As tri-county residents age, many will require the services of home care workers to bathe, feed and clothe them, meaning the low-wage occupation is projected to be one of the region’s fastest-growing.

But the rise of home care in a region that is one of the most expensive areas to live in the country has thrust the future of the occupation into the middle of high-profile battles over government spending, the cost of care, wage standards and the future of unions.

What’s not in dispute is that home-health care workers are here to stay and that they will have an outsized impact both on how elderly residents in the region are cared for and median incomes in the Tri-Counties.

“We are all fighting for the same pool of employees,” said Sherry Netherland, director of special projects for Thousand-Oaks-based Assisted Home Care.

Between 2010 and 2020, more than 4,500 new home care positions are expected to be added in Ventura, Santa Barbara and San Luis Obispo counties, according to estimates from California’s Employment Development Department. The almost 50 percent increase makes it one of the fastest-growing occupations in the region, and an aging population means the trend is likely to continue.

The number of tri-county residents aged 65 or older is projected to balloon by 83.6 percent between 2010 and 2030, according to Department of Finance projections.

Home health care workers assist clients with the activities of daily life, including bathing, dressing and feeding. Workers may also assist with cooking, tidying up around the house and driving clients to activities and appointments.
Susan Escalante works in Ventura County and said the job is all about preserving the dignity of those she cares for. “You try to make it as [easy] as possible for the people you are taking care of,” she said. “They have lived long, full lives and they deserve that respect and that dignity.”

In the region, workers earn around $11 an hour, according to the EDD. California’s minimum wage is $9.

Long-term home care is generally paid for out-of-pocket. It’s not covered by Medicare or general insurance plans, although specific long-term care insurance has become more common. Assisted Home Care’s Netherland said many people are surprised to learn that home care isn’t covered.

Workers are frequently hired to supplement family member-provided care. As birth-rates decline and worker mobility increases, children may not exist or be close enough to care for rapidly aging parents. And many relatives aren’t comfortable or able to assist with intimate tasks.

Demand is surging, and there is increased competition for workers, Netherland said. Despite the low wages, home care can be a rewarding profession for those who want flexible hours or who haven’t pursued higher -education degrees.

Despite home-care worker shortages in some areas of the country, there is a natural cap on wages because clients can only pay so much for services, said Aaron Marcum, CEO of Home Care Pulse, a provider of business management services for the home care industry.

Most U.S. residents have to pay for services privately, but California does employ workers through its In-Home Supportive Services, or IHSS, program. Through a combination of federal, state and county dollars, low-income people with disabilities as well as high-need elderly residents are provided with subsidized in-home care.

Statewide, about 70 percent of IHSS workers are family members of their clients, which means the state is paying for people who leave the workforce to care for relatives. Home-health care proponents point out that workers can provide substantial cost savings to the state, as clients are kept out of expensive institutional care.

In Ventura County, these services can cost around $12,000 annually while one year of institutional care can be upwards of $50,000, according to a presentation given to the Ventura County Board of Supervisors.

Unionization

Faced with declining membership nationally, unions around the country reached out to home health care workers.

Starting in the early 1990s, unions began organizing many counties in California. In 1999, Los Angeles County IHSS workers voted to unionize, making them the largest group to be unionized since General Motors workers did so in 1937. Now, almost every California county’s IHSS program is unionized, including those in the Tri-Counties.

On June 30, the U.S. Supreme Court dealt unionization efforts a blow by ruling that home care workers in Illinois couldn’t be forced to pay union dues. As this story went to press, the recent ruling’s effect on California IHSS unions is unclear, although the legality of mandatory membership fees for such workers in the Golden State could be challenged in court.

About 7,200 tri-county IHSS home care workers are represented by two unions. In contrast to the public sector, it is uncommon in California for private-sector, long-term care workers to be unionized.
In June, the Ventura County Board of Supervisors approved a new contract that will raise workers’ wages to $12.50 an hour, from $9.50, in 2016. This will increase county outlays by about 50 percent to $12.1 million in 2016.

The increase will also make Ventura County IHSS workers among the highest-paid home care providers in the state. Union leaders hope to fight for similar contracts in other areas. In the last 18 months, a number of counties have negotiated new contracts as the effects of the economic downturn on their budgets has eased.

Despite being viewed as an unskilled, low-paying job, home health care work is difficult and wages should reflect that, said UC Santa Barbara labor studies professor Eileen Bori, who has co-written a book on the history of home care.

“This is the fastest-growing labor force. It is the new face of labor,” she said. “If we can’t raise the salary and conditions of home-health care workers, we can just forget about having any type of middle class.”