Predictors of Job Satisfaction and Intent to Leave among Home Health Workers: An Analysis of the National Home Health Aide Survey. Discussion


This analysis is the first nationally representative study to examine the extent to which workplace and agency characteristics, job stressors/demands, and compensation are associated with agency-based home health workers’ job satisfaction and intent to leave the job. The findings support some of the hypothesized relationships articulated in the study’s conceptual framework. With respect to the hypothesized positive correlation between perceived workplace characteristics and satisfaction with the job, the analyses indicate that feeling respected by one’s supervisor, feeling valued by one’s agency, and perceived involvement in challenging work were all associated with greater job satisfaction. Workers employed in agencies that encouraged them to discuss client care with the family--a measure of aide empowerment--also had greater odds of being extremely satisfied.

The hypothesis linking the availability of benefits and compensation with higher job satisfaction was only partially supported by the observed positive correlation between the availability of a pension or retirement plan and greater job satisfaction. Contrary to expectations, higher wages and advancement potential were negatively correlated with job satisfaction or insignificant. This result is not inexplicable, given the endogenous relationship expected between wages and labor market satisfaction and turnover. Positive impacts of higher wages on job satisfaction may be obscured if higher wages and career ladder positions are used by agencies to retain otherwise dissatisfied workers, who would leave if paid less or did not see advancement possibilities.

The third hypothesis, that job stressors are negatively correlated with job satisfaction, received some support from this analysis. Satisfaction with hours worked was significantly correlated with job satisfaction. Aides who worked full-time and wanted fewer hours reported lower job satisfaction. On-the-job injury was also significantly associated with lower odds of being extremely satisfied.

The only agency characteristic related to job satisfaction was ownership status. Aides employed by standalone, for-profit agencies reported lower satisfaction than those working in non-profit agencies. Although not the focus of this report, this study found that several worker demographic characteristics were associated with job satisfaction. Aides with less than a high school education had significantly lower job satisfaction than more highly educated workers. Being the only worker in a household with dependent children was associated with higher odds of being somewhat satisfied versus dissatisfied. Age, ethnicity, and race had no effect on job satisfaction.

The findings from this study provide equivocal support for the four hypotheses testing the relationship between the various agency, worker, and policy-level variables and aide intention to leave the job. They also provide empirical evidence to support the conceptual model guiding this study. Job satisfaction was found to be strongly correlated with intent to leave the job, even after controlling for other agency-level and worker-level variables, including worker perceptions of the workplace environment. The hypothesized positive relationship between perceptions of the work environment and intent to leave the job was more nuanced. Aides’ perceptions of their workplace environment, including feeling valued by the organization and being involved in challenging work, trusted to make patient care decisions, and respected by the supervisor lowered the odds of intending to leave the job. This relationship, however, lost significance when job satisfaction was added to the model. A descriptive study using the same sample found the proportion of home health workers with positive ratings of their supervisors was greater for those workers intending to remain on the job (Bryant et al., in press). These analyses suggest that perceptions of the workplace environment go through job satisfaction and indirectly drive intent to leave the job.

The study did not support the hypothesis that compensation would have a negative relationship with intent to leave, with the exception of one variable. Workers employed by agencies offering health insurance were significantly less likely to consider leaving the job than those with no access to employer-sponsored health insurance.

One of the major findings of this study was the strong relationship between consistent assignment and aides’ intention to leave the job. Although the study did not find a relationship between consistent assignment and job satisfaction, aides assigned the same patients had significantly lower intentions of leaving the job. It may be that being assigned to the same patients provides a greater level of continuity and familiarity even if the job itself is not more satisfying. Additionally, attachment between aides and patients may foster a sense of responsibility on the part of aides and discourage dissatisfied workers from leaving their jobs.

The study supported the hypothesis that at least one job stressor is related to intent to leave. Aides who reported an on-the-job injury in the past 12 months not only were less satisfied with their jobs but also had more than twice higher odds of intending to leaving their jobs, even after controlling for job satisfaction. These results suggest that work-related injuries not only contribute to job dissatisfaction but may cause people to consider leaving the job because of ongoing health-related concerns or the ongoing physical demands of this type of work. Inadequate hours also influenced the workers’ employment intentions, as part-time aides who wanted more hours were more likely to consider leaving the job than those who felt the hours were “just right”. Interestingly, these workers did not report lower levels of job satisfaction, suggesting that they may be considering leaving the job for economic reasons rather than the quality of the job itself.

Among agency characteristics, being employed in a not-for-profit agency appears to have a positive association with job satisfaction, and a negative relationship with intent to leave the job. It is interesting to note that ownership status within the for-profit sector differentially affects the two outcomes. Those employed by standalone agencies reported lower satisfaction, while those employed in a chain-owned agency reported greater intent to leave. As the proportion of for-profit home health and home care agencies continues to grow, more research is needed to understand what factors are related to worker concerns with this part of the sector.

There also seems to be some different demographic characteristics driving intent to leave relative to job satisfaction. While race had no effect on job satisfaction, “Black/African-American only” aides were two times more likely to intend to leave the job than their “White only” peers. Household income was also related to employment intentions, as aides with lower incomes were significantly less likely to intend to leave their jobs than aides with household incomes over 300 percent FPL. These findings may reflect the fact that individuals with lower economic status may avoid the risk associated with seeking alternative employment or be less able to exit the labor force altogether.

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