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Did Better Jobs Better Care Improve Direct Care Worker Job

Outcomes?

Brigitt Heier

June 8, 2008

Presented at the annual meeting of AcademyHealth. The authors are grateful for support from The Atlantic Philanthropies and The Robert Wood Johnson Foundation.

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Data Source:Direct Care Worker Survey

• Questions measuring– Job rewards– Job problems– Perception of job quality– Turnover intention

• Response rates: – Time 1: 50%– Time 2: 42%

• Weighted to adjust for non-response

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Samples

• Excluded Direct Care Workers if:– They worked at providers who did not return

surveys at both time periods – More than 25% of survey items missing

• Repeated cross-section sample size (weighted)– Time 1: 2,532– Time 2: 1,920

• Panel sample size: 1,174

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Methods for Estimating Effects

• Time 2-Time 1 difference in means• Difference-in-differences between above

and below median implementers• Both methods applied twice

– Repeated cross-section– Panel

• 18 outcomes assessed; both scales and individual items

Difference in Means Results

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Overview:Repeated Cross-Section

• Differences were very small

• Only 3 out of 18 measures were statistically significant

• All three were contrary to BJBC intent

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Perception of Job Quality

OutcomeMeanTime 2

Mean Time 1

Mean Difference p-value

Job Satisfaction 2.25 2.30 -0.05** 0.02

Career Job 1.78 1.77 0.01 0.22

Self Efficacy (scale) 2.88 2.88 0.00 0.86

Recommend Organization for Job 2.25 2.28 -0.03 0.18

Recommend Organization for Care 2.39 2.42 -0.03 0.22

** p<.05

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Job Rewards Scales

OutcomeMeanTime 2

Mean Time 1

Mean Difference p-value

Recognition 1.32 1.35 -0.05* 0.10

Peer Support 0.98 1.00 -0.02 0.20

Helping Others 1.54 1.55 -0.01 0.60

Decision Authority 1.24 1.23 0.01 0.40

Satisfaction with Pay 0.47 0.50 -0.03 0.27

Challenge 1.28 1.28 0.00 0.73

* p<.10

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Job Problems Scales

OutcomeMeanTime 2

Mean Time 1

Mean Difference p-value

Discrimination 0.23 0.24 -0.01 0.48

Hazard Exposure 0.74 0.76 -0.02 0.51

Overload 0.71 0.74 -0.03 0.16

Travel for Work 0.33 0.32 0.01 0.51

Dead-end Job 0.78 0.78 0.00 0.94

Turnover Intention

OutcomeMeanTime 2

Mean Time 1

Mean Difference p-value

Intent to Leave 0.59 0.57 0.02 0.33

Think about Quitting 1.28 1.23 0.05* 0.10

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* p<.10

Overview:Panel Sample

• Results followed a pattern similar to the repeated cross-section analysis

• Differences were slightly bigger

• 8 out of 18 differences were statistically significant, all contrary to BJBC intent

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Difference-in-Differences Results

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Repeated Cross-Section• No significant differences between above and

below median implementers

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Implementation Index

Mean Time 2

MeanTime 1

Mean Difference p-value

Above Median 2.28 2.28 0.00 0.98

Below Median 2.22 2.29 -0.07** 0.05

Difference-in-difference -- -- 0.07 0.16

** p<.05

Example: Recommend Job

Panel• Only one significant difference between above

and below median implementers

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Implementation Index

Mean Time 2

MeanTime 1

Mean Difference p-value

Above Median 2.34 2.36 -0.02 0.53

Below Median 2.27 2.37 -0.10*** 0.01

Difference-in-difference -- -- 0.08* 0.10

* p<.10; *** p<.01

Recommend Job

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Summary• No evidence of intended BJBC effects on job

outcomes• Mean differences were:– Small in both repeated cross-section and panel

samples– Significant findings were contrary to BJBC intent

• Difference-in-difference were:– Small in both repeated cross-section and panel

samples– Only 1 out of 18 outcomes were statistically

significant