San Francisco native John Tellez remembers when he could take BART to the end of the line for just 60 cents, a bygone era when he could more easily afford to live in The City and work as an in-home caregiver for his grandmother in Daly City.
But after his grandmother passed, Tellez had to find new work on top of bearing the loss of a family member. Construction jobs helped him get by, but the rising cost of living ultimately left him homeless for nearly four years.
These days, Tellez is back on his feet and doing what he loves: helping others live safely and comfortably at home. Not only that, but the 57-year-old is heading back to school to take his real-life expertise as an in-home care provider to the next level with training to become a certified nursing assistant.
“I like helping people. You know, it’s like karma. One day I might need help again myself,” said Tellez, who now works with clients in San Francisco’s shelter-in-place hotels, many of whom request working with him due to shared experiences with homelessness.
Tellez is one of five inaugural cohort members for a pilot program between City College of San Francisco, University of California, San Francisco, and Homebridge, a San Francisco-based, in-home caregiving provider that serves older adults and individuals with complex health and behavioral needs.
On a typical day, Tellez meets with clients such as a stroke survivor living in a Japantown shelter-in-place hotel, where he assists with everything from running errands, to changing bedding, to administering medications and helping the client move safely about.
It’s the same type of work that Tellez did while supporting his grandmother and more recently as a trained in-home caregiver at Homebridge, where he has now worked for two years. But now, those hours are helping him earn a new credential and higher earning potential in his next job, which he hopes will be at a nursing home or hospital.
The program, which is funded by the San Francisco Office of Economic and Workforce Development and the Metta Fund, provides free on-the-job training to in-home supportive service workers at Homebridge and clinical training with UCSF, culminating in a certified nursing assistant certification through City College of San Francisco.
The 15-week fully accredited course started in September. It includes 10 hours of weekly instruction through CCSF plus a clinical practice requirement of 100 hours at UCSF Health.
In-home health services are a vital cog in San Francisco’s health care network that helps keep extremely low-income residents in their own homes, providing both a sense of independence and keeping the hospital and emergency room beds open for patients with other immediate needs.
But the training initiative comes at a time when San Francisco is facing a serious shortage of in-home service providers coupled with an aging population, creating the perfect storm for unmet hospital bed demands and rising homelessness.
“If you can’t survive well at home, you could lose your housing,” said Mark Burns, executive director of Homebridge. “You can’t keep the place clean and can get evicted. You could have too many emergency health experiences, end up in the ER more, and can’t help yourself at home. So you could end up in a nursing home, but there are not even enough beds.”
Older adults make up the fastest-growing age group in San Francisco. By 2030, The City’s Human Services Agency estimates 30% of the population will be 60 and older.
There are currently about 25,000 people who receive in-home care and 23,000 caregivers, according to the San Francisco Human Services Agency. Demand for in-home care recipients has grown by about 5% annually over the last two years, a trend that’s expected to continue unless workforce patterns shift.
“There’s a huge need and a huge gap. As you can imagine, it’s a really tough job,” said Kelly Dearman, executive director, of disability and aging services for SF Human Services Agency. “It’s not just about recruiting anyone, but we need people who speak various languages and can meet a variety of needs.”
In-home care is a cottage industry relative to other medical practices. In many cases, these caregivers are family members who are paid to take care of a relative full-time.
Clients who can’t afford to manage their own services, or don’t have a family member who can support them, can find in-home caregivers through San Francisco’s in-home supportive services caregiver registry or through Homebridge. (To ask questions or to apply for in-home supportive care services, San Francisco residents can call (415) 355-6700.)
But in-home support services typically pay minimum wage salaries, making it harder for caregivers to live in San Francisco and work a physically and emotionally demanding job.
Across The City, 65% of in-home service providers are women and 34% are men, according to the Human Services Agency. Black and Latinx women make up a large majority of in-home caregivers in San Francisco and beyond.
“People who work in that industry are predominantly immigrants and women of color, people who are often taken advantage of for working long hours with low pay,” said Burns. “Our goal is to move them to a place like Laguna Honda where starting (salary) is closer to $25-$26, and (they can) experience more growth in pay scale there.”
Veronica Diaz-Gracida, another program participant, has been working as an in-home caregiver for the last four years. She decided to do the program once she saw a chance to move up in the medical field, an opportunity she hadn’t considered when fees and regular work responsibilities were in the way.
“I don’t want to worry about whether or not I can pay my rent, or how I can take care of my kids and work at a job that’s a good fit for me,” said Diaz-Gracida, 32, who lives in the Mission.
Throughout the pandemic, home and community-based care workers have been first responders to older adults and people with disabilities living at home in isolation. By offering more opportunities for advancement within the field and training to move on to other medical professions, Burns and Dearman believe more people will be interested in taking on these jobs.
“This is how we get people in the door,” said Dearman.
Diaz-Gracida has goals beyond a bigger paycheck in mind. She hopes her children will see her studying and discover opportunities they could pursue, too.
“I tell my kids, ‘Every day, I had to learn new things,’” Diaz-Gracida said, adding that she plans to show them the campus once she starts her clinical training at UCSF. “I want to show them that if you want something, you have to work for it.”