When compassion meets complexity: managing the psychological contract to reduce turnover in complex elder adult care

Purpose This study aims to address why standard human resource (HR) retention strategies fail to reduce staff turnover in elder adult care settings. The introduction of caseload complexity (the coexistence of multiple, interacting physical, cognitive and social needs in residents) explores the conditions for how the psychological contract breach happens in workers. Thereby, reframing turnover as a relational problem, rather than a transactional one. Design/methodology/approach A conceptual methodology is adopted, synthesizing psychological contract theory and self-determination theory with existing literature on caseload complexity and workforce turnover in aged care and health-care settings to build an integrative five-stage model. Findings This study proposes that caseload complexity, distinct from workload, gradually erodes the implicit psychological contract in care workers formed at recruitment. The integrative model demonstrates transparent communication, structured recalibration checkpoints and autonomy-supportive onboarding to lead elder care organizations toward sustained engagement. Research limitations/implications As a conceptual synthesis, the proposed integrative model has not yet been empirically tested within aged care populations. The absence of a standardized, sector-wide workforce data set in India also limits current empirical validation. Future research should test this framework across diverse care settings to evaluate how caseload complexities influence other HR outcomes beyond turnover and retention. Practical implications This paper offers HR and operational leads in aged care organizations a low-cost, structural approach to retention. Recommendations include honest communication of clinical and administrative realities upfront during recruitment, conducting periodic (quarterly or half-yearly) check-ins for recalibrating evolving roles and decentralizing care planning to allow caregivers greater autonomy and recognition in managing complex cases. Originality/value This study combines psychological contract theory and self-determination theory to shift the discourse on elder care workers’ retention from being a transactional problem to a relational one. The focus on caseload complexity as a unique driver of turnover with particular relevance to the aged-care infrastructure in India helps extend the retention literature.