Interdependent empowerment in residential care homes: perspectives of first-line managers, care workers, and relatives

PURPOSE: This study examines factors that facilitate or limit empowerment within Swedish residential care homes based on the perspectives of first-line managers, care workers, and residents' relatives. Empowerment among formal and informal supporters may create conditions for residents' empowerment and self-determination. METHODS: Secondary analysis was conducted using data from two projects across 19 residential care homes, including six group interviews with 24 care workers, 16 individual interviews with relatives, and 19 interviews with first-line managers. Structural and psychological empowerment was used as an analytical framework. RESULTS: Empowerment was shaped by structural conditions such as time, staffing, decision-making authority and everyday interactions. Care workers and managers described how limited resources and authority reduced their ability to meet professional standards and policy expectations. Relatives often felt excluded, which weakened their influence and affected residents' opportunities for self-determination. Empowerment is interdependent across roles: constraints experienced by one group can limit the others, while supportive structures can strengthen empowerment across the system. At times, tensions arose regarding whose influence should take precedence in decisions. CONCLUSION: Strengthening structural conditions and supportive relationships at all organizational levels is essential for sustainable work environments and high-quality, person-centered care, particularly for residents who depend on others in decision-making.