Job satisfaction has implications for recruitment, retention, and quality of care.
A new analysis of 2 national data sets could help providers of home and community-based services better understand what contributes to job satisfaction among home health aides and what makes these workers want to leave the job. The results from research conducted by the LeadingAge Center for Applied Research and Social and Scientific Systems were presented at the 68th Annual Scientific Meeting of the Gerontological Society of America in November.
GSA presenters included CFAR Executive Director Robyn Stone; Christine Bishop, professor of labor economics at Brandeis University’s Heller School for Social Policy and Management; and Jess Wilhelm, a PhD candidate in international health at the Johns Hopkins Bloomberg School of Public Health.
Predictors of Job Satisfaction
To conduct their analysis, the research team linked 2007 data from:
- The National Home and Hospice Care Survey (NHHCS), a survey of Medicare- and Medicaid-certified agencies.
- The National Home Health Aide Survey (NHHAS), a survey of workers employed by the agencies participating in the NHHCS.
Researchers found that higher job satisfaction among agency-based home health workers was associated with:
- Participation in formal training programs.
- The availability of pensions.
- Having the latitude to communicate with the family about client care.
- Worker perceptions of being challenged, valued, and respected.
- Worker satisfaction with the number of hours worked each week.
Lower satisfaction levels were associated with:
- Injuries.
- Having less than a high school education.
- Working for a stand-alone, for-profit agency.
A worker’s age, ethnicity, geographic location, compensation, household income, or number of jobs did not affect job satisfaction in a statistically significant way.
Predictors of Intent to Leave
Not surprisingly, lack of job satisfaction was associated with a home health worker’s intent to leave a job. In addition, reported Stone, the research team identified these significant predictors of intent to leave:
- Perceived workplace characteristics: Not feeling valued by the organization and not finding the work challenging were associated with increasing a worker’s intention to leave a job.
- Age: Younger home health workers were significantly more likely to leave a job than older workers.
- Consistent assignment: The CFAR/SSS analysis suggests that when an agency assigns an aide to a different client each day, it increases intent to leave because, says Stone, “the aide doesn’t have the opportunity to develop a relationship with the person.”
- Work hours: Working part time and wanting more hours was associated with intent to leave the job. However, working part time and wanting fewer hours, or working full time and wanting more hours, was associated with a decrease in intent to leave.
Stone suggested that this last finding calls for more research.
“Up until now, the home care literature has focused on the fact that there are many people who are working fewer hours and want more,” she said. “But our analysis suggests that it is a lot more complex than that.”
Implications of Being Dissatisfied at Work
Home health agencies need to pay attention to worker job satisfaction, not only because it represents an intrinsic value to workers, but also because it has implications for:
- Recruitment and retention: “Word of mouth is very important for these jobs,” Wilhelm told the audience. “If you hear that people who are doing these jobs are dissatisfied, you are less likely to (apply). That makes (job satisfaction) more important for recruitment, and eventually for retention.”
- Quality of care: “Home health asides are doing emotional labor and they need their entire emotional selves to do those jobs well,” says Bishop. “So you can imagine that someone who is not satisfied with the job may not be providing the kind of service that the client would like.”
- The home health workforce: “Patterns of turnover keep the home health aide job in the secondary workforce,” says Bishop. “There’s a lower attachment of workers to employers, which reinforces lower attachment of employers to workers. Then workers are treated as if they are interchangeable, which they are not.”
What Can a Home Health Agency Do?
The CFAR/SSS analysis suggests that home health agencies could take the following actions to improve job satisfaction and reduce intent to leave:
- Take steps to reduce job-related injury.
- Include aides in the care process by encouraging them to communicate with families and involving them in care planning.
- Provide ongoing, formal training.
- Offer retirement benefits.
- Find ways to make home health jobs more challenging.
- Find new sources of labor by making home health jobs more appealing to younger workers, who expressed a greater intention to leave the job.
- Consistently assign workers to the same clients so they can build relationships that lead to job satisfaction.
“Paying attention to these pathways could buoy job satisfaction,” says Bishop.
More Research is Needed
Stone, Bishop, and Wilhelm stressed throughout their presentation that researchers still have a lot to learn about job design and working conditions in the home health field.
“We know a lot about how nursing home work is done, but home health agencies and the work environment of home health and home care aides are so different,” said Bishop. “There needs to be much more qualitative work on the conditions of work in these settings.”
This research will become particularly important as the aging population demands more home care and new models emerge to meet that demand, added Stone.