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About half of all Sonoma County residents over the age of 60 — or 50,000 people — get some sort of paid care at home, from licensed medical care to general assistance with daily living.

Those estimates, from the county's Health Services Department, support a thriving industry that will only grow as baby boomers age.

The job of a home health aide has become one of the fastest-growing occupations in Sonoma County. This decade, the number of home health aides will grow 29 percent in the county, an increase of 340jobs between 2010 and 2020, according to state Employment Development Department projections.

"We're an aging population; we know that we're just going to have an increasing need for in-home care," said Diane Kaljian, Sonoma County's director of adult and aging services.

Today, one in seven Sonoma County residents is 65 and older. By 2030, in what has been dubbed the "silver tsunami," that share will grow to one in four people, according to the U.S. Census Bureau.

"There's enough there for everybody, absolutely," said Sharon Grinnell, a nurse who started Home Health Care Inc. in Santa Rosa in 1980. "Demographically, this is a good business for another 30years."

Several different categories of workers have emerged to help care for the county's aging residents.

There are more than 1,160 people now employed in Sonoma County as home health aides, providing care that includes basic medical procedures such as injections and dispensing medication, up from 460 in 2001. Not all are at agencies like Grinnell's; some work in assisted-living homes and others are independent contractors.

That job sector doesn't include in-home supportive services, or IHSS, providers who are paid by the state. They handle things ranging from personal hygiene assistance to helping with transportation, but no medical tasks.

IHSS workers — some of whom are family members getting reimbursed — serve 1,571 Sonoma County residents over 65, according to the county Health Services Department, which oversees the program locally.

Also, there are at least 3,750 personal care aides in the county. These workers perform tasks similar to IHSS providers but are employed by private agencies. That job sector — providing what is also termed custodial care — is projected to grow by 16 percent until 2020, to 4,340workers.

Currently, custodial care agencies are not regulated, while home health agencies have strict licensing requirements.

"Our industry right now, anybody can put up their shingle and start to run their home care company," said Lucy Andrews, a registered nurse who owns At Your Service Home Care, an 11-year-old Santa Rosa custodial care firm.

That will change in 2016, when a state law takes effect requiring a minimum of five training hours, background checks and some licensing.

Meanwhile, more and more people are paying for home care services.

"It's a big relief," said Karen Mountain, 66, who hired a caregiver in November after she broke her leg. The Santa Rosa mortgage broker needed help caring for herself and her 97-year-old mother, who lives with Mountain.

An aging population is not the only factor driving growth in the home care business. Many people do not want to move into an assisted-living facility, or move their parents into one, either because of cost or for personal reasons.

"Home is familiar, home is where the family comes for the holidays, home is where you're used to," said Grinnell of Home Health Care.

The developing demographic landscape has spurred some to enter the caregiving business.

"That's one of the reasons we relocated here. Looking at the numbers, there's a huge percentage of the population that's of retirement age," said Hillary Wootton, who together with her fianc?, Michael Bagwell, owns Homewatch CareGivers, where Mountain found her caregiver.

The couple moved from Washington and opened their Santa Rosa business, which provides all in-home services except medical care, last October.

Their company employs 10 caregivers now and is still hiring, Wootton said. She gets 20 to 30 responses to each Craigslist advertisement she places. About half are qualified for the job, with training and certification as a nursing assistant or home health aide, or significant work experience.

For company owners and managers, the industry by its nature contains an inherent challenge.

"It is always in flux. People pass away," Wootton said. "Neighbors come and say they'll do it instead. You're always trying to balance, 'How many clients do I have, how many caregivers do I need?'"

The new regulations will soon force adjustments that will affect caregivers as well as clients, perhaps pushing prices up.

"The industry is really in flux," said Andrews, of At Your Service Home Care.

Custodial care has come of age more recently than home health care services.

"It has really become an industry in the last 10 years," said JulieAnn Anderson, owner of Home Instead Senior Care in Rohnert Park.

She employs 50 to 66 caregivers at any one time and serves 60 to 80 clients, the great majority of whom are 78 or older.

The bulk of her clients, Anderson said, are adult children of elderly people who realize their parents need care they can't provide, either because they lack the skills or, more commonly, because they don't have the time. The other portion of her clients are elderly who contract her services themselves, often upon leaving the hospital.

"We're trying to stop readmittance into the hospital, and often times that just means having a caregiver in place," Anderson said. "To make sure that they're eating, taking their medications, staying hydrated, that they're following doctors' orders."

Finding and choosing an agency can be a tough task, given the various levels of care offered, the dozens of agencies — more than 30 firms in the custodial care business locally — and the thicket of rules about who pays for what and what is covered by insurance or Medicare.

"We're a service that is often not really thought about much until you really need it," Andrews said. "People have a huge learning curve trying to decipher different levels of care."

Advocates say consumers must do their due diligence in selecting an agency, including trying different caregivers before deciding on one, which most agencies will arrange.

"It's complicated. You don't want to be surprised. You want to really be informed about the company's services and what their policies are," said Connie Aust, director of social and financial services at the nonprofit Council on Aging.

"You want to take the time to do that work before you hire," Aust said.

"You don't know where to go and who to turn to," said Karen Hellender of Santa Rosa, who hired a caregiver for her uncle last May. "It's not wired into your DNA about what to do when you have an elderly relative who needs help. You're really starting from scratch."

Hellender sought help, ultimately from Home Health Care Inc., after trying to care for her uncle by herself, a role that involved giving him daily insulin shots.

"I wasn't going to be able to continue to do that and continue working," she said.

The experience — she has found it positive — has turned Hellender's thoughts beyond her uncle, whose affairs she continues to manage.

"This made me realize that their time is coming as well," she said of her parents, who are 84 and 87.

"But also," she said, "in the back of your mind is the thought that in another 20-plus years that's going to be me, too."

(You can reach Staff Writer Jeremy Hay at 521-5212 or jeremy.hay@pressdemocrat.com.)