The Number That Explains Everything: Half the Workforce Caring for Our Kids Is on Public Assistance

The best direct support professional we ever had stayed four years, which in this field is close to unheard of, and she left because she had just been recertified for food assistance for the third year in a row.

She was not angry at us. She adored my daughter. She had simply run the numbers on her own life and concluded that a job which required her to enroll in the same public benefit programs her clients were on was not a job she could keep doing at thirty four.

I have been writing about this system for a while now and I have never found a single statistic that explains more of it than this one. Forty nine percent of direct care workers rely on public assistance.

Say that number out loud

PHI, which has tracked this workforce for decades, published its 2025 Key Facts report using 2024 federal data. The direct care workforce is 5.4 million people. The median hourly wage is $17.36. Median annual earnings are just under $26,000.

Thirty six percent live in households below 200 percent of the federal poverty level. Roughly fifteen percent live below the poverty line outright. And forty nine percent rely on public assistance, meaning Medicaid, food and nutrition assistance, cash assistance, or some combination.

So a state pays a provider a rate. The rate supports a wage. The wage is low enough that half the workers it produces qualify for the same safety net programs their clients depend on. The state is, functionally, paying twice for one job and pretending it only paid once.

A correction I owe you, because the honest version is stronger

There is a comparison that circulates constantly in this advocacy world, including in things I have said myself. It goes: direct support professionals earn less than fast food workers. It is the kind of line that lands in a hearing room.

I went looking for the number behind it and could not make it hold at the national level. The 2024 NCI-IDD State of the Workforce survey, which collected data from 3,936 provider agencies across 27 states and the District of Columbia covering 344,179 DSPs, puts the median DSP starting wage at $18.00 an hour and the median DSP wage at $18.39. Those figures sit above fast food median pay nationally. In individual low-wage states the comparison holds. As a national headline it does not.

I am telling you this because the accurate version is a better weapon. PHI’s finding is that direct care workers earn less than workers in occupations with similar or lower entry-level requirements in all fifty states plus the District of Columbia. All fifty. Not a rhetorical flourish, a fifty-state finding, from the organization that maintains the workforce data.

What the wage buys the rest of us

Here is where the number stops being about somebody else’s paycheck and becomes about your Tuesday.

The 2024 NCI-IDD survey found a weighted mean annual turnover rate of 37.1 percent, ranging from 16.7 percent to 53.7 percent depending on the state. Full-time vacancy rates averaged 9.7 percent and part-time 13.2 percent.

And then the figure that stopped me: of the DSPs who separated from their agency in 2024, 63.7 percent had been employed there less than one year.

Read that carefully, because it is not the same as ordinary turnover. This field is not losing seasoned people to retirement or burnout after a decade. It is losing people before they finish learning the job. Nearly two thirds of departures are inside the first twelve months, which means the system is spending its money on recruitment and orientation and never getting to the part where somebody knows that your son gets loud before he gets overwhelmed, and that the loud part is the warning, not the crisis.

That knowledge is the actual service. It takes about a year to build. The field is losing people at eight months.

The part that is genuinely hard to argue

I want to give the other side its best version, because I would rather this piece survive contact with a fiscal analyst than feel good in front of people who already agree with me.

The strongest objection is that this workforce is enormous and getting more so. 5.4 million people now, with over 772,000 new jobs projected by 2034, the largest growth of any job sector in the country. Raising the wage floor for a workforce that size is genuinely expensive, and the money comes out of a Medicaid budget where every other line has a constituency too. Anyone who tells you a two dollar raise is cheap is not being straight with you.

The counter is not that it is cheap. It is that we are already paying, in three places at once, and only one of them shows up as a wage line. We pay in the public assistance the workforce enrolls in. We pay in turnover, in the recruiting and orientation cost of replacing thirty seven percent of a workforce every year and getting nothing durable for it. And we pay in the services that quietly do not get delivered, which pushes families toward the emergency room, the police call, and eventually the institutional placement that federal law obligates the state to fund.

A state can hold the wage down. It cannot hold the cost down. It can only choose which budget line the cost appears on, and it keeps choosing the ones that are harder to see.

What to do with this

Ask your provider two questions. What do you pay direct support professionals, and how long has the person supporting my family member been here. Both are answerable and a decent agency will answer. The wage tells you whether this arrangement is stable. The tenure tells you whether you are about to start over with a stranger.

Keep the log. Authorized hours against delivered hours, every month, with dates. Nobody else is keeping it. When a state finally has to publish how many authorized hours actually get provided, your household number is what makes the aggregate mean something.

Carry the numbers, not the adjectives. When you testify or write, lead with $17.36, 49 percent, 37.1 percent, and 63.7 percent. Then spend your last thirty seconds on one afternoon in your own house. The figures buy you the credibility to be listened to. The afternoon is what gets remembered.

Stop calling it a shortage. A shortage is when nobody is available. 5.4 million people do this work and hundreds of thousands more cycle through every year. They are available. They leave. That is a different problem with a different fix, and the fix has a price tag that somebody is going to have to say out loud in a budget hearing.

Her name is not in this piece because she did not ask to be in it. She sent a card at Christmas. She works somewhere else now, for more money, doing something easier, and I cannot find a single thing wrong with the decision she made.