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


After informal caregivers, home health and home care workers (referred to in this article as home health workers or home health aides [HHAs]) provide the majority of hands-on, personal care services to older adults and younger people with disabilities (Kaye, Chapman, Newcomer, & Harrington, 2006; Stone, 2004). These workers tend to have frequent, intimate contact with clients, often developing relationships with them and becoming an important source of emotional as well as physical support (Stone, 2004). The demand for home care has increased significantly over the past three decades. Elderly and younger consumers and their families prefer home and community-based services to the receipt of care in nursing homes. Four out of five elders who require long-term services and support live in the community and want to receive care in their own home (Butler, Brennan-Ing, Wardamasky, & Ashley, 2013). Federal and state policymakers have responded to this demand, as well as the potential for cost savings, by expanding home and community-based options in lieu of nursing home placements for disabled Medicaid beneficiaries. Home health care services covered by Medicare, Medicaid and commercial insurers have also expanded to address the post-acute care needs of individuals being discharged from hospitals more quickly than in previous years, or even bypassing a hospital stay entirely. The demand for this workforce is likely to grow even more over the next 30 years as the baby boom generation ages, the number of people with disabilities increases and the availability of caregivers decreases (Redfoot, Feinberg, & Houser, 2013).

The availability and stability of home health workers are essential to the success of home health and home and community-based services in meeting current and future demands in a high-quality and efficient manner. Today, agencies, consumers, and their families are challenged to recruit and retain workers due to low status, poor pay, and challenging working conditions (HHS, 2011; Benjamin & Matthias, 2004; Stone, 2004). Home health workers have high rates of turnover, estimated to range from 44 percent to 65 percent annually, depending on how turnover is measured (Seavey & Marquand, 2011). Ninety-seven percent of states responding to a 2007 survey reported that direct service worker (including nursing home and home care/personal care aides) vacancies and/or turnover constituted “a serious workforce issue,” up from 76 percent in 2005 (PHI & DCWA-NC, 2007).


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