TWF Direct Care Staffing Index · Edition 2026.1
In one Southeast metro a direct care worker needs 87 hours a week to afford a one bedroom.
We measured every metropolitan area across seven states on the two things that decide whether a provider can staff a shift and keep the person who works it: what the job pays against what rent costs, and what the job pays against what the warehouse down the road pays.
What we found
Three numbers that explain the staffing crisis
87
Hours a week to afford rent in Miami
A front-line direct care worker in Miami-Fort Lauderdale-West Palm Beach earns $17.68 an hour. A one bedroom at HUD Fair Market Rent is $1,995 a month. At the federal standard of 30 percent of income, affording it takes 86.8 hours a week. That is more than two full-time jobs.
54.8
Median hours across all 90 metros
Miami is the extreme. The middle is not comfortable either. In the median metro in this footprint a direct care worker needs 54.8 hours a week to afford a one bedroom on their own. A 40 hour week does not reach it anywhere in the top half of this table.
5c
What direct care pays over the wage floor in Dothan
Direct care does not pay less than retail, warehouse and fast food. It pays a rounding error more. Across 90 metros the median premium is $1.74 an hour. In Dothan it is 5 cents, for work that carries background checks, mandated training and responsibility for another person.
By state
Seven states, employment weighted
Wage and rent columns are built from metro data and weighted by direct care employment. Shortage designations, minimum wage and turnover are state level figures and are shown as context, not as metro measures.
| State | Metros | Direct care workers | Hours for rent | Wage gap | Care wage | 1BR FMR | HPSA | Need met | DSP turnover |
|---|---|---|---|---|---|---|---|---|---|
| FL | 22 | 208,480 | 72.1 | $2.00 | $17.77 | $1,667 | 239 | 24.9% | not surveyed |
| GA | 14 | 90,740 | 68.4 | $1.89 | $16.68 | $1,490 | 92 | 45.3% | 33.6% |
| VA | 9 | 65,570 | 65.3 | $1.26 | $16.56 | $1,405 | 128 | 22.4% | not surveyed |
| NC | 15 | 107,410 | 60.1 | $2.10 | $17.53 | $1,374 | 218 | 12.5% | 23.9% |
| SC | 8 | 52,290 | 59.4 | $1.29 | $16.17 | $1,253 | 86 | 30.7% | 39.4% |
| TN | 10 | 61,980 | 55.9 | $1.92 | $17.16 | $1,254 | 97 | 13.2% | 37.7% |
| AL | 12 | 41,100 | 50.5 | $0.87 | $15.36 | $1,012 | 67 | 28.4% | 40.6% |
Reading the state table. Percent of need met is HRSA's psychiatrist-only ratio, so a high figure does not mean good access to counsellors or clinical social workers. DSP turnover comes from the National Core Indicators IDD survey; Virginia and Florida do not participate, so they are shown as not surveyed rather than as zero.
Every metro, ranked
All 90 metropolitan areas
Higher score means harder to recruit and hold direct care staff. The score is the mean of two percentile ranks: hours needed to afford a one bedroom, and the inverse of the wage premium over the local floor.
| # | Metro | State | Score | Band | Hours for rent | Wage gap | Care wage | Floor wage | 1BR FMR |
|---|---|---|---|---|---|---|---|---|---|
| 1 | Hilton Head Island-Bluffton-Port Royal, SC | SC | 98.9 | Severe | 79.8 | $0.15 | $15.98 | $15.83 | $1,657 |
| 2 | Virginia Beach-Chesapeake-Norfolk, VA-NC | VA | 86.0 | Severe | 72.1 | $1.20 | $16.13 | $14.93 | $1,512 |
| 3 | Naples-Marco Island, FL | FL | 82.0 | Severe | 74.6 | $1.50 | $18.54 | $17.04 | $1,797 |
| 4 | Richmond, VA | VA | 80.9 | Severe | 68.0 | $1.16 | $17.04 | $15.88 | $1,507 |
| 5 | Daphne-Fairhope-Foley, AL | AL | 79.8 | Severe | 61.4 | $1.01 | $15.04 | $14.03 | $1,200 |
| 6 | Greenville-Anderson-Greer, SC | SC | 79.8 | Severe | 59.8 | $0.90 | $15.70 | $14.80 | $1,221 |
| 7 | Miami-Fort Lauderdale-West Palm Beach, FL | FL | 79.8 | Severe | 86.8 | $1.65 | $17.68 | $16.03 | $1,995 |
| 8 | Charlottesville, VA | VA | 77.0 | Severe | 70.8 | $1.59 | $17.40 | $15.82 | $1,602 |
| 9 | Myrtle Beach-Conway-North Myrtle Beach, SC | SC | 77.0 | Severe | 60.9 | $1.15 | $15.53 | $14.38 | $1,229 |
| 10 | Auburn-Opelika, AL | AL | 74.7 | Strained | 56.0 | $0.87 | $14.79 | $13.92 | $1,077 |
| 11 | Atlanta-Sandy Springs-Roswell, GA | GA | 71.9 | Strained | 74.9 | $1.80 | $17.06 | $15.26 | $1,660 |
| 12 | Huntsville, AL | AL | 71.9 | Strained | 54.8 | $0.62 | $15.94 | $15.32 | $1,136 |
| 13 | Lakeland-Winter Haven, FL | FL | 70.8 | Strained | 55.2 | $0.96 | $17.14 | $16.19 | $1,230 |
| 14 | Asheville, NC | NC | 68.0 | Strained | 71.6 | $1.88 | $17.98 | $16.10 | $1,674 |
| 15 | Hinesville, GA | GA | 68.0 | Strained | 63.6 | $1.62 | $15.52 | $13.90 | $1,283 |
| 16 | Winchester, VA-WV | VA | 68.0 | Strained | 58.0 | $1.38 | $16.66 | $15.28 | $1,255 |
| 17 | Birmingham, AL | AL | 67.4 | Strained | 54.8 | $1.07 | $16.21 | $15.13 | $1,155 |
| 18 | Columbia, SC | SC | 65.2 | Strained | 55.3 | $1.32 | $16.19 | $14.88 | $1,164 |
| 19 | Harrisonburg, VA | VA | 65.2 | Strained | 50.5 | $0.28 | $16.11 | $15.82 | $1,057 |
| 20 | Staunton-Stuarts Draft, VA | VA | 64.6 | Strained | 50.9 | $0.67 | $16.55 | $15.87 | $1,095 |
| 21 | Greensboro-High Point, NC | NC | 64.0 | Strained | 56.1 | $1.44 | $16.64 | $15.20 | $1,213 |
| 22 | Memphis, TN-MS-AR | TN | 63.5 | Strained | 53.5 | $1.15 | $16.59 | $15.44 | $1,154 |
| 23 | Mobile, AL | AL | 63.5 | Strained | 48.6 | $0.23 | $14.55 | $14.32 | $919 |
| 24 | Crestview-Fort Walton Beach-Destin, FL | FL | 62.9 | Strained | 68.9 | $1.97 | $17.65 | $15.68 | $1,581 |
| 25 | Raleigh-Cary, NC | NC | 61.8 | Strained | 69.6 | $2.01 | $17.65 | $15.63 | $1,596 |
| 26 | Charleston-North Charleston, SC | SC | 60.7 | Strained | 70.9 | $2.08 | $17.68 | $15.60 | $1,630 |
| 27 | Panama City-Panama City Beach, FL | FL | 60.7 | Strained | 66.5 | $1.97 | $17.13 | $15.16 | $1,480 |
| 28 | Warner Robins, GA | GA | 60.1 | Strained | 59.5 | $1.73 | $15.79 | $14.06 | $1,221 |
| 29 | Port St. Lucie, FL | FL | 59.6 | Strained | 64.0 | $1.89 | $17.63 | $15.74 | $1,467 |
| 30 | Tampa-St. Petersburg-Clearwater, FL | FL | 59.6 | Strained | 73.0 | $2.16 | $17.87 | $15.71 | $1,696 |
| 31 | Cape Coral-Fort Myers, FL | FL | 59.0 | Strained | 69.6 | $2.07 | $18.10 | $16.03 | $1,638 |
| 32 | Fayetteville, NC | NC | 58.4 | Strained | 52.6 | $1.33 | $16.28 | $14.95 | $1,113 |
| 33 | Nashville-Davidson--Murfreesboro--Franklin, TN | TN | 58.4 | Strained | 67.0 | $2.02 | $18.11 | $16.08 | $1,578 |
| 34 | Charlotte-Concord-Gastonia, NC-SC | NC | 55.6 | Strained | 65.7 | $2.06 | $17.99 | $15.93 | $1,538 |
| 35 | Dothan, AL | AL | 55.6 | Strained | 42.5 | $0.05 | $13.80 | $13.75 | $762 |
| 36 | Macon-Bibb County, GA | GA | 55.6 | Strained | 57.6 | $1.74 | $15.46 | $13.72 | $1,158 |
| 37 | Savannah, GA | GA | 55.1 | Strained | 70.4 | $2.21 | $16.74 | $14.53 | $1,533 |
| 38 | Spartanburg, SC | SC | 55.1 | Strained | 51.2 | $1.40 | $16.29 | $14.88 | $1,083 |
| 39 | Blacksburg-Christiansburg-Radford, VA | VA | 54.5 | Manageable | 47.4 | $1.12 | $16.13 | $15.01 | $993 |
| 40 | Gadsden, AL | AL | 53.4 | Manageable | 43.5 | $0.79 | $14.01 | $13.22 | $792 |
| 41 | Montgomery, AL | AL | 52.8 | Manageable | 44.3 | $0.99 | $15.11 | $14.12 | $870 |
| 42 | Ocala, FL | FL | 52.8 | Manageable | 54.1 | $1.66 | $16.66 | $15.00 | $1,172 |
| 43 | Punta Gorda, FL | FL | 52.8 | Manageable | 50.7 | $1.41 | $17.71 | $16.31 | $1,167 |
| 44 | Clarksville, TN-KY | TN | 51.7 | Manageable | 52.0 | $1.59 | $16.19 | $14.60 | $1,094 |
| 45 | Jacksonville, FL | FL | 51.7 | Manageable | 59.1 | $2.02 | $17.98 | $15.96 | $1,382 |
| 46 | Valdosta, GA | GA | 51.7 | Manageable | 48.2 | $1.23 | $14.69 | $13.47 | $921 |
| 47 | Wildwood-The Villages, FL | FL | 51.7 | Manageable | 50.9 | $1.50 | $17.23 | $15.73 | $1,139 |
| 48 | Brunswick-St. Simons, GA | GA | 51.1 | Manageable | 54.0 | $1.69 | $15.75 | $14.07 | $1,105 |
| 49 | Orlando-Kissimmee-Sanford, FL | FL | 50.6 | Manageable | 73.7 | $2.67 | $18.07 | $15.41 | $1,731 |
| 50 | Tuscaloosa, AL | AL | 50.0 | Manageable | 49.1 | $1.43 | $15.23 | $13.80 | $972 |
| 51 | Decatur, AL | AL | 49.4 | Manageable | 39.9 | $0.59 | $14.96 | $14.37 | $776 |
| 52 | Pinehurst-Southern Pines, NC | NC | 49.4 | Manageable | 58.1 | $2.05 | $16.42 | $14.37 | $1,239 |
| 53 | North Port-Bradenton-Sarasota, FL | FL | 48.9 | Manageable | 69.4 | $2.34 | $18.70 | $16.36 | $1,686 |
| 54 | Palm Bay-Melbourne-Titusville, FL | FL | 48.9 | Manageable | 64.7 | $2.22 | $17.57 | $15.34 | $1,478 |
| 55 | Augusta-Richmond County, GA-SC | GA | 48.3 | Manageable | 54.5 | $1.75 | $15.72 | $13.97 | $1,114 |
| 56 | Deltona-Daytona Beach-Ormond Beach, FL | FL | 48.3 | Manageable | 60.1 | $2.14 | $17.73 | $15.59 | $1,385 |
| 57 | Wilmington, NC | NC | 48.3 | Manageable | 68.2 | $2.32 | $17.07 | $14.75 | $1,513 |
| 58 | Athens-Clarke County, GA | GA | 47.8 | Manageable | 58.4 | $2.09 | $15.59 | $13.50 | $1,183 |
| 59 | Albany, GA | GA | 47.2 | Manageable | 52.3 | $1.72 | $14.80 | $13.08 | $1,006 |
| 60 | Roanoke, VA | VA | 46.6 | Manageable | 49.3 | $1.60 | $16.44 | $14.84 | $1,053 |
| 61 | Florence, SC | SC | 44.4 | Manageable | 47.1 | $1.57 | $15.58 | $14.01 | $953 |
| 62 | Florence-Muscle Shoals, AL | AL | 44.4 | Manageable | 41.4 | $1.14 | $14.39 | $13.25 | $775 |
| 63 | Burlington, NC | NC | 41.6 | Manageable | 55.6 | $2.11 | $17.01 | $14.90 | $1,230 |
| 64 | Pensacola-Ferry Pass-Brent, FL | FL | 41.6 | Manageable | 56.4 | $2.20 | $17.15 | $14.95 | $1,257 |
| 65 | Sebastian-Vero Beach-West Vero Corridor, FL | FL | 40.4 | Manageable | 52.8 | $2.00 | $17.80 | $15.81 | $1,222 |
| 66 | Hickory-Lenoir-Morganton, NC | NC | 39.9 | Manageable | 41.4 | $1.36 | $16.86 | $15.50 | $908 |
| 67 | Sumter, SC | SC | 39.9 | Manageable | 50.0 | $1.76 | $14.96 | $13.20 | $972 |
| 68 | Durham-Chapel Hill, NC | NC | 38.2 | Manageable | 62.0 | $3.32 | $18.70 | $15.38 | $1,507 |
| 69 | Jackson, TN | TN | 36.5 | Manageable | 45.7 | $1.72 | $16.15 | $14.44 | $960 |
| 70 | Rocky Mount, NC | NC | 34.8 | Workable | 43.1 | $1.69 | $16.38 | $14.69 | $918 |
| 71 | Tallahassee, FL | FL | 34.8 | Workable | 55.3 | $2.27 | $16.76 | $14.48 | $1,204 |
| 72 | Homosassa Springs, FL | FL | 33.7 | Workable | 46.4 | $1.80 | $16.39 | $14.60 | $988 |
| 73 | Gainesville, GA | GA | 32.0 | Workable | 58.0 | $3.72 | $18.31 | $14.59 | $1,381 |
| 74 | Chattanooga, TN-GA | TN | 30.9 | Workable | 55.8 | $2.81 | $17.42 | $14.61 | $1,263 |
| 75 | Gainesville, FL | FL | 29.8 | Workable | 54.8 | $2.46 | $17.49 | $15.04 | $1,246 |
| 76 | Knoxville, TN | TN | 29.2 | Workable | 53.3 | $2.28 | $17.10 | $14.82 | $1,184 |
| 77 | Kingsport-Bristol, TN-VA | TN | 28.7 | Workable | 38.2 | $1.67 | $16.46 | $14.79 | $818 |
| 78 | Lynchburg, VA | VA | 28.1 | Workable | 48.5 | $2.10 | $16.40 | $14.30 | $1,033 |
| 79 | Anniston-Oxford, AL | AL | 26.4 | Workable | 38.9 | $1.73 | $14.97 | $13.23 | $757 |
| 80 | Morristown, TN | TN | 25.3 | Workable | 42.4 | $1.97 | $16.10 | $14.13 | $887 |
| 81 | Winston-Salem, NC | NC | 22.5 | Workable | 48.4 | $2.24 | $17.21 | $14.97 | $1,082 |
| 82 | Jacksonville, NC | NC | 20.2 | Workable | 43.6 | $2.16 | $16.50 | $14.34 | $935 |
| 83 | Cleveland, TN | TN | 18.0 | Workable | 43.9 | $2.23 | $16.47 | $14.24 | $940 |
| 84 | Columbus, GA-AL | GA | 15.7 | Workable | 46.5 | $2.58 | $15.52 | $12.94 | $939 |
| 85 | Sebring, FL | FL | 15.7 | Workable | 45.9 | $2.41 | $16.85 | $14.44 | $1,006 |
| 86 | Rome, GA | GA | 14.6 | Workable | 42.6 | $2.25 | $16.67 | $14.42 | $923 |
| 87 | Johnson City, TN | TN | 7.9 | Workable | 41.7 | $2.66 | $16.48 | $13.82 | $893 |
| 88 | Dalton, GA | GA | 6.2 | Workable | 42.4 | $2.85 | $16.32 | $13.47 | $899 |
| 89 | Greenville, NC | NC | 6.2 | Workable | 40.0 | $2.66 | $17.22 | $14.56 | $896 |
| 90 | Goldsboro, NC | NC | 1.7 | Workable | 39.5 | $3.72 | $18.48 | $14.77 | $948 |
Method
How this is built, and what it cannot tell you
Direct care is an employment weighted basket of home health and personal care aides, social and human service assistants, nursing assistants and psychiatric technicians. The wage floor is an employment weighted basket of retail salespersons, stockers and order fillers, and fast food and counter workers. Wages are median hourly from the BLS May 2025 metropolitan file. Rents are HUD Final Fair Market Rents for FY2026. Hours for rent applies the federal 30 percent of income affordability standard.
Limitations, stated plainly.
- The wage and rent layers are metro resolution. Shortage designations, minimum wage and turnover are state level and labelled as such.
- HRSA percent of need met counts psychiatrists only.
- HRSA population and practitioner counts can double count because designation types overlap. Do not sum states.
- National Core Indicators does not survey Virginia or Florida, so those turnover cells are null.
- HUD publishes no metro-wide Fair Market Rent for two CBSAs here. Miami uses the Miami-Miami Beach-Kendall HUD area and Hilton Head uses the Beaufort County HUD area. Both are named in the data file.
- BLS suppresses some occupation and metro combinations, so basket composition can vary between metros.
- Wages are May 2025 and rents are FY2026. The two do not share a reference period.
Use it, cite it. Published under Creative Commons Attribution 4.0. Cite as: The Wilkinson Firm, TWF Direct Care Staffing Index, version 2026.1, 2026-08-09. https://hr.thewilkinsonfirm.com/direct-care-index
