The roles and responsibilities of direct support professionals (DSPs) are evolving. This qualitative study explores how DSPs perceive their role and explores those perceptions across DSPs working in traditional, intermediate, and innovative agencies, as defined for the study. Examining 440 DSP survey responses and interviews with 24 DSPs, we found that DSPs working in more individualized settings tended to have expanded role functions (focused on promoting self-determination and community engagement). DSPs working in more traditional settings tended to have more care-focused role functions (concentrated on activities of daily living, medication administration, and health and safety). The role perception of DSPs at intermediate agencies and role conflict due to competing responsibilities demonstrate a need to systemically transform future service delivery.