1. HEALTH CARE AND HUMAN SERVICES POLICY, RESEARCH, AND CONSULTING - WITH REAL-WORLD PERSPECTIVE. Strengthening the Direct Service Workforce in Rural Areas March 18, 2010 DSW Resource Center Technical Assistance Webinar

2. www.dswresourcecenter.org 2 Direct Service Workforce Resource Center The National Direct Service Workforce (DSW) Resource Center supports efforts to improve recruitment and retention of direct service workers who help people with disabilities and older adults to live independently and with dignity. The Center brings together the nation’s premier resources on the topic of the Direct Support Workforce. These resources, which include web-based clearinghouses, technical experts, training tools and more, cover the full range of DSW consumer populations. The DSW Resource Center is funded and supported by the Centers for Medicare and Medicaid Services (CMS) under the U.S. Department for Health and Human Services. Strengthening the Direct Service Workforce in Rural Areas Issue Brief Available at www.DSWResourceCenter.org

3. www.dswresourcecenter.org 3 Overview “Both urban and rural areas struggle with providing quality long-term supports and services to older people and people living with disabilities, especially when it comes to providing services in consumers’ own homes. Several issues and trends make these challenges even more complex for providers and consumers in rural areas.”

4. www.dswresourcecenter.org 4 Direct Service Challenges Specific to Rural Areas Smaller, more dispersed client base Lower wages Often fewer services Caregiver support more difficult Training difficult due to geographic dispersion, smaller class sizes and lack of nearby educational institutions Transportation Worker/consumer mismatch

5. www.dswresourcecenter.org 5 Innovative Practices Challenge: Smaller, more dispersed client base / smaller financial incentives / smaller workforce Worker-owned cooperatives “Grow Your Own” initiatives General recruitment/retention activities Mentoring Career ladders Supervisor training Recognition Communication skills Collaborating with urban agencies

6. www.dswresourcecenter.org 6 Innovative Practices Challenge: Caregiver support Videoconferencing, conference calls, in-person meetings or web- based training to teach hands-on caregiver skills Developing caregiver support networks Virtual support groups and online collections of resources

7. www.dswresourcecenter.org 7 Innovative Practices Challenge: Training difficult due to geographic dispersion, smaller class size and lack of nearby educational institutions Internet-based technology Mixed training methods (online and in-person) Rural colleges Train-the-Trainer Developing clearer competencies

8. www.dswresourcecenter.org 8 Innovative Practices Challenge: Transportation Carpooling Scheduling based on geography Reimbursing workers for mileage expenses Arranging with rental companies to rent highly fuel-efficient cars to DSWs Using alternative care sites and other settings such as senior housing facilities, assisted living facilities and churches to deliver specific services. Coordinating services Telehealth

9. www.dswresourcecenter.org 9 Innovative Practices Challenge: Worker/Consumer Mismatch Participant-directed / consumer-directed programs Example: Cash and Counseling Web-based worker registries

10. www.dswresourcecenter.org 10 Questions for State Discussion What are the two biggest challenges you face in providing home and community-based services to rural areas? Has anything changed over the last year or two as the economy has struggled? What improvements have you observed? Has anything gotten worse? What strategies have you tried to address these challenges? Have any of these strategies been successful? What kinds of technical assistance would best help you address these challenges?

11. www.dswresourcecenter.org 11 Direct Service Workforce Resource Center www.dswresourcecenter.org The Lewin Group | Health care and human services policy research and consulting | www.lewin.com www.lewin.com 3130 Fairview Park Drive, Suite 800 Falls Church, VA 22042 From North America, call toll free: 1-877-227-5042 inquiry@lewin.cominquiry@lewin.com The Lewin Group is an Ingenix Company. Ingenix, a wholly-owned subsidiary of UnitedHealth Group, was founded in 1996 to develop, acquire and integrate the world's best-in-class health care information technology capabilities. For more information, visit www.ingenix.com. The Lewin Group operates with editorial independence and provides its clients with the very best expert and impartial health care and human services policy research and consulting services. The Lewin Group and logo, Ingenix and the Ingenix logo are registered trademarks of Ingenix. All other brand or product names are trademarks or registered marks of their respective owners. Because we are continuously improving our products and services, Ingenix reserves the right to change specifications without prior notice. Ingenix is an equal opportunity employer. Original © 2008 Ingenix. All Rights Reservedwww.ingenix.com Kip Brown Research Consultant kip.brown@lewin.com 703-269-5524