Introduction

Population ageing is becoming a global phenomenon. According to the World Health Organization (2021), the number of people aged 60 or over increased from 1 billion in 2020 to 1.4 billion in 2021 and will reach 2.1 billion, or 21.3% of the global population, by 2050. Just under one-fifth of the UK population (19% or 12.3 million people) were aged 65 or over in 2019. This number is projected to grow to 24% of the population (17.4 million) by 2043 while the proportion aged 85 or over is projected to rise from 2% to 4% (UK Parliament, 2021). This growing older adult population requires an increasing number of caregivers—whether in people’s homes or in a residential setting, and whether formal paid care or informal unpaid care provided by family members, friends and volunteers. As far as social interventions are concerned, older people should be specifically targeted by social support. (Horn et al., 2023) In England alone, the number of adult social care jobs needed to service the needs of the older population increased by 21% between 2009 and 2017 to approximately 1.6 million, and this number could possibly increase by 40% to around 2.25 million by 2035 (Fenton et al., 2018).

The Department of Health and Social Care (2021) points out it has to make sure that “the health and care system workforce has the right skills and the right number of staff in the most appropriate settings to provide consistently safe and high-quality care”. The emergence of domiciliary care services and the employment of direct caregivers are two ways of coping with the ageing crisis (Boris and Klein, 2006; Novak, 2018) which have been widely adopted, albeit to different degrees, by most countries (Fenton et al., 2018). However, the retention of caregivers has proven to be generally problematic worldwide (National Care Forum, 2014). Compared with other roles within social care, caregivers have low job satisfaction, and this is one of the main reasons for the high turnover in the industry. High turnover increases the costs of caregivers and their clients and has a significant influence on the healthy development of the long-term care industry.

This study focuses on paid caregivers who work for professional care agencies and help clients in their own homes. It explores the factors which affect the job satisfaction of paid home caregivers, asking ‘What shapes the job satisfaction of paid home caregivers?’, with a particular focus on organizational factors. Following this introduction, the literature review explores the extant references to these factors before moving on to the methodology which introduces the research design and data collection. A detailed account of the factors that affect the satisfaction of caregivers in practice is then given before ending with a discussion and conclusion.

Existing relevant research

This research aims to understand what shapes the job satisfaction of home caregivers, with a particular emphasis on relevant organizational factors. We reviewed the most relevant literature, starting with the newest and working back. This part first reviews existing research on the negative influences of low job satisfaction in order to further emphasize the importance of the research question. It then reviews some studies on factors influencing job satisfaction which offered some starting points for this study. In this part, theoretical perspectives are discussed and integrated with relevant literatures.

Low job satisfaction results in negative influences

The caregivers in these studies are either people working for a care organization or a self-employed person with professional skills to care for people. These caregivers help people—who are usually disabled, older adults, or those living with a mental disorder or disease—with day-to-day activities. This home care can include help with daily activities such as dressing and bathing, assistance with safely managing tasks around the house, companionship and, sometimes, also short- or long-term care relating to an illness, disease, or disability. These carers are not nurses or doctors but have undergone training to work as carers.

Home care is an increasingly popular means by which support is provided for older people and people with long-term health conditions. It has been particularly welcomed by policymakers, since it is less expensive than caring for people in hospitals or residential homes (Keefe et al., 2011). Home care is also popular with individuals who would like to be looked after in their own homes for as long as possible in their old age (Wiles et al., 2012). As the population ages, our society needs more caregivers, yet, as far back as 2004, Seavey noted that a significant number of caregivers were leaving their positions. Almost twenty years later, the position is worse. In the UK, care sector staff numbers fell by about 42,000 between April and October 2021 alone, exacerbating the sector’s problem of staff shortages (Palmer, 2021).

Caregivers are key because they provide the majority of hands-on residential care, yet home caring is assumed to be a low-skilled job (Barken et al., 2015). If individuals’ expectations at work are not fulfilled, dissatisfaction will be prevalent (Best and Thurston, 2004). There is a direct relation between job dissatisfaction and undesirable work behaviors, and caregivers’ job satisfaction is directly related to their turnover and the quality of service that they provide (Irvine and Evans, 1995).

Howes (2005) found that in the early 2000s the turnover rate for home caregivers in the UK was about 32%. Stone with Weiner (2001) point out that in the US the annual turnover rate is particularly high among long-term caregivers at about 50%. By 2019, the US caregiver turnover rate had reached 64.3% according to Home Care Pulse (2021), and continued to rise, reaching 65.2% in 2020.

In the long-term care arena, caregiver turnover increases costs for stakeholders in the care industry (including the agencies who employ the caregivers), clients and government. Staff leaving results in the expense of recruiting and training replacements (Stone, 2004; Mittal et al., 2009; Butler et al., 2012). Given its widespread knock-on effect, the industry (and its clients) would benefit hugely from an enhanced understanding of the factors affecting caregivers’ job satisfaction. Enhanced job satisfaction would not only reduce the number of caregivers quitting their jobs, but would also improve the quality of care and patient outcomes (Verbeek et al., 2010; Suhonen et al., 2013).

The costs of agencies that provide long-term care are driven up partly by having to recruit and train new staff as well as compensation payments to staff leaving as a result of injuries. High turnover leads to lower work effectiveness by disrupting teamwork and workers might suffer difficulties owing to a lack of experienced colleagues (Seavey, 2004). Also, the clients have to adapt when new caregivers come to work in their home, which some might find difficult. Thus, a high staff turnover rate has a negative influence on both the financial running of the care agency and the quality of care that long-term clients receive.

The people who are cared for and their family members may also suffer from stress and anxiety as a result of caregivers’ low job satisfaction (Castle and Engberg, 2005) owing to the disruption brought about by their negative emotions (Dawson and Surpin, 2001). In 1989, Tellis-Nayak and Tellis-Nayak pointed out that it was common to see reports about the poor quality of care given to elders and the difficult work undertaken by caregivers. Three decades later, Chamberlain et al. (2016) described the same issue. They found that low job satisfaction leads to inferior job performance, negatively impacts the quality of care received by clients and is associated with increased staff turnover. Stone et al. (2017) discussed factors related to the predictors of intent to leave the job among home health workers and pointed out that a high turnover rate increased pressure on the remaining staff who have to take on the workload of the departing carers. Powers and Powers (2011) find that caregiver turnover is a continual problem in the long-term care industry, and one of the main reasons is low wages. Both intrinsic and extrinsic factors of job satisfaction were significantly associated with the retention of home care workers.

Factors influencing job satisfaction

Studies have revealed that a high turnover rate in caregivers results in both a decline in the effectiveness of an organization and a reduction in the quality of care for older people. In addition, there is a negative association between the low job satisfaction of caregivers and the quality of care provided (Castle et al., 2007; Mittal et al., 2009).

Factors influencing job satisfaction can be divided into different types based on the work of different scholars. Herzberg et al. (2017) argue that there are two dimensions to job satisfaction—motivation and hygiene. The latter includes company policies, supervision, interpersonal relations and working conditions. Although these hygiene factors, which make up a significant part of the employee’s environment, cannot motivate employees, they can minimize dissatisfaction. In contrast, motivational factors can create satisfaction by fulfilling employees’ needs—such as for their personal growth. They are related to topics such as achievement, recognition and responsibility (Herzberg et al. 2017). Once the hygiene factors are addressed, the motivation factors will promote job satisfaction. In addtion, there is an important gaps in the opportunities for professional development and career planning for caregivers (Fitzpatrick et al., 2023). Also, individuality in the care provided, knowing the client, staff-to-resident communication and staff-to-staff communication can all influence caregivers’ job satisfaction (Suhonen et al., 2013).

Aloisio et al. (2021), in their study of long-term care facilities, recognize that factors associated with job satisfaction can be divided into individual and organizational. The former include age, health status, self-determination, psychological empowerment, job involvement, work exhaustion, and work stress; the latter comprise facility ownership, supervisor and manager support, staffing level, and social relationships. Organizational factors were identified as less influential regarding job satisfaction whereas relationships with residents were key factors.

Unlike Aloisio et al., some scholars believe that organizational factors play an important role. Suhonen et al. (2013) write that one of the means to promote caregivers’ work satisfaction occurs at the organizational level and Hussein et al. (2016) state that organizational and work factors are considered to have the greatest influence on job satisfaction. Being supported by the organization is particularly important: a certain degree of empowerment (Bowers et al., 2000) and positive respect from supervisors (Mittal et al., 2009) have been shown to improve job satisfaction. Effective work aids which support caregivers’ capacity and make the job easier could increase their job satisfaction. Working with a supportive or good-quality supervisor is associated with high job satisfaction among caregivers (Radford et al., 2015), as is positive feedback from supervisors (Van Waeyenberg et al., 2015). Employer factors that could increase job satisfaction include leadership, culture, social capital and organizational staff (Chamberlain et al., 2016). The effect of good supervisory support on intent to leave is partially mediated by job satisfaction (Bethell et al., 2017). Thus, organizational contexts should be examined and included in attempts to improve the work environment of caregivers and quality of care (Chamberlain et al., 2016). In addition, workers employed by for-profit companies are more motivated by non-monetary factors than workers at non-profit and public organizations (Kato, 2022).

Low pay for caregivers is another important reason for low job satisfaction (Chou et al., 2011). Care work is considered as low-skilled, with limited opportunities for career progression. With limited funding, providers and commissioners have to prioritize provision of care in the short term over offering long-term support to their staff in terms of their career development (Morse, 2018). For caregivers, the main factors through which they judge the value of their job include salary (Morris, 2009; Baughman and Smith, 2012), benefits (Butler et al., 2014), and pension and paid time off (Rosen et al., 2011). In addition, sensitive personalities and long working hours are also major influencing factors for depression in carers, in particular among elderly caregivers (Yang et al., 2021). Caregiver satisfaction was a significant predictor of turnover as there is a higher incidence of turnover when wages and job satisfaction are low (Cymbal et al., 2022).

Some factors that are an inherent part of the job also influence job satisfaction. Threats to safety, such as the potential for violence and injuries, as well as abuse at work, decrease job satisfaction (Sherman et al., 2008; McCaughey et al., 2012). Stone et al. (2017) found that being assigned not enough/too many work hours has a detrimental effect on job satisfaction while Chou et al. (2011) found that lengthy commutes between clients (almost always unpaid) had the same effect. Job pride, benefits and workload are considered the most influential factors in determining the job satisfaction of caregivers (Castle and Engberg, 2006). The lack of perceived personal control was another main factor reducing the job satisfaction of caregivers for older adults (Nieto et al., 2022).

Personal characteristics may also affect the level of job satisfaction. These include education and age (Butler et al., 2014), race and ethnicity (Rosen et al., 2011) and, possibly, immigration status (Sloane et al., 2010). The family situation of caregivers is also relevant: for example, the personal cost of leaving a job could affect intent to leave. Those with fewer family responsibilities are more likely to have higher job satisfaction: a job that provokes family conflicts is an important driver of job dissatisfaction (Mittal et al., 2009). More generally, emotional distress is a significant factor influencing the job satisfaction of caregivers (Rosen et al., 2011). Other personal variables that have been found to potentially influence job satisfaction include family income and support (Chou et al., 2011), and resilience and optimism (Nieto et al., 2022).

It should be noted that, of the studies in the existing literature which explore the different factors influencing the job satisfaction of caregivers, only a limited number focus on paid caregivers who work for agencies but help clients in their own homes. More studies with this focus are needed to understand caregivers’ perspectives and to explore how caregivers interpret their experience and situations. This type of study can show how things have developed, especially when in complex and sensitive environments. As a result, it can more precisely ascertain the factors which shape the job satisfaction of home caregivers.

Methodology

Data collection

We used a qualitative explorative research methodology to explore the factors that influence the job satisfaction of home caregivers for the following reasons. First, since job satisfaction might mean different things to different people, it is not practical to use one standard to measure the factors that different people have experienced. Second, different people might have different experiences at work. These experiences usually involve different contexts and result in different outcomes. In order to explore these unique experiences, it is better to interview participants one-on-one.

Semi-structured interviews were used to collect data from the 21 UK participants (Table 1). This format was chosen as it allows flexibility by using open-ended questions asking, for example, ‘how’, ‘what’ and ‘why’ (Yin, 2013; Agarwal, 2020). It not only gives space for interviewees to answer the questions (Liu, 2018), but also for them to inject new ideas (Merriam and Tisdell, 2016). The interview method is an important channel to understand social reality through the opinions of the people experiencing the issues being researched (Seidman, 2013). Its goal is to allow the researcher to understand, from the participants’ perspective, their thoughts about how people have organized the world and how they understand what goes on around them (Taylor et al., 2015). Mears (2009) considers six to nine informants to be sufficient if the researcher wishes to understand questions deeply. Following Mears’ suggestion, we planned to interview at least nine informants but left the door open to extra informants who could provide useful data for this study.

Table 1 Participant information.
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As the extant literature has established some themes in the factors that shape the job satisfaction of home caregivers, this study incorporated a number of questions related to them, while still making sure that the order of the questions was kept flexible to take into account the possible different backgrounds of informants. The questions focused on: how the informants understood their work; which factors from their work affect their satisfaction; how they had been trained in their work; how they get along with their clients and clients’ families; what their hobbies are; whether they think the interests of their clients are important; as well as whether their own voices are heard by the people who can help to improve their working conditions. Please see interview questions in Table 2.

Table 2 Interview questions.
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The interviewees invited to participate were home caregivers who provide a care service for older people. The definition of a home caregiver in this study means a person associated with a formal service system as a paid worker. This differs from family or informal carers such as relatives, partners, friends or neighbors who have a personal relationship with the older adult for whom they are caring and to whom they provide a broad range of assistance.

Although we do not have experience of working as home caregivers, two of the authors had worked in care house as volunteers for three months. This experience is helpful for us to conduct this research as partly we are insider to understand work of caregivers but also outsider to keep some distances (Liu and David, 2022). Overall, two methods were used to access potential informants in 2020: friends’ introductions by snowballing and finding interviewees online. One colleague introduced his friend who had worked as a caregiver for over ten years. This lady introduced two of her colleagues, who each introduced a further two people. Potential participants were also sought online in which 152 emails were sent to people who stated on Linkedin and Facebook that they were caregivers but only 16 replied. After sending the interview questions, 12 said they were happy to do the interview, but 4 then canceled the appointment without giving any reason. In total, we interviewed 21 caregivers: 15 females and 6 males; the oldest was 72 and the youngest was 21. Among them 1 holds a Master degree, 4 have Bachelor degrees and the other 16 had completed A-levels (the UK equivalent of graduating high school at the age of 18). The length of time that they had been working as caregivers ranged from two to more than ten years.

The interaction between interviewees and the researcher has a significant influence on the data quality (Schensul, 2012), particularly in intercultural research (Liu and Burnett, 2022). Well-informed informants are more likely to provide their opinions (Yin, 2013). All interviews were recorded, and this allowed us to concentrate on the responses and exploration of questions, rather than making notes during the conversation. All the interviews were carried out face-to-face and one-to-one in a private and quiet place chosen by the interviewees.

In order to ensure that the participants fully understood their rights in this study, a consent form, information sheet and topic guide for the interview were given to them before the interview. All participants were informed that they could withdraw from the research at any time and without having to give a reason and that the data would only be used in this study.

Data analysis

Merriam and Tisdell (2016) explain data analysis as the process of understanding the meaning of the data in order to answer the research questions. It is the process of interpreting data and writing reports about it. In this study, we used thematic analysis to analyze the data. Guest et al. (2012) propose using thematic analysis to identify themes from the words in the data text, identifying both explicit and implicit ideas.

Thematic analysis is one of the most common forms of data analysis in qualitative research. It enables researchers to increase their accuracy in interpreting data (Boyatzis, 1998) as themes are identified beyond the actual words and ideas present in the data (Guest et al. 2012). This study used Braun and Clarke’s (2006) six phases of thematic analysis: becoming familiar with the data; generation of initial codes; combining codes for themes; reviewing these themes; naming the themes; and producing an analysis report. As one of the authors carried out all the interviews, he had a rough understanding of the data. All interviews were transcribed and differences regarding the meaning and significance of the data were comprehensively discussed and agreed upon by the authors which enabled a thorough understanding of the data. After the transcription, we reread the transcripts. This meant that we immersed ourselves in and further familiarized ourselves with the data. The first task was to generate codes from the data using NVivo qualitative data analysis software. The software generated a set of codes directly from the text. These codes were then reviewed and combined into a number of themes. The difference between a theme and a code is that a theme is broader (Braun and Clarke, 2006) and usually includes a number of codes (Fereday and Muir-Cochrane, 2006). It should be noted, however, that sometimes the term for a code also works as a theme. For example, the codes ‘workload’ and ‘managers’ can also work as themes.

Above, Table 3 presents the themes from the data. All the themes were numbered, and the interviewees assigned letters: A, B, C, etc. Thus, A1 indicates data from the first participant about the first theme, and C3 refers to data from the third participant about the third theme.

Table 3 Themes from data analysis.
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Visible factors

This section explores the tangible and observable aspects of daily interactions that significantly impact caregivers’ job satisfaction. This segment delves into the direct encounters between caregivers and their clients, highlighting how these interactions shape the caregivers’ sense of accomplishment and fulfillment. By examining real-life examples from caregivers, the illustration will unfold around the profound influence of client happiness on caregiver satisfaction, the critical role of supportive family dynamics, and the significance of training and management in enhancing job performance. This comprehensive exploration aims to provide a clear picture of how visible factors contribute to the overall job satisfaction and effectiveness of caregivers in their professional environment. Factors and suggestions influencing the job satisfaction of caregivers shown in Table 4.

Table 4 Factors and suggestions influencing the job satisfaction of caregivers.
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Daily interaction with clients

For all interviewees, their clients are intrinsically linked with their level of job satisfaction. They all highlighted their sense of enjoyment when they could see that their work had improved their clients’ quality of life. “For me, I particularly like it when my client is happy, and I liked when they would chat, even if it was just five minutes” (Interviewee B3). Another said,

I like making them laugh and smile. I like to see that they feel at ease and like making them know that these people around them really care about them. (Interviewee C3)

All interviewees said that the high point of their work is to see their client is happy. In particular, if the person they look after responds well to them, they feel their work is valuable and appreciated.

My boss said, ‘Well done. The family are very happy with what’s going on’. I’m glad to hear that because I want my clients, the elders, to be happy. I’m the sister in their life when they can’t look after themselves. (Interviewee E3)

For caregivers, looking after somebody is an interactive process. Usually only the caregiver and the person who needs to be looked after are in the house. All interviewees stated that improving their clients’ quality of life is their work goal and that they felt satisfied when they saw how their work had helped the clients:

You think about what you’ve done that day. You take a deep breath, and you start again the next day. But if the things I achieve makes it a little bit extra special for the client, I find that I really enjoy that. (Interviewee R3)

For many clients, their caregivers are the people to whom they feel closest, as they are part of their daily life. Feeling connected is a significant factor in improving the quality of life for these vulnerable people.

If they’ve got no family, the happiest part for them is when you walk in that door and say ‘How are you? It’s raining outside’. You give them an insight as to what’s going on outside the door, even if they can’t get up and walk around to go out. You might be the only person they see that day. (Interviewee H3)

When you visit them, they’re happy just for you to be there. They just want to talk and they don’t always want an answer. You might be the only person they see that day so it’s important to have that. (Interviewee D3)

Providing company is one of the key aspects of looking after people. For many of these clients, to have somebody visiting them and talking with them was an important part of their requests.

The thing that makes me unhappy is that their families don’t come and visit. Their relatives – brothers, sisters, children, grandchildren – they just left. There isn’t even a phone call. (Interviewee G3)

Support from the client’s family is another factor that influences caregivers’ job satisfaction. Caregivers visit and work at their client’s home and they understand the living conditions of different families. To have the support of, and a good relationship with, the client’s family has a huge influence on their satisfaction at work.

One participant said that, for people who need to be looked after, nearly every day is the same. With the longevity of the relationship, they have a human connection with their clients. Therefore, job satisfaction can be affected by the conditions of their clients.

When there is little satisfaction in a job in caring, this has the potential to affect your mood – and this could be passed on to the client, either by distraction or anxiety that things aren’t ok for client. (Interviewee F3)

Caregivers work directly with their clients and when there is little satisfaction in a job for caregivers, they are likely to express their emotion in their daily work, which will affect their service quality.

Agency management

Some participants regard appropriate training as having an important influence on their job satisfaction. This training gives caregivers the confidence to do their job properly – in particular how to handle people they need to look after physically.

The training I had is the key part of the job I am satisfied with. When you’re dealing with somebody that is bed-bound and cannot move, and they give you specific training on how to handle that situation. (Interviewee E2)

They trained us all the same. If somebody is sick, or has a day off, that means the client gets somebody else. The replacement is able to do the same job as the regular carer so they would get used to other people coming in, as well as having their regulars come in. (Interviewee T2)

As clients’ situations and needs are subject to change and the challenges of the work may increase, some participants hoped that their agency would provide further training to increase their capabilities. However, for some experienced caregivers the training was not particularly important when it came to job satisfaction:

I know exactly what to do. I wouldn’t really need any more assistance from them now because I know what to do. For a new carer, that’s a different thing and they, of course, need that. (Interviewee J2)

A caregiver’s relationship with the line manager who keeps in daily contact with them is another factor that influences their job satisfaction. Usually, participants regard these managers as representatives of the agency. When they have issues at work, they communicate with the managers. If these managers are considerate and do their best to respond the requests of caregivers, they tend to be satisfied in their job.

In a big organization, you have what they call market managers, the area managers. It is important to air these things to the boss or suitable person so that issues can be talked about openly. (Interviewee G2)

If you’ve got a problem, some managers will listen and take it on board. But if you’ve got a manager who’s not going to listen, then frustration does become a problem. (Interviewee M2)

In the interviews, participants said that they understood that they could not always have everything they want from the agencies, but if the managers have a positive attitude and are open to trying different strategies to deal with their requests, caregivers feel their voices are heard. If they felt unheard and unsupported, however, the caregivers would be disappointed:

For me, relationships always affect me, and so if there are difficult relationships or lack of understanding in the company then I am quite affected and need to sort it out so I can work in a relaxed way. (Interviewee F2)

Communication between caregivers and their managers is important. As one participant said, “The more you can get your staff involved in sharing ideas, the more people own things and want to do a good job” (Interviewee H2). Being listened to and understood is appreciated by the caregivers, and friendly and supportive relationships among colleagues are helpful in building a relaxed working environment. Staff members who lack job satisfaction may leave and, if the turnover is high, this may result in the agency having a bad reputation in the industry.

If you don’t get satisfaction after you talk with the manager, that company does not have any compassion for the staff. Which means they’re going to lose good staff. Good staff will say, ‘Right, fair enough, we’ll go’ and then they’re [the agency] just left with the ones not doing the job properly. (Interviewee Q2)

Staff would prefer to talk problems through with the company but if they feel they are not listened to, they might leave their position. Thus, managers can play a significant role in keeping staff turnover low through enhancing job satisfaction.

Workload and pay

Typical caregivers’ duties can include managing medications or talking to doctors on their clients’ behalf, helping them bathe and/or dress, doing household chores and preparing meals. Caregivers working together on different shifts to look after elders is one way in which the agencies allocate work. How the organization arranges and allocates shifts was one of the key issues brought up by the participants. “I went to the client but the agency had changed my shift and hadn’t told me. That made me dissatisfied with them” (Interviewee D1). Another participant complained that:

You never ever feel like there is any job satisfaction because you’re just tired. They often ask if you can do another three hours and they want you to be at the next job in five minutes. (Interviewee S1)

Different agencies offer different shifts and arrangements but caregivers (as well as clients) prefer to work with regular clients rather than a constant rotation of different clients.

I don’t like it when I’m sent to lots of different people instead of having regular clients. (G1)

Many clients do not want to see all these different faces coming in all day long and they feel very confused. Different carers come on shift and then the client has to explain everything again. (Interviewee A1)

Most caregivers usually earn only the national minimum per hour wage or slightly above, which the participants regard as being low for the work they do. Sometimes, heavy workloads made carers feel less satisfied: “I looked after a husband and a wife, but the agency only paid me for one person and what can I say? I need this job” (Interviewee K1).

If only a few regular carers are involved with one client, things are more likely to work smoothly as they get to know each other well. Interviewees were particularly dissatisfied with their workloads and the organization’s method (or lack) of scheduling and workload. Pay rises were reported to be a common request and some informants reported that their work had become harder and more intense but this had not been reflected in their pay.

Invisible factors

This section delves into the less tangible but equally pivotal elements that influence caregivers’ job satisfaction. This section uncovers the psychological and emotional underpinnings that govern caregivers’ experiences. Through personal testimonies and analytical insights, it explores how these invisible factors profoundly affect caregivers’ morale and performance. The content here aims to shed light on the complexities of caregivers’ emotional landscapes, highlighting the crucial need for a supportive work environment that acknowledges and addresses these often-overlooked aspects of their roles.

Sense of belonging

Many participants said that a sense of belonging was important to them. Working for an agency gave them a sense of belonging which they felt was safer than being self-employed as they had the security of back-up when they were out working on their own.

If you’re not too sure, always phone and check so there’s always backup for you. You just go to your nearest supervisor, or the nurse that you know to ask for help. (Interviewee P5)

Participants said that support from the agency is important to their satisfaction with their work, in particular when they are unsure what to do should new situations arise in their work.

When you’re working for an agency, you’ve got the support. If something goes wrong, you can phone them and they can either talk you through it or tell you what to do. (Interviewee I5)

This support from the agency makes carers feel that they have the support of a team behind them.

It has a system of care plans for when we log in. This allows each carer to know exactly what to do and it is detailed so that it gives a sense of security. There is a clear record of the visit and any concerns. (Interviewee F5)

A sense of security was mentioned by many participants who felt that this was an important factor in their job satisfaction. Carers’ daily work is usually mobile and, as a result, they rarely meet or communicate: ‘As I am coming on a shift, other workers are leaving” (Interviewee A5). However, different agencies might have different situations and one participant said he had worked with friendly teams. Some agencies arrange for caregivers to meet up periodically and the effects of this can be different. While some caregivers might like to be connected and enjoy networking activities, others do not consider this of importance. “I haven’t gone to ‘get together days’ because going to see some people once or twice a year will not change anything” (Interviewee L5).

In terms of practical training, caregivers usually learn from the daily practice of their work and from each other.

Some nurses who became friends are excellent, and they would teach me things, such as how to dress bed-bound people and everything so I could be a better carer. (Interviewee U5)

Feeling respected

Participants expressed that they are often undervalued and do not receive enough respect from the agency, although many of them believe their work is important in a society in which an increasing number of people need to be looked after.

They don’t acknowledge your efforts at work. They check on us when they find out that you haven’t worked for a week. And they’ll call and say ‘By the way, how come you didn’t work for a week?’ That’s all. (Interviewee L4)

Treating staff well is an effective way of reducing turnover. If the agency does not treat its staff well, caregivers will leave their positions, resulting in staff shortages.

The person who owns the company, she values her staff and therefore tries all ways to listen to and understand her staff. This makes the environment more relaxed and we are happy about it. (Interviewee S4)

If a staff member leaves, the agency usually needs to find a new caregiver to replace them. When the new caregiver starts, the clients might not be happy about the change. “High staff turnover upsets the clients because they get used to a certain person” (Interviewee C4). Given the cost of hiring new staff and the preferences of the clients, high turnover rates increase the costs of the agency.

Carers are undervalued but they need to focus on many different things and be so observant in order to deliver quality care to the most vulnerable people. They need to be looked after and ensure that there are no stresses building up and that they are able to share any concerns. (Interviewee D4)

Making caregivers feel that they are respected and that their work is appreciated is important. Some participants said it is rare to get positive feedback from their agencies or managers and this makes them feel disappointed. Some also do not get enough support from the agency when they need help.

Discussion

Overall, the data mainly demonstrates that factors controlled by the agencies/organizations that employ the carers are the most important. These include workload and payment, management, feeling respected and sense of belonging to, and being supported by, the organization. Caregiver providers should pay particular attention to these in order to improve the job satisfaction – and thus, retention – of caregivers. Interviewees also emphasized that personal commitment to the job is important.

Some carers go into this job and they just think of the money. It is not a job you can do just because you want money. I think the whole thing is to have connections. And I think that carers are like books; they carry all the information of their clients. (Interviewee J5)

Caregivers’ work is to care for elders or people who cannot look after themselves and these people are usually vulnerable. Enjoying caregiving is an important part of doing this job. These interviewees emphasized that your heart being in the job is a key factor to ensure good quality service. In addition, they noted that working as a caregiver could sometimes be lonely: “You’re the only one with your client and it’s a long day so you can feel very lonely” (Interviewee B5). These circumstances demand that caregivers are committed to the job.

Caregivers’ job satisfaction affects the quality of the service they provide and there are potential negative health outcomes for clients who are cared for by dissatisfied workers (Castle and Engberg, 2005). For example, many clients are frail and might depend almost entirely upon caregivers for their social and physical needs. For many people who need to be looked after, this relationship often lasts for a number of years. If a long-term caregiver has low job satisfaction, they might express/display their negative emotions during their working hours which may, in turn, lead to established relationships between the clients and caregivers being lost. These frail individuals then have to adapt to new caregivers which, in many cases, is difficult and demands extra effort on both sides (Stone et al., 2017).

Low job satisfaction is likely to weaken the standards of care, causing psychological distress for the care receivers and higher staff turnover rates. In fact, the perceived relationship between the job satisfaction of caregivers and the quality of care delivered is so widely accepted that job satisfaction is often used as a service quality indicator (Phillips et al., 1988; Castle and Engberg, 2005). As a consequence, improving caregiver job satisfaction is an appropriate approach to enhancing the running of the care service industry.

Previous studies have shown that job satisfaction is important for caregivers and this study clearly supports this argument. In the interviews, all the participants said that their job satisfaction is influenced by the organization they work for, although to different extents. From exploratory factor analysis, two domains emerged from the data: visible factors, including allocation of workload, management and clients, and invisible factors, including feeling respected and sense of belonging. Overall, the factors controlled by the agencies have the most influence on caregivers’ job satisfaction.

The interviews revealed that training was appreciated by all participants, although to different extents. The majority regarded the training as being key to allowing them to understand how to do the work and handle the challenges. It helps them to perform their duties and their role well. This study lends support to calls for regular training for caregivers. In addition, line management of caregivers is an important factor influencing their job satisfaction. The findings suggest that agencies should strengthen the training of line managers: the managers should be aware of their critical roles and the importance of good relationships with the caregivers. It suggests these managers should listen to, understand and do their best to fulfill the requests of caregivers. Caregivers’ voices should be heard, and the agencies should do their best to meet their requests.

Caregivers would prefer to not have unexpected changes to their work schedule. If caregivers understand the needs of clients thoroughly, including their medical history, habits, and even getting to know family members, this can only improve the quality of service. The clients are usually vulnerable, and it is good for them to stay with somebody they are used to. Both caregivers and clients would like to have fixed shifts and work with the same people at regular times, rather than constant changes. This suggests that agencies should use a fixed schedule and arrange for caregivers to go to fixed clients; they should also try their best to ensure a good fit between clients and caregivers.

Caregivers reported that they are often given too many tasks by the agency, and they do not have time for themselves. Pay is another issue. Many caregivers only earn the UK minimum wage or just above which, they hope, could be increased. It suggests that the agency should compensate them fairly for their work as home caregivers.

Whether or not the caregivers feel that they are respected has a strong influence on job satisfaction. Participants expressed feeling that their work is undervalued, and they do not receive enough respect. This suggests agencies should show their appreciation of caregivers’ work, and respect caregivers. In addition, support from agencies is considered significant by the caregivers. The study suggests integrating the caregivers with the organization more, and being more supportive of the caregivers. This can be achieved by delivering different types of activities aimed at improving the sense of belonging of caregivers within the care organization.

Conclusion

This study used in-depth interviews to explore the factors which influence caregivers’ job satisfaction. The qualitative method offers an in-depth understanding of caregivers’ job satisfaction.

Despite previous literature exploring factors influencing the job satisfaction of caregivers, there has been only limited focus on paid caregivers employed by agencies. More studies are needed to explore how caregivers feel about their expectations and experience. All the participants in this study had been working as caregivers for a minimum of two years and have a deep understanding of the position. The obvious limitation of this study is the limited sample, and the fact these interviewees cannot represent the whole body of caregivers in the UK as different caregivers and agencies work under different conditions. However, the purpose of this study was not to broadly explore caregivers’ general views but to provide a deep understanding about the factors that affect their job satisfaction while listening to their voices. Future research could attempt to use a quantitative approach to gain a broader views of caregivers’ job satisfaction. Also, this study was carried out in the UK; similar studies could be conducted in other countries and a comparison of factors influencing the job satisfaction of caregivers in different countries and contexts made.

As the numbers of both people needing care and caregivers continues to grow, so does the importance of the topic. The level of caregivers’ job satisfaction is directly connected to staff turnover and service quality: thus, identifying the factors which affect caregiver job satisfaction will make both policymakers and professional care agencies aware of the needs of caregivers in practice, helping them to improve working conditions and, by extension, the quality of service they provide. There is a sound economic argument for this as these caregivers cost society considerably less than providing full-time residential care. These experiences can be used as references to handle the challenges of an ageing society in other countries with similar care industry characteristics.