Perceived HRM and turnover intentions of elderly care workers: perspective from person-job fit and institutional ownership

Since the United Nations published The Aging of Populations and its Economic and Social Implications [1], how to meet the care needs of elderly has become a new topic of livelihood security in various countries [2]. Elderly care workers are an important source of high-quality elderly care services [3]. Compared to hospital nurses, the role of elderly care workers tends to focus on caring for the personal living and basic health care of the elderly. Although they do not have qualifications for medical skills such as injections and medication [4], they are an important force in alleviating the work pressure of medical teams and improving the efficiency of medical service supply [5]. However, currently the world is generally facing a high turnover rate of elderly care workers [6], and the World Health Organization predicted that the global turnover rate of elderly care workers would be as high as 40% in 2023 [7]. Under the background of population aging, the high occupational mobility of elderly care workers is not only detrimental to guarantee the quality of life of the elderly population, but also poses challenges to the health care systems of each country.

China entered aging population society in 1999 [8]. Between 2014 and 2020, the number of officially registered elderly care workers in China increased from 194,100 to 378,900 [9]. However, the high turnover rate of China’s elderly care workers has led to a workforce gap of at least 5 million in the elderly care industry due to several reasons such as low wages [10]. Currently, each elderly care worker in China cares for an average of six elderly people every day, which is higher than the general standard of 4:1 in developed countries [11]. The reason for this phenomenon is that social prejudice against elderly and the elderly care industry affects employees’ career choices, resulting in high turnover rate in the elderly care industry [12]. Therefore, reducing the willingness of elderly care workers to turnover has become an urgent issue in the process of building China’s elderly care service system.

At present, the issue of elderly care workers’ turnover problem has gradually become a hot topic of academic attention. A research review summarized the triggering factors of turnover intention among elderly care workers into physical, cognitive, and organizational three levels [13]. Among them, at physical level, the characteristics of the elderly care industry bring high-intensity physical pressure, which has become the main reason for the frequent turnover of elderly care workers [14], due to heavy work burden and incomplete mastery of nursing professional skills, elderly caregivers often suffer from pain in lower back, neck, and shoulder joints [15], feeling physically overwhelmed and choosing to resign; At cognitive level, some studies have pointed out that elderly care workers often fails to meet their personal values and career expectations [16, 17], low income, workplace violence, and low social status lead to occupational burnout among elderly care workers [18], they choose to resign due to lack of work motivation; In addition, factors at organizational level that affect the willingness of elderly care workers to resign are often believed to be several shortcomings in management of elderly care institutions, such as the failure to provide good work facilities and conditions [19], or unreasonable salary, benefits, and career promotion systems for employees [20], which results in the loss of elderly care workers.

Social information processing theory pointed out that employees extract information from the environmental background of organizational human resource management practices, spontaneously forming their own perceptions of human resource practices [21]. They are employees’ subjective perceptions of organizational human resource management, including direct perceptions of human resource management practices and evaluations of management practice intention [22]. Perceived human resource management have been proven to be moderated by elements such as job requirements, organizational structure [23], and can influence the sense of work experience [24], this sense of experience affects personal value judgments and mediates employee behavioral responses, and are a valid predictor of employee work behaviors [25, 26]. Turnover intention can be seen as a psychological response of employees after experiencing negative work experiences. Several studies have confirmed that employees’ perceived human resource management can significantly mediate occupational burnout and turnover behavior [27, 28], which is a strategic factor for the industry to cope with shocks, ensure talent supply, and improve organizational efficiency [29]. In the past decade, Chinese elderly care workers have had low levels of education and poor nursing skills [30], the expansion of elderly care worker team has been constrained by human resource management factors such as work environment, salary and benefits, and employment training for a long time. Therefore, it is necessary to systematically examine the impact of perceived human resource management of elderly care workers on their turnover intentions and the internal mechanisms among them. Solving these issues is beneficial for meeting the goal of China’s “The Medium-and Long-term Plan for Responding Proactively to Population Aging”, and help to reduce the turnover rate of elderly care workers.

The aging process of China’s population is deepening, and the shortage of elderly care workers will continue to exist, which means the issue of turnover rate of elderly care workers is gradually receiving attention. Developed countries such as the United States and Singapore have established nursing staff grading systems for Registered Nurse(RN), Licensed Practical Nurse(LVN), and certified Nursing Assistant(NA) [43]. The collaborative team composed of nurses and care workers is efficiently managed, with clear role positioning, and can provide high-quality nursing services [44]. However, there are still serious structural problems in the organizational context of elderly care workers in China at present, such as poor working conditions, weak professional skills, and low certification rate [45]. This study empirically examined how turnover intentions of Chinese elderly care workers was generated from the perspective of perceived human resource management practices. We analyzed the effects of perceived work environment, occupational protection, welfare benefits and competency training on the turnover intentions of 305 elderly care workers from 21 provinces in terms of “perceptions of hygiene” and “perceptions of motivation”, and our findings provided useful insights for researchers and managers.

First, perceived human resource management practices had a negative effect on turnover intentions, and the better the perceived status, the lower the risk of turnover among elderly care workers. The perceived work environment of elderly care workers had the greatest impact on the turnover intentions (\({\beta }_{E}\)=-0.5164), indicating that the daily work environment of elderly care workers had a deeper impact on the work experience than the occupational protection system (\({\beta }_{P}\)=-0.3390), the welfare benefits system (\({\beta }_{M}\)=-0.2620) and the competency training system (\({\beta }_{T}\)=-0.1421). This is consistent with the findings of some earlier studies, that is, the turnover intentions of elderly care workers arises from the great difference between their ideal role before joining job and the actual working conditions after joining job, and the unsatisfactory working experience of elderly care workers maps out the practical difficulties encountered in the working environment [46]. A global study shows that the nursing shortage caused by high unemployment among nursing staff has affected countries in Europe, Asia and North America, and that working conditions, employment policies and deficiencies in career advancement programs have made the nursing profession less attractive. The reasons behind this phenomenon are diverse. Firstly, the working environment is closely related to the daily work of employees, which is closely related to their work experience. Poor working environment leads to a lack of attractiveness in the elderly care industry [3]; Secondly, the asymmetry between high work intensity and low salary levels makes elderly care workers feel that their work is undervalued and their job content lacks value [47], therefore, many elderly care workers lack work motivation; Thirdly, one important reason why elderly care workers face dual physical and psychological pressures is that they received inadequate training and education, as well as inadequate occupational protection, which are often overlooked by institutions [48]. Elderly care workers is lack of standardized professional skills [49], being misunderstood by elderly people and their families, finally resulting in physical pain and negative work emotions [50]; Finally, as the proportion of young employees in the elderly care workers’ team continues to increase, employees aspire to have reasonable and transparent career promotion channels. They hope that elderly care managers can face the difficulties of nursing work and have their own career promotion paths [13]. If elderly care institutions ignore the promotion needs of employees for a long time, employee may choose to change jobs [20]. In summary, meeting the demand for a good work experience of elderly care workers fundamentally lies in optimizing and improving the internal human resource management system of elderly care institutions from multiple aspects such as work environment, salary and benefits, occupational protection, and skill training.

Second, person-job fit can moderate the relationship between perceived human resource management practices and turnover intentions. In other words, some elderly care workers may give up the idea of turnover when there is a high degree of alignment with the requirements of the job. For example, in the field of hospitality management, person-job fit has been proven to be an important forecast indicators of employee organizational commitment, and the degree of person-job fit mediates employee work sentiment and employee engagement levels [51]. Firstly, employees with high person-job fit usually have good self-efficacy [52]. The higher the match between job skills and job requirements, the more confident individuals are in completing their tasks, believing that their efforts can meet the employer’s requirements and their expectations can be effectively rewarded, so they have positive attitudes toward work [53]. Secondly, a high level of person-job fit is also conducive to the development of strong organizational commitment and leads to employees’ identification with the concept of organizational goals and values [54]. Employees with high person-job fit tend to participate in job design spontaneously and further develop a high level of job responsibility and organizational loyalty, so that they will give up the idea of turnover out of a strong sense of responsibility even when they have a poor work experience. This result emphasizes that elderly institutions should avoid a formalized vocational competency training and assessment and evaluation system, strictly control the staff recruitment and assessment system procedures, and comprehensively promote the labor quality training of staff with the core of improving the operational skills of staff.

Finally, the magnitude of the effect of perceived human resource management practices of elderly care workers on turnover intentions varies by institutional ownership. This finding is similar to most empirical studies that looked at the public and private sectors [55]. A study of 382 nursing staff in the Jordanian health care sector showed that nursing staff working in the public sector perceived their work environment significantly better than nursing staff in the private sector, and that nursing staff in the public sector had higher levels of job well-being [56]. This is because private institutions aim for excessive profits [57] and regulate employees’ work behaviors by setting up a strict performance appraisal system. Employees are prone to burnout and induce turnover intentions; while employees in public institutions spontaneously regulate their psychological tolerance and sense of self-resistance to frustration due to the pursuit of job security [58]. The public interest nature of public institutions creates a buffer between the perceived human resource management practices and the turnover intentions, increasing the tolerance of current employees to a bad work condition and thus reducing the occurrence of impulsive departures. At present, China’s 14th Five-Year Plan for the Development of the National Aging Career and Elderly Care Service System calls for strengthening the construction of elderly care workers and promoting the reform of elderly care institutions [59]. Under the trend of mainly building public elderly institutions, it has become an inevitable requirement to build an inclusive elderly service system and promote the healthy development of the aging career by paying attention to the working condition needs of elderly care workers in public elderly institutions and reducing occupational mobility.

The study has some limitations. First, this study only focused on the role of perceived human resource practices of elderly care workers on turnover intentions, and other possible environmental factors such as organizational equity and organizational culture could be further considered in future studies. Second, this study was not hierarchically divided according to the differences in the individual characteristics of the study participants, and the next study could focus on specific levels of the elderly care workers to explore in order to further refine the findings.

For a long time, China’s elderly care service industry has been facing the dilemma of talent shortage. This study shows that elderly care workers may develop the idea of turnover when they perceive low level of human resource management in the institution, and this idea may change because of the differences in work ability and institutional ownership. The conclusion suggests that managers of elderly care institutions should develop recruitment criteria for elderly care workers based on the institutional ownership structure, pay attention to the working environment, welfare and benefits, competency training of employees, and focus on occupational protection for elderly care workers . This paper is a complement to previous research on the factors influencing turnover intentions of elderly care workers. For a long time, China’s elderly care service industry has been facing the dilemma of talent shortage. In the environment of “public-run and private-sector-supplemented” elderly care institutions in China, on the one hand, elderly care institutions should review the shortcomings of human resource management, optimize internal management mechanisms, provide stable and good working conditions for elderly care workers, and motivate their enthusiasm to work; on the other hand, the government and elderly care institutions should work to develop and improve professional standards and job requirements for elderly care service, and to ensure that carers for the elderly receive adequate knowledge education and competency training before they are formally hired. Finally, they should promote the public welfare value of elderly care services, encourage elderly care workers to conclude organizational commitments, and strengthen their sense of honor and mission, so as to better solve the dilemma of turnover of elderly care workers.