Annie Decker

In 2004, I surveyed almost 800 disabled and elderly people and more than 500 caregivers in a California homecare program and asked about their transportation. The clients told story after story about feeling trapped in their homes and about being cut off from social networks, hospitals, and work. They provided a devastating snapshot of immobility shared throughout the country. The people I surveyed live in Contra Costa County, which lies across the bay from San Francisco and contains everything from small post-industrial cities and suburbs to agricultural areas. All the survey respondents receive care through California’s In-Home Supportive Services (IHSS) program, the largest such program in the country. Overseen by the state government, administered in 58 counties, and funded in part by federal block grants, IHSS spends close to $4 billion a year on more than 360,000 clients who are elderly and frail or who live with disabilities.

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