Substantial Differences in Turnover Intention Between Direct Care Workers in Chinese Hospitals and Long-Term Care Facilities

Abstract

Objectives: High retention rates among direct care workers (DCWs) affect the quality of aged care. However, limited research has explored factors associated with retention in China's aged care industry. This study compared turnover intention among DCWs in Chinese hospitals and long-term care facilities (LTCFs).

Design: A cross-sectional survey with the stratified-random sampling method.

Setting and participants: A total of 370 DCWs from 7 hospitals and 311 DCWs from 7 LTCFs located in Fujian Province, China, were surveyed.

Measures: Turnover intention, contractual status, income, sociodemographic characteristics, and other work-related factors were self-reported by surveyed DCWs.

Results: Approximately 80% of DCWs in hospitals had employment contracts, whereas only 9% of DCWs were contractual in LTCFs. DCWs from hospitals reported lower turnover intention (20.5% vs. 37.0%) than did DCWs from LTCFs. Contracted DCWs from hospitals had the lowest turnover intention (14.8%). Contracted and noncontracted DCWs in LTCFs were more likely to report turnover intention than hospital contracted DCWs (odds ratio [OR] 3.68, P = .008 and OR = 3.17, P < .001, respectively).

Conclusions and implications: Contractual status and facility type were jointly associated with turnover intention of DCWs in China. DCWs in LTCFs were likely to report much higher turnover intention than contracted DCWs in hospitals. The expanded use of employment contracts may lower turnover intention in long-term care DCWs by improving their job stability and security. The labor market of DCWs needs to be regulated by the Chinese Labor Law.

Keywords: China; Turnover intention; direct care worker; long-term care.