The Effects of Employment-Status Congruence, Worksite Context and Formalization on Caregiver and Recipient Outcomes in Long-Term Care

Awarded Scholars:
Candace Howes, Connecticut College
Carrie Leana, University of Pittsburg
Project Date:
Jun 2011
Award Amount:
Project Programs:
Future of Work

Direct-care workers provide the majority of paid hands-on care, supervision, and emotional support to the elderly and disabled in the United States. These paraprofessionals hold a variety of jobs—from personal care assistants, home care and home health aides to certified nursing assistants. They work in diverse settings such as private homes, adult day care centers, assisted-living facilities, hospitals, and nursing homes. The jobs of direct-care workers are poorly paid and characterized by heavy physical and emotional demands. Turnover is high and overall retention is poor. Because of the aging of the U.S. population, however, the demand for these workers is expected to grow three times faster than the average rate for all other occupations—a growth rate that will result in roughly a million new caregiver positions by 2016.

Carrie Leana (University of Pittsburgh) and Candace Howes (Connecticut College), members of the Foundation’s Working Group on Care Work, will use this award from RSF to study how current trends in the organization of long-term care—such as the growth of part-time and in-home care—are affecting outcomes for caregivers and care recipients. Their research will explore such situations as whether a job is voluntary or involuntary part-time, offered through an agency, or directly by the consumer and outcomes, and how these factors correlate with the quality of care patients receive and workers’ satisfaction with caregiving. Leana and Howes hypothesize that the effects of caregivers’ job situations on the quality of the job and the quality of care is mediated by workers’ orientation towards care work (whether it is intrinsic or extrinsic, instrumental or empathetic) and how they interpret their rights and responsibilities. This research will help develop novel tools for measuring quality of care, and it will provide rich descriptions about how job-specific and intrapersonal factors interact with one another in caregiving contexts.

The project will involve two phases: a pilot phase devoted to refining a sampling strategy and developing a new measure of care quality and a full-scale phase involving face-to-face surveys of workers representing a variety of care settings and job situations. The sample will consist of 260 front-line paraprofessional care workers, stratified by job status and by the level of formalization of their employment. Besides basic demographic data, the survey will gather information such as desired job status, current work arrangements, workplace characteristics, reasons for being a caregiver, job tenure, perceptions of fairness in the workplace, and intention to stay on the job. Leana and Howes will report results in conference papers and journal articles.


RSF: The Russell Sage Foundation Journal of the Social Sciences is a peer-reviewed, open-access journal of original empirical research articles by both established and emerging scholars.


The Russell Sage Foundation offers grants and positions in our Visiting Scholars program for research.


Join our mailing list for email updates.