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.
Three numbers that explain the staffing crisis
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.
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.
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.
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% |
The Southeast, colored by how hard it is to afford to do this work
Each state is shaded by the median hours a direct care worker must work to afford a one bedroom at fair market rent. Deeper means harder. Select a state to zoom in and drop a pin on every metro we measure.
In Miami it takes 87 hours a week to rent one bedroom.
A full time week is 40 hours. Every metro in this index answers the same question: how many hours must someone earning the local direct care wage work, by themselves, to afford a one bedroom at HUD fair market rent? Pick any metro in the table below and this bar redraws.
Nine metros are severe. Twenty one are fine. The rest are the argument.
The band is not a judgment about a place. It is a statement about what a hiring manager there is actually up against, and therefore about what will and will not work.
A direct care worker needs well past a full time week to afford a one bedroom alone.
The wage clears the local floor, but not by enough to make the job an obvious choice.
Recruiting is winnable here on things other than pay.
The arithmetic works. If posts sit open here, the cause is process, not price.
Median hours a week to afford a one bedroom
Florida is the hardest state in the footprint and it is not close. Alabama is the most affordable, which is a different thing from saying the job pays well there.
A caution worth stating: a low median here does not mean a state is doing well by its workforce. Alabama is the most affordable state in the index and also carries the smallest median gap over the local retail and warehouse floor, at 93 cents an hour. Cheap rent and a wage nobody will cross the street for are not the same as a healthy market.
Find your metro
All 90 metros across seven states. Search it, filter it, sort any column. Clicking a row redraws the week bar at the top of this page. Everything here is also downloadable as CSV and JSON under Creative Commons, with no email required.
| Rank | Metro | Band | Hours for rent | Care wage | Gap over floor | 1BR rent |
|---|
Two states already ran the experiment, and the results disagree
This index measures the gap between what direct care pays and what the market next door pays. That is only worth measuring if closing it changes anything. Two states in this footprint have published enough to answer that, and the answer is more interesting than yes.
Georgia paid more, and it worked until it did not
Georgia’s rate action lifted the modeled direct support wage assumption from $10.63 to $16.70 an hour and set a $14.00 floor. Turnover fell from 46.7 percent in 2020 to 32.1 percent in 2023. Then, in the first full year after implementation, it ticked back up to 33.6 percent. In that same year 35.5 percent of Georgia agencies still turned away referrals over staffing, against a national figure of 26.6 percent.
North Carolina already has the retention, and still cannot deliver
North Carolina has the second lowest direct support turnover of any state measured, 23.9 percent against a national mean of 37.1. It is close to the ceiling of what retention alone can achieve. In one quarter of 2026 it still failed to deliver 615,836 units of Community Living and Supports because no provider or staff member was available.
Put those two together and you get the finding this index exists to make: closing the wage gap buys retention, and retention alone does not buy capacity. Georgia proved money moves the first number. North Carolina proves that even a near best in class retention rate leaves care undelivered when the post was never filled to begin with. Most workforce funding in this sector is aimed at people leaving. The harder and less funded problem is people never arriving.
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 |
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.
- The wage and rent layers are metro resolution. Shortage designations, minimum wage and turnover are state level and labeled 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.
