But the very fact that they work for households limits enforcement. The examples above illustrate other drivers, in particular the role of the state in providing care services and in regulating market or community provision. As in the case of rich countries, lack of state regulation drives fees up and care workers’ wages down, thereby excluding the poor. Sometimes, the appearance of intermediaries, like employment agencies for domestic workers, also drives prices up without improving working conditions.100 A “high road” 101 to care provision is one that does not exploit care workers in order to keep care services going, and provides quality care—two sides of the same coin.