Direct care workers seem to be copping most of the flak in the media around this, but from my experience most of the inefficiency is in over-administration and ties with the housing market as you mention.
I've seen care teams with 4-5 levels of management. Each of them not providing care themselves but getting paid close to $100 / hr for pointless meetings and phone calls.
I've seen care organisations turn into political ideology machines, completely losing the point of what their business was about. They are incentivised for there to be more disabled people in the community, and politically advocate recognition of new disabilities.
The growth in direct care does make sense if you're in the fiat clown world. As we move forward with ai and robotics I expect the definition of "disabled" to broaden, and more jobs to be printed in parallel:
