Master Plan: 5 Bold Goals

Goal four for 2030
Goal four: Caregiving That Works

"We will be prepared for and supported through the rewards and challenges of caring for aging loved ones."

Target: One Million High-Quality Caregiving Jobs

View Goal Four’s data indicators and track our progress at the Data Dashboard for Aging.

At some point in our lives, most Californians will seek care from family, friends, or paid caregivers. Likewise, most Californians will also have the privilege and responsibility of caring for an olderloved one. The COVID-19 pandemic has meant even more of us are in one or both of those roles, in more challenging circumstances. Supporting caregiving for adults, like caregiving for children, is essential for family life, the economy, and a California for all ages.

Across California, almost five million family caregivers help their parents, spouses, and friends who need assistance with everyday tasks to live well in their homes and communities. Of these, almost 1.7 million are caring for someone with Alzheimer’s Disease or dementia, usually with little support or training. This constitutes about 4 billion hours of unpaid time, valued at $63 billion, each year. Women, particularly Black, Indigenous, Latino, and Asian-American women, are providing a disproportionately large share of this care – often while simultaneously caring for children. Households of color are more likely than white households to be multi-generational, which may indicate these families are more likely to be providing unpaid caregiving across the generations. As rewarding as this work may be, the time needed to care for a loved one can result in financial hardship and a decrease in lifelong Social Security earnings, which can continue the cycle of poverty and debt for low-income households. The emotional and physical stress of caregiving can also lead to poor health outcomes for the family caregiver.

Paid caregiving is essential to older adults’ ability to choose where to live. Caregivers provide direct care in many settings – in private homes, through community-based services like adult day centers, or in residential care homes, such as assisted living facilities or nursing homes. In the coming years, California will face a labor shortage up to 3.2 million paid direct care workers. Direct care workers earn less than half of California’s median annual income and one in four falls below the federal poverty line. Most caregiving jobs are held by women; many are immigrants, and they are twice as likely as other Californians to live in low-income households. Low wages, stress, and an elevated risk of job-related injury reduce prospects for financial stability for those employed in the caregiving workforce.

As the population age, and the need for caregiving increases, virtual caregiving and telehealth will become more vital for empowering aging adults, people with disabilities, and caregivers to age well at home. However, recent research has shown that older adults with dementia, hearing loss, and impaired vision may have a hard time using digital devices and programs designed without their needs in mind. The lessons from COVID-19’s rapid pivot to telehealth, coupled with California’s global leadership in the tech sector, have the potential to drive transformative advances in virtual care.

California will pursue Caregiving That Works through the below strategies and initiatives.

Strategy A: Family & Friends Caregiving Support

Family caregivers need supports – such as paid family leave, multilingual training resources, virtual care options, and respite – so that the role remains rewarding and caregivers can maintain health, well-being, and income while caring for a loved one. Given that lower-income women, particularly women of color, disproportionately provide family caregiving, resources and support should be tailored and prioritized accordingly.

  • Initiative 107

    - Promote current state paid family leave benefits to older Californians, people with disabilities, and family caregivers. (Lead Agency: LWDA)
  • Initiative 108

    - Assess participation in state paid family leave, including recent legislation to expand equity, for equity, including LGBTQ, race, income, gender. (Lead Agency: LWDA)
  • Initiative 109

    - Develop options to include family caregivers in home and community assessments. (Lead Agency: CHHS)
  • Initiative 110

    - Consistent with CalAIM, expand respite care for family caregivers. (Lead Agency: CHHS)

Strategy B: Good Caregiving Jobs Creation

The caregiving workforce can be grown through caregiver training and professional development opportunities, along with livable wages, job placement support, and improved job quality. Higher wages will help paid caregivers work toward financial security, alleviate economic disparities, and better reflect the true value of their work.

  • Initiative 111

    - Convene a Direct Care Workforce Solutions Table to address workforce supply challenges and opportunities in skilled nursing facilities. (Lead Agencies: CHHS & LWDA)
  • Initiative 112

    - Consider expanding online training platforms for direct care workers – including opportunities for dementia training for IHSS family caregivers seeking a career ladder and more - to meet need as funding available. (Lead Agencies: CHHS, LWDA, Community Colleges)
  • Initiative 113

    - Diversify pipeline for direct care workers in home and community settings by testing and scaling emerging models (e.g., Healthcare Career Pathways; High-Road Direct Care; Universal Home Care Workers; more), to meet need as funding allows. (Lead Agencies: CHHS, LWDA, Community Colleges)

Strategy C: Virtual Care Expansion

New technologies, many pioneered in California, are paving the way for innovations in personal devices, smart home and community design, telehealth and more, and have the potential to help support caregiving and aging well across the state, nation, and globe.

  • Initiative 114

    - Identify innovative models and solutions to enhance telehealth access for Californians of all ages, races, and ethnicities, in alignment with State Broadband Council's new Strategy per August 2020 Exec Order, within existing resources. (Lead Agencies: CHHS & GovOps)
  • Initiative 115

    - Expand telehealth access to multiple Medi-Cal delivery systems, incorporating lessons from COVID-19 and including virtual communication, remote patient monitoring, provider education, beneficiary education, family caregivers, and language access considerations, within existing resources. (Lead Agencies: CHHS & GovOps)
  • Initiative 116

    - Consider opportunities to access personal and home technologies that promote healthy aging, to meet need and advance health equity, as funds available. (Lead Agencies: CHHS & GovOps)

Caregivers of family and friends too often have to choose between their own health and financial needs and caring for a loved one. Caregivers need culturally competent options that not only improve their own health and quality of life, but also those of the person for whom they are caring. Accessible and affordable long term services and supports, paid family leave, resources and training, and assistance navigating services will improve the lives of millions of caregiving families in California

Donna Benton, Professor, UCC Leonard Davis School of Gerontology, SAC Member
/Content/images/Goals/Healthcare Career Pathways

Healthcare Career Pathways (HCP) is a collaborative partnership with Ombudsman Services of Contra Costa, Solano and Alameda, Opportunity Junction, and Mt. Diablo Adult Education formed to address the critical shortage of healthcare workers. HCP provides quality clinical and classroom training to students, leading them to the certification they need to become skilled caregivers in their community.