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caring labor, compensation and benefits, contract labor, employment security, home health aides, home health care quality



  1. Ranucci, Rebecca
  2. Berry, Daphne


Background: The number of home health care organizations has grown, and the number of home health aide jobs is among the fastest growing, drawing attention to the home health care industry. Despite increased transparency into the quality of care delivered by home health care organizations, less is known about how organizational work practices directed at home health aides, who work remotely on the frontlines of providing caring home health services, impact quality.


Purpose: We examine how an organization's benefits and compensation practices for home health aides, as well as changes to home health aide employment security within the organization, impact the quality of care delivered by home health care organizations.


Methodology: We conduct a large-scale longitudinal archival study of Medicare-certified home health organizations using a fixed-effects specification to test the effects of home health aide benefits equality and compensation on the quality of patient outcomes within home health organizations. In addition, we use the proportion of contract home health aides to test moderating effects of employment insecurity.


Results: Benefits equality positively impacts quality, whereas compensation has a negative relationship with quality. However, when an organization increasingly utilizes contract aides, the positive effect of benefits equality on quality is weaker, whereas under these same conditions, compensation has a positive relationship with quality.


Conclusion: Compensation and benefits practices impact quality, and the effect these practices have on quality varies under conditions of employment insecurity created by the organization's use of contract home health aides.


Practice Implications: Home health organizations should employ a nuanced approach to improving quality, increasing compensation to permanent home health aides when the organization increases their use of contract home health aides and equally distributing benefits to home health aides when the organization does not rely as heavily on contract home health aides.