workers earning the least. (6) One in 8 direct care professionals live in poverty and three quarters earn less than the average living wage in their State. (7) Forty-six percent of direct care professionals rely on public assistance, such as Medicaid, food and nutrition assistance, or cash assistance. (8) Direct care professionals report high levels of burnout and professional fatigue from their physically and emotionally demanding work, lack of respect for the essential, skilled care they provide, and lasting trauma from battling the COVID–19 pandemic, all of which further drives high turnover. (9) The long-term care industry is struggling to hire and retain direct care professionals, with a national turnover rate between 77 to nearly 100 percent. (10) Ninety-two percent of nursing home respondents and nearly 70 percent of assisted living facilities surveyed report significant or severe workforce shortages. (11) More than half of nursing homes surveyed in 2022 reported that they limited new patient admissions due to staffing shortages. (12) A survey of State home and community-based services (referred to in this section as HCBS ) programs showed that every State reports a shortage of workers, and in 43 States, some HCBS providers have closed permanently. (13) The low-quality of direct care professional jobs reflects and perpetuates the racial and gender inequities faced by direct care professionals, who are disproportionately women, immigrants, and people of color. (14) Efforts to support the direct care professional workforce have focused on specific care settings, even though these issues are widespread across the long-term care landscape and direct care professionals across settings face similar challenges of low wages, few benefits, limited training and support, worker exploitation, and a lack of meaningful career ladders. (15) Stabilizing, growing, and supporting the direct care professional workforce across the continuum of long-term care is essential to ensuring a strong, qualified pipeline of workers,