Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Edward Alan Miller

Second Advisor

Kathrin Boerner

Third Advisor

Christine Bishop


The Home Health Aide (HHA) workforce is one of the fastest growing occupations in the country. Despite being a high demand field, the workforce is plagued by instability due to low recruitment and poor retention, not surprising outcomes for positions that are physically and emotionally demanding, generally low paid, with inconsistent hours. A better understanding of the factors that influence the HHAs’ job satisfaction and intent to leave the job is critical to building a strong workforce capable of providing high quality care.

This study examined the effect of job demands on satisfaction and intent to leave for HHAs as compared to Supportive Home Care Aides (SHCAs), an advanced HHA position in Massachusetts, to determine if aspects of the SHCA position, enhanced control and support, positively influence their work outcomes. Employing a mixed methods research design, the quantitative portion used generalized estimating equations (GEEs) to determine the direct and moderation effect of job demands, control, and support on worker outcomes and the qualitative portion used focus groups with HHAs to further investigate the impact of job demands, control, and support on the individual worker’s experiences on the job.

The quantitative results support a positive direct and moderation effect for control and support on worker outcomes, though the effect varied considerably by type of worker and by outcome. The qualitative results support the quantitative findings, highlighting the important role of control and support on HHAs’ overall experience on the job. The focus groups also brought attention to the many challenges of the job, including the responsibilities HHAs take on that often go beyond their job description.

This research has implications for home care policy and practice. Identifying job factors that positively influence a HHA’s job satisfaction or decision to remain on the job can greatly benefit home care agencies that are seeking to retain their workforce and attract new workers to the field. Implementing mechanisms, such as adoption of advanced HHA positions, to enhance the control HHAs have over their job and the amount of support they receive should be a priority for home care industry leaders.


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