Direct Support Professionals (DSPs) are the "backbone" of long term services and supports (LTSS) in the United States (Bogenschutz, Hewitt, Nord, & Hepperlen, 2014, p. 317). This study examined the relationship between DSPs and people with intellectual and developmental disabilities' (IDD) quality of life. To do so, we utilized Personal Outcome Measures® interviews from over 1,300 people with IDD to examine the impact DSP change has at individual and organizational levels. We found DSP continuity is central to quality of life of people, including human security, community, relationships, choice, and goals. States cannot continue to provide near-poverty level reimbursement rates for DSPs and still ensure quality of life.