586059

research-article2015

JAGXXX10.1177/0733464815586059Journal of Applied GerontologyJang et al.

Article

Determinants of
Job Satisfaction and
Turnover Intent in
Home Health Workers:
The Role of Job Demands
and Resources

Journal of Applied Gerontology

116
The Author(s) 2015
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DOI: 10.1177/0733464815586059
jag.sagepub.com

Yuri Jang1, Ahyoung A. Lee1, Michelle Zadrozny2,

Sung-Heui Bae3, Miyong T. Kim3, and
Nathan C. Marti1

Abstract
Based on the job demandsresources (JD-R) model, this study explored the
impact of job demands (physical injury and racial/ethnic discrimination) and
resources (self-confidence in job performance and recognition by supervisor/
organization/society) on home health workers employee outcomes (job
satisfaction and turnover intent). Using data from the National Home
Health Aide Survey (N = 3,354), multivariate models of job satisfaction
and turnover intent were explored. In both models, the negative impact of
demands (physical injury and racial/ethnic discrimination) and the positive
impact of resources (self-confidence in job performance and recognition by
supervisor and organization) were observed. The overall findings suggest
that physical injury and discrimination should be prioritized in prevention and
Manuscript received: October 31, 2014; final revision received: March 11, 2015;
accepted: April 11, 2015.
1The

University of Texas at Austin, School of Social Work, USA

the Aging, Needy, and Disabled Inc., Austin, TX, USA
3The University of Texas at Austin, School of Nursing, USA
2Helping

Corresponding Author:
Yuri Jang, School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd., D
3500, Austin, TX 78712, USA.
Email: yjang12@austin.utexas.edu

Journal of Applied Gerontology

intervention efforts to improve home health workers safety and well-being.

Attention also needs to be paid to ways to bolster work-related efficacy and
to promote an organizational culture of appreciation and respect.
Keywords
home health workers, job satisfaction, turnover intent, physical injury, racial/
ethnic discrimination

Introduction
According to the U.S. Bureau of Labor Statistics (2012), there are more than
2.2 million home health workers who provide personal assistance services for
the frail older adults and individuals with disability. By enabling those with
functional challenges to live independently in their homes and communities,
home health workers have made a substantial contribution to reducing institutionalization, lowering health care expenditures, and improving the quality
of life for both older adults and their families (Benjamin & Matthias, 2004;
Bercovitz et al., 2011; Delp, Wallace, Geiger-Brown, & Muntaner, 2010;
Yamada, 2002). With the aging of the population and the desire for aging in
place (Pastalan, 2013), home health workers are in high demand and are projected to be one of the fastest growing direct care occupations in the near
future (Paraprofessional Healthcare Institute [PHI], 2011; U.S. Bureau of
Labor Statistics, 2012). However, the home health workforce has been persistently challenged by poor wages, low social status, heavy workloads, and
high turnover rates (Delp et al., 2010; Institute of Medicine [IOM], 2008;
PHI, 2011; Sauter et al., 2002; Yamada, 2002).
Responding to the urgent need for recruitment and retention of home
health workers, the present study has used data from a national sample of
home health workers to examine factors associated with employee wellbeing. Conceptualizing job satisfaction and turnover intent as indicators of
employee well-being, the overall framework of the study was based on the
job demandsresources (JD-R) model (Demerouti, Bakker, Nachreiner, &
Schaufeli, 2001). Originally introduced to explain burnout and work disengagement, the JD-R model includes job demands and resources as major
components. Job demands refer to various types of job-related strains that
pose burden on workers and deplete their energy. On the other hand, job
resources represent factors that help workers alleviate the negative consequences of their job demands. The JD-R model has been widely used in
explaining employee well-being in various occupational settings including

Jang et al.

industry, education, and health and human services (e.g., Bakker, Demerouti,
Taris, Schaufeli, & Schreurs, 2003; Delp et al., 2010; Hakanen, Bakker, &
Demerouti, 2005; Knudsen, Ducharme, & Roman, 2009; Korunka, Kubicek,
Schaufeli, & Hoonakker, 2009).

Job Demands in the Home Health Workforce

Physical overexertion and fatigue, unfavorable work environment, workfamily conflict, and emotionally demanding interpersonal interactions have been
quite often noted as sources of job demands in home health workers (Bakker
et al., 2003; Delp et al., 2010; Mittal, Rosen, & Leana, 2009). Moving beyond
the literature, the current investigation focused on the experience of physical
injury and racial/ethnic discrimination. In working with older adults with disabilities, home health workers are often faced with physically demanding
tasks such as lifting and transferring clients and heavy housekeeping work
(Butler, Brennan-Ing, Wardamasky, & Ashley, 2014). Indeed, the home health
care sector has been identified as a high-risk industry (IOM, 2008; U.S. Bureau
of Labor Statistics, 2012). According to a recent study (McCaughey et al.,
2012), more than 1 in 10 home health workers had at least one job-related
injury (e.g., back injury, strains, and pulled muscles) in the past 12 months. In
accordance with the nationwide effort to ensure a safe environment for all
working people (Sauter et al., 2002), further attention needs to be paid to
exploring on-the-job physical injury in home health workers.
Considering that direct care work is provided in interpersonal contexts,
another type of job demand that deserves further attention is racial/ethnic discrimination. The experience of being treated unfairly or discriminated against
is quite often reported in the general U.S. population (Jang, Chiriboga, &
Small, 2008; Williams & Mohammed, 2009) and by various workforce members (Ensher, Grant-Vallone, & Donaldson, 2001), regardless of their racial/
ethnic orientation. For home health workers, the sources of discrimination
could be multiple, including clients and their families as well as agencies and
organizations (Berdes & Eckert, 2007). In a study of more than 600 direct care
workers in long-term care organizations (Ejaz, Noelker, Menne, & Bagakas,
2008), participants reported that they had heard racial/ethnic remarks more
often from their residents/clients than from other staff, with an average rate of
3.23 times from the former and 1.60 times from the latter. However, only the
racist remarks from the staff were found to have a significant impact on job
satisfaction. Although Ejaz and colleagues (2008) conceptualized racial/ethnic discrimination as a negative aspect of social support, the present study
considered it as a major job demand along with physical injury.

Journal of Applied Gerontology

Job Resources in the Home Health Workforce

Self-confidence in job performance is a personal-level resource that may
protect workers from job demands and improves employee outcomes
(Morris, 2009). Home health workers with such confidence can not only
effectively handle job demands but also enjoy a sense of autonomy, taking
pride in their role and contribution (Butler et al., 2014). As a broader level
resource, social support is widely known to have a positive impact on
employee well-being in many human service work settings (Bogo, Paterson,
Tufford, & King, 2011; Smith & Shields, 2013; Strand & Dore, 2009). One
example of social support is the recognition of the work that employees do.
Studies show that recognition and respect from supervisors, organizations,
and the general public play an important role in determining employees
morale and well-being (Ashley, Butler, & Fishwick, 2010; Benjamin &
Matthias, 2004; Morgan, Dill, & Kalleberg, 2013); this is particularly true
for home health workers, whose profession has been socially devalued and
underappreciated (Butler et al., 2014; Woodhead, Northrop, & Edelstein,
2014). By being recognized by a supervisor, organization, and/or society
for the work they do, home health workers may be intrinsically rewarded
and stay motivated (Morgan et al., 2013). In the present study, we considered various levels of job resources, including not only resources at the
personal level (self-confidence in job performance) but also the interpersonal, organizational, and societal levels (recognition from supervisor/
organization/society).
Based on the JD-R model (Demerouti et al., 2001), the present study was
designed to explore the impact of the selected job demands (physical injury
and racial/ethnic discrimination) and resources (self-confidence in job performance and recognition by supervisor/organization/society) in predicting
employee outcomes (job satisfaction and turnover intent). We hypothesized
that the presence of job demands and lack of resources would be linked to
diminished job satisfaction and increased turnover intent. The assessment
also took into consideration other variables previously known to be associated with job stress and employee well-being such as sociodemographic
characteristics (age, gender, marital status, education, household income, and
race/ethnicity) and work conditions (years as a home health worker, current
work hour, formal training, agency ownership, and agency chain affiliation).
Previous studies report that an early career stage, unstable work hours, lack
of training, and affiliation with agencies that are for-profit and part of a chain
are closely linked to home health workers job dissatisfaction and turnover
intent (Delp et al., 2010; Faul, Schapmire, DAmbrosio, Feaster, & Farley,
2009; McCaughey et al., 2012).

Jang et al.

Method
Data Set
Data were drawn from the 2007 National Home Health Aide Survey
(NHHAS), the first nationally representative sample survey of home health
aides. As a supplement to the 2007 National Home and Hospice Care Survey
(NHHCS), home health workers who were employed by the sampled agencies and provided assistance in activities in daily livingincluding eating,
toileting, bathing, dressing, or transferringwere invited to participate in the
NHHAS. Interviews were conducted in English using computer-assisted telephone interview technology. Details of the survey design and sampling procedures are available elsewhere (Bercovitz et al., 2011). A total of 3,377
individuals participated in the survey, with an 80% aide-level response rate.
After removal of 23 individuals who had more than 20% of data missing in
the variables included in the present analysis, the final sample was 3,354.

Measures
Sociodemographic characteristics. Sociodemographic information included
age (in years), gender (0 = male, 1 = female), marital status (0 = married, 1 =
unmarried), educational attainment (0 = >12 years, 1 = 12 years), annual
household income (0 = <US$20,000, 1 = US$20,000 to <US$40,000, 2 =
US$40,000 to <US$60,000, 3 = US$60,000 or more), and race/ethnicity
(0 = non-Hispanic White, 1 = non-White).
Work conditions. Job-related variables included years as a home health worker
(0 = <2 years, 1 = 2-5 years, 2 = 6-10 years, 3 = >10 years), current weekly
work hour (0 = <20 hr, 1 = 20-30 hr, 2 = 31-40 hr, 4 = >40 hr), initial formal
training (0 = no, 1 = yes), agency ownership (0 = non-profit, 1 = for-profit),
and agency affiliation (0 = non-chain, 1 = chain).
Demands. In terms of on-the-job physical demands, the incidence of injury
since starting the position or during the past 12 months was surveyed using a
list, including (a) back injuries, (b) other strains or pulled muscles, (c) animal
bites, (d) black eyes or other types of bruising, and (e) other work-related
injuries. Participants were asked to report whether they had experienced each
injury, in a yes/no format. A binary variable (0 = no injury, 1 = experience of
any injury) was used in the analysis.
In terms of emotional demands, participants were asked whether they had
been discriminated against on-the-job because of their race or ethnic origin.

Journal of Applied Gerontology

A binary response (0 = no, 1 = yes) was used. In addition, the questionnaire

included information on the source of discrimination: whether the experience
was from clients, clients family members or friends, agency management, or
other sources.
Resources. Self-confidence in job performance and recognition by a supervisor/organization/society were considered. Participants were asked to rate
how much they agreed with the statement, I am confident in my ability to
do my job, on a 4-point scale (1 = strongly disagree, 2 = somewhat disagree, 3 = somewhat agree, 4 = strongly agree). The amount that participants think that their supervisor/organization/society values or appreciates
the work they do was rated on a 3-point scale for each (1 = not at all, 2 =
somewhat, 3 = very much).
Outcomes. In terms of job satisfaction, participants were asked to rate how
satisfied they were with their job, on a 4-point response scale (1 = extremely
dissatisfied, 2 = somewhat dissatisfied, 3 = somewhat satisfied, 4 = extremely
satisfied). Turnover intent was also measured with a single item, asking how
likely participants were to leave the job at their current agency during the
next year. The original 3-point response (0 = not at all likely, 1 = somewhat
likely, 2 = very likely) was re-coded as a dichotomous variable (0 = no turnover intent, 1 = presence of turnover intent) by combining the latter two
categories.

Analytic Strategies
Descriptive and bivariate analyses were conducted to understand the characteristics of the sample and the underlying associations among study variables.
To explore determinants of job satisfaction and turnover intent, separate
regression analyses were conducted. A linear model was used for job satisfaction and a logistic model for turnover intent. Based on the JD-R model
(Demerouti et al., 2001), the sets of variables included sociodemographic
characteristics, work conditions, demands, and resources. Analyses were performed using Stata 13.

Results
Descriptive Characteristics
Table 1 summarizes the major characteristics of the sample and the study
variables. The overall description is in accordance with the national profile of

Jang et al.
Table 1. Descriptive Characteristics of Home Health Workers (N = 3,354).
Variable

M SD (minimum-maximum) or %

Sociodemographic characteristics
Age
Gender (female)a
Marital status (unmarried)
Education (high school)
Household income
<US$20,000
US$20,000 to <US$40,000
US$40,000 to <US$60,000
US$60,000 or more
Race/ethnicity (non-White)
Work conditions
Years as a home health worker
<2 years
2-5 years
6-10 years
>10 years
Current work hours
<20 hr
20-30 hr
31-40 hr
>40 hr
Training (yes)
Agency ownership (for-profit)
Agency affiliation (chain)
Demands
Physical injury
Perceived discrimination
Resources
Self-confidence in job performance
Recognition by supervisor
Recognition by organization
Recognition by society
Outcomes
Job satisfaction
Turnover intent
aVariable

45.6 11.6 (20-65)

96.9
44.0
63.3
18.9
47.6
21.6
11.8
32.8

8.3
19.6
19.2
53.0
11.3
19.2
63.1
6.5
84.8
30.9
23.1
16.6
10.8
3.67 0.66 (1-4)
2.79 0.45 (1-3)
2.69 0.51 (1-3)
2.57 0.56 (1-3)
3.51 0.65 (1-4)
25.3

excluded in multivariate analyses because of a lack of variance.

Journal of Applied Gerontology

home health workers generated from the 2000 U.S. Census (Montgomery,
Holley, Deichert, & Kosloski, 2005). Age ranged from 20 to 65 years, with an
average of 45.6 years (SD = 11.6). Reflecting the nature of the workforce, an
overwhelming majority (96.9%) was female. Due to its lack of variance, gender was excluded in further analyses. Forty-four percent of the participants
were unmarried; about 64% had received a high school education or less; and
more than 66% had an annual household income of less than US$40,000.
About 33% were non-Whites, with 21.6% being non-Hispanic Blacks, 3.7%
being Hispanics, and 7.8% being others. More than half (53%) had been
working as a home health worker for more than 10 years. A majority (82.3%)
reported 20 to 40 weekly work hours. About 85% reported that they had
received formal training to become a home health worker. Thirty-one percent
of the participants were working at for-profit agencies, and about 23% at
agencies affiliated with a chain.
About 17% of the participants had at least one on-the-job physical injury.
In a subgroup analysis of those with an injury experience (n = 555), back
injury was the most frequently reported (45.9%), followed by other strains or
pulled muscles (38.4%). The rate of experiencing racial/ethnic discrimination
was 10.8%. Among those with discriminatory experiences, 82.3% reported
the source as being agency management, 80.4% clients, and 55% clients
family members and friends. It was notable that 22.6% of the sample had
experienced either physical injury or discrimination, and 2.4% had experienced both.
Self-confidence in job performance averaged 3.67 (SD = 0.66). The scores
for recognition by supervisor/organization/society were all geared toward the
positive side, with means of 2.79 (SD = 0.45), 2.69 (SD = 0.51), and 2.57
(SD = 0.56), respectively. Job satisfaction scores were also quite high, with a
mean of 3.51 (SD = 0.65); however, about a quarter of the participants indicated a turnover intent.
Predictive models of job satisfaction and turnover intent. Prior to analyzing the
multivariate models, we examined bivariate correlations among the study
variables. All variables were found to be correlated in the expected direction,
and no concern about collinearity was identified. The highest coefficient was
found in the relationship between recognition by supervisor and recognition
by organization (r = .49, p < .001). Job satisfaction and turnover intent were
inversely correlated (r = .42, p < .001).
Table 2 summarizes the results of the multivariate analyses. In the linear
model of job satisfaction, a lower level of satisfaction was predicted by
younger age, higher education, lower income, and racial/ethnic minority status. Among the work condition variables, fewer weekly work hours and

Jang et al.
Table 2. Regression Models of Job Satisfaction and Turnover Intent.
Job satisfaction
Predictor
Sociodemographic characteristics
Age
Marital status (unmarried)
Education (high school)
Household income
Race/ethnicity (non-White)
Work conditions
Years as a home health aide
Current work hours
Training (yes)
Agency ownership (for-profit)
Agency affiliation (chain)
Demands
Physical injury
Perceived discrimination
Resources
Self-confidence in job
performance
Recognition by supervisor
Recognition by organization
Recognition by society
Summary statistics

Turnover intent

OR

95% CI

.07
.01
.05
.05
.08

4.02***
0.54
3.25**
2.39*
4.30***

0.99**
1.25*
0.63***
0.98
1.64***

[0.98, 0.99]
[1.04, 1.50]
[0.53, 0.74]
[0.89, 1.08]
[1.38, 1.94]

.01
.07
.01
.08
.02

0.95
4.03***
0.40
4.22***
0.85

0.88**
0.65***
0.97
1.25*
1.35**

[0.80, 0.96]
[0.58, 0.72]
[0.77, 1.22]
[1.02, 1.52]
[1.09, 1.66]

.10
.11

5.73***
6.16***

1.77***
1.71***

[1.42, 2.20]
[1.33, 2.21]

.11

6.65***

0.86*

[0.75, 0.98]

.19
10.4***
.30
16.4***
.01
0.35
R2 = .27
F = 74.4***

0.52***
[0.42, 0.64]
0.47***
[0.39, 0.57]
0.94
[0.80, 1.09]
2 log likelihood = 3,133.4
2/df = 475.7***/16

Note. = standardized regression coefficient; OR = odds ratio; CI = confidence internal.

*p < .05. **p < .01. ***p < .001.

affiliation with for-profit agencies were found to pose a significant risk to

job satisfaction. Both of the demand-related variables (physical injury and
perceived discrimination) significantly reduced job satisfaction. Also, selfconfidence in job performance and recognition by a supervisor or organization emerged as significant promoters of job satisfaction. Recognition by
society was positively associated with job satisfaction on a bivariate level
(r = .13, p < .001); however, it was no longer significant in the multivariate
model. The total amount of variance explained by the estimated model was
27% (F = 74.4, p < .001). The interactions between the demand and resource
variables were also explored; however, none of the interaction terms reached
statistical significance.

10

Journal of Applied Gerontology

In the logistic model of turnover intent, a higher likelihood was observed

among those of younger age, unmarried status, higher education, and racial/
ethnic minority status. Among the work condition variables, a shorter career
in home health workforce, fewer weekly work hours, and affiliation with
agencies that were for-profit and part of a chain significantly increased the
odds of having turnover intent. The experience of physical injury and racial/
ethnic discrimination increased turnover intent by 1.77 times and 1.71 times,
respectively. A substantial contribution by the resource variables was also
observed; those who reported higher levels of self-confidence in job performance and recognition by supervisor and organization were less likely to
have turnover intent. As was observed for job satisfaction, recognition by
society became non-significant in the multivariate model, and no significant
interaction effect was found.

Discussion
Responding to the growing needs for home health care and the persistent
challenges experienced by its workforce (Delp et al., 2010; IOM, 2008; PHI,
2011; Sauter et al., 2002), the present study examined factors associated with
job satisfaction and turnover intent in a national sample of home health workers. Basing our analysis on the JD-R model (Demerouti et al., 2001), we
chose to focus on the role of job demands (physical injury and perceived
discrimination) and resources (self-confidence in job performance and recognition by supervisor/organization/society). Our findings supported the proposed hypotheses by demonstrating a negative impact of job demands and the
benefit of resource; these findings have implications for services and policies
for home health workforce development.
The descriptive characteristics of the sample reflected the previously
reported profile of home health workers in the United States, with a vast
majority being women with a disadvantaged background (Montgomery et al.,
2005; PHI, 2011; Yamada, 2002). Home health services have been considered a minority industry, and the home health workforce includes a substantially higher proportion of non-White members than does the national
workforce in general (Montgomery et al., 2005). It is reported that 53% of the
national direct care workforce is composed of people of color and 23% of
foreign-born immigrants (PHI, 2011). However, the NHHAS sample only
included 33% non-Whites. The fact that the NHHAS survey was offered only
in English may indicate a systematic exclusion of non-White workers, particularly those with limited English proficiency. Considering the U.S. Census
report from 2005 that more than a quarter of home health workers spoke a
language other than English at home (Montgomery et al., 2005), the inherent

Jang et al.

11

selectiveness of the NHHAS sample calls for caution in making interpretations and generalizations from the surveys findings.
In multivariate models, workers with advanced age, lower educational
attainment, and non-minority status were found to have favorable employee
outcomes (higher levels of job satisfaction and absence of turnover intent).
The age difference in employee outcomes has been reported in the literature,
with older workers being more likely than younger workers to remain in and
be satisfied with their current positions (Butler et al., 2014; Faul et al., 2009).
It is notable that those with a higher level of education were more dissatisfied
with their job and had a higher intention of leaving it. We speculate that discordance between educational attainment and social status may be an underlying reason for this finding. A higher risk of job dissatisfaction and turnover
intent was also observed among racial/ethnic minorities.
Both job dissatisfaction and turnover intent were observed among individuals who had fewer work hours and who were affiliated with for-profit
agencies. A shorter career in the home health workforce and affiliation with
an agency with a chain membership were associated only with turnover
intent. These findings are in line with the literature demonstrating the vulnerability of direct care workers with unstable work hours, at an early career
stage, and with employment by agencies that are for-profit and part of a chain
(Delp et al., 2010; Faul et al., 2009; McCaughey et al., 2012).
Directly supporting the proposed hypotheses, we found a negative impact
of physical injury and racial discrimination. Exposure to physical hazards
and psychological stress are a central consideration in the work safety model
postulated by the National Institute for Occupational Safety and Health
(NIOSH; Sauter et al., 2002), and our findings confirm the value of considering both of these types of job demand. The rate of experiencing discrimination was substantially higher among non-Whites (24.0%) than that among
their White counterparts (4.4%). Considering the exclusion of non-Englishspeaking home health workers from the NHHAS, the reported rate of discrimination could be an underestimate. It was quite striking that a quarter of
the sample was exposed to physical injury or discrimination, or both, on the
job. Thus, our overall findings suggest that physical injury and discrimination
should be prioritized in prevention and intervention efforts to improve home
health workers safety and well-being.
Our findings concerning the role of resources can serve as an important
guideline for such intervention strategies. Three out of the four variables considered in the proposed model emerged as significant predictors of employee
outcomes, after controlling for the background and demand variables. Given
the benefits of self-confidence in job performance, ways to bolster home
health workers work-related efficacy need to be sought. One such way may

12

Journal of Applied Gerontology

be the provision of employee training. Although training in itself was not a

significant factor in our model, the literature shows that the perceived helpfulness of training has a positive impact on employee outcomes (McCaughey
et al., 2012). Efforts should be made to improve the quality of training for
home health workers, which can build not only their job-related skills but also
their self-confidence in their job performance. Our observation that employee
outcomes were substantially improved by the recognition that home health
workers had received from their supervisors and organizations highlights the
critical role of the workforce environment. Home health workers seem to be
intrinsically rewarded by supervisory and organizational relationships that are
supportive and appreciative (Butler et al., 2014; Woodhead et al., 2014).
Some limitations of the present study should be noted. First, as mentioned
earlier, the underrepresentation of non-Whites, particularly those with limited English proficiency, limits the generalizability of the findings and invites
further research with more representative samples of home health workers.
Second, the cross-sectional nature of the data limits our ability to draw causal
inferences among the study variables. Although turnover intent is an important proxy, actual turnover needs to be included in the longitudinal assessment. Also job satisfaction needs to be measured with a multidimensional
scale with a validated psychometric quality. It should also be noted that participants responses, especially to the questions on job status and relationships with their current employers, might have been biased toward socially
desirable directions.
Despite these limitations, the present study contributes to improving our
understanding of home health workers, considering both physical and psychological job demands as well as multidimensional aspects of job resources.
Our study findings suggest that three approaches are possible to improve
home health workers well-being. The first comprises prevention and intervention efforts related to physical injury and discrimination. Given the higher
rate of discriminatory experience in non-Whites, special attention needs to be
paid to minority workers. In a stress reduction intervention with Black female
workers, Mays (1995) showed that discussions on race and gender discrimination in the workplace were effective in alleviating their work-related stress.
The second consists of providing quality training to bolster home health
workers work-related efficacy and confidence. This type of person-directed
intervention is known to reduce work stress and burnout in the short term;
however, the long-term benefit would be maximized when the approach is
combined with organization-directed interventions (Awa, Plaumann, &
Walter, 2010; Westermann, Kozak, Harling, & Nienhaus, 2014; Woodhead
et al., 2014). Such effort may include supervisor training to improve support
provided to employees and promotion of an organizational culture that is

Jang et al.

13

based on mutual respect and appreciation. Multidimensional efforts to

address job demands and strengthen resources will enhance home health
workers job satisfaction and retention.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.

Funding
The authors received no financial support for the research, authorship, and/or publication of this article.

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Author Biographies
Yuri Jang is an associate professor in the School of Social Work and a faculty
research associate at the Population Research Center, The University of Texas at
Austin. Her research focuses on positive adaptation in aging, health disparities, and
minority health and service utilization.
Ahyoung A. Lee is a doctoral candidate in the School of Social Work at the University
of Texas at Austin. Her research focuses on workforce development and retention in
long-term care, occupational stress and well-being, and integrated health care.
Michelle Zadrozny, LMSW is the Director of Workforce Development at Helping
the Aging, Needy, and Disabled (H.A.N.D.). She has been providing management
consulting services to organizations in both nonprofit and private sector since 2006,
focusing on developing and implementing new initiatives to further organizational
development and employee wellness.
Sung-Heui Bae received her PhD in Health Policy and Administration from
University of North Carolina at Chapel Hill in 2008. She is a health services researcher
and an Assistant Professor at the School of Nursing at the University of Texas at

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Austin. Her program of research has focused on health policy, nurse staffing, CMS
reimbursement policy, and survey research method.
Miyong T. Kim received her PhD in Nursing Research with a minor in Psychology
from the University of Arizona in 1995. She is Professor and Associate Vice President
for Community Health Engagement at the University of Texas at Austin. Dr. Kims
areas of research expertise include community-based participatory research, comparative epidemiology, measurement science, and program evaluation.
Nathan C. Marti received his PhD in Psychology with a specialization in statistics
from the University of Texas at Austin in 2001. He was affiliated at the Statistical and
Mathematical Consulting Services at UT Austin before developing his private consulting practice, Abacist Analytics. His projects have focused primarily on healthrelated outcomes.