Nurse Aide Turnover in Home Health Care: A Scoping Review
Year 2024,
Volume: 7 Issue: 1, 23 - 43, 29.12.2024
Lauren Maziarz
,
Vivian Miller
,
Jennifer Wagner
,
Kaley Perry
,
Julia Bell
,
Melissa Burek
Abstract
Nurse Aides (NAs) delivering in-home care has increased in recent years in the United States and is expected to increase further by 2032. Understanding factors that affect turnover and retention of NAs in-home care is imperative to providing high-quality care for older adults. Eight scholarly databases were used to search for relevant peer-reviewed articles. Using a three-stage process, twenty-four articles published between 2003-2023 were included in this scoping review. Factors affecting turnover were categorized based on the Jobs Demands-Resource (JD-R) and Socioecological Model (SEM). Factors affecting turnover can be conceptualized by job demands and resources. Furthermore, intrapersonal, interpersonal, institutional, and community-level factors all influence nurse aide turnover and retention. Supervisor support, colleague or co-worker support, and performance feedback may augment home health NA’s retention and well-being. Many unique factors affect NA turnover. The problematic nature of the work, coupled with often low pay and low autonomy, means identifying job resources is imperative. Evidence supports that emphasis on support systems from the organization, co-workers, and supervisors coupled with constructive and frequent performance discussions where home health NA’s input is welcomed should substantially reduce turnover and significantly improve workplace experiences and patient care.
Thanks
This research was funded by a grant from Principle Business Enterprises, Inc. (PBE, Inc.). PBE, Inc. was not involved in the study design, data collection, analysis and interpretation of the data, or in the writing of the manuscript. PBE, Inc. was involved in the decision to submit the final manuscript for publication.
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- Matthias, R.E. & Benjamin, A.E. (2005). “Intent to stay” among paid home care workers in California. Home Health Care Services Quarterly, 24(3), 39-57. https://doi.org/10.1300/J027v24n03_03
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Year 2024,
Volume: 7 Issue: 1, 23 - 43, 29.12.2024
Lauren Maziarz
,
Vivian Miller
,
Jennifer Wagner
,
Kaley Perry
,
Julia Bell
,
Melissa Burek
References
- Ashley, A., Butler, S.S. and Fishwick, N., (2010). Home-care-aides voices from the field: Job experiences of personal support specialists—the Maine home care worker retention study. Home Healthcare Nurse, 28(7), 399–405. https://doi.org/10.1097/NHH.0b013e3181e325eb
- Banijamali, S., Jacoby, D. & Hagopian, A., 2014. Characteristics of home care workers who leave their jobs: a cross-sectional study of job satisfaction and turnover in Washington State. Home Health Care Services Quarterly, 33(3), 137-158. https://doi.org/10.1080/01621424.2014.929068
- Bergman, A., Song, H., David, G., Spetz, J., & Candon, M. (2021). The role of schedule volatility in home health nursing turnover. Medical Care Research and Review, 79(3), 382–393. https://doi.org/10.1177/10775587211034310
- Bronfenbrenner, U. (1977). Toward an experimental ecology of human development. American Psychologist, 32(7), 513–531. https://doi.org/10.1037/0003-066X.32.7.513
- Brouillette, N., Markkanen, P., Quinn, M., Galligan, C., Sama, S., Lindberg, J. E., & Karlsson, N. (2023). Aide and client safety “should go hand-in-hand”: Qualitative findings from home care aides, clients, and agency leaders. Journal of Applied Gerontology, 42(4), 571-580. https://doi.org/10.1177/07334648221146769
- Buhler-Wilkerson K. (1985). Public health nursing: In sickness or in health? American Journal of Public Health, 75(10), 1155–1161. https://doi.org/10.2105/AJPH.75.10.1155
- Butler, S.S., Brennan-Ing, M., Wardamasky, S. & Ashley, A., (2014). Determinants of longer job tenure among home care aides: What makes some stay on the job while others leave? Journal of Applied Gerontology, 33(2), 164–188. https://doi.org/10.1177/0733464813495958
- Butler, S.S., (2018). Exploring relationships among occupational safety, job turnover, and age among home care aides in Maine. New Solutions: A Journal of Environmental and Occupational Health Policy, 27(4), 501–523. https://doi.org/10.1177/1048291117739418
- Centers for Medicare and Medicaid Services (2023.). The Affordable Care Act: Increasing Transparency, Protecting Consumers. Available at: https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/increasing-transparency02162012a. (Accessed 5 May 2024).
- Centers for Medicare and Medicaid Services (2023). Calendar Year (CY) 2024 Home Health Prospective Payment System Proposed Rule (CMS-1780-P). Centers for Medicare and Medicaid Services, Newsroom. Available at: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-home-health-prospective-payment-system-proposed-rule-cms-1780-p. (Accessed 7 May 2024).
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- The Consumer Voice (2022). High Staff Turnover: A Job Quality Crisis in Nursing Homes. Available at: https://theconsumervoice.org/uploads/files/issues/High_Staff_Turnover-A_Job_Quality_Crisis_in_Nursing_Homes.pdf. (Accessed 23 January 2023).
- Demerouti, E., Bakker, A. B., Nachreiner, F., & Schaufeli, W. B. (2001). The job demands-resources model of burnout. Journal of Applied Psychology, 86(3), 499–512. https://doi.org/10.1037/0021-9010.86.3.499
- Ejaz, F.K., Bukach, A.M., Dawson, N., Gitter, R. & Judge, K.S. (2015). Examining direct service worker turnover in three long-term care industries in Ohio. Journal of Aging & Social Policy, 27(2), 139–155. https://doi.org/10.1080/08959420.2014.987034
- Faul, A.C., Schapmire, T.J., D'Ambrosio, J., Feaster, D., Oak, C.S. & Farley, A. (2010). Promoting sustainability in frontline home care aides: Understanding factors affecting job retention in the home care workforce. Home
- Health Care Management & Practice, 22(6), 408–416. https://doi.org/10.1177/1084822309348896
- Gleason, H.P. & Miller, E.A. (2021). Maximizing home health aide retention: The impact of control and support on the job. The Gerontologist, 61(4), 517-529. https://doi.org/10.1093/geront/gnab003
- Heyn, P.C., Meeks, S., & Pruchno, R. (2019). Methodological guidance for a quality review article. The Gerontologist, 59(2), 197-201. https://doi.org/10.1093/geront/gny123
- Institute of Medicine and National Research Council. (2015). The Future of Home Health Care: Workshop Summary. Washington, D.C.: The National Academies Press.
- Institute of Medicine (1988). A History of the Public Health System. Committee for the Study of the Future of Public Health. The Future of Public Health. Washington (D.C.): National Academies Press (U.S.). Available at: https://www.ncbi.nlm.nih.gov/books/NBK218224/. (Accessed 7 May 2024).
- Institute of Medicine (2011). The Future of Nursing: Leading Change, Advancing Health. Washington, D.C.: The National Academies Press.
- Jang, Y., Lee, A.A., Zadrozny, M., Bae, S.H., Kim, M.T. & Marti, N.C. (2017). Determinants of job satisfaction and turnover intent in home health workers: The role of job demands and resources. Journal of Applied Gerontology, 36(1), 56-70. https://doi.org/10.1177/0733464815586059
- Kusmaul, N., Butler, S. & Hageman, S. (2020). The role of empowerment in home care work. Journal of Gerontological Social Work, 63(4), 316-334. https://doi.org/10.1080/01634372.2020.1750524
- Lee, A.A. & Jang, Y. (2016). What makes home health workers think about leaving their job? The role of physical injury and organizational support. Home Health Care Services Quarterly, 35(1), 1-10. https://doi.org/10.1080/01621424.2016.1145165
- Liu, C.C., Liu, L.F. & Chuang, S.S. (2022). The effect of ageist behaviors on home care workers’ job satisfaction and retention in long-term care. Journal of Applied Gerontology, 41(2), 322-331. https://doi.org/10.1177/0733464820975598
- Luo, H., Lin, M. & Castle, N.G. (2013). The correlates of nursing staff turnover in home and hospice agencies: 2007 national home and hospice care survey. Research on Aging, 35(4), 375–392. https://doi.org/10.1177/0164027512443072
- Luz, C. & Hanson, K. (2015). Filling the care gap: Personal home care worker training improves job skills, status, and satisfaction. Home Health Care Management & Practice, 27(4), 230-237. https://doi.org/10.1177/1084822315584316
- Matthias, R.E. & Benjamin, A.E. (2005). “Intent to stay” among paid home care workers in California. Home Health Care Services Quarterly, 24(3), 39-57. https://doi.org/10.1300/J027v24n03_03
- Markkanen, P., Brouillette, N., Quinn, M., Galligan, C., Sama, S., Lindberg, J. & Karlsson, N. (2021). “It changed everything”: The safe home care qualitative study of the COVID-19 pandemic’s impact on home care aides, clients, and managers. BMC Health Services Research, 21, 1-14. https://doi.org/10.1186/s12913-021-07076-x
- McLeroy, K.R., Bibeau, D., Steckler, A., Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351–377. https://doi.org/10.1177/109019818801500401
- Medicare. (2024). Long-term care. Available at: https://www.medicare.gov/coverage/long-term-care. (Accessed 7 May 2024).
- Morris, L. (2009). Quits and job changes among home care workers in Maine: The role of wages, hours, and benefits. The Gerontologist, 49(5), 635-650. https://doi.org/10.1093/geront/gnp071
- Muench, U., Spetz, J., Jura, M. & Harrington, C. (2021). Racial disparities in financial security, work and leisure activities, and quality of life among the direct care workforce. The Gerontologist, 61(6), 838-850. https://doi.org/10.1093/geront/gnaa190
- Murkofsky, R.L., Phillips, R.S., McCarthy, E.P., Davis, R.B., & Hamel, M.B. (2003). Length of stay in home care before and after the 1997 balanced budget act. JAMA, 289(21), 2841–2848. https://doi.org/10.1001/jama.289.21.2841
- National Alliance for Caregiving in Collaboration with AARP; Funded by The MetLife Foundation (2023). Caregiving in the U.S. 2009, AARP. Available at: https://www.aarp.org/pri/topics/ltss/family-caregiving/caregiving_09.html (Accessed: 23 January 2024).
- Ornstein, K. A., Leff, B., Covinsky, K. E., Ritchie, C. S., Federman, A. D., Roberts, L., Kelley, A. S., Siu, A. L., & Szanton, S. L. (2015). Epidemiology of the Homebound Population in the United States. JAMA Internal Medicine, 175(7), 1180–1186. https://doi.org/10.1001/jamainternmed.2015.1849
- Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., .,… Moher, D. (2020). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372, 1–9. https://doi.org/10.31222/osf.io/v7gm2
- Pollock, A. & Berge, E. (2018). How to do a systematic review. International Journal of Stroke, 13(2), 138–156. https://doi.org/10.1177/1747493017743796
- Qualtrics. (2021). New research finds that stress and burnout are the main reasons more than half of leaders plan to leave their jobs in the next year. Available from https://www.qualtrics.com/experience-management/employee/employee-turnover/ (Accessed 7 May 2024).
- Reckrey, J. M., Federman, A. D., Bollens-Lund, E., Morrison, R. S., & Ornstein, K. A. (2020). Homebound status and the critical role of caregiving support. Journal of Aging & Social Policy, 32(6), 590–603. https://doi.org/10.1080/08959420.2019.1628625
- Schaufeli, W. B. (2017). Applying the Job Demands-Resources model: A ‘how to’ guide to measuring and tackling work engagement and burnout. Organizational Dynamics, 46(2), 120–132. https://doi.org/10.1016/j.orgdyn.2017.04.008
- Sharp Emerson, M. (2021). Building a Career in Industrial-Organizational Psychology. Harvard Extension School. Available at: https://extension.harvard.edu/blog/building-a-career-in-industrial-organizational-psychology/. (Accessed 22 January 2023).
- Sherman, M.F., Gershon, R.R., Samar, S.M., Pearson, J.M., Canton, A.N. & Damsky, M.R. (2008). Safety factors predictive of job satisfaction and job retention among home healthcare aides. Journal of Occupational and Environmental Medicine, 50(12), 1430–1441. https://doi.org/10.1097/JOM.0b013e31818a388e
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