large-scale efforts, including those of the federal government, are detailed below. In addition, there have been several large-scale efforts to build an evidence base for the best practices in the recruitment and retention of direct-care workers. These efforts are also described below.

The Better Jobs Better Care national program, which was completed in 2007, supported five state-based coalitions (in Iowa, North Carolina, Oregon, Pennsylvania, and Vermont) that designed and tested practice-based interventions and policy changes over a 4-year period. These coalitions attempted to reduce turnover and vacancy rates and improve the working environment of direct-care staff in long-term care (BJBC, 2007). Since each state used different approaches to reach these goals, no single method can be fairly highlighted over the others. All of the participating states demonstrated a range of positive results from this effort, including improvement in worker satisfaction and increased recruitment (BJBC, 2008). To accomplish this, the program improved employee pay and also pushed employers to demonstrate respect for direct-care workers in a variety of ways: by providing supervision, peer mentoring, and team building; by offering opportunities for educational advancement; and by encouraging greater communication and understanding (McDonald, 2007).

A number of efforts to bolster the direct-care workforce have been undertaken by the Employment and Training Administration (ETA) within the DOL, which has invested hundreds of millions of dollars in grants aimed at strengthening the pipeline of needed workers. The ETA’s efforts to improve career lattices through the programs of its Office of Apprenticeship were discussed above. Many of the ETA’s grants focus on long-term care workers (Freking, 2007). For example, since 2004 the Community-Based Job Training Grants have funded a number of programs to prepare students for careers in high-growth industries (DOL, 2008b). In March 2008 the DOL awarded $125 million to 69 community colleges, and 24 of these grants (totaling almost $40 million) were for developing workers for the health care industry (DOL, 2008a,d).

The ETA’s High Growth Job Training Initiative is aimed at giving workers the skills necessary to build a career in one of several different industries, including health care. Under this initiative, the ETA is investing more than $46 million to address health care workforce shortages, particularly among long-term care workers (DOL, 2007). The initiative will focus on such things as increasing the number of younger workers entering the mar-