Date of Award


Degree Name

Doctor of Philosophy


Public Affairs and Administration

First Advisor

Dr. Vincent Reitano

Second Advisor

Dr. Janet Hahn

Third Advisor

Dr. Robert Peters


Home health aide, aide communications, home health aide intent to leave, home healthcare


The population of developed countries is rapidly aging. People want to age in their residence, and as they advance in years, most people will need assistance with activities of daily living and perhaps medical assistance to remain at home. Home health aides provide a large portion of such care. However, the annual turnover rate of home health aides exceeds 60% due to factors such as low wages, poor benefits, and a challenging work environment. Many studies have been conducted to elucidate the factors contributing to job satisfaction in the home health aide population, yet despite decades of research, turnover among home healthcare aides continues to escalate. Employers urgently need practical, low-cost strategies to maintain staffing levels.

An avenue of research not previously studied in the home health community is the effect of communication processes on intent to leave. The nursing profession faces similar turnover issues, and researchers have identified a set of communication processes inversely related to intent to leave. Variables from the National Home Health Aide Survey (NHHAS), analogous to those identified in nursing, were analyzed to determine their effect on intent to leave. Chi-squared analysis of the study sample showed that a smaller percentage of aides who intended to leave responded that they strongly agreed with the independent supervisor variables: my supervisor provides clear instructions when assigning work my supervisor is supportive of progress in my career; my supervisor listens to me when I am worried about my patient's car; my supervisor values and appreciated the work I do as a home health aide very much; and, my supervisor respects me a great deal. The majority of aides in both groups, those not at all likely to leave their job and those very or somewhat likely to leave their job, indicated they had problems with agency staff and had received misinformation from the agency about a patient's health. Also, over 80% of aides in both groups indicated that they had problems with co-workers and supervisors. Also, most aides in both groups indicated that working with their co-workers or supervisors was not a reason to continue their current job.

Three logistic regression models, each with a different mix of variables, were developed. The regression analysis results indicated that in all three models, "My supervisor is supportive of progress in my career" was inversely correlated with intent to leave. The second significant variable in each regression was different for each question. In the base regression, "My supervisor listens to me when I am worried about my patient's care" was significantly inversely correlated with intent to leave. In the regression using the full set of supervisor variables," My supervisor appreciates and values my work" was significant, while in the full regression, the significant second variable was, "My organization values or appreciates my work." The implementation of supervisor training that increases positive interactions with aides may be an avenue to reduce turnover. Additionally, policy changes at the State and Federal level are needed to open home health aide career progression opportunities.

Access Setting

Dissertation-Campus Only

Restricted to Campus until