AIR, as a subcontractor of RAND Corporation, conducted a national evaluation of 10 CMS demonstration grants designed to improve the recruitment and retention of the direct service workforce (DSWs) who provide home- and community-based services to the elderly and people with disabilities. The types of interventions being implemented by the grantees were categorized into the following five groups: health coverage, education and training, career ladder, community building, and marketing and recruitment.

Through surveys and site visits, we found confirmation of high turnover and difficulty in hiring primarily due to low pay relative to the challenges of the job, and evidence that initiatives that promoted the occupation and provided recognition for long-serving and high-performing workers were most effective.