Direct care workers provide an estimated 70 to 80 percent of the paid hands-on long term care and personal assistance for Americans who are elderly, chronically ill or live with disabilities. Direct care worker refers to a category of workers in various long-term care settings who are the frontline workers on care teams. Their jobs are largely characterized by low pay, few benefits, heavy workloads and high levels of turnover. Common job titles for these workers include nursing assistants, nurse aides, in-home aides and personal care aides. In North Carolina, where this study was conducted, turnover rates of direct care workers in nursing homes have averaged approximately 100 percent per year over the last few years. A program called WIN A STEP UP was developed as one way to address these problems. The main aim of this study was to conduct an evaluation of WIN A STEP UP. The evaluation was conducted under the auspices of the Cecil G. Sheps Center for Health Services Research.