Did Better Jobs Better Care reduce direct care worker turnover? Monika Setia June 8, 2008 Presented at the Academy Health’s 25 th Annual Research Meeting (ARM). The authors are grateful for support from The Atlantic Philanthropies and The Robert Wood Johnson Foundation

Research Questions  Was the decline higher among providers with higher levels of intervention?  Did Better Jobs Better Care reduce direct care worker turnover rates?

Methods Analyze provider-level panel data on monthly turnover rates Compare trend in turnover after implementation with national trend Comparison group from BLS Use provider level fixed effects Control for seasonal effect Piecewise linear regression with six-month splines Compared high and low implementation groups

Data Direct care worker hiring and termination reporting data Submitted every pay period and end of quarter by each provider Data collection through online secure website Re-constructed into panel data on monthly turnover rates at each provider

Sample Size

Months of Follow Up Number of ProvidersPercent of providers 6 Months % 12 Months % 18 Months % 24 Months % 30 Months 86.8%

Sample Size Months of Follow Up Number of ProvidersPercent of providers 6 Months % 12 Months % 18 Months % 24 Months % 30 Months 86.8%

Analytic model Y it - Ŷ n = β o + β 1 T it + μ i + λ t + ε it Y it = Turnover rate for BJBC provider ‘i’ at time ‘t’ Ŷ n = Estimated national turnover rate β o = Constant term β 1 = Coefficient for the variable T T it = Months since provider participation in BJBC for provider ‘i’ at time‘t’ μ i = Provider fixed effect λ t = Month fixed effect

Monthly Change in Turnover Rates 0-6 months Coefficient (Margin of Error) 6-12 months Coefficient (Margin of Error) months Coefficient (Margin of Error) 12-Months Sample (N=92) 0.02 (±0.18)0.00 (±0.16) - 18-Months Sample (N=67) 0.03 (±0.20)0.01 (±0.16)-0.15 (±0.18)* *p<=0.1, **p<=0.05, ***p<=0.01

Estimated Monthly Turnover Rates

High versus Low Implementation Above-Median Coefficient (Margin of Error) Below-Median Coefficient (Margin of Error) Difference Between Coefficientsp-value 12- Months Sample (0.10) N= (0.10) N= Months Sample (0.06) N= (0.08) N= *p<=0.1, **p<=0.05, ***p<=0.01

Summary No evidence that BJBC affected turnover rates BJBC turnover rates not significantly different from national rates No difference by level of BJBC implementation Estimates of changes with large margins of error