UCLA Labor Center

Mounting Crisis in Homecare Industry Impacts Both Workers and Consumers

Publish date: March 30, 2022

Our newest report finds that the California homecare industry is facing critical issues that strain workers and consumers alike, amid growing demand that has further intensified during the COVID-19 pandemic. Lives & Livelihoods: California’s Private Homecare Industry in Crisis finds that meaningful and timely public investment in the state’s homecare workforce and infrastructure is imperative to the sustainability of the industry over the next decade and beyond.

Presently, over 700,000 Californian workers — primarily immigrant women and women of color — provide homecare for nearly three million older adults and people with disabilities. These services are key in ensuring people with disabilities and older adults can live and age at home, rather than in institutions. Despite the high value of the work, homecare workers are often underpaid and face unsafe, difficult working conditions. Researchers examined homecare in California by surveying 500 workers and 103 consumers, conducting in-depth interviews with workers and consumers, and reviewing homecare agencies and residential facilities for the elderly.

According to the study, the lack of infrastructure in homecare leaves both consumers and workers struggling. Given this deficit, homecare employers face barriers in finding, affording, and managing homecare, with two-thirds of employers relying on word-of-mouth recommendations to find workers to hire. The industry’s lack of infrastructure also makes it harder for workers to access and know their rights. Only 22% of workers reported ever taking paid sick leave.

“This work is intimate, and many individuals or families who need to hire long-term care struggle to find a homecare worker who can match their needs and resources. Once they steer through that hurdle, they are faced with the challenge of navigating their working relationship, which can lead to problematic conditions. For instance, we found that only 29% of agency and direct-hire consumers provide paid sick leave. Consumers aren’t providing benefits because they don’t have the information to do so, or can’t afford it,” said Lindsay Imai Hong, California Director of Hand in Hand.

Unpaid sick leave presents major challenges to most homecare workers:  “If I get sick, not only am I in danger, but I also put my 4-year old son at risk of getting infected. It’s a high risk, but we continue to work because most of us are breadwinners sending money back home to our relatives in our home country. When I get sick, I don’t get paid … which means that my son will not be able to eat or survive either,” said Allen Galeon, a homecare worker and member-leader with the Pilipino Workers Center.

The report finds that nearly two-thirds of homecare workers do not earn enough to cover their daily expenses, much less save for retirement or personal long-term care needs. 74% reported not having any type of personal retirement savings.

“Our homecare system requires consumers to use their retirement savings to pay for care. Without a financial safety net, workers will not be able to afford to pay for their own care in the future,” said Kimberly Alvarenga, Director of the California Domestic Workers Coalition. “Workers earn well below a living wage in California. Almost a third of workers are paid a flat rate, earning a median hourly wage of just $9.17.”

Researchers note that many families need financial support through public investment in order to pay their homecare workers a living wage. Consumers generally recognized that homecare workers need and deserve higher pay. 76% of consumers stated they would like to pay higher wages.

“Most employers want to pay their homecare workers more, but cannot afford to. We found that 85% of consumers strongly support a universal long-term care insurance program in California,” said Lucero Herrera, Senior Research Analyst at the UCLA Labor Center.

Report authors key recommendations include 1) making it easier for consumers to find care and workers to find fair employers; 2) formalizing the industry and making workers rights real through education, tools, and increased enforcement efforts; 3) addressing the crisis of low wages; and 4) increasing public investment in long-term care to help consumers access and afford homecare and other long-term care.

The report is a collaboration between the UCLA Labor Center, Hand in Hand: The Domestic Employers Network, National Domestic Workers Alliance, California Domestic Workers Coalition, Pilipino Workers Center, and the Golden Gate University Women’s Employment Rights Clinic.

Download the report.

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