|
Getting your Trinity Audio player ready...
|
Natascha Walker works full-time as her 22-year-old autistic daughter’s caregiver. Walker is a provider through California’s In-Home Support Services program, which enables disabled people and older adults to live independently outside of an institutional setting. Originally from Texas, the former high school teacher and mother of two decided to move her family to Santa Clara County in 2021 because of the lack of adequate services and support available where they lived.
Walker’s husband, 67, is a retired member of the pipefitters union. His physically demanding job took a toll on his body, limiting his mobility. Walker, a 57-year-old veteran, is partially disabled herself from a knee replacement surgery. Someone needed to stay home with their daughter whose language processing disorder made it difficult for her to communicate. But the family still needed to make a living. At first, Walker found it difficult to find information about resources available to her in California. Then one day, on a grocery run during the pandemic, she found out about the support services program.
“This program has just been amazing for us,” Walker said. “I don’t have to worry about the roof over my head anymore. Well, I didn’t until November of last year.”
Each day tens of thousands of residents like Walker do the essential work of caring for the physical, social and individualized needs of disabled people and older adults in Santa Clara and San Mateo counties. These workers, disproportionately women, people of color and immigrants looking after their family members, make up a patchwork system of paid and unpaid home caregivers.
In the coming decades, as the number of persons 65 years and older is projected to surge, the demand for long-term care will inevitably increase. The question is whether local health and long-term care systems are prepared to meet the moment and, at the same time, navigate the trickledown effects of state and federal cuts to Medicaid, the primary funding source for long-term services.
The Mid-Peninsula’s Aging Population
The population in the mid-Peninsula is aging rapidly. Between April 2020 and July 2024, the number of residents aged 65 and older grew 13.4% and 12.2% in Santa Clara and San Mateo counties, respectively, according to U.S. Census data released in June. As of last year, Santa Clara County – the most populous of the Bay Area’s nine counties – had the youngest median age at 38.1 while Marin County had the highest at 47.9. The median age in San Mateo was 41.3, three years higher than the state median age.
Across California and the nation, the number of older adults is increasing as the Baby Boomer generation ages and people live longer, according to a recent report by the Public Policy Institute of California. Immigration patterns, falling fertility rates and other factors also contribute to the demographic shift.
In 2019, to prepare for 2030 when a quarter of the state’s population will be aged 60 or older, Gov. Gavin Newsom penned an executive order calling for the development of a Master Plan for Aging. Released in January 2021, this 10-year strategy focuses on housing, health, affordability, equity and caregiving; the state has released annual reports every year since. However, despite attempts to plan for the next decade, gaps in the state budget and federal funding cuts make for an uncertain future.
Earlier this month, President Donald Trump signed a massive tax and spending bill into law, which will have far-reaching consequences for millions of Americans. Included in the GOP package are significant cuts to Medicaid, the low-cost insurance program known as Medi-Cal in California. As a result of the new law, the governor’s office says that the state expects to lose at least $28 billion in federal funds, which account for more than half of the program’s funding. This will compound a preexisting multi-billion dollar deficit in the state’s Medi-Cal budget.
“The [federal] budget bill is going to hurt a lot of people,” said Nari Rhee, the director of the Retirement Security Program at the University of California, Berkeley, Labor Center. “Older people are going to get hit from multiple directions.”
In April, the nonprofit California Health Foundation reported that cuts to Medi-Cal would reduce low-income seniors’ access to Medicare, the public insurance program for people 65 and over, as many older adults are enrolled in both programs and rely on Medi-Cal to cover their high Medicare premiums.
Medi-Cal cuts will also have serious implications for low-income seniors who rely on the program for services that Medicare doesn’t cover such as nursing facilities and In-Home Support Services.
The Family Caregiving Workforce
Through the state’s In-Home Support Services program, Medi-Cal-eligible persons aged 65 and older and people with disabilities can apply to meet with a social worker, who will then review their application. The state coordinator can authorize a certain number of hours that that person can receive services such as cleaning, grooming and meal preparation, among other things. If approved, the recipient can then hire their own caregiver to perform these tasks. The policy institute reports that most In-Home Support Services workers are family members of the person they care for and half live with the recipients of their care.
As of May 2025, there were more than 36,000 IHSS recipients in Santa Clara County and over 8,000 in San Mateo County, more than half of whom were aged 65 and older, according to data from the California Department of Social Services.
Rhee said it’s difficult to know what the impacts of federal Medicaid cuts will be on the in-home program. “The state has to make some difficult decisions around how they budget for that,” she said.
Earlier this year, the governor proposed capping overtime hours for the workers – a proposal that was ultimately rejected by the state Legislature in June.
In addition to federal Medi-Cal cuts, new work and eligibility requirements designed to go into effect at the start of 2027 will pose a challenge for caregivers. While there is technically an exemption for family caregivers, Rhee said it places the onus on Medi-Cal-eligible individuals caring for their older family members “to prove whether or not they’re working the required number of hours and if not … to actively apply for an exemption.”
Increased funding for immigration enforcement will also impact the home care workforce, 32% of whom are immigrants, according to a 2024 report by PHI, an elder and direct care policy research group.
“Our entire care system, including child care and elder care, relies on immigrant workers,” Rhee said. When asked if there are enough careworkers to meet the increased demand in the coming years, she said, “The short answer is no.”
The homecare sector is already plagued by a shortage of workers and high turnover, with caregivers citing low-wages, poor benefits and a lack of support as the primary issues.
As of July 2025, IHSS providers in Santa Clara and San Mateo counties made $20.04 and $21.30 per hour, respectively, according to data from the California Department of Social Services. Based on the MIT Living Wage Calculator, which accounts for geographic-specific costs, the current living wage in Santa Clara County is $35.44 per hour and $34.76 per hour in San Mateo County for single adults with no children.
Earlier this year, members of SEIU Local 2015, Region 5 – the union representing long-term care workers in California – started campaigning for wage increases in Santa Clara County. Last month, they rallied at the Santa Clara County Board of Supervisors, advocating for higher pay and more support for immigrant workers.
Currently providers negotiate their pay on a county-by-county level. However, there is a bill making its way through the Legislature that would allow them to collectively bargain with the state instead.
In the years since becoming an in-home services provider, Walker has become involved with SEIU Local 2015, Region 5, which encompasses the Bay Area. She is also a member of Santa Clara County’s IHSS Advisory Board.
Walker worries about the impact that Medicaid cuts will have on families. She says there’s a chance her family will have to move somewhere cheaper, where she might not have good access to her veterans affairs benefits. Her husband’s medicare premiums may go up. Perhaps they’ll have to sell their car.
Medicaid “is a lifeline for a lot of people,” Walker said, adding that lawmakers don’t realize “ that they’re actually decimating a lot of the care industry.”
“They should be taking our tax dollars and reinvesting them back into the community,” she said. “And they’re not doing that.”
