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People from lower socio-economic classes are confronted with several barriers that impede their access to health care. An important, though often forgotten barrier is embedded in the care-relationship. Differences in the social environment of health care workers and poor complicate the care-relationship. By means of in-depth interviews and focus groups with health care workers in the fields of primary and secondary antenatal and postnatal care and diabetes care we mapped their perception of poverty and of their care-relationship with intergenerational poor. Our results show that health care workers perceive the causes of poverty mainly on the individual level. When asked about the basic conditions for a good care-relationship health care workers stress the presence of trust and a fundamental attitude of relational equivalence, authenticity and respect. This ideal image has a stressfull relationship with the framework of individual guilt that puts the responsibility for a good care-relationship, at least partly, with the poor. Based on these results an educational program for health care workers has been developed.