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The Gerontologist Advance Access originally published online on June 2, 2009
The Gerontologist 2009 49(5):623-634; doi:10.1093/geront/gnp054
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© The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org.

A Dual-Driver Model of Retention and Turnover in the Direct Care Workforce

Vikas Mittal, PhD2, Jules Rosen, MD1,3,4 and Carrie Leana, PhD4

2 Jones Graduate School of Management, Rice University, Houston, Texas
3 Department of Psychiatry, School of Medicine, University of Pittsburgh, Pennsylvania
4 Katz Graduate School of Business, University of Pittsburgh, Pennsylvania

1 Address correspondence to Jules Rosen, MD, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261. E-mail: rosenji{at}upmc.edu


  Abstract

Purpose: The purpose of this study was to understand the factors associated with turnover and retention of direct care workers. We hypothesize that a dual-driver model that includes individual factors, on-the-job factors, off-the-job factors, and contextual factors can be used to distinguish between reasons for direct care workforces (DCWs) staying on the job or leaving the job. Design and Methods: We conducted 7 focus groups with 47 participants. We identified key themes they used to describe their experiences focusing on differences between stayers (had been in the same job for at least 3 years) and leavers (had changed jobs within the past 3 years). Results: Five major themes associated with turnover were identified as follows: (a) lack of respect, (b) inadequate management, (c) work or family conflicts, (d) difficulty of the work, and (e) job openings. Themes associated with retention were as follows: (a) being "called" to service, (b) patient advocacy, (c) personal relationships with residents, (d) religion or spirituality, (e) haven from home problems, and (f) flexibility. Themes associated with turnover were different from those associated with retention. Implications: DCW turnover and retention are complex, multifactorial issues. Efforts to stabilize the DCW must address the issues associated with retention as well as those associated with turnover. Specifically, factors that promote retention may be qualitatively different than those that prevent turnover. Treating retention and turnover as simply the obverse of each other may be misleading in addressing the underlying problem of job stability among DCWs.

Keywords: Long-term care, Direct care workers, Workforce, Turnover, Retention

Received September 10, 2008; Accepted February 11, 2009

Decision Editor: Nancy Schoenberg, PhD


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