The median direct care worker in the United States earned $17.36 an hour in 2024, according to PHI, which tracks the workforce annually. Median annual earnings for the same workers were just under $26,000.

Seventeen thirty-six an hour across a full-time year is about $36,000. The gap between those two figures is roughly ten thousand dollars, and none of it is the hourly rate.

It is hours. Forty-six percent of home care workers are part time, working under thirty-five hours a week. Fewer than half work full time, year round.

The paycheck is not the rate

When a business talks about what it pays people, it talks about the rate. We pay seventeen. The competitor down the road pays seventeen fifty. The retention conversation turns into a bidding conversation, which the smaller business loses, because the margin to win it is not there.

The person doing the work does not experience a rate. They experience a paycheck, and the paycheck is the rate times the hours they actually received.

Two businesses can pay the identical wage in the identical market and be entirely different jobs. One gives thirty-four hours in a clean block. The other gives the same thirty-four scattered across six days, with unpaid driving between them and dead hours in the middle. Same cost line, same wage, and only one of them is a job people stay in.

Nothing in the financial statements distinguishes the two.

Departures are not evenly distributed

A schedule like that does not get refused evenly. It gets refused by the people who have somewhere else to go — the experienced ones, with a reliable car and three other employers who would take them tomorrow.

The person who accepts the fragmented week is the person with the fewest options.

Which means the schedule is running a selection process, and running it against the top of the workforce rather than the bottom.

Why the turnover number is read wrong

Two businesses report the same turnover figure. Say seventy-five percent, which is roughly where home-based care sat in the 2025 Activated Insights benchmarking report — the lowest level in five years.

In the first, the churn is at the bottom: people who were never going to stay, in a labor market that does this to everybody. In the second, the churn is at the top, and it is being produced by how the week gets built.

Those are not the same business and they are not worth the same money. But they report the same number, and a buyer looking at it treats all of it as a labor market fact — unfixable, discount the multiple, move on.

Part of it is a labor market fact. Part of it is a scheduling fact. A scheduling fact is fixable, which means in the second business it is mispriced.

What to ask

Do not accept the turnover number. Ask for it split by tenure. Of the people who left in the last year, how long had they been there.

If the ones leaving are the newest, it is a labor market. Price it and move on.

If the ones leaving are the longest-tenured, it is not a labor market. It is something the business is doing to itself — and whatever the seller is discounting for it, they are discounting too much.

Sources

PHI, Direct Care Workers in the United States: Key Facts 2025. Activated Insights, 2025 Benchmarking Report.