Turnover of direct care workers in the long-term care industry, has reached alarming proportions. It ranges from 45 percent to over 100 percent and costs nearly $4.1 billion annually. Among the many factors contributing to the high turnover rates of direct care workers is inadequate initial training, poor orientation to the job and lack of on-going training which results in feelings of incompetence, confusion and provision of poor quality of care to frail and chronically ill populations.