SAN FRANCISCO — One rents a spare bedroom in her client’s Berkeley home, paying $200 a month as she waits for word on her application for low-income housing. Another drives from Stockton to the East Bay four times a week because rental prices in her native Oakland became out of reach. A third commutes to Berkeley from Tracy, where she and her husband moved so they could afford to raise a family.

Across the Bay Area, where rising housing costs are driving out families, teachers and countless other professionals, the astronomical cost of living is taking its toll on a critical segment of the workforce: home care attendants for seniors and people with disabilities.

The pinch is affecting workers of all ages, across levels of management and specialities, making it harder for home care companies to recruit and retain people. It’s put a strain on the aides, who often log long hours doing physically demanding work for low wages and sparse benefits. Some local providers have been forced to shut down home care services altogether.

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Home care aides help with activities of daily living, such as laundry, bathing, cooking and dressing. At least 500,000 people in California work in caregiving jobs, according to state data.

The job ranks among the lowest-paying occupations nationally, with people earning about $23,000 a year in 2017, according to the Bureau of Labor Statistics. In the Bay Area, home health workers — a category that includes home care attendants as well as people certified to administer medication — earn $25,000 to $51,000 a year, according to the bureau’s statistics for the nine Bay Area counties.

“It’s a lot of work and not enough pay for the type of work we do,” said Jolene Emerson, a caregiver who commutes from Stockton to care for clients in Alameda and Oakland.

Emerson, 29, moved to Stockton from East Oakland last year after her former building manager raised her rent to $1,650 a month. In Stockton, she pays $900 a month for a three-bedroom home for her and her three children. On the four days a week she commutes, she spends four hours on the road — on top of an already grueling 11-hour shift.

Emerson said she will probably stay in Stockton “because I don’t see the rent going down in Oakland anytime at all,” she said. Similar jobs closer to the Central Valley pay a lower hourly rate.

Caregiving has long been a low-paying field. But managers and workers at Bay Area home care agencies say the hardship in recent years has become more pronounced, as the region’s housing prices continue to climb and wages fail to keep up.

“It is a big problem,” said Nikki Brown-Booker, executive director of Berkeley’s Easy Does It, a nonprofit provider of emergency attendants to seniors and adults with disabilities. “We’ve really been struggling to find enough caregivers to fulfill the needs of all our clients.”

Brown-Booker, who has juvenile rheumatoid arthritis and herself has several caretakers, recently had one who quit and moved back in with her family in Florida.

“I’ve had people quit because they’re not making enough money, (who say) ‘I work really hard and I’m not making enough money doing the work,'” she said. “When someone can go work at Starbucks and get benefits and the same amount of pay, less stress, and have one job or two jobs as opposed to four or five jobs, they’ll make that choice.”

A recent change in the way caregivers are paid is also contributing to the problem, according to Stephanie Culhane, a manager at Inclusive Community Resources, a Berkeley company that provides home care workers to seniors and adults with disabilities.

In 2015, a revision to the federal Fair Labor Standards Act required home care workers to be paid overtime if they worked more than 40 hours a week. The policy change ended up having the opposite effect of its ostensible aim of boosting pay for workers, Culhane said. Many companies began limiting workers’ hours to 40, down from as many as 80 a week, so overtime charges don’t pile up.

“We have to to try to keep our employees at 40 hours because we don’t have money to pay exorbitant overtime,” Culhane said. “It’s caused a real problem in the entire system.”

Some caregivers who work at least 30 hours a week get medical benefits — but often not vacation — while those who log fewer hours do not. Many work a second part-time job, such as driving Uber or Lyft.

Most caregivers are paid, at least in part, by public money. If they work for low-income seniors and adults who receive Medi-Cal’s In-Home Supportive Services, or IHSS, benefits, they are paid by the state. However, because IHSS pays home care aides at an hourly rate that is negotiated with each county, they are often paid less than minimum wage in the cities where they work. Each county’s IHSS rate is established through a collective bargaining agreement reached between the county and unions that represent attendants. Some city minimum wage laws can be waived in a collective bargaining agreement.

For instance, the hourly IHSS wage for home care aides in Alameda County is $12.50 an hour. But some cities in the county — such as Berkeley, Oakland and Emeryville — have minimum wages that are higher than that. Berkeley’s minimum wage is $13.75 an hour, Oakland’s is $13.23 and Emeryville’s is $14.

Caregivers who work for people whose assets are too high to receive IHSS benefits typically earn minimum wage, or slightly more.

Jessica Quiambao, a behavioral support analyst at Berkeley’s Inclusive Community Resources who works with adults with disabilities, moved to Tracy four years ago from Oakland because she and her husband could not afford to raise a family in the Bay Area.

Soon after, Quiambao, 34, quit her job because the daily commute to Berkeley, up to two hours each way, was too much. But she returned on a part-time basis, and drives to her clients’ homes in the East Bay a couple of times a month. If the jobs were closer to home, she said, she would consider going full time. She is working to set up an office in Tracy.

“They’d love for me to come back full time, but I can’t because of the commute,” said Quiambao, who now also runs a separate private practice in Tracy part time. “It’d require me to be there so often. … The Bay Area, I love it, but we couldn’t afford it anymore.”

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