We examined employment outcomes among middle-aged and older clients with schizophrenia in three work rehabilitation programs that varied in their emphasis on conventional vocational rehabilitation (train-then-place) versus supported employment principles (place-then-train). We analyzed retrospective data from 36 veterans receiving VA Wellness and Vocational Enrichment Clinic (WAVE) services and prospective data from a randomized controlled trial of 30 subjects receiving Department of Rehabilitation/Employment Services (DOR) or Individual Placement and Support (IPS). Across interventions, half the subjects obtained volunteer or paid work. IPS participants, those with schizophrenia (versus schizoaffective disorder), and those with more education were more likely to work or volunteer. Rates of volunteer or paid work were 81% in IPS, 44% in WAVE, and 29% in DOR. Rates of competitive/paid work only were highest in IPS (69%), followed by DOR (29%) and WAVE (17%). Middle-aged and older people with schizophrenia-spectrum disorders benefit most from a supported employment approach.