The Importance of Job Perception on Retention of Home Health Aides

Background/Purpose: With the continued increase in demand for healthcare workers, particularly for direct care workers, researchers and practitioners are more interested in understanding factors affecting intention to quit among direct care workers in healthcare facilities. As any business organization, it is essential to retain committed workers for healthcare organizations that provide services to older adults and patients with chronic conditions. Direct care workers play important roles in providing personal care and assistance with daily living to patients. However, it is reported that the workers are often quite unhappy with their jobs because of work conditions and structures, such as low wage, heavy workload, lack of benefits, lack of training, and lack of opportunity for career development.

The roles of home health aides have become increasingly important in increasing the quality of home health care. In home health care organizations, healthcare workers, particularly home health aides, often express their desire to leave their jobs earlier, though they are positively satisfied with their jobs. Since the turnover rate is high in home health care, it is important to identify factors that affect workers’ intent to quit. Workers’ turnover lowers service quality due to its adverse impact on continuity and stability of service provision.

The objective of this study is to investigate if supervisor quality moderate the relationship between individual level variables and intent to quit by home health aides. It is hypothesized that job perception in individual level and perceived supervisor quality in organizational level will influence intent to quit among home health aides.

Methods: The author uses the 2007 National Home and Hospice Care Survey and 2007 National Home Health Aides Survey, nationally representative surveys of home health agencies (n = 1,036) and home health aides (n = 3,377). This study employed multilevel modeling to examine the role of supervisor quality on work-related factors and intent to quit by home health aides.

Results: After controlling for individual- and organizational-level covariates, workers who have high job satisfaction (p < .001) and high commitment to organizations (p < .01) tend to have lower intent to quit their jobs. Workers who have positive feelings of being involved in challenging work (p < .05) and being confident (p < .05) were less likely to intend to leave their jobs. Job satisfaction and being respected showed a weak relationship with intent to quit for home health aides working for agencies with high supervisor quality.

Conclusions and Implications: Job satisfaction lowers the likelihood of quitting job for home health aides and intention to quit was moderated by perceived quality of supervision. Moreover, being respected and being confident in their abilities are also crucial factors in decreasing turnover intent among home health aides. To improve home health care, it is critically important to improve quality and effectiveness of supervision carried out by home health agencies.