Workforce Initiative

As the primary funder of long-term services and supports under the Medicaid Program, CMS maintains a vital interest in the paid and informal direct service community workforce. In the past 10 years, CMS has committed substantial resources to improving the recruitment and retention of direct service workers (DSW) through its Real Choice Systems Change grants, Direct Care Community Workforce Demonstration grants and national evaluations of them, and the National Direct Service Workforce Resource Center. The Direct Service Workforce Resource Center, under the guidance of CMS, developed many resources related to workforce development including:

• The PHI State Data Center - provides data and statistics about the DSW in every state.
• Coverage of Direct Service Workforce Continuing Education and Training within Medicaid Policy and Rate Setting - A Toolkit was developed to help states better understand and utilize the CMS guidance provided in a July 13, 2011 Bulletin.

The DSW Core Competency Project

• Phase IIIB of the Road Map of Core Competencies for Direct Service Workforce Project Validation serves as the final report for the project and includes the fully validated core competency set. The full report includes the resources listed below:
  • Final Competency Set
  • Executive Summary
  • Direct Service Workforce Training Resources Toolkit
• The DSW Core Competencies Companion Guide is designed to assist stakeholders in applying the core competencies to DSW development efforts.
• Phase I and II of the Road Map of Core Competencies for the Direct Service Workforce provides an inventory and overview of competency sets used across and within long-term service and support sectors.
• Phase IIIA of the Road Map of Core Competencies was conducted in collaboration with stakeholders to synthesize results of the competency analysis and reach consensus on a set of core competencies for direct service workers.

Overviews of Workforce Challenges and Effective Improvement Strategies:

• A Synthesis of Direct Service Workforce Demographics and Challenges presents an overview of direct service workforce challenges and practices across intellectual and developmental disabilities, aging, physical disabilities, and behavioral health. It includes recommendations for action steps that could be taken in partnership across these different sectors to address workforce challenges.
• Strategies for Improving DSW Recruitment, Retention, and Quality: What We Know about What Works, What Doesn't, and Research Gaps provides examples of efforts that have demonstrated positive impacts in these areas by summarizing key findings from several national studies that reviewed the research on efforts to strengthen the direct service workforce. 
• Finding Direct Service Workforce Information and Resources Online is a one-pager of helpful websites for people looking to learn about the DSW.
• Funding Direct Service Workforce Development Activities is a one-pager and checklist of funding sources to consider for DSW development activities.
• 2013 CMS Direct Service Workforce Resource Center Summer Webinar Series White Paper summarizes some of the common themes that emerged across the 2013 Summer Webinar Series, “Celebrating Success in Direct Service Workforce Development,” highlights successful strategies and recommendations made by presenters and commitments to action from participants.
• Building Capacity and Coordinating Support for Family Caregivers and the Direct Service Workforce: Common Goals and Policy Recommendations Emerging from the CMS Leadership Summit on the Direct Service Workforce and Family Caregivers is a white paper developed following the 2010 Summit on Building Capacity and Coordinating Support for Family Caregivers and the Direct Service Workforce sponsored by CMS, the Office on Disability, and the Administration on Aging.
• 2008 Symposium on Strengthening the HCBS Direct Service Workforce Discussion Summary highlights main themes from small discussion groups at this 2008 Symposium hosted by the DSW RC with the support of DHHS and the Department of Labor. This event provided a forum for showcasing best practices in direct service workforce development, highlighted Federal and state workforce initiatives, and disseminated research findings. 
• Two short documents, were developed to provide easy access to basic information on DSW issues: Direct Service Workforce Background Information Handout and DSW Demonstration Fact Sheet 
• The Need for Monitoring the Long-Term Care Direct Service Workforce and Recommendations for Data Collection recommends a standard minimum data set that states should collect across long-term services and supports settings and different sectors of the workforce, including three basic elements: volume, stability, and compensation. 
• Strengthening the Direct Service Workforce in Rural Areas contains a summary of the challenges of the direct service workforce in rural areas and strategies that rural stakeholders can use to provide high-quality long-term care services and supports.
• Cooperatives: A Growing Strategy for Strengthening the Home and Community Based Services Direct Service Workforce provides background on cooperatives. It examines examples of worker cooperatives in the Direct Service Workforce and considers the potential for their expanded use to improve recruitment, retention, and quality.

Workforce Development through Money Follows the Person

• Using the Money Follows the Person Demonstration to Develop Direct Service Workforce provides an overview of state-experience using MFP to develop DSW infrastructure and provides helpful tips for state MFP programs to advance efforts to improve recruitment and retention of direct service workers who help people with disabilities.
• Best Practices for HCBS Ombudsmen was prepared for the Connecticut Department of Social Services as part of DSW RC TA to MFP states. It contains an explanation of roles and responsibilities of Ombudsmen within HCBS, a state comparison of these roles, and best practices for advocacy and fiscal considerations.
• QUICK TIP SHEET: Using the Money Follows the Person Demonstration to Develop Direct Service Workforce Infrastructure provides helpful tips to state MFP programs to advance efforts to improve recruitment and retention of direct service workers who help people with disabilities and older adults to live independently and with dignity.

Workforce Development through NWD Systems/ADRCs

• Two starter kits were published to the DSW RC and Administration for Community Living Aging and Disability Resource Center Technical Assistance Exchange in 2013, Starter Kit for No Wrong Door/ Single Entry Point Systems Working to Strengthen the Home and Community-Based Direct Service Workforce and Starter Kit for NWD/SEPs: Design Considerations for Publicly-Funded Matching Service Registries for Home and Community Services.
• These were accompanied by two summary documents, Issue Brief: Opportunities for No Wrong Door/Single Entry Point Systems to Strengthen the Home and Community-Based Direct Service Workforce  and Issue Brief: Connecting Older Adults and Persons with Disabilities with Personal Care Assistance: The Potential of NWD/SEPs at Hosts for Publicly-Funded Matching Service Registries.