Self-employed caregivers: Their motivations, labor conditions, and patterns of decision-making related to work selection and tenure

The purpose of this qualitative study, based on analysis of in-depth interviews, is to examine the perceptions and experiences of twenty independently employed non-kin personal care workers who provided in-home care to elderly clients on a private pay basis without any bureaucratic oversight. Specifically, it examines why these workers engaged in independent home care employment and the conditions that affected their decisions about whether to take, keep or leave a job.; These are important questions to ask because current social conditions that include an aging population and fewer available kin caregivers suggest that the need for non-kin, paid home care has grown and will continue to do so. This trend will strain a health care system already beleaguered by labor shortages and problems with recruitment and retention of good workers. It is imperative to find out from workers themselves what draws them to the work and satisfies them.; Important analytical findings are detailed and more complex than current literature suggests. Notably, these workers intentionally chose health care as a vocation. They did not make decisions based on discrete labor conditions such as wages, but within the context of relationships between various personal and environmental attributes. Embedded in decisions about which job to take were other decisions including whether to work in direct care, independently, and part-time or full-time. The most influential attributes in decision making included a desire to work in direct care, health concerns, family obligations, entrepreneurial preferences, other income sources, whether or not health insurance was an issue, and personal standards for good care. Most of the workers had health problems and other income and insurance sources, explained in part by age and marital status. Common patterns among the workers' decisions are identified that suggest that particular attributes led to particular decision outcomes. This knowledge could be used to structure labor conditions responsive to what individual workers truly need.; The findings have relevance for efforts to recruit and retain a good frontline labor force. What constitutes good labor conditions, good workers, and good care is all considered. Recommendations for change and further study are proposed.