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Paid sick leave is essential for worker well-being and the public health, yet the United States does not have a federal law guaranteeing workers access to paid sick leave. Rather, paid sick leave remains subject to company discretion and a limited number of state and local laws and varies greatly across occupations. In this brief, we examine the current state of paid sick leave access in the service sector, an industry making up almost a fifth of the United States workforce and containing some of its most vulnerable workers. Over three years since the COVID-19 pandemic first drew broad public attention to the lack of access to paid sick leave in the service sector, how much has really changed, and what are the possibilities for progress? Using recent data from the Shift Project’s national survey of hourly service sector workers, we find that half of such workers still lack access to paid sick leave. We also find that increases in paid sick leave during the pandemic were generally temporary and went most toward those who already had some paid sick leave. But, despite this stasis, we argue that it is possible for service sector firms to provide paid sick leave, given that certain firms already do provide it, most large firms already must comply with limited state and local governmental laws mandating paid sick leave, and firms have successfully implemented paid sick leave policies in response to public pressure in the past. But, we also find that simply providing paid sick leave may not be sufficient action to allow workers to stay home while sick. We show that many workers with paid sick leave still work while sick for reasons including insufficient staffing and fears of getting in trouble.