Job Satisfaction of Home Health Satisfaction Workers in the Environment of Cost Containment
Egan, Marcia, Kadushin, Goldie, Health and Social Work
In the rapidly changing field of health care, social workers' job satisfaction has received increased attention (Gleason-Wynn & Mindel, 1999; Kadushin & Kulys, 1995; Michalski, Creighton, & Jackson, 1999; Poulin, 1994; Resnick & Dziegielewski, 1996). Given the current emphasis on health care cost control, productivity, and accountability, it is interesting to note that research suggests an association between job satisfaction and job performance for all workers (Judge, Bono, Thoresen, & Patton, 2001), including social workers (Packard, 1989), and between social workers' job satisfaction and job turnover (Barber, 1986; Gleason-Wynn & Mindel, 1999; Jayaratne & Chess, 1984a; Poulin & Walter, 1992; Siefert, Jayaratne & Chess, 1991; Vinokur-Kaplan, 1996).
Social work employment in home health care is growing (U.S. Department of Labor, 2000-2001) because of quicker discharges of hospital patients and increasing numbers of community-dwelling elderly people and individuals with disabilities (Kaye, LaPlante, Carlson, & Wenger, 1996; U.S. General Accounting Office, 1998). Whereas home health care provides new opportunities for social workers, changing reimbursement policies for home care may contribute to the occurrence of ethical conflicts for social workers (Kadushin & Egan, 2001).
Recent concerns about the increase in Medicare spending for home health care resulted in passage of the Balanced Budget Act of 1997 (BBA) (P.L. 105-33), which required that Medicare's cost-based system of reimbursement be replaced with a prospective payment system (PPS) in 2000. To slow spending until the PPS could be implemented, the BBA imposed more stringent cost limits on home health care agencies through an interim payment system (IPS) that was in effect from 1997 until 2000. Research suggests that under the IPS access to home care, particularly for high-cost, chronically ill patients, was adversely affected (McCall, Komisar, Petersons, & Moore, 2001).
Research has found that home health care social workers practicing in the restrictive reimbursement environment imposed by the IPS experienced ethical conflicts between their obligation to the agency to be conscious of agency financial priorities and patient needs for care. These conflicts were moderately frequent and difficult to resolve. The most common reason identified for ethical compromise was government or third-party payer reimbursement limits (Kadushin & Egan, 2001).
Earlier research found an inverse relationship between value conflicts and job satisfaction among social workers in other fields of practice (Chachkes, 1994; Jayaratne & Chess, 1984a; Siefert et al., 1991; Vinokur-Kaplan, 1996). However, a search of the literature revealed no published research on the job satisfaction of social workers in home health care. Empirically based knowledge on the job satisfaction of home health care social workers is important to determine whether workers' job satisfaction is affected by the strain of working in this cost-conscious, rapidly changing environment. This study examined the job satisfaction of social workers in home health care agencies to provide this information.
Three areas of the literature related to job satisfaction are pertinent to the study of social worker job satisfaction in home health: (1) funding source influence and job satisfaction; (2) value conflicts, ethical compromise, and job satisfaction; (3) administrator and supervisor support and job satisfaction.
Funding Source Influence and Job Satisfaction
A survey of social workers in private practice found that the most frequently mentioned source of job dissatisfaction was the demands of managed care and third-party payers (Strom-Gottfried, 1996). Practitioners viewed third-party payers as having the greatest effect on health care consumers' access to services.
Rifle (1999) found a low negative correlation (r = -.16) between funding source influence, operationalized as the effect of private insurance on treatment decisions, and social workers' job satisfaction. Similarly, a survey of hospital social workers found a negative relationship between hospital social workers' perceptions of a shift in organizational priorities from patient care to financial interests and job satisfaction (Chachkes, 1994). Assuming that medical social workers have insufficient input into the termination process because of prospective and managed care reimbursement guidelines, Resnick and Dziegielewski (1996) reported a positive relationship between the degree of comfort in terminating with clients and workers' job satisfaction. In summary, the literature suggests an inverse relationship between the influence of funding sources and workers' job satisfaction.
Value Conflict, Ethical Compromise, and Job Satisfaction
Research findings suggest a negative relationship between value conflicts and social workers' job satisfaction. Vinokur-Kaplan (1996) found a negative relationship between the degree to which social work administrators felt that their professional values conflicted with job demands and job satisfaction in 1989, but not in 1981, presumably because reductions in federal funding during the late 1980s pressured administrators to implement policies that conflicted with their conception of desirable social services programs. Chachkes (1994) documented a negative relationship between the degree of value conflict and job satisfaction among medical social workers.
Siefert and colleagues (1991) reported a negative relationship between the frequency of value conflicts and the job satisfaction of social workers in 1989, but not in 1979, possibly because in 1989 social workers experienced pressures to allocate or ration scarce health care resources as cost-containment policies were implemented. Finally, a negative relationship between the frequency of value conflicts and job satisfaction has been documented for community mental health workers (Jayaratne & Chess, 1984a).
When value conflicts are difficult to resolve, ethical compromise may result. Stevens (1997) reported that ethical compromise related to third-party reimbursement guidelines was negatively related to job satisfaction among psychologists and was the strongest predictor of job satisfaction. There is no research available on the relationship between job satisfaction and ethical compromise among social workers.
Administrator and Supervisor Support and Job Satisfaction
There is no published research on the job satisfaction of social workers in home health care. In an unpublished dissertation, Stark (1997) found that the strongest predictor of job satisfaction among social workers in home health care was the degree to which supervisors considered their input in making decisions that affected the workers jobs. A second predictor of job satisfaction was the degree to which agency administrators considered workers' input in making similar decisions. In each case, greater consideration of worker input by supervisors and administrators was related to greater job satisfaction.
Home health social workers are employed in host settings or settings whose mission and decision making are defined and dominated by people who are not social workers (Dane & Simon, 1991). Social workers, therefore, may have less control over decisions that affect their work. In addition, social workers may view the medically driven eligibility criteria for services under Medicare and Medicaid as creating a hierarchy among home health care professionals, with social workers accorded less status than professions that provide medical interventions (Seon-Lee, 2001). A substantial body of literature documents a positive relationship between supervisory support and social workers' job satisfaction. Supervisory support has been defined in some research as emotional support. Emotionally supportive supervision is directed toward enhancing worker morale through the communication of reassurance, warmth, and encouragement. In comparison, instrumental supervision helps the worker complete a difficult task, and informational supervision provides the information necessary for the worker to do the job (Himle, Jayaratne, & Thyness, 1989a). Emotionally supportive supervision enhances the worker's psychological well-being and helps the worker mobilize the emotional energy necessary for effective job performance. Instrumental and informational supervision enhance the worker's competence to do the job successfully by providing the necessary facilities, resources, information, and skills (Kadushin & Harkness, 2002).
Research suggests that emotionally supportive supervision and social workers' job satisfaction are strongly associated (Himle et al., 1989a; Himle, Jayaratne, & Thyness, 1989b; Martin & Schinke, 1998; Newsome & Pillari, 1992; Rauktis & Koeske, 1994). Some studies suggest that emotionally supportive (Himle et al., 1989a; Rauktis & Koeske) and instrumentally supportive (Himle et al., 1989a) supervision ameliorate or buffer the effect of job-related stress on job satisfaction. However, the majority of the research does not support this buffering effect for emotionally supportive supervision (Brabson, Jones, & Jayaratne, 1991; Himle et al., 1989b; Jayaratne & Chess, 1984b; Jayaratne, Tripodi, & Chess, 1983; Koeske & Koeske, 1993).
Research also suggests a positive relationship between managerial behavior that encourages participation in decision making and social workers' job satisfaction (Grasso, 1994; Malka, 1989). Kaye (1986) reported that greater involvement in organizational decision making and higher levels of job satisfaction were related for home health staff at all professional levels.
In summary, the literature suggests there is a negative relationship between funding source influence and value conflicts and social work job satisfaction. Research findings also suggest that home health care social workers practicing under the restrictive reimbursement policies of the IPS experienced ethical conflicts over access to services for their patients. Given research findings reporting that value conflicts and social work job satisfaction are related and the emphasis on cost containment in home care, a question might be raised about whether the profession should be concerned about the job satisfaction of home health care social workers. However, current research on the job satisfaction of home health care social workers is limited to one unpublished doctoral dissertation. This study addressed this gap in knowledge by examining job satisfaction and variables related to job satisfaction of home health care social workers practicing under the reimbursement guidelines of the IPS.
The survey was implemented in the fall--winter of 1998-1999 while the IPS was in effect. The questionnaire was developed from a review of the literature, pilot tested with 19 social workers in home health care, and mailed to all members of the American Network of Home Health Care Social Workers. An additional 48 non-network member home health care social workers who volunteered for the study were included in the mailing (N = 721). Of the 408 returned completed questionnaires, 44 (10.8 percent) were ineligible for the study because the respondents were not currently in home health practice, resulting in a response rate of 57 percent (N = 364) from eligible participants. For the analysis of the job satisfaction of social workers in home health, a subset of the data from respondents who indicated they were regular (that is, noncontract) employees and practicing solely in direct practice was drawn (n = 228).
The Job Satisfaction Scale (JSS) has been examined for construct validity and reliability with good results in previous research (Koeske, Kirk, Koeske, & Rauktis, 1994). The organizational job satisfaction subscale of the JSS was selected because in earlier research the organizational subscale explained most of the variance in the job satisfaction of home health social workers (Stark, 1997).
Respondents rated their satisfaction on a scale from 1 = very dissatisfied to 11 = very satisfied on five items of the organizational subscale. One item of the subscale, satisfaction with the "quality of supervision," was excluded because of its conceptual similarity to the helpfulness of supervisors in resolving the ethical conflict measure to avoid intercorrelation of the two variables. The five subscale items used reflected workers' satisfaction with the following organizational job facets: role clarity, involvement in decision making, recognition given for one's job, authority, and interpersonal relations with fellow workers. Respondents' ratings of satisfaction with each item were summed to obtain an organizational job satisfaction score. In the present study the organizational subscale achieved a standardized Cronbach's alpha of .824.
The ethical conflict over patient access to services was defined for respondents as "a conflict arises between your agency's fiscal needs and/or reimbursement limits of 3rd party payers and patient care needs." Respondents rated three aspects of the ethical conflict: (1) how often the conflict over access to services occurred (0 = never to 4 = very often); (2) how difficult the conflict was to resolve (0 = not at all difficult to 4 = extremely difficult), and (3) how helpful supervisors and administrators were in resolving the conflict (1 = not at all helpful to 6 = very helpful). Respondents also rated how often they believed they had to compromise the professional NASW Code of Ethics in their practice (0 = never to 4 = very frequently). Last, participants provided demographic information regarding their education, years of practice in home health, number of patients in their caseload per month, and whether their agency was a for-profit or a not-for-profit organization.
All data were entered in SPSS 10.0. Univariate analyses provided descriptive statistics of all variables; bivariate and multivariate analyses were computed to examine the relationships among variables.
The respondents were predominately white, non-Hispanic (93 percent), and held social work degrees (MSW = 77.4 percent and BSW = 11.0 percent). Nearly three-quarters of the social workers were employed in not-for-profit home health agencies (74.4 percent). The social workers were on average age 45, with slightly more than six years of practice in home health and had an average of 27 patients per month in their caseloads (Table 1).
Social workers reported that they believed they had to compromise their professional ethics infrequently (M = 1.36, SD = 0.93). The ethical conflict over access to services for patients was rated as moderately frequent (M = 2.47, SD = 1.26) and moderately difficult to resolve (M = 2.69, SD = 1.08). The workers rated their agency administrators (M = 3.61, SD = 1.57) and their supervisors (M = 3.91, SD = 1.49) as moderately helpful in resolving the ethical conflict over access to services. Respondents were on average satisfied with their jobs (M = 39.7, SD = 9.78) (Table 1). The overall high level of organizational job satisfaction of these social workers is also suggested by the finding that 88 percent of the respondents' satisfaction scores occurred in the "satisfied" section of the scale (that is, above the midpoint of 30.0 of the potential range of the scale).
Correlational analyses showed that administrators' and supervisors' helpfulness in resolving the ethical conflict was significantly and positively correlated, and the difficulty of resolving the conflict and the frequency of ethical compromise were significantly and negatively correlated with organizational job satisfaction. Working in a for-profit agency was significantly correlated with greater job satisfaction (Table 2). Workers' demographics and the frequency of the ethical conflict over access to services were not significantly correlated with job satisfaction. The variables found to be significantly related (p = .05) with organizational job satisfaction were included in regression analyses.
Regression analysis revealed that the helpfulness of administrators (B = .266, p = .002) and supervisors (B =.214, p = .01) in resolving the conflict over access contributed significantly to greater satisfaction, and the frequency with which workers felt they had to compromise their professional ethics (B = -.155, p = .04) contributed significantly to less satisfaction in the regression, explaining 22 percent of the variance in job satisfaction [Adj. [R.sub.2] = .220, F(5, 145) = 9.46, p = .001]. The difficulty workers experienced in resolving the ethical conflict (B = -.116, p =. 139) and agency auspice (B = .133, p = .07) did not significantly contribute to explaining organizational job satisfaction (see Table 3).
Due to the absence of statistical significance for difficulty in the regression analysis and earlier research suggesting that supervisors' and administrators' support may moderate the relationship between difficult work situations and job satisfaction (Himle et al., 1989a; Rauktis & Koeske, 1994), two interaction terms were computed: (1) difficulty by supervisor helpfulness and (2) difficulty by administrator helpfulness. Pearson correlation analysis revealed that the interaction of supervisor helpfulness and difficulty was significantly correlated with job satisfaction (r =. 171, p = .03) and met the criterion (p = .05) for inclusion in a second regression analysis, whereas the interaction of administrator helpfulness did not (r =. 141, p =. 08). In the second regression analysis, the interaction term significantly increased the overall explanation of variance in organizational job satisfaction (B = .534, p = .023) by 2.3 percent [Adj. [R.sub.2] = .243, F(6, 144) = 9.005, p = .001]. The difficulty of resolving the conflict and the frequency of compromising professional ethics significantly contributed to the overall explanation of organizational job satisfaction (B = -.421, p = .007 and B = -.165, p = .030, respectively), as did the helpfulness of administrators (B = .262, p = .002) (Table 3).
To further understand the relationship of the interaction term and organizational job satisfaction, a prediction of satisfaction based on the results of the second regression was computed using Microsoft Excel 2000. The results clearly show that the organizational satisfaction of workers whose supervisors were very helpful in resolving ethical conflict was maintained and even slightly increased over increasing levels of difficulty (Figure 1). In comparison, job satisfaction of workers whose supervisors were not helpful decreased as the level of difficulty increased (Figure 1). This finding suggests that the helpfulness of supervisors in resolving the ethical conflict moderates the effect of difficulty on workers' organizational job satisfaction.
[FIGURE 1 OMITTED]
Participants were satisfied with the organizational aspects of their jobs. The helpfulness of administrators in resolving the ethical conflict over access contributed to greater organizational job satisfaction, and the difficulty of resolving the conflict and the frequency with which workers felt they had to compromise their professional ethics contributed to less organizational job satisfaction. Furthermore, the interaction of supervisory helpfulness and the difficulty moderated the impact of difficulty on workers' organizational job satisfaction.
Interpretation of the findings is limited in several ways. First, the nonrandom sampling frame, the cross-sectional design, the use of a mailed survey and self-report measures limit generalization to all social workers in home health. Second, because the sample may not be representative of network members, whose demographics are unknown, the findings may reflect characteristics of the sample that have not been detected. Third, the overall explanations of variance of organizational satisfaction in the regressions were moderate. This may relate to undetected characteristics of the sample, to its homogeneity in terms of education, or to variables not addressed in the study. However, given those caveats the findings provide empirically based knowledge about social workers' organizational job satisfaction in home health.
The social workers were satisfied with the organizational aspects of their job. This finding is reassuring given the potential for cost-containment pressures from the IPS to lead to an agency emphasis on financial priorities over patient care needs and to less worker satisfaction with the organizational facets of the job (Strom-Gottfried, 1996). There are several possible explanations for this finding. Because this study sampled professionally trained workers who identified with their profession, the stresses they encountered on the job may have been assuaged through support from colleagues and their own professional identity, skills, and networking (Vinokur-Kaplan, 1996). The social workers in this sample on average had been in home health care practice several years. It is possible that workers who are more satisfied tend to remain in the field and those who are dissatisfied leave. Thus, this sample may have been biased toward social workers who were satisfied with their home health organizations (Poulin, 1994).
Administrators' helpfulness significantly contributed to greater satisfaction. This finding supports previous research that found a positive relationship between managerial behavior that encourages participation in decision making and job satisfaction in home health social work (Kaye, 1986; Stark, 1997).
The significance interaction term in increasing job satisfaction supports earlier research suggesting that supervision may moderate the relationship between difficult work situations and job satisfaction (Himle et al., 1989a; Rauktis & Koeske, 1994). That is, the supervisor's helpfulness in resolving the conflict may ameliorate the negative effect of the difficulty of resolving the conflict on worker's job satisfaction by providing instrumental and informational supervision. In providing informational and instrumental support, the supervisor provides administrative supervision, helping the worker gain access to resources to meet patient needs and to do her or his job (Kadushin & Harkness, 2002). In contrast, emotionally supportive supervision--communicating warmth and encouragement--might not moderate the effect of the difficulty of resolving the ethical conflict on job satisfaction because it contributes little to the workers' ability to do their jobs (Himle et al., 1989a; Kadushin & Harkness).
In discussing the findings it is important to note that, consistent with a trend toward non-social work supervision in other host settings (Berger & Mizrahi, 2001; Gibelman & Schervish, 1997), the majority of social workers in home health care-approximately two-thirds according to one survey-are supervised by nurses (Stark, 1997). It would seem that nurse supervisors might not easily provide supervision focused on professional development and mentoring to social workers because nurses would not have the benefit of an educational background in social work ethics, values, and knowledge on which to draw. However, it should be noted that the type of supervision found to interact with difficulty and enhance social workers' organizational job satisfaction as defined for respondents in this study was administrative supervision (that is, "helping the worker resolve an ethical conflict over patient access to services"), rather than supervision focused on professional development or mentoring.
Given the finding in this study that supervisors' helpfulness in moderating difficulty was related to greater job satisfaction and other research documenting a reduction in the availability of supervision to social work staff in environments affected by managed care and other cost-containment policies (Berger & Mizrahi, 2001; Gibelman & Schervish, 1997), the question is whether there is reason to be concerned about the future job satisfaction of home health care social workers. In fact, the literature suggests that in environments affected by cost containment, a trend from supervision focused on professional development and mentoring and toward administrative supervision has occurred (Kadushin & Harkness, 2002). If these assumptions are correct, it may be unlikely that the type of supervision that buffers the effect of difficulty on job satisfaction for home health care social workers is threatened by cost-containment measures.
More frequently, compromising social work's ethics significantly contributed to less organizational job satisfaction. This is the first study to examine and to find a relationship between the frequency of ethical compromise and social work job satisfaction. Although social workers may view external reimbursement guidelines and managed care systems as unchangeable impediments to service delivery, workers may also believe that agencies should be more responsive to acquiring other sources of funding and to providing needed, but nonreimbursable, services (Galambos, 1999). If so, workers may attribute pressures that result in their compromising professional ethics to their organization's emphasis on financial priorities over patient care needs (Chachkes, 1994). Poulin (1994) suggested that in terms of worker job satisfaction, poor performance, and turnover, the cost to the organization of underfunded or absent resources for services so that social workers can do their work may be greater than the savings.
Although the difficulty workers experienced in resolving the ethical conflict over access significantly contributed to less job satisfaction, the frequency of the conflict was unrelated to job satisfaction. The lack of consistency between this finding and earlier research (Jayaratne & Chess, 1984a; Siefert et al., 1991) may result from differences in measurement. That is, earlier research used a single item "global measure" of job satisfaction, asking respondents how satisfied they were overall with their jobs; this research measured a specific facet of job satisfaction with a multiple-item scale. Earlier research measured value conflicts in general. This study identified a specific ethical conflict, operationally defined the conflict for participants, and separately measured how often the conflict occurred and how difficult the conflict was to resolve.
IMPLICATIONS FOR SOCIAL WORK
The findings have implications for administrators, supervisors, and social workers in home health and for social work education. The findings encourage both home health administrators and supervisors to discuss ethical conflicts over access to services with workers and, thus, maximize opportunities to be helpful by involving workers in decisions and problem solving. The findings also support administrators' efforts to acquire budget revenues for needed but nonreimbursable services so that workers can avoid ethical conflicts and ethical compromise over patient access. The findings imply that supervisors may enhance workers' satisfaction with their organizations by providing instrumental and administrative supervision that helps social workers resolve the ethical conflict between loyalty to their agency's policies and financial needs and patient needs for services.
In an environment focused on cost containment, workers may anticipate a negative reaction from supervisors or administrators in bringing up issues about nonreimbursable services. Thus, they may hesitate to discuss these conflicts and try to resolve them (Kadushin & Harkness, 2002). The findings of this research suggest that the perceived risk of approaching a supervisor or administrator with this ethical conflict may be worth the benefit in organizational job satisfaction.
Workers might do well to engage in these discussions in management terms, showing how acquiring coverage or providing uncovered services is cost-effective and contributes to agency goals (Goode, 2000; Schneider, Hyer, & Luptak, 2000). Discussions about the ethical conflict may also be productive if workers help non-social work supervisors and administrators understand social work's ethical obligation not to abandon clients and to advocate for client access to service in their agencies (Galambos, 1999). Other research suggests that home health care administrators' and supervisors' lack of knowledge about Medicare rules and regulations for social work reimbursement is an obstacle to using social workers (Goode). The findings of this study imply that practitioners might do well to educate administrators and supervisors about Medicare rules and regulation for the reimbursement of social work services (Schneider et al.).
The findings call for the inclusion in social work education and professional continuing education of the knowledge and skills needed for practitioners to effectively engage supervisors and administrators in settings affected by cost-containment policies, particularly when agency priorities and patient care needs conflict and when supervisors and administrators are not social workers (Kadushin & Harkness, 2002; Schneider et al., 2000).
Future research should replicate this study under the PPS with a larger, random sample of home health care social workers and include additional variables such as organizational climate (Meyerson, 1994), funding sources for services, types of supervision, dynamics of the supervisor-worker relationship, and professional discipline of the supervisor.
Table 1. Results of Univariate Analyses of Home Health Care Worker Characteristics and Major Variables on Job Satisfaction Variable M SD Range Worker age in years 44.91 9.5 25-77 Years in home health practice 6.25 4.2 1-21 Caseload in number patients/month 26.62 16.88 12-90 Frequency of professional compromise 1.36 0.93 0-4 Frequency of ethical conflicts-- 2.47 1.26 0-4 patient access Difficulty of resolving ethical 2.69 1.08 0-4 conflicts--patient access Administrators' helpfulness in 3.61 1.57 1-6 resolving the conflict Supervisors' helpfulness in 3.91 1.49 1-6 resolving the conflict Organizational job satisfaction 39.74 9.78 16-55 Table 2. Results of Bivariate Correlational Analysis of Major Variables on Home Health Care Worker Job Satisfaction Difficulty of Resolving the Helpfulness Ethical Conflict Administrator Supervisor Variable (D) Helpfulness (S) Difficulty of resolving the ethical conflict (D) 1.00 Administrator helpfulness -.150 * 1.00 Supervisor helpfulness (S) -.020 .509 *** 1.00 D by S interaction .606 ** .280 ** .745 ** Frequency of ethical compromise .314 *** -.119 -.045 Auspice of agency .199 ** -.071 -.008 Organizational job satisfaction -.161 * .334 ** .339 *** D by S Frequency of Auspice Variable Interaction Ethical Compromise of Agency Difficulty of resolving the ethical conflict (D) Administrator helpfulness Supervisor helpfulness (S) D by S interaction 1.00 Frequency of ethical compromise .157 * 1.00 Auspice of agency .098 .008 1.00 Organizational job satisfaction .171 * -.156 * .141 * Organizational Variable Job Satisfaction Difficulty of resolving the ethical conflict (D) Administrator helpfulness Supervisor helpfulness (S) D by S interaction Frequency of ethical compromise Auspice of agency Organizational job satisfaction 1.00 * p = .05. ** p = .01. *** p = .001. Table 3. Standardized Regression Coefficients in Multiple Regressions Model Model Variable 1 2 Helpfulness of administrators .266 ** .262 * Helpfulness of supervisors .214 ** -.188 Difficulty resolving ethical conflict -.116 -.421 ** Difficulty by supervisors interaction -- .534 * Frequency of compromising ethics -.155 * -.165 * Auspice of agency .133 .126 Adj. [R.sup.2] .220 .243 * p < .05. ** p < .01. [F(5, 145) =9.463, p = .001] [F(6,144) = 9.005, p = .001]
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ABOUT THE AUTHORS
Marcia Egan, PhD, is associate professor, College of Social Work, University of Tennessee, 822 Beale Street, Memphis, TN; e-mail: email@example.com. Goldie Kadushin, PhD, is associate professor, School of Social Welfare, University of Wisconsin-Milwaukee. An earlier version of this article was presented at the annual program meeting of the Council on Social Work Education, February 27, 2002, Nashville, TN.
Original manuscript received October 10, 2001 Final revision received March 12, 2002 Accepted May 7, 2002…
Questia, a part of Gale, Cengage Learning. www.questia.com
Publication information: Article title: Job Satisfaction of Home Health Satisfaction Workers in the Environment of Cost Containment. Contributors: Egan, Marcia - Author, Kadushin, Goldie - Author. Journal title: Health and Social Work. Volume: 29. Issue: 4 Publication date: November 2004. Page number: 287+. © 1999 National Association of Social Workers. COPYRIGHT 2004 Gale Group.
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