By Jeff Gallagher, TLC Vice President

I have spent more than 30 years working in the field of intellectual and developmental disabilities.

I did not start in leadership. I started as a Direct Support Professional.

I was one of the people helping individuals get dressed, take medications, learn new skills, participate in their communities, and live as independently as possible. I learned early that this work is about much more than providing care. It is about relationships, trust, patience, and being there for people during both challenges and successes.

Over three decades, I have watched something that has always troubled me. As a society, we often ask the people doing some of the hardest and most important work to accept some of the lowest wages.

Think about that for a moment.

We ask people to care for individuals with some of the greatest needs in our communities, yet we struggle to compensate those caregivers in a way that reflects the value of their work. We should not be surprised that we have a workforce crisis.

Across the country, Direct Support Professionals (DSP) are leaving the field at alarming rates. A 2025  survey of provider agencies representing more than 344,000 DSPs found an average turnover rate of 37%. Another survey found that 88% of provider organizations experienced moderate or severe staffing challenges. North Carolina is experiencing the same reality.

This is not simply a staffing problem. When DSP positions are vacant, people wait for services, providers turn families away, and parents reduce work hours or leave jobs to provide care themselves. Thousands of North Carolinians are already waiting for services, and we cannot seriously talk about reducing that waitlist without addressing the workforce needed to provide support.

Today, I have the privilege of serving as Vice President at TLC, founded as Tammy Lynn Center, in Raleigh. Each year, we support nearly 2,000 children and adults with intellectual and developmental disabilities. Like providers across North Carolina, we have experienced workforce challenges firsthand.

Several years ago, we decided to try something that should not be revolutionary: invest in our people.

TLC committed to paying frontline staff between $15 and $23 an hour, above North Carolina’s average DSP wage of $15.76 according to National Core Indicators. We also created Career Pathways, a professional development program that provides advanced training and an opportunity for employees to earn national certification.

Why? Because these should not be jobs people take until something better comes along. They should be careers.

People should be able to develop skills, earn certifications, advance into leadership, and make a sustainable living while doing meaningful work. That investment is making a difference. Our frontline vacancies are now the lowest they have been in years, possibly the lowest in our organization’s history.

We have not solved the workforce crisis, but we have learned an important lesson: when you invest in people, people stay.

North Carolina came dangerously close to moving in the opposite direction. Last year, a $319 million Medicaid shortfall resulted in reimbursement reductions of 3% to 10% for providers delivering Medicaid-funded services. Those reductions were eventually reversed, but the message was clear.

Medicaid reimbursement is not just a budget number. It affects whether providers can recruit employees, increase wages, offer training, and say “yes” when another family calls asking for help.

We also need to be honest about something else. For decades, our culture has often placed greater financial value on the people who manage systems than on the people who provide hands-on support.

But the person helping someone at two o’clock in the morning matters.

The person teaching daily living skills matters.

The person helping someone communicate, participate in the community, and live a meaningful life matters.

Those professionals are the foundation of our support system, and we cannot continue asking them to do extraordinary work while treating their jobs as ordinary.

This September, organizations across the country will celebrate Direct Support Professional Recognition Week. These professionals deserve our gratitude, but gratitude alone is not a workforce strategy.

If we truly value Direct Support Professionals, we must demonstrate it through competitive wages, training, career advancement, and funding systems that support those investments.

I started this journey as a DSP. Today, I serve in leadership, but I have never forgotten where I started.

And if there is one thing I have learned in more than 30 years, it is this: You cannot build a strong system of care while undervaluing the people who provide the care.

If North Carolina wants fewer families waiting for services and more people with disabilities living full and independent lives, we have to make these careers worth staying in.

At TLC, we have seen what happens when we invest in people.

North Carolina should take notice.