live in the most integrated community setting suited to their medical needs, have meaningful choices about their living arrangements, and exercise more control over the services they receive” (CMS, 2008b).

The PAS Workforce Project

The 5-year PAS Workforce Project, run through the Center for Personal Assistance Services, has the goal of building and disseminating an evidence base for best practices concerning the personal assistance workforce. The information collected includes data on individual interventions as well as related legislation and policy efforts. The project pays particular attention to strategies to improve worker retention in consumer-directed programs, including issues related to wages, training, safety, and supervision, as well as to the development of infrastructures that facilitate consumer-directed programs (CPAS, 2008). To be included, a program must have documented operational experience as well as evidence of program success and replicability.

National Clearinghouse on the Direct-Care Workforce

PHI’s National Clearinghouse on the Direct-Care Workforce is a national, online library of information regarding the direct-care workforce for long-term care. The clearinghouse collects government and research reports, fact sheets, briefs, and other information on issues such as career advancement, education and training, recruitment and retention, job environment, and best practices (National Clearinghouse for the Direct-Care Workforce, 2008). The clearinghouse also produces original research and analysis, including monitoring of state-based initiatives.


Because direct-care workers provide the bulk of paid direct-care services for older patients in nursing homes and other settings, it is vitally important that the capacity of this segment of the workforce be enhanced in both size and ability to meet the health care needs of older Americans. However, the recruitment and retention of sufficient numbers of these workers is challenging due to serious financial disincentives and job dissatisfaction as well as high rates of turnover and severe shortages of available workers.

As it exists today, the education and training of direct-care workers is inadequate to impart the necessary knowledge, skills, and abilities to these workers, especially as the complexity and severity of older adults’ needs increase and as more adults are cared for in home- and community-based settings. The government should raise the federal minimum training

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