Recruitment and Retention of Direct Care Workers During the COVID-19 Pandemic: Challenges and Opportunities.

The COVID-19 pandemic exacerbated the challenges of home- and community-based service (HCBS) providers in recruiting and retaining direct care workers (DCWs). One of the largest and fastest-growing occupations in the U.S., DCWs are essential to the growing population of persons in need of long-term services who wish to remain in their homes. We surveyed all Connecticut Medicaid HCBS providers about their pandemic-era recruitment and retention challenges, strategies employed to overcome them, recommendations for regulatory and policy changes, and use of American Rescue Plan Act (ARPA) funding. Respondents ( = 447) noted the continuing key roles played by compensation and working conditions, emphasized unintended consequences of government unemployment policies, provided creative suggestions for professionalization of DCW work, and suggested best practices for consideration, including the success of word-of-mouth and employee referral bonuses in recruiting and the importance of organizational culture in retention.