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State FundingStates have begun to experiment with different mechanisms for funding direct services workforce initiatives. In some states, budget pressures may make obtaining direct appropriations of new funding unlikely, but that does not mean stakeholders should not look to state legislatures and agencies for potential funding. States are interested in reducing the enormous expenditures associated with institutional long term care by offering more services in home and community based settings. A central task in an attempt to obtain state funding is making the case that workforce initiatives will help states build the capacity needed to provide home and community based services, resulting in both improved quality of care and reduced costs in the future. The optimal funding strategy will depend on each state’s unique circumstances. A state's budget situation and process will obviously be a major factor in obtaining funding and the best starting point in any state may be to look at whether there are existing funds that could be redirected to Direct Service Workforce initiatives. The makeup of the stakeholders in a state, the priority agenda items for a legislative session, and the success of similar initiatives historically will also influence the best way to pursue funding. Whether pursuing legislative appropriations or an administrative rule change to expand the permitted use of already allocated funds, advocates must be strategic about what to ask for and how to ask for it. Advocates should also consider looking at local-level governments for funding and support. The macro-level problems of the direct service workforce may require a comprehensive statewide solution, but advocates may need to use smaller projects on the county or city level to demonstrate the benefits of a particular intervention before promoting it as a broader solution. There are two on-line resources that include general information about state grants:
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Health Reform Webinar on Strengthenging the Direct Service Workforce In Rural Areas: On March 18, 2010 the Direct Service Workforce Resource Center held a webinar on strengthening the direct service workforce in rural areas. Webinar on Nurse Delegation: On February 17, 2010 Susan Reinhard, RN, PhD, of AARP and national expert on nurse delegation, moderated the webinar and provided an overview of nurse delegation. New Jersey discussed their nurse delegation pilot program and North Dakota discussed changes that have been made in their state to support nurse delegation. Webinar on the Findings from DSW Demonstration Evaluation: On November 16, 2009 Sarah Hunter from the RAND Corporation and Laura Steighner from American Institutes for Research (AIR) presented the results from the evaluation of the 10 Direct Service Workforce Demonstration grants. CMS awarded the demonstration grants in 2003 and 2004 to better understand how to improve recruitment and retention of the direct service workforce. Strategies for Improving DSW Recruitment, Retention, and Quality: What We Know about What Works, What Doesn't, and Research Gaps: This report provides examples of efforts that have demonstrated positive impacts on recruitment, retention, and quality of services by summarizing key findings from several national studies that reviewed the research on efforts to strengthen the direct service workforce. Direct Service Workforce Core Competencies Annotated Bibliography: This resource was developed in response to requests from several states for information about developing core competencies for DSWs across sectors. Although each sector has its own sets of competencies, no state or national body has yet developed a common set of core competencies and career path for DSWs across the physical disabilities, aging, behavioral health, and intellectual/ developmental disabilities sectors. This annotated bibliography summarizes the recommendations from six state-level reports, two national studies, and a Federal bill to develop such competency-based training across sectors. Strengthening the Direct Service Workforce in Rural Areas: Due to geographic isolation, fewer available services, transportation limitations, demographic trends reducing the supply of informal caregivers and less ability to recruit an adequate supply of direct service workers, many rural areas struggle with providing quality home-based supports. This issue brief 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. |
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