Fewer than half of long-term services and supports direct care workers are still in those jobs a year later, according to a Sept. 29, 2026, analysis from Brookings’ Hamilton Project. Economists Krista Ruffini, Karen Shen, and Yulya Truskinovsky tracked Current Population Survey data from January 2010 through December 2025 for nursing assistants, home health aides, and personal care aides in residential and home care settings.
The authors count about 4.9 million direct care workers nationwide and note nearly 1.2 million people in nursing homes and other residential settings plus nearly 7.3 million receiving care at home or in the community.
Pay, benefits, and exits
In the CPS sample, LTSS direct care wages averaged about $16–$17 an hour—about $16.63 in home care and $17.46 in residential care—below many nearby health and caregiving jobs. Access to pensions and employer health insurance was also lower, especially in home care.
Workers who stayed typically gained about $0.50–$0.59 an hour. Those who left for other work saw raises of as much as about $2.70 an hour and were roughly 10–20 percentage points more likely to get employer health insurance or a pension. About 11–12% of residential and 16–17% of home care direct care workers moved from or to non-employment across a year. Most who left for other jobs stayed in health care or LTSS rather than shifting to unrelated low-wage fields.
The paper also cites high facility nursing-staff turnover near 46% on average in referenced CMS provider data, with only about 12% of facilities under 30%.
Why this matters for providers and DSPs
The pattern matches what I/DD agencies already see: people leave for pay and benefits, not only for unrelated gigs. Provider agency leaders comparing residential and home HCBS lines can use the residential-versus-home wage gap and the “leaver” raise figures when arguing for rate study updates and wage pass-through design—not only vacancy counts.