By Kindel Holloman, Marketing Manager
During the 2026 National Association of State Directors of Developmental Disabilities Services (NASDDDS) Directors Forum and Annual Conference, discussions repeatedly returned to a challenge shaping the future of intellectual and developmental disabilities (I/DD) services: the direct care workforce. State leaders, providers, and subject matter experts explored not only the scope of the workforce crisis, but also what it will take to build a stronger, more sustainable workforce.
The challenges are well known. Recruitment remains difficult. Retention remains a concern. Demand for home- and community-based services continues to grow. At the same time, states face competing priorities and ongoing pressure to make the most of limited resources. Against this backdrop, states must determine which investments will have the greatest impact on workforce stability, service quality, and outcomes for people with I/DD.
Exhibit A: Demand is Not Going Away
One of the clearest messages emerging from conference discussions was that workforce challenges are not temporary and that demand for services will continue to grow. States continue to face growing demand for home- and community-based services, while providers struggle to recruit and retain enough direct care workers to meet those needs. Conference participants noted there is "never a shortage of work," underscoring the reality that demand for services continues to outpace workforce capacity in many areas.
Workforce shortages have become a system-wide challenge. When positions go unfilled, service capacity declines, wait times increase, staff burnout rises, and states face greater difficulty ensuring consistent access to community-based supports.
For state leaders, the priority is identifying investments most likely to strengthen workforce stability and ensure continued access to community-based supports.
Exhibit B: The Cost of Inaction
Workforce shortages carry costs that extend far beyond vacancy rates and staffing metrics, affecting individuals, families, providers, and communities. Conference discussions highlighted the importance of recognizing the human cost of direct care workforce shortages. When providers cannot recruit or retain enough staff, the impact is felt throughout the I/DD service system.
Individuals may experience disruptions in services, reduced continuity of care, and fewer opportunities to participate fully in their communities. Families often assume additional responsibilities when services are unavailable or inconsistent. Providers face increased overtime costs, higher turnover, and greater administrative strain as they work to maintain services with limited staff. Communities may also feel the effects when workforce constraints make it more difficult for people with I/DD to access employment opportunities, participate in community activities, and maintain the support needed to thrive.
Viewed through that lens, workforce investments become more than budget decisions. They are investments in the outcomes states seek to achieve, including greater independence, community participation, and consistent access to quality supports and services for people with I/DD.
Exhibit C: What Direct Care Workers Value Most
Building a stable workforce requires more than competitive wages. Understanding what workers value is critical to attracting and retaining them.
While workforce surveys can provide valuable insights, gaps remain in understanding worker priorities and experiences. These gaps underscore the importance of gathering direct feedback to guide investments in benefits, supports, and workplace experiences.
Conference participants identified several factors that may influence workforce satisfaction and retention, including:
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Health and wellness benefits
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Paid time off and scheduling flexibility
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Access to training and professional development
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Career advancement opportunities and clear pathways for growth
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Recognition and appreciation from employers and the broader system
Above all, participants emphasized hearing directly from workers rather than making assumptions about what matters most to them. Workforce investments are most effective when they reflect the needs and experiences of the people they are intended to support.
Exhibit D: Making Informed Investments
Making informed workforce investments requires understanding both what the data shows and what information may be missing. Resources such as the National Core Indicators® Intellectual and Developmental Disabilities (NCI®-IDD) State of the Workforce Survey help states better understand workforce conditions by collecting data on turnover and tenure, compensation, benefits, recruitment and retention, and demographics. However, participants also raised important questions about whether states are consistently collecting the information needed to fully understand the root causes of workforce challenges.
Several discussions focused on moving beyond reactive responses toward more deliberate, data-informed planning. By analyzing state and national workforce data, states can identify trends, evaluate investments, and better understand which strategies produce measurable results. Participants also highlighted the value of objective analysis of state and national workforce data to help agencies gain deeper insights and develop new strategies.
In an environment of competing priorities and limited resources, states cannot afford to make workforce investments based on assumptions alone. Better data can help leaders identify what is working, what is not, and where investments are most likely to strengthen workforce stability and improve outcomes.
Exhibit E: Return on Investment
With limited resources, many states are asking an important question: What is the return on investing in the direct care workforce? Conference discussions highlighted the potential for investments in the direct care workforce to deliver benefits across the broader system, including:
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Improved workforce retention
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Greater workforce stability
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Stronger service delivery capacity
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Better support for individuals and families
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More sustainable systems over the long term
Participants also noted that investments in the direct care workforce can strengthen local economies and support employment opportunities in communities across the country.
An emerging opportunity to strengthen the broader service system is developing and investing in peer support roles for people with I/DD and traumatic brain injury. Individuals with lived experience can provide valuable support while helping states identify opportunities to improve programs, inform policy, and strengthen service delivery.
While no single initiative will solve workforce challenges, strategic investments aligned with clear goals and measurable outcomes can help states build a more stable workforce, strengthen services, and make meaningful progress.
The Verdict
The workforce challenges facing I/DD systems are complex and will require sustained attention. Conversations at the 2026 NASDDDS Directors Forum and Annual Conference suggest that meaningful progress is possible when states take a deliberate approach to understanding workforce needs, using data to guide decisions, and investing in strategies that support recruitment, retention, and long-term workforce stability.
Investment in the direct care workforce is essential to the future of I/DD services and to building a stronger, more sustainable system. By supporting workforce stability, states can strengthen service quality, expand community inclusion, and improve outcomes for people with intellectual and developmental disabilities, their families, and the communities in which they live.
