National Evaluation of the Demonstration to Improve the Recruitment and Retention of the Direct Service Community Workforce

by John Engberg, Nicholas G. Castle, Sarah B. Hunter, Laura A. Steighner, Elizabeth Maggio

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Direct service workers (DSWs) provide personal care or nonmedical services to individuals who need assistance with activities of daily living. Direct service work is very physically and emotionally demanding, and pay for DSWs is too low to attract a stable and sufficiently trained pool of workers that is adequate for the needs of the vulnerable individuals who require their assistance. To help address this issue, in 2003–2004 the Centers for Medicare and Medicaid Services (CMS) awarded ten grants under the Demonstration to Improve the Direct Service Community Workforce; these grants funded initiatives to improve the recruitment and retention among DSWs. Funded initiatives included such efforts as increasing access to health care, training, mentoring, recognition, worker registries, and marketing campaigns. In 2005, CMS funded a national evaluation, by a consortium led by the RAND Corporation, to study the implementation and outcomes of the ten funded initiatives. As part of this evaluation, researchers reviewed grantees' records, interviewed project stakeholders, conducted site visits, and surveyed direct service agencies, DSWs, and consumers. In this volume, the authors present their findings on the implementation and outcomes from the ten grantees.

Table of Contents

  • Chapter One


  • Chapter Two

    Implementation Analyses

  • Chapter Three

    Analysis of Worker Surveys

  • Chapter Four

    Analysis of Agency Surveys and Web Data

  • Chapter Five

    Summary, Synthesis, and Discussion

  • Appendix A

    Site Summaries

  • Appendix B

    Site-Visit Interview Protocols

  • Appendix C

    Survey Methods

  • Appendix D

    Survey Instruments

  • Appendix E

    Additional Worker Survey Results

  • Appendix F

    Statistical Modeling

  • Appendix G

    Cost Survey Instruments

  • Appendix H

    Cost Survey Results

  • Appendix I

    Consumer Survey Analysis

This work was prepared for the Centers for Medicare and Medicaid Services (CMS). The research was conducted in RAND Health, a division of the RAND Corporation.

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