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

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

John Engberg
Nicholas G. Castle
Sarah B. Hunter
Laura A. Steighner
Elizabeth Maggio
Copyright Date: 2009
Published by: RAND Corporation
Pages: 418
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  • Book Info
    National Evaluation of the Demonstration to Improve the Recruitment and Retention of the Direct Service Community Workforce
    Book Description:

    Direct service workers (DSWs) provide personal care or nonmedical services to individuals who need assistance with activities of daily living. Direct service work is low-paying and very physically and emotionally demanding, and turnover rates among DSWs are high. In 2003-2004, the Centers for Medicare and Medicaid Services funded ten efforts to increase recruitment and retention among DSWs. This volume evaluates these efforts.

    eISBN: 978-0-8330-6010-5
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-ii)
  2. Preface
    (pp. iii-iv)
  3. Table of Contents
    (pp. v-vi)
  4. Figures
    (pp. vii-viii)
  5. Tables
    (pp. ix-xii)
  6. Summary
    (pp. xiii-xvi)
  7. Acknowledgments
    (pp. xvii-xviii)
  8. Abbreviations
    (pp. xix-xxii)
  9. CHAPTER ONE Introduction
    (pp. 1-6)

    More than 50 million Americans—20 percent of the U.S. population—are living with some kind of disability that, for nearly half of this population, affects their capacity to see, hear, walk, or perform other essential life functions (McNeil, 2001). The “graying” of America is exacerbating the problem: Because of advances in medicine, people are living longer, but with longevity comes the increased risk of an age-related disability requiring some level of assistance with the activities of daily living or simple nonmedical procedures to improve quality of life.

    Current policies, such as the Americans with Disabilities Act and the U.S....

  10. CHAPTER TWO Implementation Analyses
    (pp. 7-50)

    In this chapter, we describe the implementation analyses conducted on each type of initiative undertaken by the grantees. First, we discuss the methods of our analysis, including the design, approach, data collection, and analysis procedures. The results from the implementation analyses are organized by initiative type, with key findings regarding the planning and implementation of the initiatives and outcomes observed, followed by a list of recommendations that were derived from these implementation analyses (titled “Things to Consider”). Entities interested in implementing any of these initiatives may find these sections useful when planning similar efforts.

    The approach for the implementation analyses...

  11. CHAPTER THREE Analysis of Worker Surveys
    (pp. 51-68)

    In this chapter, we analyze the views of workers who participated in the demonstrations. We examine their responses to questions regarding their job satisfaction and organizational commitment, whether the job is meeting their expectations, and their intent to stay in their current job.

    First, we give an overview of the process that was used to collect the survey data from a sample of the demonstration participants and a comparison group of workers. Next, we describe the characteristics of the workers and their jobs. We then examine how job satisfaction and other survey responses differed among the workers of the various...

  12. CHAPTER FOUR Analysis of Agency Surveys and Web Data
    (pp. 69-90)

    The agency survey requested information on turnover, retention, vacancies, and related human resources practices. We received 128 agency survey responses: 26 from demonstration agencies and 102 from comparison agencies. More details about the survey process are presented in Appendix C.

    Table 4.1 provides basic demographic statistics for the agency administrators who responded to the surveys, as well as the sample sizes by state and by grant participation status. The majority of the responding administrators were female, especially among the comparison agencies. The average age of the agency administrators was approximately 50 years for both the participating and comparison agencies. Average...

  13. CHAPTER FIVE Summary, Synthesis, and Discussion
    (pp. 91-98)

    Starting in 2003, CMS funded ten demonstration projects aimed at improving the recruitment and retention of DSWs. The grantees designed and implemented a wide range of initiatives, all of which combined a variety of initiatives that were expected to work best in the local context to address the particular needs of local consumers, workers, and, in most cases, agencies. These demonstrations represent trailblazing attempts to create systems that provide high levels of satisfaction for both workers and consumers with the aim of creating lasting relationships that may benefit all involved.

    RAND teamed with the University of Pittsburgh Graduate School of...

  14. APPENDIX A Site Summaries
    (pp. 99-304)
  15. APPENDIX B Site-Visit Interview Protocols
    (pp. 305-324)
  16. APPENDIX C Survey Methods
    (pp. 325-334)
  17. APPENDIX D Survey Instruments
    (pp. 335-360)
  18. APPENDIX E. Additional Worker Survey Results
    (pp. 361-366)
  19. APPENDIX F Statistical Modeling
    (pp. 367-376)
  20. APPENDIX G Cost Survey Instruments
    (pp. 377-378)
  21. APPENDIX H Cost Survey Results
    (pp. 379-382)
  22. APPENDIX I Consumer Survey Analysis
    (pp. 383-388)
  23. Bibliography
    (pp. 389-396)