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Table 1 Summary Table

From: Invisible no more: a scoping review of the health care aide workforce literature

Education [14, 15, 18, 19, 21, 25, 26, 28, 29, 33–36, 40, 42–45, 47, 52, 53, 56, 69, 71, 72]
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]
Supply [14–22, 24, 27, 28, 32–35, 39–41, 44, 45, 48–58, 62, 66–68, 70, 72–85]
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]
Use [18, 29, 30, 40, 42, 45–47, 57, 70, 80, 81, 85–91]
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]
Demand [15, 16, 22, 24, 27, 28, 31–35, 39–42, 44, 47–50, 53–59, 62, 65–69, 72–77, 79, 80, 82–89, 91–94]
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]
Illness and Injury [24, 44, 49–51, 60–64, 73, 90, 94]
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]
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