Better Supervision for Better Care?
Do better jobs lead to better care? Penn State researchers certainly believe so. "People are energized and motivated when they are working in productive, satisfying roles. Energized employees are bound to provide better care," says Dr. Diane Brannon, Professor of Health Policy and Administration. Brannon, along with Peter Kemper, Teta Barry and Joseph Angelelli have been studying workers in home health, assisted living, and nursing home facilities as part of the Better Jobs, Better Care programs sponsored by the Robert Wood Johnson Foundation and the Atlantic Philanthropies.
Diane Brannon
Recruitment and retention of workers has long been a problem for many such facilities, where annual turnover rates are reported to range between 40 percent and 100 percent. Turnover rates are worst for relatively low paid "direct care" workers who help elderly or disabled patients with their daily activities. Those workers often are the main companions of patients unable to move freely around their community. The researchers are conducting a formative evaluation of management practices to determine the most successful and to see if good practices do reduce employee turnover. Brannon and her colleagues presented some of their findings at the AcademyHealth Annual Research Meeting in Boston in June.
"It is clear that supervision really matters," says Brannon. When asked to rate their intention to leave their job and their job perceptions in a number of areas, workers intending to leave said they were dissatisfied with their pay. However, they also felt overloaded and unsupported by their supervisors. Wage rates, often thought to be the main driving force for leaving direct care work, were clearly a factor, but other factors related to work design were important too. These finding have a number of implications for policy makers. Explains Brannon, "organizations may be able to do more about the quality of supervision than about pay levels for direct care workers."
Most direct care workers are women and Brannon explains that previous research on "job satisfaction" or intent to stay at a particular job may have ignored factors women consider important in the workplace. In particular, those studies ignored the importance of workers' feelings about "helping others". Knowing that helping others is an important factor in employees' decisions to stay in their jobs is crucial to hiring the right people in the first place. "We can develop screening tools that will help organizations identify candidates with a strong desire to help others and are, therefore, more likely to stay," adds Brannon. Employers may be able recruit individuals who are more likely to stay with messages about the personally rewarding relationships workers establish with patients.
None of this means that workers are uninterested in less work or more pay. When asked the single most important thing that their employers could do to improve their jobs, one third of the workers wanted better pay. According to the US Bureau of Labor, the median hourly rate for direct care workers was $8.70 in 2002, but they can usually earn more in hospital jobs than long term care jobs. Residential home care workers are likely to earn $12,000, compared with $15,000 for nursing home workers and $18,000 for hospital workers. "These discrepancies need to change, but we also need to be aware of the other aspects of jobs that affect employees' decisions to leave direct care work," says Brannon.
As there will be more elderly people in need of this kind of care as baby boomers enter long term care systems, the need to recruit and retain high quality workers will become even more important. Government agencies and service organizations would do well to listen to their current employees.