The State of Work: Home Care Providers in the Inland Empire
Executive Summary
California and the Inland Empire are on the precipice of a home care crisis. As California’s population ages, the demand for home care services, including those provided through the In-Home Supportive Services (IHSS) program, is anticipated to grow significantly. The state’s senior population increased from 4.5 million in 2012 to 6.1 million in 2022 and is projected to increase to nearly 8.5 million by 2035. The number of seniors with disabilities is expected to rise from 1.2 million in 2022 to 1.7 million by 2035. Between 2012 and 2035 the number of seniors comprising the Inland Empire’s population is expected to nearly double, changing from 470 thousand to 910 thousand. There is substantial demand for home health care workers to take care of these aging populations, yet these workers face persistent challenges that affect their financial well-being, job satisfaction, and ability to deliver quality care.
Combining findings from original analyses of American Community Survey (ACS) data, interviews with workers and union representatives, and prior research, we examine the state of work among home care workers in the Inland Empire, most of whom are women of color. Our findings highlight five major challenges that home care workers face: low pay, bureaucratic barriers, long work hours and unpaid labor, family responsibilities, and limited access to education and training. To address these challenges, the report recommends policy actions at the state and federal levels that aim to bolster support for California’s home care workforce and improve outcomes for their clients.
Home care workers in the Inland Empire, as elsewhere in California, earn very low incomes. Our analysis of 2022 ACS 5-year data estimates reveal that personal annual income of home care workers are $21,402 in California, $21,000 in Riverside County, and $19,488 in San Bernardino County. IHSS workers’ base wages in both counties are less than $20 per hour. This level of compensation is inadequate to meet rising living costs and fails to recognize the critical services these workers provide. Additionally, bureaucratic obstacles—such as inconsistent authorization processes, inadequate reimbursement structures, and the “share of cost” policy—place financial strain on workers and complicate service delivery. Many home care workers, particularly those caring for family members, exceed their authorized work hours without compensation. This dynamic of long work hours and unpaid labor is often driven by a sense of familial duty, as well as gaps in the authorized hours that fail to account for the full extent of caregiving needs.
Family responsibilities further complicate the work of many IHSS providers, who frequently care for their own relatives and feel obligated to work beyond their allotted hours. Blending personal and professional lives can lead to emotional stress, burnout, and financial strain. Many caregivers also face barriers in career advancement due to limited access to education and training. In the Inland Empire, for instance, only 11% of home care workers hold a bachelor’s degree or higher, compared to 17% state-wide. Workers report a desire for training in specific caregiving skills and pathways to higher education, yet access to this training remains limited, especially after the state government was forced to terminate the IHSS Career Pathways Program due to insufficient funds to support the growing demand for it. Although unions have initiated training and educational resources for members, home care workers still have many unmet needs for skill development and career mobility.
Several policy initiatives are recommended to address these issues:
- Declaring the state rather than county governments as the employer of record would enable IHSS workers to engage in standardized, state-wide contract negotiations, which would in turn help to achieve greater pay equity and improve workers’ benefits, including their access to paid sick leave, vacation hours, and retirement plans.
- At the federal level, expanding Medicare to cover home care services for all seniors, rather than limiting support to low-income individuals through Medicaid, could help to reduce bureaucratic hurdles and improve access to care.
- Policies to expand paid service hours, structured training in family caregiving, and mental health resources would support home care workers facing long hours, unpaid care work, and emotional strain.
- Increasing IHSS wages through public investment at the county, state, and federal levels would benefit workers and stimulate local economies. Research indicates that higher wages for home care providers increase tax revenues and support a range of industries in regional economies.
Enhanced public investment in the IHSS program and a focus on improving working conditions, training, and wages are essential to meet California’s growing demand for home care. As home care workers gain better support and resources, both caregivers and their clients will benefit from higher-quality, more reliable care that promotes the health and well-being of California’s most vulnerable populations.