Opinion: The Caregivers Are Ignored While Executives Cash In

These are the workers who stabilize lives, prevent crises, and support individuals with profound needs, yet in community-based services, they are consistently undervalued and excluded from decisions that shape the services they provide.

If we want to understand why the system keeps failing the people who depend on it most, we have to start by looking honestly at how we treat the workforce that holds it together.

Direct Support Professionals are a deeply diverse workforce in their approach to the job.

Some staff disengage, scrolling on their phones while individuals are left unstimulated or unsafe.

But others bring extraordinary intuition and skill, often without formal credentials.

One DSP taught my son how to put his shoes on the correct feet — something a long line of highly educated specialists had tried and failed to teach. She simply believed he could learn it, and he did. This wasn’t in his ISP. It wasn’t part of any formal program. It was the quiet, everyday brilliance of someone who saw his potential and acted on it.

This is the tragedy and the promise of the system: the people with the least power and lowest pay are often the ones who make the greatest difference.

When most people think about disability services, they imagine group homes or day programs where individuals with significant needs receive daily support. What they don’t see are the people on the frontlines . These are the caregivers who prepare meals, clean the house, administer medications, deliver communication therapy (often without professional oversight and support), and help with routines and activities of daily living.

They are the backbone of the system, yet they are paid poverty wages, given little training, and are excluded from decisions that directly affect the people they care for.

Meanwhile, the agencies that run these programs, the nonprofit “provider agencies” funded by the state, pay their executives six-and seven-figure salaries.

These executives complain loudly about a “workforce crisis,” but rarely acknowledge their own role in creating it. They cry poverty while ignoring the fact that the people closest to residents are treated the worst, and those furthest away are rewarded the most.

Families know this imbalance well. They ask for caregivers to be included in meetings about their loved ones. They are often told “no.” Staff are forced to carry out programs they know don’t work. And when turnover rises, residents suffer the trauma of losing trusted relationships. The result is a system that undermines both dignity and stability.

This is not just about money. It is about respect, accountability, and priorities. If agencies truly cared about solving the workforce crisis, they would start by looking inward. They would flatten executive pay scales and tie compensation to resident outcomes and staff retention. They would invite caregivers and families into governance and program planning. They would reallocate budgets to fund training, mentorship, and crisis support instead of bloated executive salaries. And they would publish executive salaries, turnover rates, and training budgets so the public can see where money really goes.

The truth is simple: the system is upside down. The people who do the hardest work like feeding, bathing, calming, and supporting individuals with severe and profound needs are treated as expendable. The people furthest from the work are rewarded the most. Until that changes, no amount of new funding will fix the crisis. Humane care requires not just dollars, but dignity, and dignity begins with listening to the people who do the work.

Massachusetts is at a crossroads. Unless the state demands accountability from provider agencies, these inequities will deepen.

The public deserves to know that the workforce crisis is not just about wages. It is about a system that silences caregivers, sidelines families, and protects executives. If we want decent, humane care for people with disabilities, we must flip the priorities: put individuals, families, and direct support workers at the center, and hold executives accountable for outcomes, not excuses.