The Effects of Land Use on the Mobility of Elderly and Disabled and Their Homecare Workers, and the Effects of Care on Client Mobility: Findings from Contra Costa, California

This study looks at the relationships among land use; the mobility of disabled and elderly recipients of public home healthcare; the mobility of their homecare workers; and how much care those homecare workers provide. The findings are based on nearly 1,300 survey responses from clients and homecare workers in the In-Home Supportive Services (IHSS) program in Contra Costa County, California, a publicly funded program for individuals with disabilities who have low incomes. The homecare workers I surveyed belong to the Service Employees International Union (SEIU). The qualitative data and descriptive statistics paint a portrait of both populations’ transportation habits and challenges. Regression analyses, controlling for variables such as car ownership, disability level, gender, age, and race, tested the interactions between the variables of interest in six hypotheses. The results are complex and occasionally conflicting, yet patterns appear. For example, the IHSS clients have car-use rates far lower than average, with only 10% driving themselves when they leave home, and almost half live alone; these facts, combined with their low incomes and disabilities, mean that IHSS clients are sensitive to how much transportation assistance they receive in terms of how often they leave home and what destinations they are able to reach. They also respond to land use characteristics, especially when measured at the neighborhood scale, with those living in higher density and accessibility areas generally experiencing greater mobility. The homecare workers similarly have low incomes and use alternative modes of transportation more often than do Contra Costa commuters on average. Unlike their clients, homecare workers living in higher density and accessibility areas generally experienced increased travel challenges. But living closer to their clients was associated with being able to provide more effective care, as was having an easier commute measured by other variables. The more care provided, the greater mobility their clients experienced. The populations of care recipients and professional homecare workers are growing as, among other trends, the proportion of senior citizens increases and families disperse across the country or world. Understanding mobility barriers as well as ways to facilitate efficient and effective care provision becomes all the more important. This study describes transportation problems that IHSS clients and caregivers encounter and points to certain possible responses, in particular expanding the transportation assistance that caregivers are able to provide.