This study supported the findings described in the literature review of positive perceptions of the workplace environment contributing to higher job satisfaction. These factors had the greatest increase in the odds of being satisfied with the job. Workplace characteristics contributed to turnover intention through job satisfaction. Home health workers who feel valued by the organization and challenged in their work may have higher job satisfaction, which can indirectly drive turnover intentions. Organizations can support the design of the job and cultural environment to enhance valuing and respecting aides and their work. In addition, agencies can foster positive relationships between home health workers and supervisors. While we did not find a significant relationship between HHA satisfaction or turnover intentions and empowerment of the aide (confidence, feeling trusted to make patient care decisions), one possible explanation is aides are not rewarded when they take on independent decision-making (Bishop et al., 2009).
Interestingly, the current analysis found that a consistent assignment policy was not associated with home health workers’ job satisfaction, but was positively linked with aides’ lower intentions to leave the job. One speculation why consistent assignment influences turnover intention and not job satisfaction is the relationship with the client is a driving factor for aides to stay on the job and not related to overall satisfaction with the job itself. In the nursing home setting, the quality of the relationship between individuals and the aides is valued by residents, family members, and caregivers and improves nursing assistants’ feelings of direct responsibility for individual care (PHI, 2001; Nolet, Roberts, & Bowers, 2012; Castle, 2011). Another possibility is consistent assignment may be related to travel time. An aide who has the same clients may have fewer clients and it reduces the travel time to go to a client’s home. There is a need for more research on consistent assignment for home care workers because most of the prior studies have focused on the nursing home setting.
Compensation and Perceived Job Stressors or Demands
Workload, indicated by aides’ perception of time to assist clients with ADLs, was not associated with job satisfaction or turnover intention (after controlling for job satisfaction in model II). However, satisfaction with hours worked and injuries on the job were correlated with higher job satisfaction and lower intention to leave the job. Part-time workers who indicated wanting more hours had higher intentions to leave the job, but it was not associated with job satisfaction. The desire for more hours may not influence how an aide feels about the job but impacts their decision of whether or not they can continue to work at the agency. Full-time workers who want fewer hours had lower levels of job satisfaction. One speculation may be that workers felt overwhelmed by the job and were less satisfied with the work. A challenge for agencies is to provide sufficient hours for staff, given the instability of the clientele (e.g., loss of hours if a client goes to the hospital) and difficulty to guarantee hours.
Most benefits were not significantly correlated with job satisfaction or employment intention. Aides who had pension or retirement plans available at the agency had higher levels of job satisfaction, while aides who had health insurance availability at the agency, regardless of whether or not they participated, had lower intention to leave the job. Further research could pinpoint which benefits are most valuable to workers and the impact of benefits that are available but are not affordable, providing home health agencies with guidance on spending limited benefit dollars. Providers face difficulty providing benefits and higher pay because agencies operate under bankruptcy, and Medicaid reimbursement rates are close to the actual cost of providing care (Harahan & Stone, 2007).