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Millions Of Californians Need Home Care. But An Industry 'In Crisis' Is Ill-Equipped To Meet Demand, Report Finds

A female home health aide stands and gives a seated female medicine and crackers in a living room.
Home health workers allow older people and those with disabilities to continue residing in their homes.
(Michael M. Santiago/Getty Images
Getty Images North America)
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In California, millions of older adults and people with disabilities get help at home with bathing, eating and cleaning, allowing them to stay in a familiar setting. Demand for these services is expected to only surge over the next decade, as the youngest of the baby boomers enter their 60s and 70s.

But the home care industry’s status quo is untenable, according to a new report by the UCLA Labor Center. Home care is prohibitively costly for many families who need the services. At the same time, the industry, which employs an estimated 700,000-plus workers, is underpaying many of them — leading to high rates of turnover and labor shortages.

Many caregivers — predominantly women of color — are not earning a living wage or receiving medical benefits, let alone able to accrue any savings.

UCLA’s survey of 500 caregivers found the median hourly rate was $14.50, while those paid a flat rate earned a median of $9.17 an hour. In one of the state’s worst-ever wage theft cases, many members of a mostly Filipino work force at a “board and care” chain were making as little as $2.40 an hour.

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Tess Sattar, who organizes with the Pilipino Workers Center, said home care workers such as herself are used to being “discriminated against, violated and exploited because of being immigrants and women of color.”

“When we get sick, we have to stay home,” Sattar said. “No work, no pay — but we have no choice. In my case, I need a job to support myself and my family.”

Researchers also surveyed more than 100 employers, including families who hire caregivers for loved ones. Lian Hurst Mann's mother needs round-the-clock care, but Mann can only afford to pay for 40 hours a week.

Mann said she and her daughter are “exhausted” providing care the rest of the time and would like to add more home care hours. But Mann said she is committed to paying the home care worker a living wage, overtime, sick leave and bonuses, under guidelines she’s following from The Hand in Hand Domestic Employers Network.

“That is a lot for us,” Mann said. “Yet for [the home care worker], it’s her entire livelihood. Like most private employers, we wish we could pay more to her — even more.”

One idea that employers such as Mann are lining up behind: a publicly-funded, long-term care program that would serve households across income brackets. Of the employers surveyed by UCLA, 85% said they would support a 1% income tax to finance the program.

“A program like this will dramatically change the landscape of home care in this state,” said Lucero Herrera, a senior research analyst with the UCLA Labor Center.

Help For Long-Term Care Is Limited

Currently, California’s only publicly supported long-term care program is restricted to residents with very low incomes. But long-term care advocates are hopeful the state will model a program after one in Washington state, which uses a .58% payroll tax, but has been slow to get off the ground. State Assemblymember Eloise Gómez Reyes (D-Colton) has introduced a bill that would create a board to oversee and manage funds generated by a similar tax.

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Aside from a payroll tax, UCLA researchers are recommending that more be done to connect those who need home care with caregivers, home care agencies, and board-and-care facilities, also known as residential care facilities for the elderly.

“The lack of infrastructure leaves consumers struggling to find workers and manage a work relationship with them,” Herrera said. “And it makes it hard for workers to access and know their rights.”

The report also recommends that the government set higher standards for agencies and facilities with regard to wages and worker protections; investing in home care worker co-ops that will prioritize the treatment of its members; and providing education for employers so they can understand their obligations to staff, as well as for workers so they become familiar with labor laws.

Assemblymember Adrin Nazarian (D-North Hollywood), who chairs the Assembly’s Aging and Long Term Care Committee, said he has asked for tens of millions of dollars in the upcoming budget year for initiatives such as providing education to more caregivers of patients with Alzheimer's and dementia, and expanding training programs for home health aides.

Have a question about Southern California's Asian American communities?
Josie Huang reports on the intersection of being Asian and American and the impact of those growing communities in Southern California.