Job satisfaction of home health satisfaction workers in the environment of cost containment.

Job satisfaction of home health satisfaction workers in the environment of cost containment. In the rapidly changing field of health care, social workers'job satisfaction has received increased attention (Gleason-Wynn &Mindel, 1999; Kadushin & Kulys, 1995; Michalski, Creighton, &Jackson, 1999; Poulin, 1994; Resnick & Dziegielewski, 1996). Giventhe current emphasis on health care cost control, productivity, andaccountability, it is interesting to note that research suggests anassociation between job satisfaction and job performance for all workers(Judge, Bono, Thoresen, & Patton, 2001), including social workers(Packard, 1989), and between social workers' job satisfaction andjob turnover (Barber, 1986; Gleason-Wynn & Mindel, 1999; Jayaratne& Chess, 1984a; Poulin & Walter, 1992; Siefert, Jayaratne &Chess, 1991; Vinokur-Kaplan, 1996). Social work employment in home health care is growing (U.S.Department of Labor, 2000-2001) because of quicker discharges ofhospital patients and increasing numbers of community-dwelling elderlypeople and individuals with disabilities (Kaye, LaPlante, Carlson, &Wenger, 1996; U.S. General Accounting Office, 1998). Whereas home healthcare provides new opportunities for social workers, changingreimbursement ReimbursementPayment made to someone for out-of-pocket expenses has incurred. policies for home care may contribute to the occurrence ofethical conflicts for social workers (Kadushin & Egan, 2001). Recent concerns about the increase in Medicare spending for homehealth care resulted in passage of the Balanced Budget Balanced budgetA budget in which the income equals expenditure. See: budget.balanced budgetA budget in which the expenditures incurred during a given period are matched by revenues. Act of 1997 (BBA BBAabbr.Bachelor of Business Administration )(P.L. 105-33), which required that Medicare's cost-based system ofreimbursement be replaced with a prospective payment system (PPS (Packets Per Second) The measurement of activity in a local area network (LAN). In LANs such as Ethernet, Token Ring and FDDI, as well as the Internet, data is broken up and transmitted in packets (frames), each with a source and destination address. ) in2000. To slow spending until the PPS could be implemented, the BBAimposed more stringent cost limits on home health care agencies throughan interim payment system (IPS (1) (Inches Per Second) The measurement of the speed of tape passing by a read/write head or paper passing through a pen plotter.(2) (IPS) (Intrusion Prevention S ) that was in effect from 1997 until 2000.Research suggests that under the IPS access to home care, particularlyfor high-cost, chronically ill patients, was adversely affected (McCall,Komisar, Petersons, & Moore, 2001). Research has found that home health care social workers practicingin the restrictive reimbursement environment imposed by the IPSexperienced ethical conflicts between their obligation to the agency tobe conscious of agency financial priorities and patient needs for care.These conflicts were moderately frequent and difficult to resolve. Themost common reason identified for ethical compromise was government orthird-party payer reimbursement limits (Kadushin & Egan, 2001). Earlier research found an inverse relationship A inverse or negative relationship is a mathematical relationship in which one variable decreases as another increases. For example, there is an inverse relationship between education and unemployment — that is, as education increases, the rate of unemployment between valueconflicts and job satisfaction among social workers in other fields ofpractice (Chachkes, 1994; Jayaratne & Chess, 1984a; Siefert et al.,1991; Vinokur-Kaplan, 1996). However, a search of the literaturerevealed no published research on the job satisfaction of social workersin home health care. Empirically based knowledge on the job satisfactionof home health care social workers is important to determine whetherworkers' job satisfaction is affected by the strain of working inthis cost-conscious, rapidly changing environment. This study examinedthe job satisfaction of social workers in home health care agencies toprovide this information. LITERATURE REVIEW Three areas of the literature related to job satisfaction arepertinent to the study of social worker job satisfaction in home health:(1) funding source influence and job satisfaction; (2) value conflicts,ethical compromise, and job satisfaction; (3) administrator andsupervisor support and job satisfaction. Funding Source Influence and Job Satisfaction A survey of social workers in private practice found that the mostfrequently mentioned source of job dissatisfaction was the demands ofmanaged care and third-party payers (Strom-Gottfried, 1996).Practitioners viewed third-party payers as having the greatest effect onhealth care consumers' access to services. Rifle (1999) found a low negative correlation Noun 1. negative correlation - a correlation in which large values of one variable are associated with small values of the other; the correlation coefficient is between 0 and -1indirect correlation (r = -.16) betweenfunding source influence, operationalized as the effect of privateinsurance on treatment decisions, and social workers' jobsatisfaction. Similarly, a survey of hospital social workers found anegative relationship between hospital social workers' perceptionsof a shift in organizational priorities from patient care to financialinterests and job satisfaction (Chachkes, 1994). Assuming that medicalsocial workers have insufficient input into the termination processbecause of prospective and managed care reimbursement guidelines,Resnick and Dziegielewski (1996) reported a positive relationshipbetween the degree of comfort in terminating with clients andworkers' job satisfaction. In summary, the literature suggests aninverse relationship between the influence of funding sources andworkers' job satisfaction. Value Conflict, Ethical Compromise, and Job Satisfaction Research findings suggest a negative relationship between valueconflicts and social workers' job satisfaction. Vinokur-Kaplan(1996) found a negative relationship between the degree to which socialwork administrators felt that their professional values conflicted withjob demands and job satisfaction in 1989, but not in 1981, presumably pre��sum��a��ble?adj.That can be presumed or taken for granted; reasonable as a supposition: presumable causes of the disaster. because reductions in federal funding during the late 1980s pressuredadministrators to implement policies that conflicted with theirconception of desirable social services social servicesNoun, plwelfare services provided by local authorities or a state agency for people with particular social needssocial servicesnpl → servicios mpl socialesprograms. Chachkes (1994)documented a negative relationship between the degree of value conflictand job satisfaction among medical social workers. Siefert and colleagues (1991) reported a negative relationshipbetween the frequency of value conflicts and the job satisfaction ofsocial workers in 1989, but not in 1979, possibly because in 1989 socialworkers experienced pressures to allocate or ration rationa fixed allowance of total feed for an animal for one day. Usually specifies the individual ingredients and their amounts and the amounts of the specific nutriments such as carbohydrate, fiber, individual minerals and vitamins. scarce health careresources as cost-containment policies were implemented. Finally, anegative relationship between the frequency of value conflicts and jobsatisfaction has been documented for community mental health workers(Jayaratne & Chess, 1984a). When value conflicts are difficult to resolve, ethical compromisemay result. Stevens (1997) reported that ethical compromise related tothird-party reimbursement guidelines was negatively related to jobsatisfaction among psychologists and was the strongest predictor of jobsatisfaction. There is no research available on the relationship betweenjob satisfaction and ethical compromise among social workers. Administrator and Supervisor Support and Job Satisfaction There is no published research on the job satisfaction of socialworkers in home health care. In an unpublished dissertation, Stark(1997) found that the strongest predictor of job satisfaction amongsocial workers in home health care was the degree to which supervisorsconsidered their input in making decisions that affected the workersjobs. A second predictor of job satisfaction was the degree to whichagency administrators considered workers' input in making similardecisions. In each case, greater consideration of worker input bysupervisors and administrators was related to greater job satisfaction. Home health social workers are employed in host settings orsettings whose mission and decision making are defined and dominated bypeople who are not social workers (Dane & Simon, 1991). Socialworkers, therefore, may have less control over decisions that affecttheir work. In addition, social workers may view the medically driveneligibility criteria for services under Medicare and Medicaid Medicare and MedicaidU.S. government programs in effect since 1966. Medicare covers most people 65 or older and those with long-term disabilities. Part A, a hospital insurance plan, also pays for home health visits and hospice care. ascreating a hierarchy among home health care professionals, with socialworkers accorded less status than professions that provide medicalinterventions (Seon-Lee, 2001). A substantial body of literaturedocuments a positive relationship between supervisory support and socialworkers' job satisfaction. Supervisory support has been defined insome research as emotional support. Emotionally supportive supervisionis directed toward enhancing worker morale through the communication ofreassurance, warmth, and encouragement. In comparison, instrumentalsupervision helps the worker complete a difficult task, andinformational supervision provides the information necessary for theworker to do the job (Himle, Jayaratne, & Thyness, 1989a).Emotionally supportive supervision enhances the worker'spsychological well-being psychological well-beingResearch A nebulous legislative term intended to ensure that certain categories of lab animals, especially primates, don't 'go nuts' as a result of experimental design or conditions and helps the worker mobilize mo��bi��lizev.1. To make mobile or capable of movement.2. To restore the power of motion to a joint.3. To release into the body, as glycogen from the liver. the emotionalenergy necessary for effective job performance. Instrumental andinformational supervision enhance the worker's competence to do thejob successfully by providing the necessary facilities, resources,information, and skills (Kadushin & Harkness, 2002). Research suggests that emotionally supportive supervision andsocial workers' job satisfaction are strongly associated (Himle etal., 1989a; Himle, Jayaratne, & Thyness, 1989b; Martin &Schinke, 1998; Newsome & Pillari, 1992; Rauktis & Koeske, 1994).Some studies suggest that emotionally supportive (Himle et al., 1989a;Rauktis & Koeske) and instrumentally supportive (Himle et al.,1989a) supervision ameliorate a��mel��io��rate?tr. & intr.v. a��me��lio��rat��ed, a��me��lio��rat��ing, a��me��lio��ratesTo make or become better; improve. See Synonyms at improve.[Alteration of meliorate. or buffer the effect of job-related stresson job satisfaction. However, the majority of the research does notsupport this buffering effect for emotionally supportive supervision(Brabson, Jones, & Jayaratne, 1991; Himle et al., 1989b; Jayaratne& Chess, 1984b; Jayaratne, Tripodi, & Chess, 1983; Koeske &Koeske, 1993). Research also suggests a positive relationship between managerialbehavior that encourages participation in decision making and socialworkers' job satisfaction (Grasso, 1994; Malka, 1989). Kaye (1986)reported that greater involvement in organizational decision making andhigher levels of job satisfaction were related for home health staff atall professional levels. In summary, the literature suggests there is a negativerelationship between funding source influence and value conflicts andsocial work job satisfaction. Research findings also suggest that homehealth care social workers practicing under the restrictivereimbursement policies of the IPS experienced ethical conflicts overaccess to services for their patients. Given research findings reportingthat value conflicts and social work job satisfaction are related andthe emphasis on cost containment cost containment,n the features of a dental benefits program or of the administration of the program designed to reduce or eliminate certain charges to the plan. in home care, a question might beraised about whether the profession should be concerned about the jobsatisfaction of home health care social workers. However, currentresearch on the job satisfaction of home health care social workers islimited to one unpublished doctoral dissertation. This study addressedthis gap in knowledge by examining job satisfaction and variablesrelated to job satisfaction of home health care social workerspracticing under the reimbursement guidelines of the IPS. METHOD The survey was implemented in the fall--winter of 1998-1999 whilethe IPS was in effect. The questionnaire was developed from a review ofthe literature, pilot tested with 19 social workers in home health care,and mailed to all members of the American Network of Home Health CareSocial Workers. An additional 48 non-network member home health caresocial workers who volunteered for the study were included in themailing (N = 721). Of the 408 returned completed questionnaires, 44(10.8 percent) were ineligible in��el��i��gi��ble?adj.1. Disqualified by law, rule, or provision: ineligible to run for office; ineligible for health benefits.2. for the study because the respondentswere not currently in home health practice, resulting in a response rateof 57 percent (N = 364) from eligible participants. For the analysis ofthe job satisfaction of social workers in home health, a subset of thedata from respondents who indicated they were regular (that is,noncontract) employees and practicing solely in direct practice wasdrawn (n = 228). Measurement The Job Satisfaction Scale (JSS JSS Junior Secondary SchoolJSS JICO (Joint Interface Control Officer)Support SystemJSS Javascript Style Sheets (Netscape)JSS Network Security Services for JavaJSS Joint Support Ship ) has been examined for constructvalidity construct validity,n the degree to which an experimentally-determined definition matches the theoretical definition. and reliability with good results in previous research (Koeske,Kirk, Koeske, & Rauktis, 1994). The organizational job satisfactionsubscale of the JSS was selected because in earlier research theorganizational subscale explained most of the variance in the jobsatisfaction of home health social workers (Stark, 1997). Respondents rated their satisfaction on a scale from 1 = verydissatisfied to 11 = very satisfied on five items of the organizationalsubscale. One item of the subscale, satisfaction with the "qualityof supervision," was excluded because of its conceptual similarityto the helpfulness of supervisors in resolving the ethical conflictmeasure to avoid intercorrelation of the two variables. The fivesubscale items used reflected workers' satisfaction with thefollowing organizational job facets: role clarity, involvement indecision making, recognition given for one's job, authority, andinterpersonal relations with fellow workers. Respondents' ratingsof satisfaction with each item were summed to obtain an organizationaljob satisfaction score. In the present study the organizational subscaleachieved a standardized Cronbach's alpha Cronbach's (alpha) has an important use as a measure of the reliability of a psychometric instrument. It was first named as alpha by Cronbach (1951), as he had intended to continue with further instruments. of .824. The ethical conflict over patient access to services was definedfor respondents as "a conflict arises between your agency'sfiscal needs and/or reimbursement limits of 3rd party payers and patientcare needs." Respondents rated three aspects of the ethicalconflict: (1) how often the conflict over access to services occurred (0= never to 4 = very often); (2) how difficult the conflict was toresolve (0 = not at all difficult to 4 = extremely difficult), and (3)how helpful supervisors and administrators were in resolving theconflict (1 = not at all helpful to 6 = very helpful). Respondents alsorated how often they believed they had to compromise the professionalNASW NASW National Association of Science WritersNASW National Association of Social Workers (Washington, DC)NASW National Association of Social WorkersNASW National Association for Social Work (UK)Code of Ethics in their practice (0 = never to 4 = veryfrequently). Last, participants provided demographic informationregarding their education, years of practice in home health, number ofpatients in their caseload case��load?n.The number of cases handled in a given period, as by an attorney or by a clinic or social services agency.caseloadNoun per month, and whether their agency was afor-profit or a not-for-profit organization. Analysis All data were entered in SPSS A statistical package from SPSS, Inc., Chicago (www.spss.com) that runs on PCs, most mainframes and minis and is used extensively in marketing research. It provides over 50 statistical processes, including regression analysis, correlation and analysis of variance. 10.0. Univariate analyses provideddescriptive statistics descriptive statisticssee statistics. of all variables; bivariate bi��var��i��ate?adj.Mathematics Having two variables: bivariate binomial distribution.Adj. 1. and multivariateanalyses were computed to examine the relationships among variables. FINDINGS Univariate Analysis The respondents were predominately white, non-Hispanic (93percent), and held social work degrees (MSW (MicroSoft Word) See Microsoft Word. = 77.4 percent and BSW BSW Bachelor of Social Work (degree)BSW Bundesverband Solarwirtschaft (German Solar Industry Association)BSW BrettspielWelt (online gaming site)BSW Biblical Studies on the Web =11.0 percent). Nearly three-quarters of the social workers were employedin not-for-profit home health agencies (74.4 percent). The socialworkers were on average age 45, with slightly more than six years ofpractice in home health and had an average of 27 patients per month intheir caseloads (Table 1). Social workers reported that they believed they had to compromisetheir professional ethics professional ethics,n the rules governing the conduct, transactions, and relationships within a profession and among its publics.professional ethics liability,n 1. infrequently in��fre��quent?adj.1. Not occurring regularly; occasional or rare: an infrequent guest.2. (M = 1.36, SD = 0.93). Theethical conflict over access to services for patients was rated asmoderately frequent (M = 2.47, SD = 1.26) and moderately difficult toresolve (M = 2.69, SD = 1.08). The workers rated their agencyadministrators (M = 3.61, SD = 1.57) and their supervisors (M = 3.91, SD= 1.49) as moderately helpful in resolving the ethical conflict overaccess to services. Respondents were on average satisfied with theirjobs (M = 39.7, SD = 9.78) (Table 1). The overall high level oforganizational job satisfaction of these social workers is alsosuggested by the finding that 88 percent of the respondents'satisfaction scores occurred in the "satisfied" section of thescale (that is, above the midpoint mid��point?n.1. Mathematics The point of a line segment or curvilinear arc that divides it into two parts of the same length.2. A position midway between two extremes. of 30.0 of the potential range of thescale). Bivariate Analysis Correlational analyses showed that administrators' andsupervisors' helpfulness in resolving the ethical conflict wassignificantly and positively correlated, and the difficulty of resolvingthe conflict and the frequency of ethical compromise were significantlyand negatively correlated with organizational job satisfaction. Workingin a for-profit agency was significantly correlated with greater jobsatisfaction (Table 2). Workers' demographics The attributes of people in a particular geographic area. Used for marketing purposes, population, ethnic origins, religion, spoken language, income and age range are examples of demographic data. and the frequency ofthe ethical conflict over access to services were not significantlycorrelated with job satisfaction. The variables found to besignificantly related (p = .05) with organizational job satisfactionwere included in regression analyses. Multivariate Analysis Regression analysis In statistics, a mathematical method of modeling the relationships among three or more variables. It is used to predict the value of one variable given the values of the others. For example, a model might estimate sales based on age and gender. revealed that the helpfulness of administrators(B = .266, p = .002) and supervisors (B =.214, p = .01) in resolving theconflict over access contributed significantly to greater satisfaction,and the frequency with which workers felt they had to compromise theirprofessional ethics (B = -.155, p = .04) contributed significantly toless satisfaction in the regression, explaining 22 percent of thevariance in job satisfaction [Adj. [R.sub.2] = .220, F(5, 145) = 9.46, p= .001]. The difficulty workers experienced in resolving the ethicalconflict (B = -.116, p =. 139) and agency auspice aus��pice?n. pl. aus��pi��ces1. also auspices Protection or support; patronage.2. A sign indicative of future prospects; an omen: Auspices for the venture seemed favorable. (B = .133, p = .07)did not significantly contribute to explaining organizational jobsatisfaction (see Table 3). Due to the absence of statistical significance for difficulty inthe regression analysis and earlier research suggesting thatsupervisors' and administrators' support may moderate therelationship between difficult work situations and job satisfaction(Himle et al., 1989a; Rauktis & Koeske, 1994), two interaction termswere computed: (1) difficulty by supervisor helpfulness and (2)difficulty by administrator helpfulness. Pearson correlation analysisrevealed that the interaction of supervisor helpfulness and difficultywas significantly correlated with job satisfaction (r =. 171, p = .03)and met the criterion (p = .05) for inclusion in a second regressionanalysis, whereas the interaction of administrator helpfulness did not(r =. 141, p =. 08). In the second regression analysis, the interactionterm significantly increased the overall explanation of variance inorganizational job satisfaction (B = .534, p = .023) by 2.3 percent[Adj. [R.sub.2] = .243, F(6, 144) = 9.005, p = .001]. The difficulty ofresolving the conflict and the frequency of compromising professionalethics significantly contributed to the overall explanation oforganizational job satisfaction (B = -.421, p = .007 and B = -.165, p =.030, respectively), as did the helpfulness of administrators (B = .262,p = .002) (Table 3). To further understand the relationship of the interaction term andorganizational job satisfaction, a prediction of satisfaction based onthe results of the second regression was computed using Microsoft Excel (tool) Microsoft Excel - A spreadsheet program from Microsoft, part of their Microsoft Office suite of productivity tools for Microsoft Windows and Macintosh. Excel is probably the most widely used spreadsheet in the world.Latest version: Excel 97, as of 1997-01-14. 2000. The results clearly show that the organizational satisfaction ofworkers whose supervisors were very helpful in resolving ethicalconflict was maintained and even slightly increased over increasinglevels of difficulty (Figure 1). In comparison, job satisfaction ofworkers whose supervisors were not helpful decreased as the level ofdifficulty increased (Figure 1). This finding suggests that thehelpfulness of supervisors in resolving the ethical conflict moderatesthe effect of difficulty on workers' organizational jobsatisfaction. [FIGURE 1 OMITTED] Participants were satisfied with the organizational aspects oftheir jobs. The helpfulness of administrators in resolving the ethicalconflict over access contributed to greater organizational jobsatisfaction, and the difficulty of resolving the conflict and thefrequency with which workers felt they had to compromise theirprofessional ethics contributed to less organizational job satisfaction.Furthermore, the interaction of supervisory helpfulness and thedifficulty moderated the impact of difficulty on workers'organizational job satisfaction. DISCUSSION Interpretation of the findings is limited in several ways. First,the nonrandom sampling frame, the cross-sectional design, the use of amailed survey and self-report measures limit generalization gen��er��al��i��za��tionn.1. The act or an instance of generalizing.2. A principle, a statement, or an idea having general application. to allsocial workers in home health. Second, because the sample may not berepresentative of network members, whose demographics are unknown, thefindings may reflect characteristics of the sample that have not beendetected. Third, the overall explanations of variance of organizationalsatisfaction in the regressions were moderate. This may relate toundetected characteristics of the sample, to its homogeneity HomogeneityThe degree to which items are similar. in terms ofeducation, or to variables not addressed in the study. However, giventhose caveats the findings provide empirically based knowledge aboutsocial workers' organizational job satisfaction in home health. The social workers were satisfied with the organizational aspectsof their job. This finding is reassuring given the potential forcost-containment pressures from the IPS to lead to an agency emphasis onfinancial priorities over patient care needs and to less workersatisfaction with the organizational facets of the job (Strom-Gottfried,1996). There are several possible explanations for this finding. Becausethis study sampled professionally trained workers who identified withtheir profession, the stresses they encountered on the job may have beenassuaged through support from colleagues and their own professionalidentity, skills, and networking (Vinokur-Kaplan, 1996). The socialworkers in this sample on average had been in home health care practiceseveral years. It is possible that workers who are more satisfied tendto remain in the field and those who are dissatisfied leave. Thus, thissample may have been biased toward social workers who were satisfiedwith their home health organizations (Poulin, 1994). Administrators' helpfulness significantly contributed togreater satisfaction. This finding supports previous research that founda positive relationship between managerial behavior that encouragesparticipation in decision making and job satisfaction in home healthsocial work (Kaye, 1986; Stark, 1997). The significance interaction term in increasing job satisfactionsupports earlier research suggesting that supervision may moderate therelationship between difficult work situations and job satisfaction(Himle et al., 1989a; Rauktis & Koeske, 1994). That is, thesupervisor's helpfulness in resolving the conflict may amelioratethe negative effect of the difficulty of resolving the conflict onworker's job satisfaction by providing instrumental andinformational supervision. In providing informational and instrumentalsupport, the supervisor provides administrative supervision, helping theworker gain access to resources to meet patient needs and to do her orhis job (Kadushin & Harkness, 2002). In contrast, emotionallysupportive supervision--communicating warmth and encouragement--mightnot moderate the effect of the difficulty of resolving the ethicalconflict on job satisfaction because it contributes little to theworkers' ability to do their jobs (Himle et al., 1989a; Kadushin& Harkness). In discussing the findings it is important to note that, consistentwith a trend toward non-social work supervision in other host settings(Berger & Mizrahi, 2001; Gibelman & Schervish, 1997), themajority of social workers in home health care-approximately two-thirdsaccording to according toprep.1. As stated or indicated by; on the authority of: according to historians.2. In keeping with: according to instructions.3. one survey-are supervised by nurses (Stark, 1997). It wouldseem that nurse supervisors might not easily provide supervision focusedon professional development and mentoring to social workers becausenurses would not have the benefit of an educational background in socialwork ethics, values, and knowledge on which to draw. However, it shouldbe noted that the type of supervision found to interact with difficultyand enhance social workers' organizational job satisfaction asdefined for respondents in this study was administrative supervision(that is, "helping the worker resolve an ethical conflict overpatient access to services"), rather than supervision focused onprofessional development or mentoring. Given the finding in this study that supervisors' helpfulnessin moderating difficulty was related to greater job satisfaction andother research documenting a reduction in the availability ofsupervision to social work staff in environments affected by managedcare and other cost-containment policies (Berger & Mizrahi, 2001;Gibelman & Schervish, 1997), the question is whether there is reasonto be concerned about the future job satisfaction of home health caresocial workers. In fact, the literature suggests that in environmentsaffected by cost containment, a trend from supervision focused onprofessional development and mentoring and toward administrativesupervision has occurred (Kadushin & Harkness, 2002). If theseassumptions are correct, it may be unlikely that the type of supervisionthat buffers the effect of difficulty on job satisfaction for homehealth care social workers is threatened by cost-containment measures. More frequently, compromising social work's ethicssignificantly contributed to less organizational job satisfaction. Thisis the first study to examine and to find a relationship between thefrequency of ethical compromise and social work job satisfaction.Although social workers may view external reimbursement guidelines andmanaged care systems as unchangeable un��change��a��ble?adj.Not to be altered; immutable: the unchangeable seasons.un��change impediments IMPEDIMENTS, contracts. Legal objections to the making of a contract. Impediments which relate to the person are those of minority, want of reason, coverture, and the like; they are sometimes called disabilities. Vide Incapacity. 2. to service delivery,workers may also believe that agencies should be more responsive toacquiring other sources of funding and to providing needed, butnonreimbursable, services (Galambos, 1999). If so, workers may attributepressures that result in their compromising professional ethics to theirorganization's emphasis on financial priorities over patient careneeds (Chachkes, 1994). Poulin (1994) suggested that in terms of workerjob satisfaction, poor performance, and turnover, the cost to theorganization of underfunded un��der��fund?tr.v. un��der��fund��ed, un��der��fund��ing, un��der��fundsTo provide insufficient funding for.underfundedadj → infradotado (econ��micamente)or absent resources for services so thatsocial workers can do their work may be greater than the savings. Although the difficulty workers experienced in resolving theethical conflict over access significantly contributed to less jobsatisfaction, the frequency of the conflict was unrelated to jobsatisfaction. The lack of consistency between this finding and earlierresearch (Jayaratne & Chess, 1984a; Siefert et al., 1991) may resultfrom differences in measurement. That is, earlier research used a singleitem "global measure" of job satisfaction, asking respondentshow satisfied they were overall with their jobs; this research measureda specific facet facet/fac��et/ (fas��it) a small plane surface on a hard body, as on a bone. fac��etn.1. A small smooth area on a bone or other firm structure.2. of job satisfaction with a multiple-item scale. Earlierresearch measured value conflicts in general. This study identified aspecific ethical conflict, operationally defined the conflict forparticipants, and separately measured how often the conflict occurredand how difficult the conflict was to resolve. IMPLICATIONS FOR SOCIAL WORK The findings have implications for administrators, supervisors, andsocial workers in home health and for social work education. Thefindings encourage both home health administrators and supervisors todiscuss ethical conflicts over access to services with workers and,thus, maximize opportunities to be helpful by involving workers indecisions and problem solving problem solvingProcess involved in finding a solution to a problem. Many animals routinely solve problems of locomotion, food finding, and shelter through trial and error. . The findings also supportadministrators' efforts to acquire budget revenues for needed butnonreimbursable services so that workers can avoid ethical conflicts andethical compromise over patient access. The findings imply thatsupervisors may enhance workers' satisfaction with theirorganizations by providing instrumental and administrative supervisionthat helps social workers resolve the ethical conflict between loyaltyto their agency's policies and financial needs and patient needsfor services. In an environment focused on cost containment, workers mayanticipate a negative reaction from supervisors or administrators inbringing up issues about nonreimbursable services. Thus, they mayhesitate to discuss these conflicts and try to resolve them (Kadushin& Harkness, 2002). The findings of this research suggest that theperceived risk of approaching a supervisor or administrator with thisethical conflict may be worth the benefit in organizational jobsatisfaction. Workers might do well to engage in these discussions in managementterms, showing how acquiring coverage or providing uncovered services iscost-effective and contributes to agency goals (Goode, 2000; Schneider,Hyer, & Luptak, 2000). Discussions about the ethical conflict mayalso be productive if workers help non-social work supervisors andadministrators understand social work's ethical obligation not toabandon clients and to advocate for client access to service in theiragencies (Galambos, 1999). Other research suggests that home health careadministrators' and supervisors' lack of knowledge aboutMedicare rules and regulations for social work reimbursement is anobstacle to using social workers (Goode). The findings of this studyimply that practitioners might do well to educate administrators andsupervisors about Medicare rules and regulation for the reimbursement ofsocial work services (Schneider et al.). The findings call for the inclusion in social work education andprofessional continuing education continuing education:see adult education. continuing educationor adult educationAny form of learning provided for adults. In the U.S. the University of Wisconsin was the first academic institution to offer such programs (1904). of the knowledge and skills needed forpractitioners to effectively engage supervisors and administrators insettings affected by cost-containment policies, particularly when agencypriorities and patient care needs conflict and when supervisors andadministrators are not social workers (Kadushin & Harkness, 2002;Schneider et al., 2000). Future research should replicate this study under the PPS with alarger, random sample of home health care social workers and includeadditional variables such as organizational climate (Meyerson, 1994),funding sources for services, types of supervision, dynamics of thesupervisor-worker relationship, and professional discipline of thesupervisor.Table 1. Results of Univariate Analyses of Home Health Care WorkerCharacteristics and Major Variables on Job SatisfactionVariable M SD RangeWorker age in years 44.91 9.5 25-77Years in home health practice 6.25 4.2 1-21Caseload in number patients/month 26.62 16.88 12-90Frequency of professional compromise 1.36 0.93 0-4Frequency of ethical conflicts-- 2.47 1.26 0-4 patient accessDifficulty of resolving ethical 2.69 1.08 0-4 conflicts--patient accessAdministrators' helpfulness in 3.61 1.57 1-6 resolving the conflictSupervisors' helpfulness in 3.91 1.49 1-6 resolving the conflictOrganizational job satisfaction 39.74 9.78 16-55Table 2. Results of Bivariate Correlational Analysis of Major Variableson Home Health Care Worker Job Satisfaction Difficulty of Resolving the Helpfulness Ethical Conflict Administrator SupervisorVariable (D) Helpfulness (S)Difficulty of resolving the ethical conflict (D) 1.00Administrator helpfulness -.150 * 1.00Supervisor helpfulness (S) -.020 .509 *** 1.00D by S interaction .606 ** .280 ** .745 **Frequency of ethical compromise .314 *** -.119 -.045Auspice of agency .199 ** -.071 -.008Organizational job satisfaction -.161 * .334 ** .339 *** D by S Frequency of AuspiceVariable Interaction Ethical Compromise of AgencyDifficulty of resolving the ethical conflict (D)Administrator helpfulnessSupervisor helpfulness (S)D by S interaction 1.00Frequency of ethical compromise .157 * 1.00Auspice of agency .098 .008 1.00Organizational job satisfaction .171 * -.156 * .141 * OrganizationalVariable Job SatisfactionDifficulty of resolving the ethical conflict (D)Administrator helpfulnessSupervisor helpfulness (S)D by S interactionFrequency of ethical compromiseAuspice of agencyOrganizational job satisfaction 1.00* p = .05. ** p = .01. *** p = .001.Table 3. Standardized Regression Coefficientsin Multiple Regressions Model ModelVariable 1 2Helpfulness of administrators .266 ** .262 *Helpfulness of supervisors .214 ** -.188Difficulty resolving ethical conflict -.116 -.421 **Difficulty by supervisors interaction -- .534 *Frequency of compromising ethics -.155 * -.165 *Auspice of agency .133 .126Adj. [R.sup.2] .220 .243* p < .05. ** p < .01. [F(5, 145) =9.463, p = .001] [F(6,144) =9.005, p = .001] REFERENCES Balanced Budget Act of 1997, P.L. 105-33, 111 Stat. 251. Barber, G. (1986). Correlates of job satisfaction among humanservice workers. Administration in Social Work, 10, 25-38. Berger, T., & Mizrahi, T. (2001). An evolving paradigm ofsupervision within a changing health care environment. Social Work inHealth Care, 32, 1-18. Brabson, H., Jones, C., & Jayaratne, S. (1991). Perceptions ofemotional support, stress and strain among African-American humanservices workers. Journal of Multicultural Social Work, 1, 77-101. Chachkes, E. (1994). 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Nonproft and Voluntary Sector Quarterly, 25,89-107. ABOUT THE AUTHORS Marcia Egan, PhD, is associate professor, College of Social Work,University of Tennessee The University of Tennessee (UT), sometimes called the University of Tennessee at Knoxville (UT Knoxville or UTK), is the flagship institution of the statewide land-grant University of Tennessee public university system in the American state of Tennessee. , 822 Beale Street, Memphis, TN; e-mail:megan@utk.edu. Goldie Kadushin, PhD, is associate professor, School ofSocial Welfare, University of Wisconsin-Milwaukee. An earlier version ofthis article was presented at the annual program meeting of the Councilon Social Work Education The Council on Social Work Education (CSWE) is the national association for social work education in the United States of America.The CSWE sets and maintains standards of courses and accreditation of bachelor's degree's and Master's degree programs in social work. , February 27, 2002, Nashville, TN. Original manuscript received October 10, 2001 Final revisionreceived March 12, 2002 Accepted May 7, 2002