the nearly five million direct care workers# who support older adults and peop disabilities.

But despite high demand, many# are paid little more than minimum wage.

As Judy Woodruff reports, a longstanding# work force shortage means people with## disabilities who depend on those# workers to live independently and## access their community are left# without the support they need.

It's part of our series Disability Reframed.

JUDY WOODRUFF: For the past 14 years,## Luciana (ph) Offlee has been by Tyler# Corkin's (ph) side.

The 33-year-old## has cerebral palsy and autism.

He mostly# communicates using sounds and hand gestures.

CHINA OFFLEE, Direct Support# Professional: That's some good bacon?

TYLER CORKIN, Louisiana Resident: Yes.

CH for nearly every part of life# in his Maurepas, Louisiana home.

CHINA OFFLEE: Feeding him, transporting him# back and forth out of his chair, bathing him,## giving him medication, his medication,# and just keeping him comfortable.

JUDY WOODRUFF: So you do# pretty much everything for him?

CHINA OFFLEE: Yes.

And I also wash his# laundry, m JUDY WOODRUFF: She says the most rewarding part# of her job is exploring the community with Tyler.

CHINA OFFLEE: Yes, you're getting excited, huh?

JUDY WOODRUFF: CHINA OFFLEE: Just being able to take# him out and just doing things with him## is entertaining for him.

And it's giving him# a chance to get out and be around people.

JUDY WOODRUFF: But for each hour China is# with him as a direct support professional,## or DSP, she's paid $9.

She works seven# days a week, and even with overtime pay,## still has to hold a second# job to support her family.

There's a shortage of people who do the# work you do, direct support professionals.

CHINA OFFLEE: Yes.

CHINA OFFLEE: Because they're not pa not enough pay.

You have got to have# a heart to do this kind of work.

JUDY WOODRUFF: What's the hardest thing about it?

CHINA OFFLEE: Just being away# from my JUDY WOODRUFF: There's been a national# shortage of DSPs like China for decade largely because state officials have# limited Medicaid funding that helps## cover their wages and career# advancement has been difficult.

The national turnover rate for DSPs is more# than 40 percent, with rates reaching over## 50 percent in some states.

Advocates say a lack# of investment in Medicaid nationwide drives the## problem.

It is the largest funding source# for the services that many DSPs provide.

In Louisiana, those who hire DSPs say there is# simply not enough money to pay them more.

Those## employers are expected to cover a range of costs# that include wages, health insurance and training,## typically paid for by Medicaid, at rates# that state officials ultimately decide.

Two years ago, the Louisiana state# legislature allocated the money that## allowed for a $9-an-hour wage floor for# direct support professionals, a work force## that helps to sustain some of the more than one# million people in this state with disabilities.

STATE SEN. FRANKLIN FOIL (R-LA): It's hard to# find people to come and take these difficult## jobs when you have a rate that low.

So we need# to JUDY WOODRUFF: Louisiana Republican State# Senator Franklin Foil has family members## with disabilities, including a son with# autism and a sister with Down syndrome.

From Louisiana's capital, Baton Rouge,## Foil has pushed to increase the state's# Medicaid rates and What do you think it would take to# persuade some of your colleagues in the## state legislature that they needed to improve# the Medicaid reimbursement rate ST ATE SEN. FRANKLIN FOIL: I think part of it was,## there was always a pus once you explain to people and give them# the real-life experiences to get them on## board.

But it does cost money.

And when you# have limited funds, you have to allocate.

But this, in my opinion, is not an# option.

It's something that we have to do,## because these people have no other way in# many cases to get the support they need.

JUDY WOODRUFF: This is it.

STATE SEN. FRANKLIN FOIL: This is it.

26-year-old Jakeel Abdullah has seen# the DSP Abdullah was diagnosed with bipolar disorder# in high school and has chronic back pain## after a surgery left him without feeling# in his right leg.

He uses a cane to get## around the city and the community college# where he takes classes in game design.

JAKEEL ABDULLAH, New Orleans# Resident: When I wake up,## I know I'm disabled.

JUDY WOODRUFF: He says he's struggled# to find a direct service worker, or DSW,## as they're known in Louisiana, to help# with basic physical needs, including## personal hygiene and transportation# to school and social activities.

JAKEEL ABDULLAH: Finding someone# you can trust to come into your## home and put your life potentially on# the line it has been a struggle that makes me# not even want to live here, honestly.

JUDY WOODRUFF: Abdullah also thinks there# should be an increase in hourly wages and## that all DSWs in the state should# go through a certification program.

JAKEEL ABDULLAH: I have had DSWs tell# me, this is more of a resume filler## or a stepping-stone to more real work,# such as working in hospitals and nursing## homes.

No one wants this to feel like# a part-time job or it's not a career.

JUDY WOODRUFF: Over 1,000 miles# away, in Brooklyn, New York,## 25-year-old Fatimah Howard# is just starting her career.

The mother of three was hired as a# DSP in January.

She works in a day## habilitation program, where people with# disabilities attend exercise classes,## volunteer and visit community sites.# Today, they're going to the library.

It's where Fatimah and her co-worker Nate teach a## sign language class so their group can# learn to communicate with a deaf FATIMAH HOWARD, Direct# Support Professional: Exactly.

I love to do it becaus to be here every day.

So, the days I'm# not here, they call my phone to ask if## I'm here.

They're like, am I coming, when# I'm coming back.

They depend on you.

And## I let them know that they can really# depend on me for whatever they need.

I take it seriously.

I love it.

JUDY WOODRUFF: Does that surprise you t FATIMAH HOWARD: I mean, it doesn't surprise me,# because companies like this are un and the people who make decisions on how much# we get paid doesn't see it.

They don't play## the role that we play every day, so they# don't know how much work we actually do,## which is sad for the people we# support, because they love their staff.

They want to continue to hire the same# staff, not just people come an JUDY WOODRUFF: In her spare time, Fatimah# takes courses as part of the E-Badge Academy,## a DSP certification program.

She says it# gives her the chance to refine her skills.

FATIMAH HOWARD: It makes a difference,# because we learn how to provide ethical## support.

And that's important.

You learn about# the safety.

You learn advocating w the people we support and making sure# they advocate for themselves as well.

KERRI NEIFELD, Commissioner, New York Office for# People with Developm so that people can continue to grow and# develop their professional skills in our field.

JUDY WOODRUFF: Kerri Neifeld is the commissioner# of the New York state Office for People with## Developmental Disabilities.

Last year, her# office partnered with a DSP advocacy group## to offer credentialing to those who do this work# in New York state and bonuses up to about $2,000.

KERRI NEIFELD: What's happening for our# providers is, it's changing the culture## within provider organizations.

It's letting staff# know that the work that they're doing, treat DSPs as# professionals and want to see them succeed.

JUDY WOODRUFF: Back in Maurepas, Louisiana,## DSP China Offlee says she doesn't# always feel China, what would you say to people who# don't understand how hard this work is## and who are not sure if more money# should go into paying higher wages?

CHINA OFFLEE: I think they know.# They know that we should be paid## more.

It's just that they're not giving it.

JUDY WOODRUFF: Money she says she and so# many other DSPs need that allow people## with disabilities to more fully live their# lives and be part of their communities.

How would you describe your relationship# with Tyler after all these years?

CHINA OFFLEE: Well, he considers# me his person.

He really does.

Don't you, Tyler?

Yes.

JUDY WOODRUFF: So he considers you his person CHINA OFFLEE: Yes.

CHINA OFFLEE: Well, I really consider# him as one of mine, actual JUDY WOODRUFF: And she says she will# keep caring for Tyler as long as she can.

For the "PBS NewsHour," I'm Judy# Woodruff in Maurepas, Louisiana.