Having a Say in Patient Care: Factors Associated with High and Low Voice among Home Care Workers

OBJECTIVES

To identify factors associated with high and low "voice"-or level of input in patient care decisions-among home care workers (HCWs), an often marginalized workforce that provides care in the home to older adults and those with chronic conditions.

DESIGN

We conducted a secondary analysis of data from a cross-sectional survey assessing experiences of HCWs in caring for adults with heart failure. The survey measured HCWs' voice using a validated, 5-item instrument.

SETTING AND PARTICIPANTS

The survey was conducted virtually from June 2020 to July 2021 in partnership with the 1199 Service Employees International Union (1199SEIU) Training and Employment Funds, a union labor management fund. English- or Spanish-speaking HCWs employed by a certified or licensed home care agency in New York, NY, were eligible.

METHODS

HCW voice was the main outcome of interest, which we assessed by tertiles (low, medium, and high, with medium as the referent group). Using multinominal logistic regression, we calculated odds ratios (ORs) and 95% CIs for the relationship between participant characteristics and low and high levels of voice.

RESULTS

The 261 HCWs had a mean age of 48.4 years (SD 11.9), 96.6% were female, and 44.2% identified as Hispanic. A total of 38.7% had low voice, 37.9% had medium voice, and 23.4% had high voice. In the adjusted model, factors associated with low voice included Spanish as a primary language (OR 3.71, P = .001), depersonalization-related burnout (OR 1.14, P = .04), and knowing which doctor to call (OR 0.19, P < .001). Factors associated with high voice included Spanish as a primary language (OR 2.61, P = .04) and job satisfaction (OR 1.22, P = .001).

CONCLUSIONS AND IMPLICATIONS

Organizational factors such as team communication practices-including among non-English speakers-may play an important role in HCW voice. Improving HCW voice may help retain HCWs in the workforce, but future research is needed to evaluate this.

Understanding Multilevel Factors Related to Retention Among the Direct Care Workforce: Incorporating Lessons Learned in Considering Innovative Interventions

GOAL

This article explores how broad, contextual factors may be influential in the retention of direct care workers (DCWs; i.e., entry-level caregivers) who provide vital support to patients in healthcare settings. We reflect on lessons learned from an evaluation of a multisite intervention to improve retention among DCWs employed primarily in hospital settings at three health systems.

METHODS

We evaluated a multitiered program for entry-level caregivers that included a risk assessment, a 4-day curriculum, and follow-up sessions, as well as workforce coaching at the three health systems. As part of our evaluation, we collected data on roughly 3,000 DCWs from the three health systems; the information included hiring date, any transfer date, and any termination date for each new DCW, as well as demographic information, position characteristics, and termination status and reasons for any termination. In addition, we collected information about organizational characteristics, including staffing and number of employees. We also conducted interviews with 56 DCWs and 21 staff members who implemented a retention program across each of the three health systems and remotely conducted virtual observations of the curriculum sessions at each system.

PRINCIPAL FINDINGS

Although the program we evaluated focused on individual-level factors that may affect retention, our findings revealed other broader, contextual challenges faced by DCWs that they said would have an impact on their willingness to stay in their positions. These challenges included (1) job-related factors including limited compensation, aspects of the job itself, and the inability to advance in one's position; (2) health system challenges including the mission, policies, staffing, and organizational culture; and (3) external factors including federal policies and the ongoing COVID-19 pandemic.

PRACTICAL APPLICATIONS

As the direct care workforce continues to grow, interventions to improve retention should consider the interconnectedness of these multilevel factors rather than solely individual-level factors. In addition, further research is needed to rigorously evaluate any potential intervention and consider how such an approach can target DCWs in hospital-based settings who are most affected by the multilevel challenges identified. Finally, any intervention to improve retention must be also aligned to ensure equity, especially in this population of low-wage DCWs, many of whom are marginalized women and individuals of color.

Influencing factors of the treatment level of elderly care workers and their career development prospects

BACKGROUND

The increasingly aging population in current China has encouraged the emergence of the diversified and multi-level elderly care service industry, and the demand for high-quality elderly life with the help of elderly caregivers continues to grow.

METHODS

Based on the existing questionnaire data, this article explores the influencing factors of the treatment level of care staff, and explores their future development prospects.

RESULTS

The results show that whether they have participated in relevant vocational skills competitions, whether they have worked overtime, whether they have overtime wages, and their monthly income have significant effects on their satisfaction of treatment levels. Elderly care workers who have participated in skills competitions are more satisfied about their salary. In addition, workers who rarely and occasionally work overtime are more satisfied compared with those who have never worked overtime; Caregivers with a monthly income of 5,000-6,999 yuan are more satisfied with their salary and treatment than those with below 3,000 yuan.

CONCLUSION

Therefore, in order to better match the supply and demand of care workers, we should provide formal training and skill competitions for them, appropriately increase their salary level and reasonably arrange their working hours, so as to attract more professional talents into elderly care industry.

Focusing on the Positive: Home Health Aides' Desire for Autonomy and Control

Home Health Aides (HHAs) are one of the fastest growing workforces in the country, yet the industry struggles to recruit and retain workers. This study explored HHAs' experiences with the level of control, autonomy, and decision-making authority in their work. Six focus groups with 37 HHAs were conducted in Massachusetts. Findings showed that HHAs viewed control as a positive job characteristic, which attracted them to and led them to remain in the position. Positive benefits included having control over client selection, location, hours, and the ability to determine their day-to-day tasks and schedules. The study results highlight the value that HHAs place on autonomy and control and the potential benefit that these job qualities have for greater recruitment and retention of these workers. Amplifying control by bolstering training and expanding scope of practice may entice new individuals to pursue a HHA career and help maintain those currently in the position.

Making a Bad Situation Worse: Examining the Challenges Facing Rural Home Care Workers

This study examines the unique challenges facing rural home care workers. Semi-structured interviews were undertaken between July 2021 and February 2022 with 23 participants that have experience in rural home care delivery. The major challenge confronting rural home care workers involved distance and transportation. This challenge emerged due to long distance between clients, unreliable vehicles, inadequate reimbursement, and inclement weather. In turn, this challenge exacerbated three other types of challenges facing rural home care workers: workforce challenges that consisted of a persistent labor shortage and shorter visits that forced workers to rush through tasks, client isolation due to the social and physical seclusion of households, and the poor working conditions of home care work more broadly. Without policy interventions that respond to these particular challenges, the care gap in rural areas can be expected to grow.

Personal assistants in England and the factors associated with absenteeism

Personal assistants (PAs) have become an increasingly important element of long-term care (LTC) in England since the introduction of Direct Payments in 1996 and the Care Act 2014 legislation. The PAs, who are directly employed by social care users, can perform a number of support tasks including vital assistance in activities of daily living (ADL). Internationally these roles would be classed as domestic care work, including the employment of migrant care workers, e.g. in Germany and Austria. High turnover rates and work absenteeism in this market can cause disruption of these important daily activities, causing LTC users to potentially suffer neglect and poorer quality of life. Although there is research on turnover and absenteeism in nursing workforce in hospitals and LTC workers in nursing homes, little attention has been given to reasons for turnover of PAs and even less for absenteeism, which often precedes turnover, in a workforce of over 100,000 people in England. This research aims to fill this gap in knowledge by analyzing the reasons behind the absenteeism of PAs using quantitative methods. We used survey data of PAs in England, exploring the factors associated to one form of absenteeism-sick leave from work. After controlling for a number of factors ranging from job characteristics such as number of hours worked and type of contract, socio-economic characteristics from the PA and their employer, and supply and demand factors at local government region, the findings suggest a number of factors that significantly influenced sick leave, including distances traveled to work and number of PAs employed. Following the analysis, two people with life experience of LTC discuss the findings of the study and how they compare to their experiences of the market for PAs, providing a unique perspective from the people who could benefit the most from improving PA retention and reducing absenteeism.

Hourly Wages and Turnover of Community Health Workers According to US State Certification Policy and Medicaid Reimbursement, 2010-2021

Objectives. To evaluate the effects of state community health worker (CHW) certification programs and Medicaid reimbursement for CHW services on wages and turnover. Methods. A staggered difference-in-differences design was used to compare CHWs in states with and without CHW certification or CHW Medicaid reimbursement policies. Data were derived from the 2010 to 2021 Current Population Survey in the United States. Results. CHW wages increased by $2.42 more per hour in states with certification programs than in states without programs (P = .04). Also, hourly wages increased more among White workers, men, and part-time workers (P = .04). Wages increased by $14.46 in the state with the earliest CHW certification program adoption (P < .01). Neither of the policies assessed had an effect on occupational turnover. Conclusions. CHW wages are higher in states with certification programs. However, wage gaps exist between Whites and non-Whites and between men and women. Public Health Implications. Federal, state, and employer-based strategies are needed to establish and sustain effective CHW programs to meet the needs of communities experiencing health and access disparities. (Am J Public Health. 2022;112(10):1480-1488. https://doi.org/10.2105/AJPH.2022.306965).

Factors Affecting the Job Satisfaction of Caregivers in a Home-Based Elderly Care Program

Population aging has increased the demand for elderly care worldwide. The home-based elderly care system plays an important role in meeting this demand in developing countries. The quality of home-based elderly care is associated with the job satisfaction of caregivers in home-based elderly care programs, which has rarely been studied. This paper explores the factors that affect the job satisfaction of these elderly caregivers, including personal characteristics, working conditions, employment status, training, caregiver–client relationships, welfare, work experience, and burnout. It utilizes data from the Shanghai Domestic-work Professionalization Survey (SDPS), which was conducted among four types of in-home caregivers (n = 1000) in Shanghai over the period from May to September 2021. This paper selected a sample of elderly caregivers (n = 285) to examine their job satisfaction. The results show that gender, age, marital status, how they earned the job, relation with clients, social insurance, and work experience are significantly associated with the job satisfaction of in-home elderly caregivers, and their job satisfaction is negatively associated with their burnout levels. However, training and working conditions have no significant effect on the job satisfaction of in-home elderly caregivers, which is different from previous studies on formal care workers, such as nurses, in the institutional care system.

The Effects of Wages and Training on Intent to Switch or Leave Among Direct Care Workers

Background and Objectives

Although most studies have not separated turnover of direct care workers (DCWs) into those who switch to another organization (switchers) and those who leave the industry (leavers), switchers and leavers have different impacts on the facilities they quit and the labor market for DCWs. We distinguished between intent to switch and intent to leave and investigated the impact of wages and training on each turnover intention.

Research Design and Methods

Data were obtained from Japan’s Fact-Finding Survey on Long-term Care Work. We included DCWs (n = 7,311) in the analyses and used multinomial regression by sex and provider type to compare those who wanted to switch and those who wanted to leave with those who wanted to remain in their current workplace.

Results

The impacts of an increase in wages and a higher training score were larger for intent to switch than intent to leave. Compared with wages, the impact of training was greater. The impact of job characteristics on turnover intention varied between women and men and across provider types.

Discussion and Implications

This study provides a better understanding of the difference in the determinants of switching and leaving and simultaneously increases our understanding of the differences between women and men and across provider types.

Understanding Influential Factors in Turnover Within the Home Care Workforce

By 2060, over 98 million Americans will be 65 years of age and older. As the population ages, there is a need to ensure sufficient resources are available to accommodate potential physical and cognitive limitations. The home care workforce is important in supporting older adults, and retaining the workforce is crucial to provide needed care. This workforce is primarily female, Caucasian, and has lower income and education levels. However, those demographics are changing. The purpose of this study was to understand factors influencing turnover within the non-medical home care industry. A survey was developed to examine factors that might influence turnover. Factors were based on prior research from the long-term care and home care industries. We surveyed workers who had resigned from a non-medical home care company and who consented to participate during two study periods. In both study periods “personal reasons” was the most common factor for leaving employment. There was a relationship between tenure and reason for leaving. Those that left after a year or more cited personal reasons more frequently than other factors. Understanding the needs of individuals at different points in time (ie, new employees compared to longer-term employees) may facilitate the design of retention strategies and reduce turnover.

Maximizing Home Health Aide Retention: The Impact of Control and Support on the Job

BACKGROUND AND OBJECTIVES

This study examined relationships between the level of control and support and home health aides (HHAs) job satisfaction and intent to leave the job.

RESEARCH DESIGN AND METHODS

Data derive from a survey of 512 HHAs in Massachusetts. Logistic regression using generalized estimating equations was employed for the analysis. Dependent variables included satisfaction and intent to leave the job as a home care aide generally and satisfaction and intent to leave the job at the aide's current agency.

RESULTS

The findings showed that greater control and support on the job were important predictors of positive work outcomes, controlling for job demands and other covariates. The odds of HHAs being satisfied with their job as a home care aide increased with the degree of control, whereas the odds of HHAs being satisfied with their job at their current agency increased with the extent of support. Control was negatively associated with HHAs' intent to leave the job as an aide; no relationship was found between control or support and HHAs' intent to leave their current agency.

DISCUSSION AND IMPLICATIONS

The results from this study illustrate the importance for HHAs of having control and autonomy in their work, as well as the benefit of support from supervisors and the home care agency, on satisfaction and intent to leave. Expanding HHA's ability to maintain control over their day-to-day work, as well as enhancing the supports available to them, is likely to benefit home care workers, clients, and agencies through increased retention.

Changes of profession, employer and work tasks in later working life: an empirical overview of staying and leaving

Occupational change encompasses change of profession, employer and work tasks. This study gives an overview on occupational change in later working life and provides empirical evidence on voluntary, involuntary and desired occupational changes in the older workforce in Germany. The analyses were based on longitudinal data from 2,835 participants of the German lidA Cohort Study, a representative study of employees born in 1959 or 1965. Multinomial logistic regression analyses were performed in order to characterise the change groups in their previous job situation. The findings indicate that occupational change among older workers is frequent. In four years, 13.4 per cent changed employer, 10.5 per cent profession and 45.1 per cent work tasks. In addition, the desire for change often remains unfulfilled: the share of older workers who wanted to but did not change was 17.6 per cent for profession, 13.2 per cent for employer and 8.9 per cent for work tasks. The change groups investigated differ in terms of their socio-demographic background, health and job factors such as seniority and leadership quality. In times of ageing populations, the potential of occupational change among older workers requires more consideration in society, policy and research. Special attention should also be paid to the group of workers who would have liked to change but feel that they cannot leave.

Exploring the Results of the Ontario Home Care Minimum Wage Change

Background

:In 2014, Ontario increased its "minimum wage" for personal support workers (PSWs) in publicly funded home care.

Objective

The objective of this article is to determine the short-term results of this policy for home care PSWs' wages, hours and job stability.

Methods

This study uses descriptive graphs and ordinary least squares and unconditional quantile regressions, using PSWs across Canada as comparison groups.

Results

Pre-policy nominal wages for Ontario home care PSWs stagnated, whereas real wages declined. The policy increased home care PSWs' wages without noticeably affecting hours or job stability. However, wages were already increasing for low-wage home care workers in the rest of Canada.

Conclusions

Ontario exercises monopsony power in the home care market and, before the wage increase, kept nominal wages stable compared to rising real and nominal wages in the rest of Canada. This PSW-specific wage increase did not represent a drastic change relative to market conditions.

Home sweet home? How home health aide compensation, benefits and employment security influence the quality of care delivered by home health organizations

BACKGROUND

The number of home health care organizations has grown, and the number of home health aide jobs is among the fastest growing, drawing attention to the home health care industry. Despite increased transparency into the quality of care delivered by home health care organizations, less is known about how organizational work practices directed at home health aides, who work remotely on the frontlines of providing caring home health services, impact quality.

PURPOSE

We examine how an organization's benefits and compensation practices for home health aides, as well as changes to home health aide employment security within the organization, impact the quality of care delivered by home health care organizations.

METHODOLOGY

We conduct a large-scale longitudinal archival study of Medicare-certified home health organizations using a fixed-effects specification to test the effects of home health aide benefits equality and compensation on the quality of patient outcomes within home health organizations. In addition, we use the proportion of contract home health aides to test moderating effects of employment insecurity.

RESULTS

Benefits equality positively impacts quality, whereas compensation has a negative relationship with quality. However, when an organization increasingly utilizes contract aides, the positive effect of benefits equality on quality is weaker, whereas under these same conditions, compensation has a positive relationship with quality.

CONCLUSION

Compensation and benefits practices impact quality, and the effect these practices have on quality varies under conditions of employment insecurity created by the organization's use of contract home health aides.

PRACTICE IMPLICATIONS

Home health organizations should employ a nuanced approach to improving quality, increasing compensation to permanent home health aides when the organization increases their use of contract home health aides and equally distributing benefits to home health aides when the organization does not rely as heavily on contract home health aides.

The Role of Empowerment in Home Care Work

The home care industry experiences similar problems with the recruitment and retention of direct care workers (DCWs) as those faced by institutions, and it is important to identify strategies to help retain and grow this important workforce. The empowerment of DCWs has been shown to be an effective strategy for increasing job satisfaction and decreasing turnover in nursing homes but has not been studied in home care. Using Kanter's organizational theory of empowerment, including structural empowerment (structure of opportunity, access to resources, access to information, and access to support) and psychological empowerment (meaning, competence, self-determination or autonomy, and impact) this study examined whether home care workers (HCWs) feel empowered in carrying out their jobs. An exploratory, qualitative study of 12 HCWs, recruited from two states in the United States, found high levels of both structural and psychological empowerment among research participants, as well as a number of disempowering aspects of their job. Findings suggest ways to support elements of the work that HCWs find empowering and decrease elements that contribute to job dissatisfaction and turnover.

Comparison of BRFSS Data Between Home-Based Care Providers and Health Care Support Workers in Clinical Environments in Washington State

Background: The demand for home-based health care support providers (HB providers) is growing as the locus of care shifts to private homes. However, industry representative data of these workers are limited. Methods: Washington Behavioral Risk Factor Surveillance System (WA BRFSS) data from 2011 to 2016 were analyzed to compare HB providers (n = 385) with health care support occupations not based in the home, non-HB providers (n = 229), and all other occupations (n = 32,011). Findings: More HB providers were overweight (4.2%, 95% confidence interval [CI] = [3.3%, 5.2%]) than non-HB providers and all other occupations. Significantly more HB providers had arthritis (33.2%, 95% CI = [27.0%, 39.4%]) and diabetes (9.4%, 95% CI = [5.7%, 13.2%]) than non-HB providers. Nearly twice as many HB providers currently smoked (31.3%, 95% CI = [24.2%, 38.4%]) than non-HB providers. Significantly more HB providers reported serious mental illness (6.8%, 95% CI = [2.8%, 10.7%]) than all other occupations (2.2%). Conclusion/Application to Practice: It is imperative to maintain good health in this home-based health care population as these workers are aging and their professional time becomes limited.

Racial–Ethnic Differences in Turnover Intent Among Home Health Aides

Home health aides are crucial to ensuring quality services for the growing older adult population needing home-based care in the United States. We utilize data from the nationally representative 2007 National Home Health Aide Survey ( N = 3,344) to analyze racial–ethnic disparity in turnover intent. Non-Hispanic Black and non-Hispanic Other home health aides had higher all-cause turnover intent than Non-Hispanic Whites. Cause-specific turnover intent varied by race–ethnicity. Compared with non-Hispanic White home health aides, (a) non-Hispanic Black home health aides were more likely to leave due to low pay and educational/advancement opportunities; (b) Hispanic home health aides were more likely to leave due to a perceived lack of respect or difficulty with their supervisor/agency; and (c) non-Hispanic home health aides were more likely to leave due to an impending move. Findings suggest that efforts to address high levels of turnover intent among home health aides should account for differences in race–ethnic groups.

Exploring Relationships Among Occupational Safety, Job Turnover, and Age Among Home Care Aides in Maine

As the U.S. population ages, the number of people needing personal assistance in the home care setting is increasing dramatically. Personal care aides and home health workers are currently adding more jobs to the economy than any other single occupation. Home health workers face physically and emotionally challenging, and at times unsafe, work conditions, with turnover rates ranging from 44 percent to 65 percent annually. As part of a mixed-method, longitudinal study in Maine examining turnover, interviews with 252 home care aides were analyzed thematically. Responses to interview questions regarding the job's impact on health and safety, the adequacy of training, and the level of agency responsiveness were examined. Emergent themes, indicating some contradictory perspectives on workplace safety, quality of training, and agency support, were compared across three variables: job termination, occupational injury, and age. Implications for increasing occupational safety and job retention are discussed.

Quality of Care and Job Satisfaction in the European Home Care Setting: Research Protocol

Introduction:

Since the European population is ageing, a growing number of elderly will need home care. Consequently, high quality home care for the elderly remains an important challenge. Job satisfaction among care professionals is regarded as an important aspect of the quality of home care.

Aim:

This paper describes a research protocol to identify elements that have an impact on job satisfaction among care professionals and on quality of care for older people in the home care setting of six European countries.

Methods:

Data on elements at the macro-level (policy), meso-level (care organisations) and micro-level (clients) are of importance in determining job satisfaction and quality of care. Macro-level indicators will be identified in a previously published literature review. At meso- and micro-level, data will be collected by means of two questionnaires utilsed with both care organisations and care professionals, and by means of interRAI Home Care assessments of clients. The client assessments will be used to calculate quality of care indicators. Subsequently, data will be analysed by means of linear and stepwise multiple regression analyses, correlations and multilevel techniques.

Conclusions and Discussion:

These results can guide health care policy makers in their decision making process in order to increase the quality of home care in their organisation, in their country or in Europe.

Determinants of Job Satisfaction and Turnover Intent in Home Health Workers

Based on the job demands–resources (JD-R) model, this study explored the impact of job demands (physical injury and racial/ethnic discrimination) and resources (self-confidence in job performance and recognition by supervisor/organization/society) on home health workers’ employee outcomes (job satisfaction and turnover intent). Using data from the National Home Health Aide Survey ( N = 3,354), multivariate models of job satisfaction and turnover intent were explored. In both models, the negative impact of demands (physical injury and racial/ethnic discrimination) and the positive impact of resources (self-confidence in job performance and recognition by supervisor and organization) were observed. The overall findings suggest that physical injury and discrimination should be prioritized in prevention and intervention efforts to improve home health workers’ safety and well-being. Attention also needs to be paid to ways to bolster work-related efficacy and to promote an organizational culture of appreciation and respect.

The home health workforce: a distinction between worker categories

The demand for home health aides is expected to rise, despite concerns about the sustainability of this workforce. Home health workers receive low wages and little training and have high turnover. It is difficult to recruit and retain workers to improve clinical outcomes. This study presents national estimates to examine how home health workers and the subgroup of workers differ in terms of sociodemographic characteristics, compensation, benefits, satisfaction, and retention. Hospice aides fare better than other categories of workers and are less likely to leave their job. Policymakers should consider strategies to increase the quality and stability of this workforce.

A blood-based predictor for neocortical Aβ burden in Alzheimer's disease: results from the AIBL study

Dementia is a global epidemic with Alzheimer's disease (AD) being the leading cause. Early identification of patients at risk of developing AD is now becoming an international priority. Neocortical Aβ (extracellular β-amyloid) burden (NAB), as assessed by positron emission tomography (PET), represents one such marker for early identification. These scans are expensive and are not widely available, thus, there is a need for cheaper and more widely accessible alternatives. Addressing this need, a blood biomarker-based signature having efficacy for the prediction of NAB and which can be easily adapted for population screening is described. Blood data (176 analytes measured in plasma) and Pittsburgh Compound B (PiB)-PET measurements from 273 participants from the Australian Imaging, Biomarkers and Lifestyle (AIBL) study were utilised. Univariate analysis was conducted to assess the difference of plasma measures between high and low NAB groups, and cross-validated machine-learning models were generated for predicting NAB. These models were applied to 817 non-imaged AIBL subjects and 82 subjects from the Alzheimer's Disease Neuroimaging Initiative (ADNI) for validation. Five analytes showed significant difference between subjects with high compared to low NAB. A machine-learning model (based on nine markers) achieved sensitivity and specificity of 80 and 82%, respectively, for predicting NAB. Validation using the ADNI cohort yielded similar results (sensitivity 79% and specificity 76%). These results show that a panel of blood-based biomarkers is able to accurately predict NAB, supporting the hypothesis for a relationship between a blood-based signature and Aβ accumulation, therefore, providing a platform for developing a population-based screen.

Determinants of Longer Job Tenure Among Home Care Aides

An inadequate supply of direct care workers and a high turnover rate in the workforce has resulted in a “care gap” in our long-term care system. As people are increasingly choosing community-based care, retention of home care workers is particularly important. The mixed-method study described herein explored determinants of longer job tenure for home care aides ( n = 261). Study participants were followed for 18 months, completing two mail surveys and one telephone interview each. Predictors of longer job tenure included older age, living rurally, lower physical function, higher wages, a greater sense of autonomy on the job, and less frequent feelings of personal accomplishment. Thematic analysis of telephone interviews revealed long-term stayers to be less concerned about low wages and inconsistent hours than those who left their jobs within a year; both groups of workers reported high levels of job satisfaction. Policy implications of study findings are discussed.

Older women doing home care: exploitation or ideal job?

The increased need for both personal assistance workers and meaningful employment opportunities for older workers results in growing numbers of older home care aides. This study examined lifetime financial security and perceived advantages of older age in this field through interviews with 31 older home care aides. Study participants experienced high levels of financial insecurity and perceived older workers as particularly well suited to the home care job. The consequences of this low-wage, low-status work are explored along with implications for social workers to advocate for improved conditions for these workers providing essential care to frail elders.

Adult Social Care Workforce Analysis in England

Changes in demographic and regulations in social care in England are expected to alter the social care landscape and increase pressure on people working in the adult social care sector, especially those who deliver direct care services. While significant work has been done to understand the demand side of the adult social care system, work on the supply side is considerably limited and analysis has been dominated by methods such as macro- and micro-simulation. This paper demonstrates that system dynamics modelling can be used to understand the dynamics of the social care workforce who deliver direct care services in the formal sector, specifically, to identify the main feedback loops that govern the dynamics of the system, to identify sensitive and influential factors, and to show non-linearity in the system. Therefore, system dynamics should play a more important role in the analysis of adult social care system.

Workforce implications of injury among home health workers: evidence from the National Home Health Aide Survey

PURPOSE OF STUDY

 The direct care workforce continues to rank as one of the most frequently injured employee groups in North America. Occupational health and safety studies have shown that workplace injuries translate into negative outcomes for workers and their employers. The National Institute for Occupational Safety and Health (NIOSH) Organization of Work and Occupational Safety and Health framework is used to examine (a) relationships between injuries and work outcomes as reported by home health aides (HHAs) and (b) the likely efficacy of employee training and supervisor support in reducing worker risk for injury. 

DESIGN AND METHODS

 Data for this analysis were drawn from the 2007 National Home Health Aide Survey, a nationally representative survey. Ordinary least squares regression and multinomial logistic regression were used to examine relationships between worker injury and (a) worker outcomes and (b) organizational outcomes and to examine ratings of training and supervisory support relative to risk of injury. 

RESULTS

 Injured aides had lower job satisfaction, higher turnover intent, and poor employment and care quality perceptions. HHA perceptions of poor training and poor supervisory support were significantly related to higher risk for workplace injuries. 

IMPLICATIONS

 The current study suggests that workplace training has an important role in helping reduce direct care worker injuries, thereby decreasing organizational expenses related to injury, such as workers' compensation, sick time, and turnover. The NIOSH Organization of Work and Occupational Safety and Health framework offers a mechanism by which occupational health and safety interventions may be derived to reduce incidents of injury.

Stabilising the aged care workforce: an analysis of worker retention and intention

Concerns about the capacity of the aged care industry to attract and retain a workforce with the skills required to deliver high quality care are widespread, but poor conceptualisation of the problem can result in strategies to address turnover being poorly targeted. A census of residential and community aged care services conducted by the National Institute of Labour Studies (NILS) in 2007 provided a comprehensive empirical account of the workforce, and estimated turnover on the basis of retention: that is, the proportion of the workforce who had been in their job for 1 year or less. This paper adds the dimension of intention: that is, workers’ expectations as to whether in 1 year’s time, they would still be working in the same aged care service. The dual driver model that takes both retention and intention into account was applied in further analysis of the 2007 NILS data. Investigation of relationships between workforce instability and 13 variables covering worker attributes, organisational attributes and structural attributes of the industry demonstrated the usefulness of the dual driver model for reconceptualising and analysing stability and, in turn, refining strategies to address turnover. What is known about the topic? Widespread concerns about turnover in the aged care workforce are based on estimates of 25% turnover per annum in both residential and community care workforces reported by NILS in 2007. This rate is low compared to US reports averaging ~50%. What does this paper add? Application of the dual-driver model to the analysis of 13 variables covering worker, organisational and structural attributes clarifies the nature of instability and shows that drivers affecting retention and workers’ intentions to stay or leave the job operate differently in the residential and community care workforces. What are the implications for practitioners? Those involved in workforce management and policy development in aged care should give more attention to identifying and realising workers’ intentions to stay, addressing factors affecting retention, and developing more refined strategies to address instability rather than focusing primarily on recruitment.

Why I became a home support worker: recruitment in the home health sector

Home care is considered an essential pillar of the health care systems in many industrialized countries. With an increased demand for home health workers, there has been growing interest in examining recruitment and retention of these workers. With a focus on recruitment of home support workers, in this study we draw on data from interviews with 57 home support workers in three Canadian provinces, to examine the factors that attract individuals to employment in this sector. These factors include: previous experience, financial considerations, and enjoying working with people. Understanding these overlapping factors can aide in the recruitment of future workers.

Home care aides' voices from the field: job experiences of personal support specialists

In response to a rapidly aging population that is living longer with more chronic health needs, increased recruitment and successful retention of home care aides is essential. Insight into the job experiences of Personal Support Specialists is provided through the qualitative findings from a mixed-method mail survey (n = 131). Workers described reasons why they do their jobs (feeling rewarded, valuing helping, and being energized by home care work) as well as the challenges they face providing home care (low wages, along with a lack of benefits, respect, and recognition). Both short- and long-term recommendations are formulated based on workers' narrative responses.

Why do they leave? Factors associated with job termination among personal assistant workers in home care

Recruiting and retaining an adequate number of personal support workers in home care is both challenging and essential to allowing elders to age in place. A mixed-method, longitudinal study examined turnover in a sample of 261 personal support workers in Maine; 70 workers (26.8%) left their employment in the first year of the study. Logistic regression analysis indicated that younger age and lack of health insurance were significant predictors of turnover. Analysis of telephone interviews revealed three overarching themes related to termination: job not worthwhile, personal reasons, and burnout. Implications of study findings for gerontological social workers are outlined.