One of the most important measures that could be taken to build workforce capacity, including recruitment and retention, would be to increase reimbursement to organizations providing long term care waivers.  Current reimbursement levels challenge even the best managed organizations to break even. A reimbursement increase would allow organizations providing agency-directed personal care to increase hourly wages to the all-important workers providing actual hands-on care. Without the ability to offer a living wage, it is difficult to recruit workers.  Consequently, people who have been screened and approved for the waivers cannot receive the care they need at home.  The results can be disastrous for the individual, often costing them their independence when they have no choice but to go to a nursing home—not to mention that nursing home placement comes at a much higher price to Virginia Medicaid than does community based care.