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.