This also means that there is concerningly high variance in the quality of individual care providers, since it's a difficult job and pays awful you get the usual mix of "passionate about kids" and "I can't find any other work". Even the best facilities you have to be very observant to make sure your kid doesn't end up in a bad situation. I recall one care provider fondly telling me how much she loves riding her bike to work only to later find out she had her license taken away by repeated DUIs and another that fled the country after too many parents complained about situations that looked a lot like abuse.

Ultimately they're very much like nursing homes for small children. Very frustrating to pay so much only to have to remain vigilant that you don't pick up your kid only to find they've been sitting in some other kid's pee for an hour.