California: Size of Direct-Care Workforce, 2015

Total: 643,040

California: Occupational Growth Projections, 2014-2024

California: Median Hourly Wages for Direct-Care Workers, 2015

California: Median Hourly Wages for Direct-Care Workers, 2005 - 2015

Adjusted for Inflation (2015 dollars)

California: Direct-Care Workers Without Health Insurance, 2012-2014

CA figures are for Pacific division (WA, OR, CA, AK, HI)

California: Direct-Care Workers Covered by Employer-Sponsored Health Insurance, 2012-2014

CA figures are for Pacific division (WA, OR, CA, AK, HI)

California: Direct-Care Worker Households Relying on Means-Tested Public Assistance, 2012-2014

CA figures are for Pacific division (WA, OR, CA, AK, HI)

Nurse Aides

 Minimum Training HoursMinimum Clinical Hours
California 150 100
Federal standard 75 16

Source: California Code of Regulations, Title 22, Division 5, Chapter 2.5, Article 3, § 71835.
See also: In-depth comparison of state nurse aide training requirements

Home Health Aides

 Minimum Training HoursMinimum Clinical Hours
California 120 20
Federal standard 75 16

Source: California Code of Regulations, Title 22, Division 5, Chapter 6, §74747.
See also: In-depth comparison of state home health aide training requirements

Personal Care Aides

California offers personal assistance services under the Medicaid State Plan and two Medicaid HCBS waivers: the In-Home Operations Waiver and the Multipurpose Senior Services Program. Neither the Medicaid State Plan nor the waiver programs require training for agency-employed aides. Participant-directed services are available under the In-Home Services and Supports (IHSS) Program. In this program, training is at the discretion of the participant and can be facilitated by the county-based public authorities. Additionally, California is one of six states awarded a three-year grant by the federal government to develop a training and credentialing program for PCAs, as part of the Personal and Home Care Aide State Training (PHCAST) Program, a provision of the Affordable Care Act of 2010.

Source: This chart is based on information collected by PHI researchers in 2014.
See also: In-depth comparison of state personal care aide training requirements

SB 852: In order to impliment the US Department of Labor's recent final rule on the Fair Labor Standards Act, this budget allocates $180 million for home care worker overtime pay "in exchange for rules to prevent excessive overtime." (Adopted June 15, 2014.)

AB 241: The Domestic Workers Bill of Rights guarantees California direct care workers overtime and minimum wage protections. Domestic workers are entitled to receive time-and-a-half pay for working more than 45 hours a week, or more than 9 hours a day. (Adopted September 26, 2013)

AB 1217: Beginning July 1, 2014, the Home Care Services Protection Act of 2013 provides for the licensure and regulation of private home care organizations in California. Under this law, as of January 1, 2015,  home care aides must be certified, which requires completion of a background check, tuberculosis screening, and 5 hours of training with a curriculum approved by the State Department of Social Services. Certified workers will be listed at a state registry. These standards are not required of providers in the state's In Home Services and Supports program. (Adopted October 13, 2013)

AB 1612
: Upon federal approval, this bill imposes a sales tax on In-Home Supportive Services (IHSS) providers -- most commonly referred to as a “provider fee.” This tax would allow the State to access additional federal Medicaid matching funds to support the IHSS program. The provider will be held harmless, however, in that the state will cover the amount of the tax on behalf of the provider. (Vetoed by Governor September 15, 2014)

AB 1682
: This legislation, adopted in 1999, requires each county in the state to create an employer of record for independent providers providing services and supports under the In-Home Supportive Services (IHSS) Program, California’s largest in-home care program. The employer of record must establish a registry of potential IHSS workers, provide potential worker referrals to IHSS consumers, conduct background screening of IHSS workers, and make available training for IHSS workers and consumers. (Adopted July 12, 1999)

St. John’s Enhanced Home Care Pilot Program: St. John's Well Child and Family Center in Los Angeles ran a pilot program on enhanced roles for home care aides. The "enhanced" role for home care workers included additional training on team-based communication, coordination of health services, paramedical tasks, and chronic disease management. The pilot programs resulted in better health results for consumers as well as lower overall health care costs.

QuickMatch: Non-profit organizations across California recently adopted an online matching service platform to connect independent care providers and consumers. The platform allows users to browse local home care workers. The platform is operated by Centers for Independent Living in Marin County, Alameda County, San Francisco County, San Diego County, and the Central Coast in California as well as St. Louis, MO.

San Francisco Public Authority: Since 1996, the San Francisco IHSS Public Authority has served as the employer of record for home care workers providing services and supports under the In-Home Supportive Services (IHSS) program in San Francisco. IHSS is a statewide publicly funded program providing personal assistance services to low-income people with chronic and disabling conditions. The Authority has advocated for raising worker wages, and provides health and dental insurance. It also operates a matching service registry to provide lists of screened workers to IHSS consumers for potential in-home employment, and arranges training and support services for both workers and IHSS consumers.

Value the care! No. 7: High-hour consumers in the California IHSS program: Impact of compensating overtime hours (PDF): This brief, issued by PHI in January 2013, examines how the proposed extension of basic labor protections to home care workers would affect California’s In-Home Supportive Services (IHSS) program.

Hidden in Plain Sight: California's Paid Medi-cal Caregivers are Vulnerable (PDF): This Fact Sheet, issued in April 2012 by the UCLA Center for Health Policy Research, notes that hundreds of thousands of caregivers participating in California's Medi-Call program are economically insecure and face the risk of long-term economic instability due to the fragile economy. 

Costs and Benefits of In-Home Supportive Services for the Elderly and Persons with Disabilities: A California Case Study (PDF): This 2010 briefing paper examines the cost-effectiveness of California's state-funded IHSS program, which facilitates in-home services and supports for low-income individuals with chronic and disabling conditions. Among other things, it argues that cutting the IHSS program in order to lower the state’s deficit is shortsighted because money spent on the IHSS program has huge multiplier effects: 85 percent of the spending goes directly to pay for the wages of IHSS workers. One billion dollars spent by the state on the IHSS program generates 216,000 full-time equivalent jobs and contributes $360 million in state income tax revenue.

Impact of California’s Medi-Cal Long Term Care Reimbursement Act on Access, Quality, and Costs (PDF): This 2008 report from the PAS Center at UCSF evaluates the initial impact of California’s new nursing home reimbursement system, created by the Medi-Cal Long Term Care Reimbursement Act of 2004 (AB 1629), on access to services, quality of care, and the finances of freestanding nursing homes accepting Medi-Cal residents. Among other things, the Act increased average hourly wages for direct-care staff.

Impact of Medical Benefits on the Los Angeles County IHSS Workforce: A Five-Year Study: In Los Angeles County, personal care workers who meet eligibility requirements can receive healthcare benefits. Since 2003, the Personal Assistance Services Council (PASC) of L.A. County has commissioned annual studies (the results of which are posted here) to examine how these benefits have affected retention and quality.

PHI State Facts: California's Direct-Care Workforce (PDF): This PHI Fact Sheet on California, released in November 2010, outlines demographics, employment projections, and policy issues related to the direct-care workforce in California.

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