1 Did Better Jobs Better Care Improve Direct Care Worker Job Outcomes? Brigitt Heier June 8, 2008 Presented at the annual meeting of AcademyHealth. The authors are grateful for support from The Atlantic Philanthropies and The Robert Wood Johnson Foundation.

2 Data Source: Direct Care Worker Survey Questions measuring – Job rewards – Job problems – Perception of job quality – Turnover intention Response rates: – Time 1: 50% – Time 2: 42% Weighted to adjust for non-response 2

Samples Excluded Direct Care Workers if: – They worked at providers who did not return surveys at both time periods – More than 25% of survey items missing Repeated cross-section sample size (weighted) – Time 1: 2,532 – Time 2: 1,920 Panel sample size: 1,174 3

4 Methods for Estimating Effects Time 2-Time 1 difference in means Difference-in-differences between above and below median implementers Both methods applied twice –Repeated cross-section –Panel 18 outcomes assessed; both scales and individual items

Difference in Means Results 5

Overview: Repeated Cross-Section Differences were very small Only 3 out of 18 measures were statistically significant All three were contrary to BJBC intent 6

7 Perception of Job Quality Outcome Mean Time 2 Mean Time 1 Mean Differencep-value Job Satisfaction **0.02 Career Job Self Efficacy (scale) Recommend Organization for Job Recommend Organization for Care ** p<.05

8 Job Rewards Scales Outcome Mean Time 2 Mean Time 1 Mean Differencep-value Recognition *0.10 Peer Support Helping Others Decision Authority Satisfaction with Pay Challenge * p<.10

9 Job Problems Scales Outcome Mean Time 2 Mean Time 1 Mean Differencep-value Discrimination Hazard Exposure Overload Travel for Work Dead-end Job

Turnover Intention Outcome Mean Time 2 Mean Time 1 Mean Differencep-value Intent to Leave Think about Quitting * * p<.10

Overview: Panel Sample Results followed a pattern similar to the repeated cross-section analysis Differences were slightly bigger 8 out of 18 differences were statistically significant, all contrary to BJBC intent 11

Difference-in-Differences Results 12

Repeated Cross-Section No significant differences between above and below median implementers 13 Implementation Index Mean Time 2 Mean Time 1 Mean Differencep-value Above Median Below Median **0.05 Difference-in-difference ** p<.05 Example: Recommend Job

Panel Only one significant difference between above and below median implementers 14 Implementation Index Mean Time 2 Mean Time 1 Mean Differencep-value Above Median Below Median ***0.01 Difference-in-difference *0.10 * p<.10; *** p<.01 Recommend Job

15 Summary No evidence of intended BJBC effects on job outcomes Mean differences were: – Small in both repeated cross-section and panel samples – Significant findings were contrary to BJBC intent Difference-in-difference were: – Small in both repeated cross-section and panel samples – Only 1 out of 18 outcomes were statistically significant