586059 research-article2015
JAGXXX10.1177/0733464815586059Journal of Applied GerontologyJang et al.
Article
Determinants of Job Satisfaction and Turnover Intent in Home Health Workers: The Role of Job Demands and Resources
Journal of Applied Gerontology 1–16 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0733464815586059 jag.sagepub.com
Yuri Jang1, Ahyoung A. Lee1, Michelle Zadrozny2, Sung-Heui Bae3, Miyong T. Kim3, and Nathan C. Marti1
Abstract 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 Manuscript received: October 31, 2014; final revision received: March 11, 2015; accepted: April 11, 2015. 1The
University of Texas at Austin, School of Social Work, USA the Aging, Needy, and Disabled Inc., Austin, TX, USA 3The University of Texas at Austin, School of Nursing, USA 2Helping
Corresponding Author: Yuri Jang, School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd., D 3500, Austin, TX 78712, USA. Email: [email protected]
Downloaded from jag.sagepub.com at UNIV OF LETHBRIDGE on October 18, 2015
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Journal of Applied Gerontology
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. Keywords home health workers, job satisfaction, turnover intent, physical injury, racial/ ethnic discrimination
Introduction According to the U.S. Bureau of Labor Statistics (2012), there are more than 2.2 million home health workers who provide personal assistance services for the frail older adults and individuals with disability. By enabling those with functional challenges to live independently in their homes and communities, home health workers have made a substantial contribution to reducing institutionalization, lowering health care expenditures, and improving the quality of life for both older adults and their families (Benjamin & Matthias, 2004; Bercovitz et al., 2011; Delp, Wallace, Geiger-Brown, & Muntaner, 2010; Yamada, 2002). With the aging of the population and the desire for aging in place (Pastalan, 2013), home health workers are in high demand and are projected to be one of the fastest growing direct care occupations in the near future (Paraprofessional Healthcare Institute [PHI], 2011; U.S. Bureau of Labor Statistics, 2012). However, the home health workforce has been persistently challenged by poor wages, low social status, heavy workloads, and high turnover rates (Delp et al., 2010; Institute of Medicine [IOM], 2008; PHI, 2011; Sauter et al., 2002; Yamada, 2002). Responding to the urgent need for recruitment and retention of home health workers, the present study has used data from a national sample of home health workers to examine factors associated with employee wellbeing. Conceptualizing job satisfaction and turnover intent as indicators of employee well-being, the overall framework of the study was based on the job demands–resources (JD-R) model (Demerouti, Bakker, Nachreiner, & Schaufeli, 2001). Originally introduced to explain burnout and work disengagement, the JD-R model includes job demands and resources as major components. Job demands refer to various types of job-related strains that pose burden on workers and deplete their energy. On the other hand, job resources represent factors that help workers alleviate the negative consequences of their job demands. The JD-R model has been widely used in explaining employee well-being in various occupational settings including
Downloaded from jag.sagepub.com at UNIV OF LETHBRIDGE on October 18, 2015
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Jang et al.
industry, education, and health and human services (e.g., Bakker, Demerouti, Taris, Schaufeli, & Schreurs, 2003; Delp et al., 2010; Hakanen, Bakker, & Demerouti, 2005; Knudsen, Ducharme, & Roman, 2009; Korunka, Kubicek, Schaufeli, & Hoonakker, 2009).
Job Demands in the Home Health Workforce Physical overexertion and fatigue, unfavorable work environment, work–family conflict, and emotionally demanding interpersonal interactions have been quite often noted as sources of job demands in home health workers (Bakker et al., 2003; Delp et al., 2010; Mittal, Rosen, & Leana, 2009). Moving beyond the literature, the current investigation focused on the experience of physical injury and racial/ethnic discrimination. In working with older adults with disabilities, home health workers are often faced with physically demanding tasks such as lifting and transferring clients and heavy housekeeping work (Butler, Brennan-Ing, Wardamasky, & Ashley, 2014). Indeed, the home health care sector has been identified as a high-risk industry (IOM, 2008; U.S. Bureau of Labor Statistics, 2012). According to a recent study (McCaughey et al., 2012), more than 1 in 10 home health workers had at least one job-related injury (e.g., back injury, strains, and pulled muscles) in the past 12 months. In accordance with the nationwide effort to ensure a safe environment for all working people (Sauter et al., 2002), further attention needs to be paid to exploring on-the-job physical injury in home health workers. Considering that direct care work is provided in interpersonal contexts, another type of job demand that deserves further attention is racial/ethnic discrimination. The experience of being treated unfairly or discriminated against is quite often reported in the general U.S. population (Jang, Chiriboga, & Small, 2008; Williams & Mohammed, 2009) and by various workforce members (Ensher, Grant-Vallone, & Donaldson, 2001), regardless of their racial/ ethnic orientation. For home health workers, the sources of discrimination could be multiple, including clients and their families as well as agencies and organizations (Berdes & Eckert, 2007). In a study of more than 600 direct care workers in long-term care organizations (Ejaz, Noelker, Menne, & Bagaka’s, 2008), participants reported that they had heard racial/ethnic remarks more often from their residents/clients than from other staff, with an average rate of 3.23 times from the former and 1.60 times from the latter. However, only the racist remarks from the staff were found to have a significant impact on job satisfaction. Although Ejaz and colleagues (2008) conceptualized racial/ethnic discrimination as a negative aspect of social support, the present study considered it as a major job demand along with physical injury.
Downloaded from jag.sagepub.com at UNIV OF LETHBRIDGE on October 18, 2015
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Journal of Applied Gerontology
Job Resources in the Home Health Workforce Self-confidence in job performance is a personal-level resource that may protect workers from job demands and improves employee outcomes (Morris, 2009). Home health workers with such confidence can not only effectively handle job demands but also enjoy a sense of autonomy, taking pride in their role and contribution (Butler et al., 2014). As a broader level resource, social support is widely known to have a positive impact on employee well-being in many human service work settings (Bogo, Paterson, Tufford, & King, 2011; Smith & Shields, 2013; Strand & Dore, 2009). One example of social support is the recognition of the work that employees do. Studies show that recognition and respect from supervisors, organizations, and the general public play an important role in determining employees’ morale and well-being (Ashley, Butler, & Fishwick, 2010; Benjamin & Matthias, 2004; Morgan, Dill, & Kalleberg, 2013); this is particularly true for home health workers, whose profession has been socially devalued and underappreciated (Butler et al., 2014; Woodhead, Northrop, & Edelstein, 2014). By being recognized by a supervisor, organization, and/or society for the work they do, home health workers may be intrinsically rewarded and stay motivated (Morgan et al., 2013). In the present study, we considered various levels of job resources, including not only resources at the personal level (self-confidence in job performance) but also the interpersonal, organizational, and societal levels (recognition from supervisor/ organization/society). Based on the JD-R model (Demerouti et al., 2001), the present study was designed to explore the impact of the selected job demands (physical injury and racial/ethnic discrimination) and resources (self-confidence in job performance and recognition by supervisor/organization/society) in predicting employee outcomes (job satisfaction and turnover intent). We hypothesized that the presence of job demands and lack of resources would be linked to diminished job satisfaction and increased turnover intent. The assessment also took into consideration other variables previously known to be associated with job stress and employee well-being such as sociodemographic characteristics (age, gender, marital status, education, household income, and race/ethnicity) and work conditions (years as a home health worker, current work hour, formal training, agency ownership, and agency chain affiliation). Previous studies report that an early career stage, unstable work hours, lack of training, and affiliation with agencies that are for-profit and part of a chain are closely linked to home health workers’ job dissatisfaction and turnover intent (Delp et al., 2010; Faul, Schapmire, D’Ambrosio, Feaster, & Farley, 2009; McCaughey et al., 2012).
Downloaded from jag.sagepub.com at UNIV OF LETHBRIDGE on October 18, 2015
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Method Data Set Data were drawn from the 2007 National Home Health Aide Survey (NHHAS), the first nationally representative sample survey of home health aides. As a supplement to the 2007 National Home and Hospice Care Survey (NHHCS), home health workers who were employed by the sampled agencies and provided assistance in activities in daily living—including eating, toileting, bathing, dressing, or transferring—were invited to participate in the NHHAS. Interviews were conducted in English using computer-assisted telephone interview technology. Details of the survey design and sampling procedures are available elsewhere (Bercovitz et al., 2011). A total of 3,377 individuals participated in the survey, with an 80% aide-level response rate. After removal of 23 individuals who had more than 20% of data missing in the variables included in the present analysis, the final sample was 3,354.
Measures Sociodemographic characteristics. Sociodemographic information included age (in years), gender (0 = male, 1 = female), marital status (0 = married, 1 = unmarried), educational attainment (0 = >12 years, 1 = ≤12 years), annual household income (0 =
JAGXXX10.1177/0733464815586059Journal of Applied GerontologyJang et al.
Article
Determinants of Job Satisfaction and Turnover Intent in Home Health Workers: The Role of Job Demands and Resources
Journal of Applied Gerontology 1–16 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0733464815586059 jag.sagepub.com
Yuri Jang1, Ahyoung A. Lee1, Michelle Zadrozny2, Sung-Heui Bae3, Miyong T. Kim3, and Nathan C. Marti1
Abstract 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 Manuscript received: October 31, 2014; final revision received: March 11, 2015; accepted: April 11, 2015. 1The
University of Texas at Austin, School of Social Work, USA the Aging, Needy, and Disabled Inc., Austin, TX, USA 3The University of Texas at Austin, School of Nursing, USA 2Helping
Corresponding Author: Yuri Jang, School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd., D 3500, Austin, TX 78712, USA. Email: [email protected]
Downloaded from jag.sagepub.com at UNIV OF LETHBRIDGE on October 18, 2015
2
Journal of Applied Gerontology
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. Keywords home health workers, job satisfaction, turnover intent, physical injury, racial/ ethnic discrimination
Introduction According to the U.S. Bureau of Labor Statistics (2012), there are more than 2.2 million home health workers who provide personal assistance services for the frail older adults and individuals with disability. By enabling those with functional challenges to live independently in their homes and communities, home health workers have made a substantial contribution to reducing institutionalization, lowering health care expenditures, and improving the quality of life for both older adults and their families (Benjamin & Matthias, 2004; Bercovitz et al., 2011; Delp, Wallace, Geiger-Brown, & Muntaner, 2010; Yamada, 2002). With the aging of the population and the desire for aging in place (Pastalan, 2013), home health workers are in high demand and are projected to be one of the fastest growing direct care occupations in the near future (Paraprofessional Healthcare Institute [PHI], 2011; U.S. Bureau of Labor Statistics, 2012). However, the home health workforce has been persistently challenged by poor wages, low social status, heavy workloads, and high turnover rates (Delp et al., 2010; Institute of Medicine [IOM], 2008; PHI, 2011; Sauter et al., 2002; Yamada, 2002). Responding to the urgent need for recruitment and retention of home health workers, the present study has used data from a national sample of home health workers to examine factors associated with employee wellbeing. Conceptualizing job satisfaction and turnover intent as indicators of employee well-being, the overall framework of the study was based on the job demands–resources (JD-R) model (Demerouti, Bakker, Nachreiner, & Schaufeli, 2001). Originally introduced to explain burnout and work disengagement, the JD-R model includes job demands and resources as major components. Job demands refer to various types of job-related strains that pose burden on workers and deplete their energy. On the other hand, job resources represent factors that help workers alleviate the negative consequences of their job demands. The JD-R model has been widely used in explaining employee well-being in various occupational settings including
Downloaded from jag.sagepub.com at UNIV OF LETHBRIDGE on October 18, 2015
3
Jang et al.
industry, education, and health and human services (e.g., Bakker, Demerouti, Taris, Schaufeli, & Schreurs, 2003; Delp et al., 2010; Hakanen, Bakker, & Demerouti, 2005; Knudsen, Ducharme, & Roman, 2009; Korunka, Kubicek, Schaufeli, & Hoonakker, 2009).
Job Demands in the Home Health Workforce Physical overexertion and fatigue, unfavorable work environment, work–family conflict, and emotionally demanding interpersonal interactions have been quite often noted as sources of job demands in home health workers (Bakker et al., 2003; Delp et al., 2010; Mittal, Rosen, & Leana, 2009). Moving beyond the literature, the current investigation focused on the experience of physical injury and racial/ethnic discrimination. In working with older adults with disabilities, home health workers are often faced with physically demanding tasks such as lifting and transferring clients and heavy housekeeping work (Butler, Brennan-Ing, Wardamasky, & Ashley, 2014). Indeed, the home health care sector has been identified as a high-risk industry (IOM, 2008; U.S. Bureau of Labor Statistics, 2012). According to a recent study (McCaughey et al., 2012), more than 1 in 10 home health workers had at least one job-related injury (e.g., back injury, strains, and pulled muscles) in the past 12 months. In accordance with the nationwide effort to ensure a safe environment for all working people (Sauter et al., 2002), further attention needs to be paid to exploring on-the-job physical injury in home health workers. Considering that direct care work is provided in interpersonal contexts, another type of job demand that deserves further attention is racial/ethnic discrimination. The experience of being treated unfairly or discriminated against is quite often reported in the general U.S. population (Jang, Chiriboga, & Small, 2008; Williams & Mohammed, 2009) and by various workforce members (Ensher, Grant-Vallone, & Donaldson, 2001), regardless of their racial/ ethnic orientation. For home health workers, the sources of discrimination could be multiple, including clients and their families as well as agencies and organizations (Berdes & Eckert, 2007). In a study of more than 600 direct care workers in long-term care organizations (Ejaz, Noelker, Menne, & Bagaka’s, 2008), participants reported that they had heard racial/ethnic remarks more often from their residents/clients than from other staff, with an average rate of 3.23 times from the former and 1.60 times from the latter. However, only the racist remarks from the staff were found to have a significant impact on job satisfaction. Although Ejaz and colleagues (2008) conceptualized racial/ethnic discrimination as a negative aspect of social support, the present study considered it as a major job demand along with physical injury.
Downloaded from jag.sagepub.com at UNIV OF LETHBRIDGE on October 18, 2015
4
Journal of Applied Gerontology
Job Resources in the Home Health Workforce Self-confidence in job performance is a personal-level resource that may protect workers from job demands and improves employee outcomes (Morris, 2009). Home health workers with such confidence can not only effectively handle job demands but also enjoy a sense of autonomy, taking pride in their role and contribution (Butler et al., 2014). As a broader level resource, social support is widely known to have a positive impact on employee well-being in many human service work settings (Bogo, Paterson, Tufford, & King, 2011; Smith & Shields, 2013; Strand & Dore, 2009). One example of social support is the recognition of the work that employees do. Studies show that recognition and respect from supervisors, organizations, and the general public play an important role in determining employees’ morale and well-being (Ashley, Butler, & Fishwick, 2010; Benjamin & Matthias, 2004; Morgan, Dill, & Kalleberg, 2013); this is particularly true for home health workers, whose profession has been socially devalued and underappreciated (Butler et al., 2014; Woodhead, Northrop, & Edelstein, 2014). By being recognized by a supervisor, organization, and/or society for the work they do, home health workers may be intrinsically rewarded and stay motivated (Morgan et al., 2013). In the present study, we considered various levels of job resources, including not only resources at the personal level (self-confidence in job performance) but also the interpersonal, organizational, and societal levels (recognition from supervisor/ organization/society). Based on the JD-R model (Demerouti et al., 2001), the present study was designed to explore the impact of the selected job demands (physical injury and racial/ethnic discrimination) and resources (self-confidence in job performance and recognition by supervisor/organization/society) in predicting employee outcomes (job satisfaction and turnover intent). We hypothesized that the presence of job demands and lack of resources would be linked to diminished job satisfaction and increased turnover intent. The assessment also took into consideration other variables previously known to be associated with job stress and employee well-being such as sociodemographic characteristics (age, gender, marital status, education, household income, and race/ethnicity) and work conditions (years as a home health worker, current work hour, formal training, agency ownership, and agency chain affiliation). Previous studies report that an early career stage, unstable work hours, lack of training, and affiliation with agencies that are for-profit and part of a chain are closely linked to home health workers’ job dissatisfaction and turnover intent (Delp et al., 2010; Faul, Schapmire, D’Ambrosio, Feaster, & Farley, 2009; McCaughey et al., 2012).
Downloaded from jag.sagepub.com at UNIV OF LETHBRIDGE on October 18, 2015
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Jang et al.
Method Data Set Data were drawn from the 2007 National Home Health Aide Survey (NHHAS), the first nationally representative sample survey of home health aides. As a supplement to the 2007 National Home and Hospice Care Survey (NHHCS), home health workers who were employed by the sampled agencies and provided assistance in activities in daily living—including eating, toileting, bathing, dressing, or transferring—were invited to participate in the NHHAS. Interviews were conducted in English using computer-assisted telephone interview technology. Details of the survey design and sampling procedures are available elsewhere (Bercovitz et al., 2011). A total of 3,377 individuals participated in the survey, with an 80% aide-level response rate. After removal of 23 individuals who had more than 20% of data missing in the variables included in the present analysis, the final sample was 3,354.
Measures Sociodemographic characteristics. Sociodemographic information included age (in years), gender (0 = male, 1 = female), marital status (0 = married, 1 = unmarried), educational attainment (0 = >12 years, 1 = ≤12 years), annual household income (0 =
