title: Invisible no more: a scoping review of the health care aide workforce literature.
abstract: BACKGROUND
  Healthcare aides (HCAs) are the primary caregivers for vulnerable older persons. They have many titles and are largely unregulated, which contributes to their relative invisibility. The objective of this scoping review was to evaluate the breadth and depth of the HCA workforce literature.
  
  
  METHODS
  We conducted a search of seven online bibliographic databases. Studies were included if published since 1995 in English, peer-reviewed journals. Results were iteratively synthesized within and across the following five categories: education, supply, use, demand and injury and illness.
  
  
  RESULTS
  Of 5,045 citations screened, 82 studies met inclusion criteria. Few examined HCA education; particularly trainee characteristics, program location, length and content. Results in supply indicated that the average HCA was female, 36-45 years and had an education level of high school or less. Home health HCAs were, on average, older and were more likely to be immigrants than those working in other settings. The review of studies exploring HCA use revealed that their role was unclear - variation in duties, level of autonomy and work setting make describing "the" role of an HCA near impossible. Projected increased demand for HCAs and high rates of turnover, both at the profession and facility-level, elicit predictions of future HCA shortages. Home health HCAs experienced comparatively lower job stability, earned less, worked the fewest hours and were less likely to have fringe benefits than HCAs employed in hospitals and nursing homes. The review of studies related to HCA illness and injury revealed that they were at comparatively higher risk of injury than registered nurses and licensed practical nurses.
  
  
  CONCLUSIONS
  This is the largest, most comprehensive scoping review of HCA workforce literature to date. Our results indicate that the HCA workforce is both invisible and ubiquitous; as long as this is the case, governments and healthcare organizations will be limited in their ability to develop and implement feasible, effective HCA workforce plans. The continued undervaluation of HCAs adversely impacts care providers, the institutions they work for and those who depend on their care. Future workforce planning and research necessitates national HCA registries, or at minimum, directories.
authors.affiliation: CLEAR Outcomes Research Program, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Hewko
authors.affiliation: CLEAR Outcomes Research Program, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Cooper
authors.affiliation: CLEAR Outcomes Research Program, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada.
authors.forename: Hanhmi
authors.initials: H
authors.lastname: Huynh
authors.affiliation: CLEAR Outcomes Research Program, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada.
authors.forename: Trish L
authors.initials: TL
authors.lastname: Spiwek
authors.affiliation: CLEAR Outcomes Research Program, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Carleton
authors.affiliation: CLEAR Outcomes Research Program, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada.
authors.forename: Shawna
authors.initials: S
authors.lastname: Reid
authors.affiliation: CLEAR Outcomes Research Program, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada.
authors.forename: Greta G
authors.initials: GG
authors.lastname: Cummings
keywords: Frail elderly; Health manpower; Health services accessibility; Home care services; Home health aides; Nurses’ aides; Nursing homes; Review