As shown in Table 1, independent variables in job satisfaction and intent to leave models were classified according to the theoretical framework depicted in Figure 1. Of the independent variables identified in this table, the focus of analyses was on those factors that were mutable--under the control of the home health agency or that could be reasonably influenced through public policies. These are referred to throughout this report as “policy” variables. Other variables, including demographic and agency characteristics were included as control variables. Intervening variables were comprised largely of variables related to organizational culture, workplace characteristics, and labor market characteristics, defined in terms of unemployment rates in the state in which the home health worker resided at the time the survey was taken.
Agency Structure and Policy Variables
MSA status of agency was included as a control variable with three categories based on the classification of the county of the agency: metropolitan, micropolitan, or neither. Agency ownership and chain-affiliation were combined to form three categories for agencies: chain-affiliated for-profit, standalone for-profit, and not-for-profit or other. The size of the agency was included as a control variable, with size being defined as the number of full-time equivalent (FTE) nursing employees (registered nurse, licensed practical nurse) and direct care employees and contractors (certified HHA/certified nurse aide [CNA], contract HHA/CNAs, non-certified aides).
Agency policy variables included the consistency of patient assignment, which we hypothesized to be linked to job satisfaction and intent to leave job for both workers and patients. The availability of career ladder positions for aides, an agency-level variable derived from the NHHCS, was included as a policy variable indicating advancement potential for direct care workers.
Perceived Workplace Characteristics
Aides’ perceptions are important intervening variables affecting the link between workforce outcomes (job satisfaction and turnover) and agency policies and practices. These variables are subjective and derived from the NHHAS survey of aides. Aide perception variables are considered to be the product both of agency structure and policies, but also influenced by worker characteristics.
Adequate time for assisting patients with ADLs is included as an indicator of how much time is allotted for home health care visits and is conceptually similar to a measure of the staffing rate in an institutional setting. The variable for sufficient time for ADLs has three levels: more than enough time, enough time, and not enough time. Another important intervening variable is whether or not the aide experienced a work-related injury in the past 12 months, which could be a product of training, supervision, environment, or worker characteristics.
Aides’ relationships with their organizations, supervisors, and patients are expected to be an important factor in both their satisfaction and their intent to leave their jobs. In this analysis we have included three relationship variables with two levels: Aide feels valued by Organization (“Very Much” versus “Somewhat or Not at All”), Aide feels respected by Supervisor (“A Great Deal” versus “Somewhat or Not at All”), and Aide feels respected by patients (“A Great Deal” versus “Somewhat or Not at All”).
Given the frequency of part-time work among home health and hospice aides, two variables were combined to assess aides’ satisfaction with their hours. The number of hours aides worked in a given week was combined with whether aides would like more hours, fewer hours, or think their hours are about right to yield four categories: Part-time (<30 hours/week) & Want More Hours, Full-Time (>30 hours/week) & Want Fewer Hours, Hours About Right, and Other (“PT/wants fewer hours” or “FT/wants more hours”). Most aides (72.0 percent) thought their hours were “about right” and only 14.3 percent indicated that they worked part-time and wanted more hours. Approximately 3.3 percent of aides worked full-time and wanted fewer hours.
Pay and benefits are policy variables that are expected to directly influence worker satisfaction and retention. Wages were included in the analysis as a continuous variable. Hourly wages were computed for salaried workers based on self-reported hours and pay amounts. Wage amounts are in 2007 dollars and were not adjusted for inflation or for local differences in cost of living. The mean hourly wage for the analytical sample was $12.15.
While both the agency-level NHHCS and the NHHAS contain data on benefits, prior research has identified discrepancies between agencies’ and aides’ reporting of the availability of benefits (Bishop et al., 2009). Agencies may not supply the same benefits to all workers. Furthermore, aides’ perceptions of their benefits are expected to affect their satisfaction and turnover intentions more than agencies’ reported benefits; therefore, aide-level benefit information from the NHHAS was used in this analysis. Some benefits (paid sick leave, paid holidays, paid personal or vacation days) were eliminated from the analysis because they were not found to significantly affect either dependent variable. The availability of health insurance and the availability of pension or retirement plans were retained in the multivariate analysis.
A number of worker characteristics derived from the NHHAS were included in the analysis as control variables. Aides’ age (<30 years, 30-54 years, and >55 years), race (White only, Black/African-American only, Other), and Hispanic/Latino ethnicity were included. Due to the small number of males in the sample (5.0 percent), gender was not included in the analysis. Aides’ education was limited to three levels: No HS Diploma/GED, Diploma/GED, and some college. Over 40.0 percent of aides reported having some college and only 6.3 percent had neither a diploma nor a GED.
Some variables, such as having ever had formal training and presently working at more than one job concurrently, may be influenced by agency policies (training and hours, respectively). However, these were included primarily as control variables. In addition, several factors mediating the relationship between job satisfaction and workers’ intentions to leave may result in dissatisfied workers staying in their jobs. Factors that influence labor mobility among this demographic of low-wage workers could include household poverty or a household relying on a single income with dependent children. Labor market conditions, represented in this analysis by state unemployment rates, may also discourage aides from leaving their jobs.
Variables described above are presented in Table 1, along with the specification of response categories, population mean for each variable, the source of data for each variable, and the role of each variable in the multivariate model (e.g., policy, control).
TABLE 1. Description of Variables Included in Models of Job Satisfaction and Intent to Leave, NHHAS, 2007
|Variables Included in Model||Response Categories or Levels||Proportion of Respondents (%)||Data Source||Type/Role of Variables|
|Job satisfaction||Extremely satisfied||47.2%||NHHAS||Dependent,
|Intend to leave job in next 12 months||Yes||24.2%||NHHAS||Dependent|
|Education||<No Diploma or GED||6.3%||NHHAS||Control|
|HS Diploma or GED||53.2%|
|At least some college||40.4%|
|Aide only worker in household with dependent children||Yes||17.0%||NHHAS||Control|
|Holds more than 1 job||Yes||22.3%||NHHAS||Control|
|Home Care Structure& Policies|
|MSA status of agency||Metropolitan||82.9%||NHHCS||Control|
|Ownership and chain-
affiliation of agency
patients each week
|Job & Workplace Characteristics|
|Aide feels valued by
|Somewhat /not at all||32.3%|
respected by patients
|A great deal||91.2%||NHHAS||Intervening|
|Somewhat/not at all||8.8%|
respected by supervisor
|A great deal||76.7%||NHHAS||Intervening|
|Somewhat/not at all||23.2%|
hours worked and FT status
|PT, want more hours||14.3%||NHHAS||Intervening|
|PT wants fewer hours/ FT wants more hours||10.1%|
|FT, fewer hours||3.3%|
|Hours about right||72.3%|
|Adequate time to
assist patients with
|More than enough time||42.3%||NHHAS||Intervening|
|Not enough time||4.1%|
|Has had work-related injury in past 12 months||Yes||12.9%||NHHAS||Intervening|
|Hourly wage||Dollars per hour (2007)||$12.15||NHHAS||Policy|
|Career ladder positions are available at agency||Yes||9.8%||NHHCS||Policy|
|Receives paid sick leave||Yes||57.4%||NHHAS||Policy|
|Receives paid time off||Yes||66.5%||NHHAS||Policy|
|Health insurance available||Yes||77.0%||NHHAS||Policy|
|Pension or retirement
|Economic & Sociopolitical Factors|
|State unemployment rate, 2007||4.7%||BLS||Control|