, this theme explores the complex relationship between respecting the preferences of people receiving care and maintaining the dignity and wellbeing of care workers. Participants consistently recognised that person-centred care requires acknowledging the wishes of those receiving support, particularly in relation to intimate personal care. However, they also highlighted the challenges that arise when these preferences are influenced by assumptions surrounding gender identity or sexual orientation. Rather than presenting this as a conflict between workers' rights and clients' rights, participants described the need for organisations to create supportive systems that protect both.

One participant reflected on requests for carers of a particular gender, explaining that these preferences often stem from previous life experiences rather than prejudice alone.

"It's quite usual for someone to request the gender of their support worker... someone you're supporting who is a woman would like a woman to support them because of their relationship to men and their discomfort around men, which is entirely reasonable."

This demonstrates that gender preferences within care are often linked to trust, trauma and shared experiences. Rather than dismissing these requests as discriminatory, participants acknowledged that personal care involves unique forms of vulnerability that require careful consideration.

At the same time, participants recognised that these situations could place LGBTQ+ workers in particularly difficult positions. One participant explained that organisations have a responsibility to think carefully before placing workers into environments where they may experience discrimination.

"There is very little framework to deal with that discrimination other than make sure that we're not putting people in the position where they might be discriminated against."

Rather than expecting workers to manage prejudice once it occurs, the participant argued that organisations should proactively reduce the likelihood of such situations arising. This shifts responsibility from the individual worker towards the organisation itself, a pattern also documented in other institutional settings, where organisations have been found responsible for anticipating and mitigating environments in which transgender and non-binary people are placed at heightened risk (Suhomlinova & O'Shea, 2021).

The importance of organisational preparation was further illustrated through discussions surrounding introductions between workers and people receiving support. One participant argued that conversations about identity should occur before care begins rather than leaving workers to negotiate these discussions alone.

"It is actually our duty of care as well to kind of be honest about who they might be meeting and what that person's about... so that those sorts of people can feel that they know exactly what they're getting."

Similarly, they emphasised that this approach was intended to protect workers from avoidable discrimination.

"That's why it's important that everybody else in the Co-op sees it as that kind of practical safety issue rather than like an ideological... it is your duty to make sure that you know who you might be supporting and their potential reaction."

These reflections position inclusion not simply as an equality issue but as a matter of worker safety and organisational responsibility.

The consequences of failing to provide this support were evident in the experiences described earlier: participants recalled being turned away from clients' teams outright because of their sexuality, and in one case being told directly that a client did not want to receive personal care from a gay support worker. These accounts illustrate that despite increasing awareness surrounding LGBTQ+ inclusion, assumptions and prejudice continue to influence who is considered an acceptable care worker. Participants accepted that individuals receiving support should retain choice regarding intimate care, yet these experiences demonstrate that such choices can also have significant emotional and professional consequences for workers.

Alongside these challenges, participants repeatedly described Equal Care as providing an environment in which they felt heard, trusted and able to contribute towards organisational change. Rather than simply employing LGBTQ+ workers, participants felt that the organisation created opportunities for them to influence practice and policy.

One participant reflected positively on their experience within the organisation.

"They've been really kind to trust me and let me already be useful on the policy side of things... looking at training and building new policies."

This sense of trust extended further as they became involved in developing organisational guidance around gender identity.

"I've been trusted to be the person that should put together the trans policy."

For this participant, organisational support meant more than acceptance; it involved being recognised as someone whose experiences could shape future practice.

Another participant similarly reflected on the organisational culture, describing it as different from previous experiences of care work.

"I like what Equal Care does because it's not being told what to do... you can choose what you want to do."

This emphasis on autonomy was echoed by another participant who described the organisation as having:

"Definitely an openness."

However, participants were equally clear that supportive organisational cultures do not remove the challenges associated with negotiating identity. One participant cautioned against assuming that inclusion simply means the absence of discrimination.

"It's not enough just to not discriminate against them."

Instead, organisations must actively develop the knowledge, policies and confidence required to support diverse workers. Another participant expanded upon this by suggesting that many organisations believe themselves to be inclusive without fully understanding the experiences of minority workers.

"They need to be more robust about validating the experiences of people as opposed to just leading with the idea that they themselves wouldn't discriminate."

These reflections suggest that meaningful inclusion requires continuous learning rather than relying upon good intentions alone.

Taken together, this theme demonstrates that balancing client choice with worker dignity is one of the most complex aspects of community care. Participants recognised the importance of respecting the wishes of people receiving support, particularly within intimate care relationships, while simultaneously arguing that organisations have a responsibility to protect workers from avoidable discrimination. Their experiences suggest that Equal Care's cooperative and relationship-centred approach provides a more supportive environment by encouraging openness, trust and worker participation in organisational decision-making. Nevertheless, participants also acknowledged that organisational support cannot entirely remove the need to negotiate identity within care relationships. Instead, it can reduce the burden by ensuring that responsibility for inclusion is shared collectively rather than resting solely upon individual care workers.

Conclusion

This article explored how gender identity and sexual orientation shape the experiences of care workers within community care, demonstrating that identity extends beyond a personal characteristic and becomes embedded within the practice of caregiving itself. Across all conversations, participants described continually negotiating how and when aspects of their identity were disclosed, adapting to the needs of the people they supported while simultaneously managing their own sense of authenticity and professional identity. Rather than presenting identity as static, the findings revealed that it was relational, context-dependent and continually shaped by the dynamics of care.

A key finding was that participants carried an additional layer of emotional labour alongside their caring responsibilities. Beyond providing physical and emotional support, they described responding to stereotypes, educating colleagues, managing assumptions, and navigating prejudice from both society and, at times, the people they supported. These experiences illustrate that identity itself becomes work, requiring continual judgement, resilience and adaptation in ways that are often invisible within everyday care practice.

The findings also highlighted the complexity of balancing person-centred care with the dignity and wellbeing of care workers. Participants recognised the importance of respecting the preferences of people receiving support, particularly within intimate care relationships, while also acknowledging that these preferences can sometimes result in exclusion or discrimination towards LGBTQ+ workers. Rather than framing these issues as opposing rights, participants emphasised the need for organisational systems that protect both workers and those receiving care.

Importantly, the experiences shared within Equal Care suggest that organisational culture can play a significant role in reducing the burden of identity negotiation. Participants consistently described an environment characterised by openness, trust and opportunities to influence organisational practice, particularly through involvement in policy development and inclusive decision-making. While Equal Care did not eliminate the challenges associated with gender identity and sexuality, it appeared to create conditions in which workers felt heard, valued and supported. This shifted responsibility for inclusion away from individual workers and towards the organisation itself.

Overall, these findings suggest that creating truly inclusive care environments requires more than policies of non-discrimination. It requires organisations to recognise that care workers also bring identities, vulnerabilities and lived experiences into caring relationships. Supporting these identities through proactive organisational practices not only promotes worker wellbeing but also strengthens relationship-centred care, benefiting both care workers and the people they support.

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  https://www.equalcare.coop/