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 = -. …