Stabilising the aged care workforce: an analysis of worker retention and intention
Anna L. Howe A , Debra S. King B , Julie M. Ellis C D , Yvonne D. Wells E F , Zhang Wei B and Karen A. Teshuva EA 90 Grayson Street, Hackett, ACT 2602, Australia. Email: anna.howe@bigpond.com
B National Institute of Labour Studies, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia. Email: deb.king@flinders.edu.au; zhang.wei@flinders.edu.au
C School of Nursing and Midwifery, La Trobe University, Bundoora, Vic. 3086, Australia. Email: j.ellis@latrobe.edu.au
D Aged Care Services Australia Group Pty Ltd, 101 Punt Road, Windsor, Vic. 3181, Australia.
E Australian Institute of Primary Care and Ageing, La Trobe University, Bundoora, Vic. 3086, Australia. Email: k.teshuva@latrobe.edu.au
F Corresponding author. Email: y.wells@latrobe.edu.au
Australian Health Review 36(1) 83-91 https://doi.org/10.1071/AH11009
Submitted: 11 February 2011 Accepted: 20 June 2011 Published: 24 February 2012
Abstract
Concerns about the capacity of the aged care industry to attract and retain a workforce with the skills required to deliver high quality care are widespread, but poor conceptualisation of the problem can result in strategies to address turnover being poorly targeted. A census of residential and community aged care services conducted by the National Institute of Labour Studies (NILS) in 2007 provided a comprehensive empirical account of the workforce, and estimated turnover on the basis of retention: that is, the proportion of the workforce who had been in their job for 1 year or less. This paper adds the dimension of intention: that is, workers’ expectations as to whether in 1 year’s time, they would still be working in the same aged care service. The dual driver model that takes both retention and intention into account was applied in further analysis of the 2007 NILS data. Investigation of relationships between workforce instability and 13 variables covering worker attributes, organisational attributes and structural attributes of the industry demonstrated the usefulness of the dual driver model for reconceptualising and analysing stability and, in turn, refining strategies to address turnover.
What is known about the topic? Widespread concerns about turnover in the aged care workforce are based on estimates of 25% turnover per annum in both residential and community care workforces reported by NILS in 2007. This rate is low compared to US reports averaging ~50%.
What does this paper add? Application of the dual-driver model to the analysis of 13 variables covering worker, organisational and structural attributes clarifies the nature of instability and shows that drivers affecting retention and workers’ intentions to stay or leave the job operate differently in the residential and community care workforces.
What are the implications for practitioners? Those involved in workforce management and policy development in aged care should give more attention to identifying and realising workers’ intentions to stay, addressing factors affecting retention, and developing more refined strategies to address instability rather than focusing primarily on recruitment.
References
[1] Caring for older Australians: Productivity Commission Inquiry Report. Canberra: Productivity Commission; 2011; Vol. 2: 347–86.[2] A healthier future for all Australians. Final report. Canberra: National Health and Hospitals Reform Commission; 2009.
[3] Duckett SJ. Health workforce design for the 21st century. Aust Health Rev 2005; 29 201–10.
| Health workforce design for the 21st century.Crossref | GoogleScholarGoogle Scholar | 15865571PubMed |
[4] Page S, Willey K. Workforce development: planning what you need starts with knowing what you want. Aust Health Rev 2007; 31 98–105.
| Workforce development: planning what you need starts with knowing what you want.Crossref | GoogleScholarGoogle Scholar |
[5] Mittal V, Rosen J, Leana C. A dual-driver model of retention and turnover in the direct care workforce. Gerontologist 2009; 49 623–34.
| A dual-driver model of retention and turnover in the direct care workforce.Crossref | GoogleScholarGoogle Scholar | 19491356PubMed |
[6] Castle NG, Engberg J. Staff turnover and quality of care in nursing homes. Med Care 2005; 43 616–26.
| Staff turnover and quality of care in nursing homes.Crossref | GoogleScholarGoogle Scholar | 15908857PubMed |
[7] Kash BA, Castle NG, Naufal GS, Hawes C. Effect of staff turnover on staffing: a closer look at registered nurses, licensed vocational nurses and certified nursing assistants. Gerontologist 2006; 46 609–19.
| Effect of staff turnover on staffing: a closer look at registered nurses, licensed vocational nurses and certified nursing assistants.Crossref | GoogleScholarGoogle Scholar | 17050752PubMed |
[8] Wiener JM, Squillace MR, Anderson WL, Khatutsky G. Why do they stay? Job tenure among certified nursing assistants in nursing homes. Gerontologist 2009; 49 198–210.
| Why do they stay? Job tenure among certified nursing assistants in nursing homes.Crossref | GoogleScholarGoogle Scholar | 19363015PubMed |
[9] Donoghue C. Nursing home staff turnover and retention: an analysis of national level data. J Appl Gerontol 2010; 29 89–106.
| Nursing home staff turnover and retention: an analysis of national level data.Crossref | GoogleScholarGoogle Scholar |
[10] Decker FH, Harris-Kojetin LD, Bercovitz A. Intrinsic job satisfaction, overall satisfaction and intention to leave the job among nursing assistants in nursing homes. Gerontologist 2009; 49 596–610.
| Intrinsic job satisfaction, overall satisfaction and intention to leave the job among nursing assistants in nursing homes.Crossref | GoogleScholarGoogle Scholar | 19515636PubMed |
[11] Filipova AA. Relationships among ethical climates, perceived organizational support and intent to leave for licensed nurses in skilled nursing facilities. J Appl Gerontol 2011; 30 44–6.
| Relationships among ethical climates, perceived organizational support and intent to leave for licensed nurses in skilled nursing facilities.Crossref | GoogleScholarGoogle Scholar |
[12] Morris L. Quits and job changes among home care workers in Maine: the role of wages, hours and benefits. Gerontologist 2009; 49 635–50.
| Quits and job changes among home care workers in Maine: the role of wages, hours and benefits.Crossref | GoogleScholarGoogle Scholar | 19574539PubMed |
[13] Martin B, King D. Who cares for older Australians: a picture of the residential and community based aged care workforce, 2007. Adelaide: National Institute of Labour Studies, Flinders University; 2008.
[14] Flavel J. The aged care workforce: methods to increase supply to remedy possible shortages. Aust Bull Labour 2007; 33 106–29.
[15] Chenoweth L, Jeon Y-H, Merlyn T, Brodaty H. A systematic review of what factors attract and retain nurses in aged and dementia care. J Clin Nurs 2010; 19 156–67.
| A systematic review of what factors attract and retain nurses in aged and dementia care.Crossref | GoogleScholarGoogle Scholar | 20500254PubMed |
[16] Residential aged care in Australia 2008–09: a statistical overview. Canberra: Australian Institute of Health and Welfare; 2010. AIHW Cat. No. AGE 62: 11.
[17] Howe AL. Migrant care workers, or migrants working in long term care? A review of Australian experience. J Aging Soc Policy 2009; 21 374–92.
| Migrant care workers, or migrants working in long term care? A review of Australian experience.Crossref | GoogleScholarGoogle Scholar | 20092128PubMed |
[18] Graham EM, Duffield C. An ageing nurse workforce. Aust Health Rev 2010; 34 44–8.
| An ageing nurse workforce.Crossref | GoogleScholarGoogle Scholar | 20334756PubMed |
