NIVEL 2 DEL SDSC (CENTRALOG Y CONTROCAD)

Table 6.3 provides a summary of the variables used in this study. For each variable, conceptual and operational definitions of terms used in this study are provided in the table.

Table 6.4 Variables of Interest

Variables Item Definition and Label Source

Dependent Variables

Job satisfaction Overall satisfaction with their job (Satisfied = 1, Dissatisfied = 0)

NHHAS Intent to leave Intent to leave this job at agency in the next year

(Likely to leave = 1, Not at all likely = 0)

NHHAS

Independent Variables

Individual Level – Personal Backgrounds

Age Age NHHAS

Age 1 (Less than 24 years old)

Age 2 (25 – 34 years old)

Age 4 (45 – 54 years old)

Race Race NHHAS

Race 1 White

Race 2 Black

Education Highest grade or year completed in school

(More than 1 year college/trade school = 1, Others = 0)

NHHAS

Household income Total household income in past year NHHAS

Household income 1 (Less than $20,000 = 1, Others = 0) Household income 2 (20,000 – under 30,000, Others = 0)

Job tenure Number of years in work NHHAS

Job tenure 1 (Less than 2 years = 1, Others = 0) Job tenure 2 (2 – 5 years = 1, Others = 0) Job tenure 3 (6 – 10 years = 1, Others = 0)

Work-related environment

Training Classroom or formal training received to become a home

health aide (Yes = 1, No = 0)

NHHAS

Hourly rate Hourly rate of pay NHHAS

Health insurance available Availability of health insurance coverage at agency (Yes = 1, No = 0)

NHHAS

Benefit Number of benefits provided by the agency NHHAS

Same patients assignment Patient assignment during work (Same patients = 1, Others = 0)

NHHAS

Job perception

Respect Respected by my agency (Agree = 1, Disagree = 0) NHHAS

Challenge Involved in challenging work (Agree = 1, Disagree = 0) NHHAS

Trust Trusted to make patient care decisions (Agree = 1, Disagree = 0)

NHHAS

Confidence Confident in ability (Agree = 1, Disagree = 0) NHHAS

Task reward/motivation

Commitment to job Recommend this job to others (friends or family members) (Yes = 1, No = 0)

NHHAS

Facility Level – Organizational Factors

Supervisor Quality (Centered on group mean)

Home health aides’ perception of supervisor supportiveness (Centered on group mean with mean score of the 4 items)

NHHAS Valued or appreciated by

organizations

Valued or appreciated by the organization as a home health aide (Centered on group mean)

NHHAS

Geographical location Metropolitan Statistical Area Status NHHCS

Location 1 (Metropolitan = 1, Others = 0) Location 2 (Micropolitan = 1, Others = 0)

Ownership Type of ownership of agency (1=For-profit, 2=Others) NHHCS

Agency types Types of agency NHHCS

Agency 1 (Home health care only = 1, Others = 0) Agency 2 (Hospice care only = 1, Others = 0)

Agency 3 (Mixed agency = 1, Others = 0)

Medicare revenue source Percentage of Medicare as the agency’s patient care revenue NHHCS Medicare 1 (Above 75 percent = 1, Others = 0)

Medicare 2 (50 – 74 percent = 1, Others = 0) Medicare 3 (25 – 49 percent = 1, Others = 0)

Medicaid revenue source Percentage of Medicaid as the agency’s patient care revenue NHHCS Medicaid 1 (Above 50 percent = 1, Others = 0)

Medicaid 2 (25 – 50 percent = 1, Others = 0) Medicaid 3 (10 – 24 percent = 1, Others = 0)

Medium size (100 – 499 = 1, Others = 0) Small size (Below 100 = 1, Others = 0)

Staff level per 100 patients ((HHA+RN+LPN+AIDE)*100)/size NHHCS

Staffing ratios Number of FTE RN/LPN employees on staff per 100 patients

NHHCS

HHA Home health aides (HHA/(HHA+RN+LPN+AIDES))*100

RN Registered nurses (RN/(HHA+RN+LPN+AIDES))*100

LPN Licensed practical nurses

(LPN/(HHA+RN+LPN+AIDES))*100

AIDE Non-certified aides

(AIDES/(HHA+RN+LPN+AIDES))*100

Community Level – Community Environment Context

Unemployment rate Unemployment rate ARF

Poverty level Percentage of persons below the poverty level ARF

Median household income ARF

6.7.1Dependent Variables:

The dependent variables are 1) job satisfaction and 2) intent to quit as desired outcomes of home health aides. Job satisfaction: In the survey, home health aides provided their level of satisfaction in several different aspects of their jobs: morale, salary, benefits, challenging works, and learning new skills. Then overall job satisfaction was measured in a single item. The author used a single item measure to provide more reliability and validity. A sample item is “How they are satisfied with their current job as home health aides” The responses to the item are scored as 1=extremely satisfied,

2=somewhat satisfied, 3=somewhat dissatisfied, and 4=extremely dissatisfied. Categories in the regression need to be converted into dummy variables. Therefore, job satisfaction variable as categorical variable cannot be used as dependent variable without converting it into the variable like “satisfied” and “not satisfied.” The author truncated this variable into a dichotomous variable for statistical analysis (satisfied = 1, dissatisfied = 0).

Intent to quit: Intent to quit refers to a worker’s plan to leaving his/her job in the near future. In this study, this item was measured with the following question: “How likely is it

you will leave this job at (agency) in next year?” The responses to this item are scored as 1 = very likely, 2 = somewhat likely, and 3 = not at all likely. The author also truncated this variable into a dichotomous variable for the analysis (intent to leave = 1, not intended = 0).

6.7.2Independent Variables:

Individual-Level

Work-related factors and job perception variables are included: training, hourly rate of payment, health insurance, and benefits. These variables are the factors that explain the environment in which individual workers perform their tasks. Training was measured with the variable, “Did you receive any classroom or formal training to become a home health aides?” This variable is answered as 1 = yes and 0 = no. Health insurance was measured with the variable of availability of health insurance in the organization (1 = Yes, 0 = No). Benefit indicates the number of benefits from a given list that home health aides reported as available at each sampled agency. The following benefits were included from a list of benefits provided by the sample agencies: paid sick leave, paid holidays off, paid vacation and personal days off, pensions, extra pay for working on holidays, paid child care, dental care or vision care, paid disability, and paid bonus. Scores ranged from 0 to 9. Patient assignment was measured with the question, “Are you assigned to care for the same patients on most weeks you work, or do the patients you are assigned to change each week you work?” (same patients = 1, others = 0). Job perception was measured with the following variables: respected by my agency, involved in challenging work, trusted to

make patient care, and confident in ability. The score of each question is ranged from

perception had good internal consistency (Cronbach’s  = .82). All the variables were also truncated into dichotomous variables (agree = 1, others = 0).

In the domain of organizational process, task reward/motivation is also an important factor that explains intrinsic rewards that employees receive from their tasks and organizations. That is to say, task reward and motivation are influenced by

environment factors. Home health aides can feel rewarded and motivated when they experience respect from their organizations and fellow staff members. Environmental factors help home health aides decide their level of commitment to their organizations.

Commitment to organization is defined with the question, “If a friend or family member

needed care and asked your advice about receiving home health care from agency, would you (4 = definitely recommend, 3 = probably recommend, 2 = probably not recommend, and 1 = definitely not recommend)?” This variable was also truncated into a

dichotomous variable (recommend = 1, not recommend = 0).

Individual differences are employed for this study. Individual differences may be defined as individual background information for home health aides. These differences can be measured through sociodemographic profiles such as age, gender, race, marital status, education, household income, current health status, and job tenure. For this study, the author used age (less than 24 = 1, 25 – 34 years old = 2, 35 – 44 years old = 3, 45 – 54 years = 4, and more than 55 = 5), race (white = 1 and black = 1), education (fewer than 12 years/12 years = 0, more than 1 year college/trade school = 1), household income (less than $20,000 = 1 $20,000 – $30,000 = 1), and job tenure (less than 2 years =1, 2 – 5 years = 1, 6 – 10 years = 1).

Organizational-Level

The author employed organizational structures as the variables that characterize the agencies. Organizational structures, within this model, mean the factors that explain the characteristics and types of organizations. Under this broad concept, organizational structures can be explained as the factors affecting work environment and the outcomes of workers in the environment. They are measured according to the following variables: ownership types, agency types, geographical location, percent of patient revenue sources, and staffing ratio.

Ownership type is defined as the type of ownership of the agency (e.g. for-profit,

private nonprofit, city/county/state government, Department of Veteran Affairs, and other federal agencies) (for-profit = 1, others = 0). Agency types are defined as the types of agency (e.g., home health agency only, hospice agency only, or both home health and hospice agency). Revenue sources for patients are defined with the question, “About what percentage of this agency’s patient revenue comes from each of the following?”

(Medicare, Medicaid, Private insurance, patient payments, and other sources). Among the revenue sources, the study focused on the revenue sources of Medicare and Medicaid for the analysis. The Medicare revenue source variable was categorized into three variables (More than 75 percent, 50 – 75 percent, 25 – 50 percent). Medicaid revenue source variable was categorized into three variables (more than 50 percent, 25 – 50 percent, 10 – 25 percent). Agency size was measured with the variables of the number of patients receiving home health services and/or the number of hospice patients. This variable was categorized into three variables (< 100 = small size, 100 – 500 = medium size, more than 500 = large size).

With regard to the characteristics of staffing, the author includes the number of direct care workers such as home health aides and personal care aides and the number of service care staff, such as Registered Nurses and Licensed Practical Nurses. This study also includes the staffing level variable indicating the level of direct care workers per patients. The variable for staffing level of direct care workers is calculated with the following equation: (((HHA + RN + LPN + personal aides) × 100) / size). The staffing ratios for each workforce will be calculated with the following equation: for home health aides, (HHA/(HHA+RN+LPN+AIDES)) × 100; for Registered Nurses,

(RN/(HHA+RN+LPN+AIDES)) × 100; for Licensed Practical Nurses,

(LPN/(HHA+RN+LPN+AIDES)) × 100; and for non-certified personal aides,

(AIDES/(HHA+RN+LPN+AIDES)) × 100. Geographical locations are recoded to two categories, metropolitan and micropolitan.

The model posits that organizational support is important because organizations function as domains housing the organizational processes that support home health aides in delivering home health care and services. Organizational support has been used as a term combined with managerial support in the field of management to describe aspects of the internal work environment of health care organization, and home health agencies. To explore the supportiveness of an organizational culture, this study used variables that determined workers’ perceptions of supervisory behaviors and whether or not the workers felt valued and appreciated by their organizations. These variables were used to determine whether they moderate the relationship between work-related factors, job perception, job satisfaction, and intent to quit of home health aides. For example, supervisor quality was measured with the variables of clear instructions, supportive,

listen to me, and tell me for doing a good job. The score of the questions is ranged from strongly disagree (1) to strongly agree (4). In the present study, the supervisor quality scale had good internal consistency (Cronbach’s  = .81). The variable is centered on the group mean.

Value or appreciates from organizations indicates the degree of supportiveness

from organizations to their workers. It was measured using the variable: “How much do you think the organization at (agency) values or appreciates the work you do as a home health aide? The score is ranged from not at all (1) to very much (3). The variable is centered on a group mean.

Community-Level

In the healthcare market, external economic environmental factors at community

level may be associated with workers’ job satisfaction and intent to quit. As described in

the section on conceptual framework, economic inequality has a severe effect on low- wage workers such as home health aides and nurse assistants. In this study, the author used the following community-level control variables: unemployment rate, percent of persons below the poverty level, and median household income for county of residence The data on external environmental factors was obtained from the 2007 ARF to control for differences across areas. All the variables are centered on grand mean.