Table 1 Summary Table

Reasons for becoming an HCA

1) Desire to help or inclination to work with people

2) Aspiration to work in healthcare

3) Job security or desirable job benefits [33, 41, 53]

Transitions into HCA career (range)

Not working or unemployed: 22.1 % [53] to 28.4 % [72]

Perceptions of training (range)

Felt well-prepared for work by initial training: 38 % [42] to 96.5 % [33]

Initial training topics

Patient Care: Personal/resident care [21, 28, 33], lifting/handling, fall prevention, medications, nutrition, First Aid, continence, oral hygiene [26], talking with residents [21, 33]. Perceived as excellent by 57.9 % to 66.6 % of HCAs [21]

Holistic Care: Recognizing abuse, philosophy and values, cultural safety, sexuality, common disabilities [28], dementia care, discuss resident care with family, work with abusive residents [21, 33]. Perceived as excellent by 41.9 % to 44.6 % of HCAs [21]

Provider and policy: Personal safety, emergency procedures, infection control, service policy/protocol, risk management, fire and safety [26], record resident information, prevent work injuries, organize tasks, work with supervisors, work with coworkers, problems-solve work issues [21, 33]. Perceived as excellent by 32.2 % to 52.8 % of HCAs [21]

Requested topics for initial training

Patient care: Care skills [21, 29], talk with residents, medication management, pain management [21]

Holistic care: Abusive residents [21, 29], discuss resident care with family members, work with residents family, dementia care [21], mental health training, integrating health promotion, multicultural training, challenging behavior skills [29]

Provider and policy: Work with coworkers, organize work tasks, work with supervisors, problem solving for work issues, record resident information, prevent work injuries [21], physical preparation for the role, training in management, stress management [29]

Location of initial or vocational training (range)

Facility employing: 43.1 %, among immigrants [33] to 65.3 %, rural [53]

Community college 15.7 %, among immigrants [33] to 23.8 %, micropolitan [53]

High school: 6.0 %, micropolitan setting to 6.3 %, rural [53]

Vocational or trade school: 5.4 %, micropolitan to 6.6 %, urban [53]

Cost of training (range)

Entirely paid for by employer: 67.9 %, urban [53] to 78 % [28]

Training hours (range)

Ratio classroom to clinical: 50:50 [69] to 95:5, in “other” long-term care settings [14]

Qualification

National Vocational Qualification (UK): 4 levels of qualification [18, 42, 47]

Home Helper (Japan): 3 levels of qualification [69]

Mean age (range)

Exact ages - 36 [78] to 47.6 [32]; Age ranges – 31–35 [55] to 41–50 [75]

Education (range)

High school or less: 40.4 %, home health [41] to 92 %, nursing homes [80]

Some college/post-secondary: 8 %, home health, nursing home and assisted living [79] to 38.7 %, hospital [17]

Marital status (range)

Married/living with partner: 38 %, hospital [22] to 82.6 %, Danish [66]

Dependents (range)

Adult or child, living at home (U.S. specific): 38.9 %, non-immigrant [33] to 60.5 %, female [52]

Children under 18: 28.8 %, home health HCAs [81] to 52 % [76]

Primary language (range)

English: 74.5 %, home health [17] to 99.1 %, rural [53]

Non-English: 1 %, non-immigrant to 50.9 %, immigrant [33]

Immigration status (range)

U.S. citizen: 88 % [76] to 99.3 %, rural [53]

Non-U.S. citizens: 6 % female to 17.3 %, male [52]

Gender (range)

Female: 76 %, permanent full-time (Japan) [67] to 98.3 % [66]

Employment characteristics (range)

Full-time: 14 %, Canada [48] to 79.3 %, hospital [81]

Weeks worked annually (mean): 40.7, home health [17] to 47.5, hospital [81]

Weekly hours worked (mean): 13, home care (Danish) [28] to 38, U.S.-based nursing home [22]

Weekly overtime hours worked (mean): U.S.-specific 9.71 [57] to 10.1 [58]

Shift work (range)

Mainly day: 43.4 % [66] to 61 %, nursing home [80]

Mainly evening: 22 %, nursing home [80] to 24.8 % [66]

Mainly night: 10.5 % [66] to 17 %, nursing home [80]

Wage (range)

Hourly in U.S. dollars (mean): $7.45 in home health and nursing homes, 2002 [39] to $17.84 in home health, 2006 [22]

Household income < $30,000: 49.6 %, home health [35] to 70.3 %, female [52]

<150 % federal poverty level: 18 % [84] to 37.9 %, home health [39]

Requiring federal assistance (range)

Any: 5 % [76] to 31.4 %, nursing home [33]

Food stamps: 10.78 %, nursing home [24] to 14 % [84]

Tasks assigned

Patient contact: provide personal care [18, 42] (indirect and direct) [40, 45], feeding [40, 45, 47], oral care [40, 45]

Physical [40, 70]

Clerical/Administrative [40]: general [42, 45, 47]

Non-patient contact [42]: housekeeping [40, 47]

Similar to RN [29]: Administer medications, catheterization [42, 47]

Staffing (FTE/100 residents)

HCA: 25.3 [80] to 38.5 [89]

RN: 8.5 [80] to 25.9 [89]

LPN: 11.2 [80] to 23.7 [89]

Projected growth of the profession

HCAs: 62.5 % (2000–2010) [84] to 114 % (2010–2020) [48]

Home health aides: 47.3 % (2000–2010) [84] to 69.4 % (2010–2020) [74]

Tenure in profession (range)

Months (mean): 79.2 [68], nursing home to 148.8 [80]

11-20 years: 22.3 % [24] to 22.8 % [53], both in nursing homes

>20 years: 12.3 % [35] to 12.5 %, nursing home [53]

Turnover – profession

Within 2 to 3 years of training: 37 %, Denmark [65] to 46.3 %, Taiwan [32]

Tenure in facility (range)

Months (mean): 25.96 [56] to 118.3 [79], both in nursing homes

<2 years: 41.8 %, rural to 42.6 %, micropolitan [53]

Turnover – job/facility (range)

Annual: 59.4 % [91] to 170.5 % [86]

6-month: 13.1 % [75] to 64.4 % [88]

3-month: 18.8 % [57] to 19 % [58]

Community and facility-level factors related with turnover (—, + or NS)

Community: High unemployment rate: (—) [57, 82, 91]

Facility: For-profit status: (+) [58, 82, 83, 87, 94]

Chain membership: (+) [93, 94],(—) [80], NS [82]

Higher LPN staffing levels: (—) [80, 91]

Greater HCA HPRD: (—) [57, 58, 86]

High HCA wages: (—) [28, 58, 72, 85, 87, 94]

Provision of benefits: (—) [58, 72], NS [22, 82, 93]

Union contract in place: (—) [58, 92]

Greater HCA perceived quality of care: (—) [80, 88, 89]

Impact of interventions on turnover

0.2 FTE Retention Specialist x 6 months: (—) (p < 0.05) [75]

Multi-pronged curriculum based intervention: (—) (p ≤ 0.05) [83]

Intent to leave facility/job (range)

33.8 % (≥50 years) to 61.0 % [54]

Community and facility-level factors related with intent to leave facility/job (—, + or NS)

Community: Job alternative: (+) [79], number of nursing homes in county (—) [80]

Facility: Rewarding income: (—) [32, 55, 68, 79, 80]

Insurance coverage: (—) [49, 72]

Supportive supervision: (—) [32, 49]

Recruitment into employment

Word of mouth [16, 33, 40]

Individual factors related with turnover (—,+ or NS)

Age: Increasing age (—) [22, 72, 94]

Race/ethnicity: White (Reference), Hispanic (+), Black NS, Other NS [22], Hispanic NS [92], Racial minority (—) [80]

Marital status: Married (+) [80], NS (compared to home health aides) [22]

Individual factors related with intent to leave (—, + or NS)

Age: Younger (+) [54, 67, 68]

Shift: Nights (+) [67, 68]

Education: > High school (+) [49, 79]

Job security: High (—) [56], Low (+) [68]

Job history: >2 jobs in last 5 years (+) [49, 79]

Job satisfaction: High (—) [49, 80]

Benefits (range) – U.S. specific unless otherwise stated

Without health insurance: 12.7 %, immigrants employed in nursing homes [33] to 33 %, home health aides [82]

Health insurance available: 83.3 % [49] to 91.6 %, micropolitan [53]

Utilize/access health insurance: 25.5 %, home health to 62.3 %, hospital [39]

Pension plan: 60 % [58] to 71.2 %, micropolitan [53]

Paid sick time: 65.7 %, micropolitan [53] to 79.0 %, nursing home [58]

Paid vacation days: 64 % [58] to 89 % [56], both in nursing homes

Subsidized transportation: 3.9 %, rural [53] to 38.7 %, Canada [27]

Unionization

U.S. NHs: 10.4 % of HCAs [77] to19 % of facilities [92]

Work-related injury rate (range)

Proportion of HCAs injured: 18.5 %, home health aides [94] to 59.44 %, NHs [49]

Number of injuries per HCA (average): 1.54 [51] to 2.63 [24]

Types of injuries

Most common: MSI [60, 64]

Rate of injury by profession

HCA higher than RN [61, 62, 64]

HCA higher than LPN [61, 64]

Rate of injury by setting

Highest in LTC, as compared to acute care and community [60, 61]

Injury claim/sickness absence

HCA have higher rate than RN [61, 63]

HCA and LPN have similar rates [60, 63]

Factors related to risk of injury (—, +, NS)

Availability of equipment: (—) [50, 64]

Workplace aggression: (+) [44, 64]

Lower age: (+) [58], (—) [62]

Gender: Female (+) [60, 62]