This reflection comes from my work alongside Ryan, a friend and colleague who lived with Becker’s Muscular Dystrophy and taught me firsthand about the broken systems around personal care.

The Long Road to Yes

Ryan used to tell me all the time: “There’s no one out there.” He meant personal care assistants – the people who show up every single day to make it possible for someone with significant support needs to live a full life.

Honestly? He wasn’t wrong. The ones who did apply were often wildly unfit for the job. Flaky, unprofessional, or so poorly matched it felt like an insult.

It took months of conversations before Ryan even let me peek behind the curtain. At first, he would just vent. I’d get annoyed in my ignorance – here I was with professional experience, networks, and a desperate desire to help, and he was holding back. The lack of trust offended me. The hard truth I had to face and call readers to recognize when it comes to personal care – trust is everything. Why do so many people with disabilities struggle to trust the systems, the services, or the workers around them? We’ve let trust corrode because – as a society – we suck at valuing care. That’s on us. 

From Venting to Partnership

What started as venting eventually turned into input-seeking. Then months later, it became, “Okay, you can look at the job posts.” That moment was huge for me.

With persistence, I convinced him to let me see resumes, to sit in on interviews, even to be the first interview so he didn’t have to waste his time on people who were never going to be a fit. Years of building trust finally paid off.

And I’ll say it again: trust is everything.

The Workforce Crisis is Real

Ryan’s distrust wasn’t paranoia. It was reality. In the United States, the direct care workforce – which includes personal care assistants – is in crisis. Turnover rates hover around 40–60% annually, and agencies report chronic difficulty filling open positions (Campbell et al., 2021). The demand for direct care workers is projected to grow faster than nearly any other occupation, yet wages remain low and training inconsistent (PHI, 2023).

A 2022 National Academies of Sciences report described the long-term services and support system as “broken and unsustainable,” highlighting that people with disabilities often face long waitlists and under-qualified workers (National Academies, 2022). No wonder Ryan kept saying “there’s no one out there.”

It’s not just about numbers – it’s about trust. Studies show that the personal nature of care creates vulnerabilities for both worker and recipient, making the relationship uniquely dependent on reliability, respect, and consistency (Stone, 2020). Caregiving isn’t just about health. It’s dignity. It’s survival.

The LinkedIn Post that Changed Everything

When Ryan hit his lowest point – hospitalized for over a month and with care needs that had doubled – he trusted me to step in.

I posted his job description on my LinkedIn. Confident in my connections. Confident in my ability to represent his needs and his voice accurately.

Within 24 hours, we had more than a dozen viable candidates.
Within 48 hours, I had screened nearly 20 legit humans and set up first interviews.
We needed two caregivers. We had four strong finalists. Ryan actually got to choose.

Going from people ghosting interviews to turning away good candidates was nothing short of a miracle – not because the candidates suddenly existed, but because the process was finally handled with trust, clarity, and respect.

The Work Behind the Work

Helping Ryan evaluate his needs. Translating those needs into caregiver-friendly language. Budgeting out what care he could afford. Planning schedules. Sitting in interviews. This wasn’t just recruiting. It was advocacy. It was building the bridge between a system that fails people and the human beings who need it to work.

It shouldn’t take months or years of persistence for someone to feel safe enough to ask for help.

The Real Problem

The problem isn’t that people don’t need care. The problem is that we’ve built systems that make it unsafe to ask for it. We’ve let distrust fester because we’ve consistently undervalued, underpaid, and undertrained the people who do this work.

Ryan deserved better. They all do. We all do.

The Lesson

Trust doesn’t just happen. It’s earned. In personal care, it’s the difference between surviving and actually living.

If we want to fix the so-called “care crisis,” we don’t just need more workers. We need systems and communities people can trust. We need processes that respect people’s time, autonomy, and actual needs. We need to stop acting surprised when people with disabilities hesitate to let us in.

Because given how things are? Their skepticism is earned.

Works Cited

• Campbell, S., et al. (2021). It’s Time to Care: Why the Direct Care Workforce Matters in Long-Term Care. Health Affairs, 40(6), 921–929.
• National Academies of Sciences, Engineering, and Medicine. (2022). The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press.
• PHI (2023). U.S. Direct Care Workforce Data Center. Retrieved from https://phinational.org
• Stone, R. I. (2020). The direct care workforce: A key dimension of home and community-based services policy. Journal of Aging & Social Policy, 32(4–5), 361–379.