In California, where over half a million caregivers are paid by a state programs to support the aging population, many find themselves in financial distress.

Sabrina Bishop is a live-in caregiver for an older man with advanced dementia working around the clock in San Diego. She makes $18.50 an hour – just over the state’s minimum wage – barely lifting her above the poverty line.

“He is unfortunately at the end stage of dementia. And so he really needs to be watched 24 hours a day,” she said.

Bishop works the night shift, but the day Lisa Ling spent with her, the caregiver who relieves her arrived late and the afternoon caregiver called out. This meant Bishop was also responsible for Mike’s care during the day, a situation she often finds herself in. 

Mike, a 74-year-old former church acquaintance, depends on Bishop for nearly everything after his wife passed away and Bishop began caring for him.

Bishop said she does all this work for people like Mike despite the lack of support and compensation. She could make more money working in fast-food, but chooses to stay in this career any way. 

“If I did that, people like Mike, the forgotten individuals unfortunately will pass away. How come we can’t put more money into this program to make sure that these individuals are cared for?” said Bishop.

The program Bishop is referring to is In-Home Supportive Services, or IHSS. Each state handles it differently, but the California program helps pay workers who are caring for half a million, mostly lower-income, individuals in the state. These individuals would otherwise require hospital or nursing facility care.

“We have three paid sick leave days…We just bargained for two more. So we have a total of five, but we haven’t received the other two yet,” Bishop said.

IHSS doesn’t cover all of Mike’s around-the-clock care. He doesn’t have kids, so his extended family manages his money and pays Bishop out of pocket to supplement his care. Bishop still doesn’t make enough money to make ends meet.

To survive, she has to work other jobs, like cleaning homes. Doug Moore, the executive director  of  the United Domestic Workers of America (UDW) —the union Bishop is part of — said the work of caregivers is not respected.

“I think they see the valor, but they don’t want to make the investment for the valor. We need to invest in it now. Um, and that’s what they need to do not just in California, but in Congress and the president, invest in care,” said Moore.

Bishop said there is an emotional and physical toll that comes with her job and many don’t value the work until it’s their own family.

The light bulb doesn’t shine until it’s one of their family members or them themselves. And unfortunately, that’s too late,” said Bishop.

Despite the challenges, Bishop remains dedicated to her role, driven by a promise to Mike’s late wife to never abandon him.

“I let her know that I will be here for Mike. And she was like, ‘OK, now I can go in peace because I know that there’s a person here that cares about my husband, that’s gonna provide for him and make sure that he gets all the things that he needs and make sure that he is safely in his home,'” Bishop said.

The Biden administration recently announced its steps to prioritize care, including creating standards to ensure Medicaid access and establishing minimum staffing standards for nursing homes. But for the family and paid caregivers currently living this, they feel much more support, resources, and protections are needed. So many of these workers take care of people in the late stages of life and when they pass away, they have to find new jobs and don’t receive benefits or retirement.