The Gerontologist Publishes Findings from CFAR Study of Home Health Workers

CFAR | April 26, 2016

Job satisfaction, consistent assignment, and health insurance are associated with lower intent to leave a job among home health workers, according to a recent analysis by the LeadingAge Center for Applied Research (CFAR) and Social and Scientific Systems Inc. 

Job satisfaction, consistent assignment, and health insurance are associated with lower intent to leave a job among home health workers, according to a recent analysis by the LeadingAge Center for Applied Research (CFAR) and Social and Scientific Systems Inc.

The Gerontologist published the findings online on April 21.

“Predictors of Intent to Leave the Job Among Home Health Workers: Analysis of the National Home Health Aide Survey” was authored by Robyn Stone, Natasha Bryant, and Linda Hermer from CFAR; Christine Bishop from Brandeis University, Jess Wilhelm, formerly from SSS; and Marie R. Squillace from the Office of the Assistant Secretary for Planning and Evaluation (ASPE) at the U.S. Department of Health and Human Services, which funded the study.

Study findings are based on an analysis of a database linking the 2007 National Home Health Aide Survey with the 2007 National Home Health Agency Survey.

Study Overview

The CFAR/SSS study examined whether there is a relationship between a worker’s intent to leave a current job and a range of home health worker characteristics, agency characteristics, worker perceptions of job quality, and external economic factors.

In addition to identifying factors that lower intent to leave a job – like job satisfaction, consistent assignment, and health insurance – the researchers discovered that being assigned insufficient work hours, and experiencing on-the-job injuries, were associated with greater intent to leave the job.

In addition, African American workers and workers with a higher household income expressed greater intent to leave the job.

“The findings suggest that intention to leave the job may be reduced through policies that prevent injuries, improve consistency of client assignment, improve experiences among African American workers, and offer sufficient hours to workers who want them,” write the authors.

Consistent Assignment

The role of consistent assignment in lowering intent to leave among home health workers was one of the study’s most important findings, according to the authors. Other studies have identified that aides in nursing homes have lower intent to leave a job if they are consistently assigned to provide care for the same residents. However, this is “the first such finding” for home health workers, say the authors.

If further studies confirm the positive relationship between consistent assignment of home health workers and their intent to leave a job, “agencies will need to examine their staffing practices and work toward a goal of consistent assignment,” write the authors. The researchers also suggest that the Centers for Medicare and Medicaid Services should consider including consistent assignment as “a potential element in the home health survey process.”

Health Insurance

Researchers found a correlation between an agency’s provision of health insurance and lower intention to leave the job. This finding could reflect the fact that the overall job culture is supportive of home health workers, write the authors. It also could indicate “job-lock,” the tendency for a worker to sacrifice job opportunities in order to retain health benefits.

“The passage of the Affordable Care Act (ACA) in 2010 expanded coverage to uninsured Americans in many states,” the authors write. “It would be interesting to explore the effects of the ACA on the association between the availability of agency-based insurance coverage and worker’s employment decision in states that did, versus did not, expand Medicaid.”

Number of Hours

Researchers found that home health aides who worked part-time and wanted more hours were two-to-three times more likely to intend to leave the job than those who felt their hours were “about right.”

“Ensuring satisfactory hours for part-time workers who want more may improve retention and help to augment the home health labor supply,” write the authors.

On-the-job Injuries

The analysis found that on-the-job injuries were associated with significantly higher intent to leave a job among home health workers. Workplace injuries were common among the study sample. Researchers found that 13% of home health workers experienced one or more injuries in the past year.

“Better training, along with provision of devices or braces for lifting and moving patients, may reduce injuries and improve retention potential for this workforce,” they write.

Worker Characteristics

African American home health aides were more than twice as likely as their White-only counterparts to intend to leave their jobs.

‘This finding underscores the importance of recognizing racial and ethnic differences among this workforce and implications for retention,” write the authors. “Policy makers should consider the inclusion of cultural competence in training standards to improve workplace interactions and agencies need to better understand the unique needs and circumstances of African American aides.”

Need for More Research

The authors call for more longitudinal research that examines:

  • How various factors affect the worker’s job decisions over time.
  • The relationship between intention to leave and actual turnover in the home care setting.
  • Interventions that are most likely to reduce turnover and improve retention.

Additional research is critical because the demand for home health workers is likely to increase dramatically over the next 20 years as the baby boomers age, according to the authors.

“Understanding the determinants of intent to leave and actual turnover will help policy makers, agencies, workers, clients, and their families to modify … specific policy-, workplace-, and worker-level factors that will support a more stable, higher quality home health workforce,” they write.