Job Satisfaction among Case Managers for Community-dwelling Older Adults

The significant role of case managers in improving the health status of clients and in achieving cost-containment has been increasingly recognized. However, very few studies have touched on the emerging group of case managers who work exclusively with frail older adults. The purpose of this study was to determine the level of overall job satisfaction and some of its determinants among case managers of the Visiting Nurse Health System, Atlanta, Georgia, working primarily with older adults in two community-based programs. The objectives were to learn: (1) the level of overall job satisfaction among these case managers; (2) how these case managers perceive their role; and (3) what factors facilitate their work, what factors present barriers to their job performance, and what policy or procedural changes they feel would improve their performance. An established job satisfaction scale was employed to assess job satisfaction among the case managers. The overall job satisfaction scores ranged from 109 to 198 (out of a maximum possible score of 216), with a mean of 158.2, which is considerably higher than the theoretical mid-point of the scale (126). Nine subscales of job satisfaction, ordered by the satisfaction level from highest to lowest were, Coworkers, Supervision, Nature of Work, Communication, Contingent Rewards, Fringe Benefits, Operating Conditions, Pay, and Promotion. Case managers in the Older Group (aged 45 and older) showed higher overall satisfaction compared to those in the Younger Group (younger than 45). Furthermore, satisfaction levels with Fringe Benefits and Operating Conditions were significantly higher in the Older Group than in the Younger Group. No significant difference was found in job satisfaction between case managers in the two programs (CCSP and CBSP). Case managers with longer experience (at least 4 years) showed a higher satisfaction level with Pay compared to those with shorter experience (less than 4 years) in their current program. No significant difference in job satisfaction was found between social worker and nurse case managers, except that nurse case managers were significantly more satisfied with Fringe Benefits than social worker case managers. Qualitative analysis of the interview found that case managers tended to describe their role in terms that were either related to program objectives or activities. They viewed their role more as providing or ensuring services to their clients than as cost-containment. At the same time, initial assessment appeared to be the most important component of their role compared to other activities, such as evaluation or contact with service providers. Nature of the work, management, and coworkers are the three major sources of facilitating factors reported. On the other hand, the majority of deterring factors, related to operating procedures, pay, promotion, supervision, funding, and management, fell in the category of organizational factors. Deterring factors related to individual factors were related to communication and coworker relationship. Long-term study is needed to learn the job satisfaction among case managers working primarily with older adults and to determine what contributes to or undermines their job satisfaction. Policy changes might be needed at the organizational level to enhance job satisfaction among case managers. JOB SATISFACTION AMONG CASE MANAGERS FOR COMMUNITY-DWELLING OLDER ADULTS