title: Job perceptions and intent to leave among direct care workers: evidence from the better jobs better care demonstrations.
abstract: OBJECTIVE
  We assess how perceived rewards and problems with caregiving work and supervision relate to intent to leave among direct care workers who are employed in provider organizations participating in the Better Jobs Better Care (BJBC) demonstration; we also examine how these relationships vary by provider type.
  
  
  METHODS
  Direct care workers from 50 skilled nursing facilities, 39 home care agencies, 40 assisted living facilities, and 10 adult day services in five states completed a paper survey administered prior to the implementation of the BJBC interventions in each organization. We include direct care workers (n = 3,039) with complete data in the analyses using multinomial regression clustered by provider organization to compare those not at all likely to leave and those very likely to leave in the next year with a middle referent group who are somewhat likely to leave.
  
  
  RESULTS
  Logistic regression results were that work overload and lack of upward mobility increased intent to leave. Respondents with positive assessments of their supervisor, who valued helping others, and for whom the income was perceived as rewarding were less likely to be in the very likely to quit category and more likely to be in the stable category. Some differences between provider types are observed, especially between home care workers and those employed in facilities.
  
  
  CONCLUSIONS
  These findings provide support for many of the management-practice improvements taking place in the field, including those implemented in the BJBC demonstration. Follow-up surveys will provide insight into their effectiveness.
authors.affiliation: Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA 16802, USA. f8z@psu.edu
authors.forename: Diane
authors.initials: D
authors.lastname: Brannon
authors.forename: Teta
authors.initials: T
authors.lastname: Barry
authors.forename: Peter
authors.initials: P
authors.lastname: Kemper
authors.forename: Andrea
authors.initials: A
authors.lastname: Schreiner
authors.forename: Joe
authors.initials: J
authors.lastname: Vasey
mesh_terms: D000328:Adult; D040561:Assisted Living Facilities; D001291:Attitude of Health Personnel; D002322:Career Mobility; D003631:Day Care, Medical; D005006:Ethnicity; D018576:Home Health Aides / Q000523:psychology*; D006801:Humans; D007400:Interprofessional Relations; D007588:Job Satisfaction; D016015:Logistic Models; D008875:Middle Aged; D009728:Nursing Assistants / Q000523:psychology*; D010563:Personnel Turnover; D012866:Skilled Nursing Facilities; D014481:United States; D016526:Workload / Q000523:psychology*