ment (Bowers et al., 2003). Other factors contributing to worker dissatisfaction include excessive paperwork, frequent patient deaths, combative and uncooperative patients, and inadequate staffing (Cherry et al., 2007). Aides who work in understaffed facilities feel extra time pressure, which contributes to burnout and absenteeism (Bowers et al., 2000). Research has shown that job satisfaction and organizational culture are strong predictors of worker commitment to an organization (Sikorska-Simmons, 2005), and, as discussed in Chapter 4, poor supervisory relationships are a key driver of turnover (Tellis-Nayak, 2007).
Caring for older patients can be emotionally draining, especially when patients are at the end of life (Haley et al., 2003; Holland and Neimeyer, 2005; Jezuit, 2000; Viles, 2000). Moreover, the work can be physically taxing. Direct-care staff in nursing homes have one of the highest rates of workplace injury among all occupations. In 2006, according to the BLS, the rate of non-fatal occupational injury and illness involving days away from work was 526 incidents per 10,000 workers among nursing aides, orderlies, and attendants (BLS, 2007a). This was four times the average rate among all occupations and was a higher rate than found among either construction workers (488) or truck drivers (411). Fifty-six percent of injuries and illnesses among direct-care workers were directly related to patient interaction, and 86 percent of these injuries and illnesses were due to overexertion. Nursing aides, orderlies, and attendants also had the highest rate of musculoskeletal disorders among all occupations examined.
Among personal-care aides, the documentation and treatment of on-the-job injuries is impeded when aides change employers, which can affect an individual worker’s ability to access worker’s compensation benefits (Scherzer, 2005, 2006b). In addition, the rate of injury to personal-care aides may be severely underestimated, largely because independent providers are generally ignored by current surveillance mechanisms.
In 1996 the IOM recommended that all personnel who provide direct care (especially in nursing homes) should receive annual training in lifting and transferring patients. The committee also concluded that hospitals and nursing homes should develop effective programs to reduce work-related injuries (IOM, 1996). Chapter 6 of this report identifies a number of technologies that have been developed to assist both direct-care workers and informal caregivers in performing some of the physically demanding tasks that are involved in caring for older adults.
Finally, trends in the care of older adults, such as the movement toward more home-based care, can affect the job environment for these home- and community-based workers. For example, as more workers are hired directly by patients under consumer-directed models of care, home-care workers may have to contend with a more ambiguous situation in terms of their lack of supervisory management. This in turn can make it less likely that these