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The rapid growth of the homecare industry is being driven by the aging of the baby boom generation and by the shift from high-cost care in nursing homes to the more affordable alternative of homecare. As a result, homecare jobs have grown more quickly than other occupations and many more workers will be needed to meet the growing future demand.
Homecare plays a critical role in our society, allowing the elderly and people with disabilities to maintain their independence and maximize their quality of life. Homecare workers assist consumers with activities of daily living, such as bathing, dressing, toileting, meal preparation, house cleaning, managing medication, monitoring health conditions, and transport to medical appointments. Homecare is also physically and emotionally challenging work that is disproportionately done by women and workers of color. And yet, job quality in the industry is very low.
California’s investment in homecare has saved the state money in the past, by having care provided in clients’ homes when possible, rather than in more expensive nursing homes. However, if the homecare system is unable to attract enough workers to meet growing demand, high turnover and a shortage of workers will place a significant burden on consumers and the public.
Turnover: The California Legislative Analyst’s Office estimates that annual turnover of IHSS workers is about 33 percent. That means that as many as 180,000 consumers must search for, hire, and train a new homecare provider each year. The cost of turnover per long-term care worker is estimated to be at least $2,500.
Worker shortages: While data limitations prevent definitive measurement, several indirect indicators suggest a shortage of homecare workers in California:
Effects on consumers and the public: When consumers are unable to find a homecare worker, they may not get the full care that they need. Researchers have documented that lack of sufficient care leads to negative health effects such as missing meals, dehydration, falls, burns, wetting or soiling clothes, and making a mistake in taking medication. Moreover, if the homecare system is unable to attract enough workers to meet growing demand, consumers will have to turn to more costly forms of long-term care such as nursing homes. In California, the annual cost of nursing homecare ($97,000) is nearly double the annual cost of homecare ($57,000).
California can address the state’s homecare crisis by raising the wages of publicly-funded workers, who provide the majority of care in the industry. Taking this step will prevent imminent industry shortages, ensuring that consumers continue to get the quality care that they deserve and preventing increases in the public cost of long-term care. Raising the wages of homecare workers would also have a significant impact on the lives of workers and their families, and would recognize the value and dignity of caregivers in our state.
Sarah Thomason is a research and policy associate at the Labor Center, focusing on low-wage work. Before joining the Labor Center, she conducted research for National People’s Action, El Colegio de México, and the Insight Center for Community Economic Development. Sarah received a Master of Public Policy degree from UC Berkeley in 2013. Prior to graduate school, Sarah worked as an organizer on economic justice campaigns in Chicago, Yonkers, and New York City.
Annette Bernhardt is director of the Low-Wage Work Program at the UC Berkeley Labor Center, as well as a senior researcher at the UC Berkeley Institute for Research on Labor and Employment. She recently was visiting professor in the UC Berkeley sociology department, as well as a fellow at the Roosevelt Institute. Previously she was policy co-director of the National Employment Law Project, where she coordinated policy analysis and research support for campaigns around living wage jobs, enforcement of workers' rights, and accountable development. A leading scholar of low-wage work, Dr. Bernhardt has helped develop and analyze innovative policy responses to economic restructuring in the United States.