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

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

Percent

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.

Source

About the Authors

Shannon McConville is a research fellow at the Public Policy Institute of California and a member of the PPIC Economic Policy Center. Her research interests include health care access, utilization, and outcomes among vulnerable populations and the impact of vocational training programs on economic mobility. Her current work focuses on examining safety net programs, assessing the effects of Medicaid coverage expansions on individuals involved with the criminal justice system, and analyzing the employment outcomes and economic returns of career technical education. Before joining PPIC, she was a research training fellow in the Health Services and Policy Analysis doctoral program at the University of California, Berkeley; a senior research associate at the Department of Health Research and Policy at Stanford University; and a project manager at the Lewis Center for Regional Policy Studies at the University of California, Los Angeles. She holds a master’s in public policy from the University of California, Los Angeles.

Daniel Payares-Montoya is a research associate at the Public Policy Institute of California. He is a member of the PPIC Economic Policy Center, and he also contributes to the PPIC Higher Education Center. His research focuses on expanding economic opportunity through the labor market, the relation between the labor market and higher education, income inequality, climate-related jobs, and economic development. Before joining PPIC, he worked as a consultant for the World Bank, concentrating on green growth and green finance in developing countries, and as a researcher at the Center for Latin American Studies, University of California Berkeley, focusing on the socio-economic impact of globalization and industrialization in the Americas. He has also conducted research on productivity, education, and labor markets for Fedesarrollo, the Private Council on Competitiveness, and Proantioquia Foundation in Colombia. He holds a master’s degree in public policy from Universidad de Chile and a master’s degree in development practice from the University of California, Berkeley.

Sarah Bohn is vice president and director of the PPIC Economic Policy Center and senior fellow at the Public Policy Institute of California, where she holds the John and Louise Bryson chair in policy research. She is also a member of the PPIC Higher Education Center. As the founding director of the PPIC Economic Policy Center, she leads research and engagement to inform California policymaking to support greater opportunity and upward mobility for workers, families, and businesses statewide. A labor economist, her research focuses on the job market, workforce skills, and the role of education and government programs in upward mobility. Her other areas of expertise include immigration policy, poverty measurement, income inequality, and career technical education. Her work has been published in major academic journals, including the American Economic Review, Demography, American Economic Journal: Economic Policy, and The Review of Economics and Statistics. Previously she served as vice president of research at PPIC. She holds a PhD in economics from the University of Maryland, College Park.

Mary Severance is a senior editor at the Public Policy Institute of California. She edits and helps develop publications and briefings so that they are accessible to their audiences. She also writes copy for the PPIC website and for institutional publications. Before she joined PPIC in 2008 as the institute’s production editor, she was a senior project editor at University of California Press. She has also worked as a copyeditor and college English instructor. She holds an MA and PhD in English from the State University of New York, Buffalo, and a BA in English from Carleton College.