Evaluating the success of an intervention to increase satisfaction and retention among home health attendents

It is expected that the demand for home health aides (HHAs), a component of the direct care workforce, will continue to increase as the baby boomer generation ages (PHI, 2009). Yet, many challenge exist to ensuring a stable paraprofessional workforce that can consistently deliver the scope and quality of service required to meet the increasingly complex care needs of a growing, diverse patient population. High attrition rates among HHAs are attributed to dissatisfaction with the low pay and erratic nature of the work. In 2008, one large home health agency in New York City sought to increase retention and satisfaction of HHAs by piloting a program that would guaranteed pay for a full week, regardless of hours worked. This model was expected to increase “guaranteed” capacity; improve consistency of care; improve patient satisfaction; regularity of hours and compensation for HHAs, with corresponding improvements in employee satisfaction and retention. A quasi-experimental design was adopted to evaluate the outcomes of the initiative. Ninety HHAs were recruited to the pilot and a comparable group of HHAs were assigned to a control group. HHAs were matched on years of tenure at the agency and region in which the HHA worked. Survey and administrative data, as well as interviews with key informants, were collected for both groups to assess the outcomes of the pilot project. Implementation of the pilot was complicated by many unintended operational and staff-related issues, which negatively impacted the cost-effectiveness of the pilot. Other key findings include increased satisfaction and commitment to the agency among HHAs in pilot group, as well as some evidence of improvements in patient satisfaction. This paper will present the methodology and findings of both the formative and summative evaluations of the project.