Having a Say Matters: The Association Between Home Health Aides’ Voice and Job Satisfaction

Mara Bensson-Ravunniarath,1 Joanna Bryan Ringel,2 Ariel Avgar,3 Faith Wiggins,4 Ann Lee,4 Margaret V McDonald,5 Lourdes R Guerrero,6 John Kallas,3 Geoffrey Gusoff,7 Megan Shen,8 Emily Tseng,9 Nicola Dell,9 Sara Czaja,2 Lee A Lindquist,10 Madeline R Sterling2 1Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; 2Department of Medicine, Weill Cornell Medicine, New York, NY, USA; 3Cornell University, School of Industrial Labor Relations, Ithaca, NY, USA; 4 1199SEIU Training and Employment Fund, New York, NY, USA; 5Center for Home Care Policy & Research, VNS Health, New York, NY, USA; 6Department of Neurosciences, UC San Diego, San Diego, CA, USA; 7Department of Family Medicine, UCLA, Los Angeles, CA, USA; 8Clinical Research Division, Fred Hutch Cancer Center, Seattle, WA, USA; 9Cornell Tech, Cornell University, New York, NY, USA; 10Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USACorrespondence: Madeline R Sterling, Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, 420 East 70th Street, Room LH-357, New York, NY, 10021, USA, Tel +1646-962-5029, Email [email protected]: Despite a rapidly growing need for home health aides (HHAs), turnover rates are high. While this is driven in large part by the demanding nature of their work and low wages, another factor may be that HHAs are often not considered part of the medical team which can leave them feeling unheard by other healthcare professionals. We sought to determine whether this concept, or HHAs’ perceived voice, was associated with job satisfaction.Methods and Design: This cross-sectional survey of English- and Spanish-speaking HHAs caring for adults with heart failure (HF) was conducted from June 2020 to July 2021 in New York, NY in partnership with a labor management fund of a large healthcare union that provides benefits and training to HHAs. Voice was assessed with a validated 5-item scale (total score range 5 to 25). Job Satisfaction was assessed with the 5-item Work Domain Satisfaction Scale (total score range 5 to 35). Multivariable linear regression analysis was used to examine the association between voice and job satisfaction.Results: A total of 413 HHAs employed by 56 unique home care agencies completed the survey; they had a mean age of 48 years, 97.6% were female, 60.2% were Hispanic, and they worked as HHAs for a median of 10 years (IQR, 5, 17). They had a median Voice score of 18 (IQR 15– 20) and mean job satisfaction score of 26.4 (SD 5.6). Higher levels of voice (1.75 [0.46– 3.04]) were associated with greater job satisfaction (p=0.008). When adjusting for Race/Ethnicity, HF training, and HF knowledge, the association between Voice and job satisfaction remained significant ((1.77 [0.40– 3.13])Conclusion: HHAs with a voice in the care of their patients experienced greater job satisfaction. Voice may be an important target for interventions aiming to improve HHAs’ retention in the field.Keywords: long-term care, home health aide, communication, healthcare tea