Understanding Compensation Challenges for Home Care Workers and Their Relationship to Job Turnover

Background and Purpose: As our population ages, there is increasing demand for personal care assistance at home.  The personal care aide position is projected to be the fastest growing occupation in the country between 2010 and 2020, but it is also one of the poorest compensated, with an average hourly wage of just $9.57.  Low compensation contributes to high turnover rates which are costly to employers, society and elders needing care.  Direct-care workers are often the members of interdisciplinary teams with whom social workers interact most frequently. Even during economic recession, retention of these important workers remains challenging for many home care agencies.  When a worker terminates employment, there is the possibility of a reduction in quality of care or potentially no care at all.  This paper reports on a thematic analysis of interviews with 252 home care aides whose employment status was tracked for 18 months.

Methods: In October 2008, a 12-page questionnaire was mailed to all personal care workers (n=496) employed by 11 participating home care agencies representing all 12 counties of a rural New England state.  Completed surveys were returned by 261 workers (response rate of 52.6%).  During the 18 months of data collection, 90 workers (34.5%) left their employment.  At the time of termination, 88 of the “leavers” completed a telephone interview of 16 open-ended questions regarding job experience and reasons for leaving their job.  Of the 171 “stayers”, 164 completed telephone interviews at the end of the data collection period and were asked about their job experiences and what might cause them to leave their jobs.  Telephone interviews were transcribed verbatim and a thematic analysis regarding reasons for actual or possible termination was completed.

Results:  The issue of compensation was central to both groups, with low pay; insecure hours; and lack of health insurance, mileage reimbursement, and paid holidays and sick days emerging as themes in most (83.4%) of the interviews.  While low pay and lack of health insurance were equally important reasons for terminating for both groups, insecure hours (p < .001) and lack of mileage reimbursement (p < .05) were of greater concern to “leavers” and lack of paid sick time (p < .05) and paid holidays (p < .1), for those who stayed.

Implications:  Assuring quality and consistent care to frail elders living at home is of paramount concern to gerontological social workers and thus advocacy for improved compensation and benefits (e.g., increasing minimum wage, guaranteeing paid sick leave) for these important direct-care workers is essential.  For example, social work advocacy for the expansion of Medicaid as directed by the ACA has been important—though so far not successful—in the state where this study took place.  Many home care workers would benefit from this expansion and have already in states that have implemented it.  Further implications will be discussed within the context of increasing retention of this critically important component of our long-term care workforce.