Academic journal article Australian Health Review

Impact of Organisational Characteristics on Turnover Intention among Care Workers in Nursing Homes in Korea: A Structural Equation Model

Academic journal article Australian Health Review

Impact of Organisational Characteristics on Turnover Intention among Care Workers in Nursing Homes in Korea: A Structural Equation Model

Article excerpt


In Korea, the aging population is growing faster than anywhere else in the world. The proportion of people aged >65 years exceeded 7% in 2000, and this number is expected to be >14% in 2018. Furthermore, this percentage is expected to be >20% by 2026, a value indicative of a super-aged society.1 This 26-year time span from an aging society to a super-aged society is very fast compared with the 36, 94 and 154 years predicted for Japan, the US and France, respectively.2

The Korean government implemented long-term care insurance on 1 July 2008 as a social insurance similar to that in Japan and Germany. Through this insurance, older people who cannot maintain their daily activities due to their old age or chronic disease are provided nursing service benefits. This nursing service is provided primarily at nursing home facilities. Before the introduction of this insurance, in June 2008, there were 1332 nursing homes in Korea; by December 2010, this number had nearly doubled to 2429.3

Most services at Korean nursing homes are performed by care workers. Over 100 000 care workers currently work at nursing homes and account for over 80% of nursing home employees.4 However, because wages are low, the work environment is poor and the services provided are labour-intensive and considered suitable for unskilled workers, care workers face mental and physical difficulties and experience a high level of stress and turnover.5 Studies carried out in the USA and Israel have also reported very high turnover rates for care workers. These studies reported turnover rates between 74% and 100% per year overall and a record 400% at some nursing homes.6

Turnover intention is one response to job satisfaction that is characterised by a desire to switch from the current company to another company.7 Job satisfaction is inversely related to turnover intention.8 Factors that affect turnover intention include jobrelated factors, work groups and human resource management systems. Accumulating research suggests that the adoption of high-performance work practices (HPWPs) is related to an organisation's performance.9 HPWPs include incentive compensation, training, employee participation, selectivity and flexible work arrangements.10 These practices increase employees' knowledge, skills and abilities (KSAs), empower employees to leverage their KSAs for organisational benefit and increase employees' motivation to do so.11,12 The result is greater job satisfaction, lower employee turnover and higher productivity, all of which help improve organisational performance.13

The turnover of care workers has a direct negative effect on the health of frail elderly residents at nursing homes, as well as on the efficiency of nursing home services in general.14 Research on nurses has shown that turnover among nurses increases their colleagues' workload and stress, and has an adverse impact on the amount and quality of nursing care due to a shortage of nurses. At the organisational level, administrative costs are increased because of expenses associated with the recruitment and training of new employees.15 Therefore, reducing the turnover of care workers is very important in managing the health of elderly residents as well as in effectively managing nursing facilities. Thus, the present study was designed to analyse the organisational factors, especially HPWPs, affecting the turnover intention of care workers at Korean nursing homes using a structural equation model. Unlike more advanced Western countries that are in the mature phase of long-term care system development, Korea is in the initial stages. As such, Korea's experiences can provide valuable information for many developing countries that will have to contend with an aging society in the near future.

Materials and methods

Data collection

We chose a random sample of 14 nursing homes in Seoul and Gyeonggi Province, Korea, with a capacity of more than 50 elderly residents and whose administrators agreed to participate in the study. …

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