Before the 1970s, people with disabilities and aging adults who couldn’t care for themselves had very limited options. Most ended up in state hospitals, nursing homes, or other institutions—often far from family and at very high cost to taxpayers. Family members providing care at home were largely unpaid, unsupported, and invisible in public policy.

In the mid-20th century, several forces started to shift this model. The Independent Living Movement of the 1960s–70s advocated for disabled people to live in their communities with dignity, not in institutions. The broader civil rights and disability rights movements pushed the government to provide equal access, autonomy, and financial support. And the creation of Medicaid in 1965 opened the door for states to fund community-based care as an alternative to institutional care.

Founding of IHSS

In 1973–1974, California launched In-Home Supportive Services (IHSS) as a pilot program in select counties, originally administered under Aid to the Blind and Disabled (ABD). By 1979, IHSS expanded statewide, allowing low-income aging adults and disabled residents to hire caregivers—including family members—using state, county, and federal funds.

The core purpose of IHSS was (and remains) to prevent unnecessary institutionalization, save taxpayer money, and allow people to remain safely in their own homes...