When Jim Piet, who has cerebral palsy, wanted to hire a new personal care assistant to assist him with everyday tasks, it took four months. Piet, who lives in Concord, New Hampshire, uses a power wheelchair and has a personal care assistant, or PCA, who assists him with getting out of bed, showering, and dressing, as well as preparing meals and transportation. These services are covered by Medicaid.
Often, PCA positions don’t pay well. Granite State Independent Living, one of the state’s major agencies seeking DSPs (direct support professionals) and PCAs, has employment openings paying $18 to $22 per hour. These positions do not require a high school diploma or a nursing license.
“You can make almost as much money working retail,” his wife, Pat Piet said. “And retail does not require the same amounts of soft skills and emotional and physical investment.” Jim Piet uses two providers to recruit his PCAs: Granite State Independent Living and GT Independence.
He says GT Independence pays aides more. However, Granite State Independent Living offers superior support. “It’s a double-edged sword,” he explained. He added they frequently hire people who are incapable of doing the job or who “bring (their) own baggage.” When he’s in the community, employees don’t always act appropriately, treating him like “a charity case,” he said.
“I always cringe when people talk about how emotionally satisfying the job is,” Pat Piet said. “You want to enjoy going to work. You want to get something emotionally out of it. But I feel like when we advertise that, we tend to get people who are emotionally needy and are looking to the person they’re caring for to fill that gap. … This is a job. You get your emotional needs met from friends and family, not at your job.”
Potential employees frequently express frustration and wonder why Pat can’t simply take care of Jim. The couple points out that she has her own career, which has forced her to come into the office when he needs help. Jim also stated that he wants Pat to simply be his wife and not rely on her constantly. Still, she helps him with his responsibilities when they cannot find an aide.
The Piets aren’t alone. In 2024, the home healthcare industry’s turnover rate was 79.2%, representing a 12% rise over the previous two years. Nationally, wages for caregivers are also low. As of January 2025, the average hourly wage for caregivers is around $16, resulting in an annual income of about $33,800 for full-time caregiving.
However, the tight labor market in New Hampshire exacerbates the problem. The United States Chamber of Commerce ranks New Hampshire as having the most severe worker shortage in the country. As of 2023, the latest data available, the state had only 28 employees available for every 100 unfilled jobs.
According to Phil Sletten, an economist and research director at the New Hampshire Fiscal Policy Institute, the size of the labor force has yet to recover from the height of the COVID-19 pandemic. In 2019, the labor force was about 777,300 people, but in 2024 it was roughly 771,600.
This makes it tough to hire for any position in New Hampshire. Sletten agreed that low pay for DSPs and PCAs was limiting hiring opportunities. According to New Hampshire Employment Security, the median hourly income for home health and personal care aides in New Hampshire in June 2024 was $17.27. This covers those who care for anyone, not just disabled people. The median wage for all professions is $25.01.
As someone who lives in the neighboring state of Massachusetts, I’ve experienced this shortage firsthand due to cerebral palsy. In my first three semesters of college, I had three different PCAs. The lack of dependable PCAs added to my stress. I didn’t want to be worried about getting to class on time or using the bathroom.
In Massachusetts, the PCA program’s annual expenses have increased from around $1.2 billion in 2020 to an estimated $2 billion by 2027. Due to rising costs, the Healey administration is proposing a ceiling that would tie program spending to standards established by the Health Policy Commission in 2026.
Advocates argue that this could result in people not receiving PCA services or PCAs not receiving wages increases in the future. However, the state says it will help put the program on a “sustainable long-term fiscal trajectory.”
“Our proposed budget does not make any cuts to the PCA program in FY26,” said Stacey Nee, a MassHealth spokesperson, in a statement to GBH News. “PCA spending continues to grow as a share of the state budget at an unsustainable rate. We propose aligning the program with other areas of health care spending in order to ensure that the program remains sustainable for the members who rely on it most.”
All disabled people deserve to be a part of their community, and the proper support allows us to do that. The shortage of caregivers is a safety issue. People’s lives are at risk without proper care.
Sources:
Smith, Meghan. “Disability Advocates Rally against Proposed Cap on In-Home Aides.” WGBH, PBS, 12 Mar. 2025, http://www.wgbh.org/news/local/2025-03-12/disability-advocates-rally-against-proposed-cap-on-in-home-aides.
Skipworth, William. “In New Hampshire, People with Disabilities Face Challenges Hiring the Help They Need .” New Hampshire Bulletin, States Newsroom, 27 May 2025, newhampshirebulletin.com/2025/05/27/in-new-hampshire-people-with-disabilities-face-challenges-hiring-the-help-they-need/.
Zeraus, Genevieve. “Is Low Pay Worsening the Caregiver Shortage?” Next Avenue, Twin Cities PBS, 13 May 2025, http://www.nextavenue.org/is-the-shortage-of-caregivers-because-they-are-not-getting-paid-enough/.