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- Personal care services are supports for older adults and people with disabilities who need assistance with daily activities such as dressing, eating, and housecleaning.
- In California, Medi-Cal pays for personal care services through several programs, the largest of which, In-Home Supportive Services, provides care to over 700,000 people.
- But the model relies on people managing their own caregivers independently. People who cannot manage their own care are often unable to access needed personal care services.
What Are Personal Care Services?
Personal care services are essential for older adults and people with disabilities who need assistance with daily activities — like dressing, eating, and housecleaning — to live with dignity and to age in their communities rather than in institutional settings such as nursing facilities.
In California, Medi-Cal pays for personal care services through several programs, the largest of which, In-Home Supportive Services (IHSS), provides care to over 700,000 people of all ages with disabilities. IHSS relies on a client-directed model in which participants must manage their own care independently, including hiring and supervising their providers.
Who Has Trouble Accessing These Services and Why?
A 2024 Justice in Aging study finds personal care services are largely inaccessible to people who cannot manage their own care, particularly if they do not have family or community support. This leaves many at risk of injury, prolonged homelessness, hospitalization, and unnecessary institutionalization.
Their primary challenges include difficulty navigating complex program applications and administrative processes, hiring and managing care providers, and ensuring the quality of the services they receive.
Looking Ahead: What Can Policymakers Do to Improve Access to Personal Care Services for Older Adults and People with Disabilities?
Californians Who Struggle the Most to Access Personal Care Services
Gaps in care disproportionately harm those:
- Leaving incarceration
- Living with cognitive and decisionmaking impairments
- With limited English proficiency
- Living in rural communities
- Experiencing homelessness or at risk of homelessness
- Facing discrimination
The Justice in Aging study highlights several opportunities for personal care services programs to more effectively serve people who can — and cannot — personally direct their care.
- Promote additional modes of care. Expand how personal care services are offered by helping counties contract with home care agencies to act as the employer of IHSS providers for certain clients, relieving them from having to hire their own providers.
- Expand service availability. Increase access to waiver programs for people with the highest care needs by removing enrollment caps and geographic limits, making these services more widely available.
- Reduce administrative barriers. Review and improve IHSS and other program rules to enable enrollment in these programs and improve access to personal care services.
- Fill care gaps through CalAIM. Improve the availability of personal care services through Medi-Cal managed care programs, including Community Supports.
- Replicate promising county practices. Adopt innovative practices like training, case management, and peer support to facilitate access to client-driven services.
