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1 Introduction

Japanese society is becoming a hyper-aging society where the percentage of elderly people is high among its population, making how the elderly people can participate in social activities and enjoy their lives is of at most importance. In order to achieve this, elderly care is a central social policy. If the youth witness misery among the elderly, they could despair of their future and lead to the stagnation of our society’s productivity. Therefore, the elderly care in Japan must become the role model for other countries that will become aging societies, which adds another perspective to the importance of elderly care in Japan. Elderly care is a form of service based on human interactions. Even though machines and robot can support the process, manpower will always be in the center. And the care workers learn skills and knowledge through wide-ranging experiences, thus every worker has a different approach and there are thousands of effective methods.

There have not been scientifically valid advices, and these methods only exist as the tacit knowledge among the care workers. This leads to ill health of the workers due to hard works, and they leave the care profession after falling ill. Naturally, an experienced care worker can offer a better care than an inexperienced one. The key question then is how to retain as many experts in the profession of elderly care.

We have always advocated a form of high-grade elderly care where both those being cared and the care workers can retain peace of their mind and can humanely interact while performing their roles. In short, a system where not only the care-receiver but also the care worker can be joyful while engaging in the care work. One method to achieve this is to scientifically systematize the tacit knowledge of the expert care workers and may enable workers to share it. We can basically say that it is how to conduct care without causing back pain. In order to systematize tacit knowledge, we employed every means including movement analysis, eye motion analysis and muscle usage analysis. We have also created structure to utilize our findings at the frontline service. This type of research is certainly helpful in reduce the turnover rate of the care workers. But we also must study the psychological reasons for employees leaving their job. In other words, how to make the care work feel worthwhile.

In this report, we interviewed 1179 employees from the care company that operates 40 elderly care homes in order to determine and analyze the reasons for turnover of care workers. We used data assembled from the 40 care homes including “Index relating to the Performance of the Facility”, “Index relating to the Facility”, “Employee’s Performance Index”, “Employee’s Self Evaluation Index” and “Index relating to Client’s Evaluation”.

2 Research Items and Methods

Among the data we used, the response variable was the employee turnover rate (From 2013.9 to 2014.8), and the result of its multiple regression analysis was 0.40 ± 0.23. This is the average of the 40 facilities. The number is higher than common turnover rate due to the inclusion of the part-time staff. The 4 categories of explanatory variables are the “Facility Index”, Index relating to Staff Performance, Relating to Employee’s Self Evaluation and Relating to Client’s Evaluation. We explain each category below.

2.1 Facility Index

We selected these 9 items as index for facility relation.

How long it has been operating (in months), room number, floor number, average care rate, residential style private retirement homes, private retirement homes with in-house nursing care services, conventional style retirement homes, (which has one public kitchen and dining room, not individual as the above two), transportation from the nearest train station, and the time necessary from the nearest train station. The result are shown in the Table 1.

Table 1. Index relating to the facility
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Facility Types.

“Residential” stands for “Residential style private retirement homes”. The definition of this type of facility is that it only provides support in everyday life such as meals, and the care is received in the same way as when the care-receiver is living in his/her own home. In other words, the residents or their family must hire an external care-service provider on their own.

“Specific” stands for “Private retirement homes with in-house nursing care services”. This type of facility provides each resident care in bathing, toilet and meal as well as other support in their daily lives and exercises following the care plan. The residents are charged for 10 % of cost (fixed). This type of facility cannot be found in the west.

“Elderly” stands for “Rental housing exclusively for the elderly”. This facility type is rental housing built and run by private company and approved by municipality. It mainly accepts residents that require relatively easy or no care. The “Elderly” type facility is decreasing due to the abolishment of the system, and they are shifting towards elderly homes with in-house service.

Facility Hardware.

“Conventional” type is the ordinary facility with one centralized canteen.

“Unit” type is the facility with bath and canteen on each floor. In this type, the whole care can be conducted in each floor.

“Mixed” type also has one big canteen just like “Conventional” type. However, the dementia specialized floor has its own canteen and bathroom, which allows it to run complete care within itself.

2.2 Index Relating to Employee Performance

These 5 items are for the Index relating to Employee Performance.

Assessment for short-term target achievement, number of accidents during the care (per 1 resident), number of incident reports (per 1 employee at the end of last month), number of “Thanks” Card (per 1 employee at the end of last month) and number of “Voice for Super Court Staff” (per 1 employee at the end of last month). We explain each item below.

Assessment for Short-Term Target Achievement.

“Assessment for short-term target achievement” is calculated as thus: The planning administrator of private retirement homes with charging in-house elderly care services, or the service manager/administrator of charging elderly care visiting residential style private retirement homes produces assessment for short-term care plan target. It is assessed in 4 grades; 1) No effect, 2) effective but not enough, 3) effective, 4) satisfactory. The “assessment for short-term target achievement” is the average of all the plans and clients.

Number of Accidents During Care.

The number of accidents during care was assembled according to accident reports. We distinguished between accidents during care and accident occurred outside the care time. In this paper, we calculate the ratio of accident in relation to each facility’s number of residents. The type of accidents are: 1. Fall and fall down, 2. Miss-dosing and dropping of medication, 3. Accidental ingestion, aspiration, 4, Cut, chafing, 5, Bruise, sprain, 6. Damaged or lost property, 7. Unauthorized leave, and 8. Others.

Number of Incident Reports.

We believe that it is important to compile the incident reports where care workers realized something that could have resulted in serious accidents. These information are highly valuable in preventing accidents from occurring. If a care worker notes many instances like this, it shows that he/she is attentive and dedicated. We call this “Alarm-Attention-Concern Process”. Heinrich’s law that shows “for every accident that causes a major injury, there are 29 accidents that cause minor injuries and 300 accidents that cause no injuries” is the basis for this process.

Number of “Thanks” Cards.

“Thanks” Card: When a staff felt gratitude toward another staff, he/she writes “who” feels gratitude toward “whom” and “why” in “Thanks” Card and put it in the “Drop BOX”. The system is that these cards are gathered weekly and displayed for every staff to see. This way, “Gratitude” is shared by everyone. The purpose of this is to create a corporate culture where people can thank each other easily. It is important to maintain a work environment where the staff can feel satisfied in order to increase the productivity of individuals and organization. We aim for increasing the number of “Company Satisfaction Ratio”. We calculate the number of “Thanks” Card in relation to the number of employee. It is deemed that the higher the number of “Thanks” Card, more motivated and attentive the staff.

Number of “Voice for Super Court Staff” Cards.

The staff can submit their opinions, requests or comments from the residents to the company through a card called “Voice for Super Court Staff”, which is designed to express (1) Complains, (2) Requests and (3) Gratitude. Just like “Thanks” Card, we deem that the higher the number of “Voice for Super Court Staff”, more motivated and attentive the staff. Moreover, it can boost the morale of the staff by making the sign of gratitude from the residents and their family readily available. We calculate the number of “Voice for Super Court Staff” in relation to the number of employee.

2.3 Index Relating to Staff Self Evaluation

In order to determine how satisfied the staff are, we gave them this questionnaire with 21 questions. The number of the answers we got was 1179.

Q01::

Do you feel the sense of purpose with the contribution the company makes to the society? (E.g. Elderly care seminar for local residents and businesses, learning experience for students, or presentation of research on elderly care and long life.)

Q02::

Do you think the company follows law strictly?

Q03::

Do you agree with the company policy?

Q04::

Do you think departments and branches are well-coordinated?

Q05::

Do you think the necessary discipline and manners are followed?

Q06::

Are you happy with the Staff Proposal System (Praise for good idea)

Q07::

Do you think the atmosphere of your department is good?

Q08::

Do you think there are many self-sufficient people around you?

Q09::

Do you think your department encourages honest opinions?

Q10::

Do you think the company welfare and facilities are sufficient for this company? (E.g. congratulations and condolences, housing support, support for obtaining new qualifications or self-improvement, the discount tickets for the natural hot spring located in the Super Hotel, Hananoi, Osaka branch, or the free stay tickets at any Super Hotels, etc.)

Q11::

Do you find your current duties worthwhile?

Q12::

Do you feel that your duties and responsibilities are clearly defined at the workplace?

Q13::

Do you think the education and training for improving staff’s ability are implemented?

Q14::

Are you happy with the training and education?

Q15::

Can you picture the future in your job?

Q16::

Do you feel that the targets are appropriate?

Q17::

Do you think the evaluation you get is fair?

Q18::

Is the meeting between the staff and their superior based on “Monthly target sheet” held monthly?

Q19::

Do you enjoy working here?

Q20::

Are you interested in this study?

Q21::

Do you find the criteria and method of staff evaluation clear?

2.4 Related to Client’s Evaluation

Those related to Client’s Evaluation are these 5 items. Satisfaction for customer service (manner and language, average of both the residents and their family), satisfaction for food (taste, only the residents), satisfaction for cleaning of public area (average of both the residents and their family), satisfaction for cleaning of individual rooms (average of both the residents and their family), the total satisfaction rate (average of both the residents and their family). The research method is to collect “questionnaire about life here” from the residents and their family every 6 months.

3 Research Results

3.1 Index Related to Employee Performance

Table 2 shows the result of Index relating to Employee Performance.

Table 2. Research result of index relating to employee performance
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3.2 Index Relating to Employee Self Evaluation

Table 3 shows the result of questionnaire relating to Employee Self Evaluation.

Table 3. Result of questionnaire relating to employee self evaluation
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We applied factor analysis on these results. Table 4 shows the outcome of this analysis. 2 interpretable factors where eigenvalue is more than 1 were sampled. After examining the items that constitute the factors, we identified that the first factor related to the employee’s satisfaction rate for the job, company and department, and their degree of agreement with the company’s management policy and its social contribution activities, and the second factor related to the atmosphere and environment of the workplace including such questions as “Does your department have good atmosphere?” or “Do you think your department encourages honest opinions?” Therefore, we named the first factor “Job Satisfaction Factor” and the second factor “Workplace Atmosphere Factor”, and calculated its number in each branch.

Table 4. Result of factor analysis of questionnaire relating to employee self evaluation relation.
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3.3 Related to Client’s Evaluation

Table 5 shows the result of Client’s Evaluation.

Table 5. Client’s evaluation research result
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3.4 Multiple Regression Analysis

We conducted multiple regression analysis based on the data above. We set Staff Turnover Rate as response variable, we deduced 22 variable from explanatory variable, and conducted the analysis through stepwise method. That result showed R square = .411, F = 9.61, p < .01, the coefficient that has not been standardized are.

Employee Turnover Rate = 0.790 - 0.257 × Facility Hardware Ordinary Type (dummy variable) - 0.002 × Time of operation (in months) - 0.011 × “Thanks” Card coefficient (standardized coefficient).

Facility Hardware Ordinary Type (dummy variable): β = - .466, p < .01, VIF = 1.105.

Time of operation (in months): β = - .329, p < .05, VIF = 1.077.

Number of “Thanks” Card: β = - .310, p < .05, VIF = 1.035.

We will deepen our argument following these results.

4 Discussion

Our analysis demonstrated that the employee’s turnover rate is related mainly to the type of facility, how long it has been open and the number of “Thanks” Card. Below will present the cause of each factors.

4.1 Employee’s Turnover Rate Is Lower When the Facility Is Conventional Type

When the facility is unit type and not conventional type, there are fewer interactions among the care workers and it is not possible to share the responsibilities. The work at unit type is also divided between each floor, meaning there are not many chance to seek advices from one’s colleagues, leading to a lack of communication. This influences the turnover rate.

4.2 Longer the Facility Has Been Operating, Lower the Turnover Rate

A new facility is operated by staff gathered from different branches. Therefore, there are often not enough communication and many differences of opinions. This leads to some staff leaving due to disagreement in belief. In comparison, a facility that has been operating some time gives staff time to adjust to their colleagues, and those stayed in the job tend to agree with the policy of Super Court leading to lower turnover rate. Also, the administration of the facility stabilizes after some time, which leads to staff having calmer mind and having more time to care for the residents, making them feel more purposeful and influencing the turnover rate.

4.3 Higher the Number of “Thanks” Cards, Lower the Turnover Rate

High number of “Thanks” Card shows that the facility has the culture of expressing gratitude. This can be seen to produce more relaxed work environment, leading to lowering of turnover rate. Also, encouraging the expression of gratitude and notifying every staff about it have an effect of boosting their morale, and make the job feel more worthwhile, leading to the lowering of turnover rate.

4.4 Overview

In order to lower the turnover rate of employee, we learnt from these results that:

  1. 1.

    The fact that turnover rate is lower when the facility is conventional type showed us the importance of communication among the staff.

  2. 2.

    It has been generally considered that the turnover rate is linked to the extent the staff identify with the company policy, and deeper the identification, lower the turnover rate. However, we discovered that how long the facility has been operating is also related to turnover rate. There is statistic that shows the staff of new facility has better understanding of company policy, but this merely reflects the enthusiasm and high self-confidence of new staff and does not necessary prove their better understanding of the company policy. As a result, the discrepancy between their view and management principle lead to higher turnover rate. A new facility is staffed with workers from different branches, which means their different background prevent them from correct understanding of the company policy. This means the principle is not integrated into their action and leading to discrepancy. Therefore, correct management of a new facility can be considered important.

  3. 3.

    The fact that turnover rate is lower when the number of “Thanks” Card is high showed us that creating a working environment that makes it easier for staff to operate is important.

5 Conclusion

This report held interview with 1179 staff from a care company that operates 40 facilities in order to conduct multiple regression analysis of the factors that leads to high employee turnover rate. We used data collected from the 40 facilities, namely Index relating to the Performance of the Facility, Index relating to the Facility, Index relating to Employee’s Performance, Employee’s Self Evaluation Index and Index relating to Client’s Evaluation. As a result, we gained knowledge that turnover rate is lower when: the facility type is conventional, when the facility is operating for longer time, and when the number of “Thanks” Card and “Voice for Super Court staff” Card.

We will now present how to proceed on each point.

  1. 1.

    We must establish a structure where the staff can communicate with each other no matter whether the facility is Conventional or Unit type. In addition to utilizing IT communication method such as every staff carrying iPad, we will also hold committee for improving the working environment. Also, we are today gradually shifting to the mixed type which uses good aspects of both conventional and unit types.

  2. 2.

    In order to improve staff’s understanding of and agreement with the company policy, we are implementing these 4 programs:

  • Hiring people who already share our belief. In order to achieve this, we are constantly improving the questionnaire for interview.

  • Internship

  • Constant improvement of questionnaire during orientation

  • Constant improvement of monthly meeting between staff and their superior (for new recruits the facility manager) based on the monthly target sheet (Q18)

  1. 3.

    In order to reduce the mental pressure of the staff, it is important that they can conduct their duty smoothly and have enough mental space to care about other things. Therefore, an effective training that can reduce their physical hardship is necessary. These are two training for such improvement:

  • We conduct training that can improve the average care skill quality.

  • We conduct their care work movement analysis, for instance during bathing support, in order to standardize the work.