PPIC Logo Independent, objective, nonpartisan research
Policy Brief · April 2024

Policy Brief: California’s Care Workforce

Shannon McConville, Daniel Payares-Montoya, Sarah Bohn, and Mary Severance

Supported with funding from the Blue Shield of California Foundation and the James Irvine Foundation

California’s care sector is at a critical juncture. State master plans on the aging population and early care and education (ECE) have underscored the need to expand the care workforce and improve outcomes for the workers who provide essential services to young children, older residents, and people with disabilities. An overview of current care workforce realities can help policymakers address future demand.

California’s diverse care workforce is aging, and many jobs offer low wages

California’s care workforce is comprised mostly of women, with Latina and Black women, as well as foreign-born residents overrepresented relative to their share of the workforce overall. While the diversity of the care workforce may help meet the culturally specific needs of those receiving services, the aging of direct care workers heightens the challenge of meeting growing demand. About two-thirds of California’s personal care and home health aides are over 40 years of age, and nearly 40% are over 55.

Many care workers earn low wages. In the first quarter of 2023, median hourly wages ranged from a low of $15.60 for home health and personal care aides to a high of $20.10 for certified nurse assistants. Child care workers earned about $18 and preschool teachers earned $19.50 per hour. Moreover, more than half of care workers are employed part time, compared to just 33% of all workers or 40% of women. Low wages and limited hours generate low earnings overall for care workers: we find about a quarter of care workers are poor or near-poor, and 30% to 40% rely on safety net programs.

Median hourly wages are lower for care workers than for workers overall

Dollars per hour

figure 1 - Median hourly wages are lower for care workers than for workers overall

SOURCE: OEWS Employment and Wage Statistics Data, May 2022 occupational estimates and first quarter 2023 wage estimates.

NOTES: Data is based on a survey of employers and is used here to show broad differences across occupations. Information on wages is pooled from three years of surveys and weighted to reflect quarterly employment counts by size, industry, and area. Self-employed and household workers are not included.

Demand for services is growing—but there are many workforce challenges

Meeting the demand for quality, affordable caregiving has long been a major concern, but the growing population of older Californians will put additional pressure on policymakers to address these needs. Home health and personal care aide jobs are projected to increase 29% to over a million jobs by 2030.

Policy changes in health and education could further shift care workforce needs. For example, state efforts to address long-term care financing—via a payroll tax or Medi-Cal coverage of assisted living—could boost demand for direct care workers. Likewise, the expansion of transitional kindergarten to nearly all four-year-olds by the 2025–26 school year will shift ECE demand to public school settings.

A key challenge is retaining workers; care workers are more likely than workers in other sectors to change employers or leave the labor force within just a few years of starting a job. The prevalence of part-time work contributes to this challenge; boosting hours could help retain workers and grow the workforce, but care workers report concerns about family obligations, access to safety net benefits, and other issues.

Moreover, attracting new workers to jobs that tend to offer low wages and limited advancement opportunities is a challenge to meeting growing demand. Unlike in other sectors of the economy where workforce shortfalls can be addressed by increasing wages, care services are already too costly for many California families. Also, the state and federal government are major purchasers of care services so determining payment rates and how much workers are paid require budget tradeoffs.

Most care workers do not work full time, though there is variation across occupations


figure 2 - Most care workers do not work full time, though there is variation across occupations

SOURCES: American Community Survey (ACS) – IPUMS, 2021 and 2022.

NOTES: Occupation is based on a person’s primary job where they work the most hours. Full-time, full-year employment is defined as at least 35 hours per week and at least 50 weeks per year. All female workers excludes care workers.

How can California expand its care workforce?

Efforts in several major areas could improve prospects for care workers and help California meet its need for caregiving services.

Investing in well-defined career pathways. Advancing to higher-level positions would offer opportunities for economic mobility. More support may be needed for people pursuing pathways to nursing and TK–12 teaching—and making sure they can complete programs in a timely manner is critical. The most remunerative pathways would typically take workers beyond direct caregiving occupations.

Improving economic security for care workers. Most new care jobs will be in positions that require relatively little training. Improving the economic security of these workers—rather than relying solely on advancement—must remain a key part of the conversation. Establishing universal core competencies tied to wage progression, targeted business supports for self-employed providers, and increasing payment rates through government programs could help care workers gain more economic stability.

Better integrating direct care and ECE workers into health and education sectors. Experts in direct care and ECE stress the need to integrate care services—particularly in home-based settings—into their broader sectors. One potential strategy is to create a “universal home care” aide position with streamlined qualifications and scope of practice; this could make direct care workers more integral and better-paid members of health care teams.

Going forward, it will be important to monitor progress on master plan workforce initiatives and additional investments in care worker training. It will also be critical to integrate available administrative and licensing data to evaluate how policies and funding levels are changing the size of the care workforce—and to assess the impact on workers’ well-being.


Economic Mobility Economy Jobs and Employment Workforce and Training