Best Cities and Counties in California to Start a Home Care Agency in 2026
Team Carepolicy.usBut opportunity depends on location. Coastal metro hubs already have hundreds of providers, while inland and rural counties often have high senior ratios with few agencies. If you’re a nurse, doctor, or investor considering the home care business in California, choosing the right county could be the difference between fast growth and heavy competition.
Why California’s Home Care Market Is Growing
- Population Size: California has the largest senior population in the country. See California’s Master Plan for Aging.
- Migration Patterns: Retirees are moving inland and to lower-cost regions (e.g., Riverside, Sacramento, Central Valley).
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Diverse Demand:
- Private Pay: Strong in affluent areas like Orange County, San Diego, and the Bay Area.
- Medicaid (Medi-Cal Waivers): Crucial in lower-income rural and inland regions.
- Aging in Place Preference: Over 80% of California seniors prefer to stay at home, driving demand for in-home services.
Book a licensing consultation to assess market saturation and licensing timelines for your target county.
Table: Seniors vs. Agencies by California Counties / Cities
Here’s a simplified Saturation Index = (Agencies ÷ Seniors 65+) × 10,000.
Lower index = more demand per agency (better opportunity).
| County / City | Estimated Agencies | % Seniors (65+) | Total Population | Seniors (65+) | Saturation Index | Market Insight |
|---|---|---|---|---|---|---|
| Riverside County | 350 | 16.4% | 2,500,000 | 410,000 | 8.5 | Fastest-growing retiree destination; demand outpaces supply. |
| Sacramento County | 210 | 15.3% | 1,585,000 | 242,500 | 8.7 | Expanding senior population, moderate competition. |
| San Bernardino County | 220 | 14.3% | 2,200,000 | 314,600 | 7.0 | Large area, underserved rural pockets; major growth zone. |
| Orange County | 500+ | 17.0% | 3,200,000 | 544,000 | 9.2 | Wealthy, aging fast, strong private-pay demand. |
| San Diego County | 450+ | 16.0% | 3,300,000 | 528,000 | 8.5 | Strong senior base; premium services thrive. |
| Los Angeles County | 1,200+ | 15.2% | 10,000,000 | 1,520,000 | 7.9 | Enormous market but extremely saturated—niche care needed. |
| Santa Clara County (Silicon Valley) | 160 | 14.1% | 1,900,000 | 268,000 | 6.0 | High income, but already crowded; tech-driven services succeed. |
| Alameda County (East Bay) | 140 | 15.0% | 1,700,000 | 255,000 | 5.5 | Competitive, urban-focused agencies dominate. |
| Fresno County (Central Valley) | 75 | 13.8% | 1,020,000 | 141,000 | 5.3 | Underserved agricultural hub; Medicaid waiver clients strong. |
| Kern County (Bakersfield) | 55 | 13.5% | 935,000 | 126,000 | 4.3 | Few providers, large low-income senior base—big opportunity. |
| Sonoma County (Wine Country) | 45 | 23.0% | 500,000 | 115,000 | 3.9 | One of the highest senior ratios; strong private-pay demand. |
| Shasta County (Northern CA) | 20 | 25.5% | 182,000 | 46,410 | 4.3 | Very senior-heavy, underserved rural market. |
Key Takeaways
Best Opportunities (Low Index, High Demand)
- Sonoma County: Seniors are nearly one-quarter of the population; affluent retirees support private-pay care.
- Shasta County (Northern CA): Very senior-heavy and underserved—perfect for waiver-based or mixed-model agencies.
- Kern & Fresno Counties (Central Valley): Fewer agencies, large senior bases, strong demand for Medi-Cal waiver services.
- Riverside & San Bernardino Counties: Retiree migration hotspots with massive senior growth but still catching up on provider coverage.
Moderate Opportunities (Need Differentiation)
- Sacramento County: Expanding metro with growing senior base. Agencies can thrive with hybrid models (private + Medi-Cal).
- Orange & San Diego Counties: Affluent seniors willing to pay for premium care, but agencies must differentiate with Alzheimer’s, respite, or cultural services.
Saturated Markets
- Los Angeles County: Largest senior base but also the most agencies. Only unique, niche-focused agencies succeed here.
- Santa Clara & Alameda Counties: Competitive Bay Area markets; high incomes allow private pay, but differentiation is key.
Get customized policies and procedures for your agency to stand out in competitive markets.
Insights for Providers and Investors
- Affluent Regions = Premium Care: Coastal areas (Orange, San Diego, Sonoma) are ideal for luxury and specialized services.
- Rural Regions = Waiver Opportunity: Shasta, Kern, and Fresno have high senior density but fewer providers, making them ripe for Medi-Cal-based business models. Explore the HCBA Waiver.
- Retiree Migration Hotspots: Inland counties like Riverside and San Bernardino are gaining seniors rapidly—set up early to capture growth.
- Big Cities = Niche Only: In LA, San Francisco Bay Area, and San Diego, competition is fierce. Agencies must specialize in Alzheimer’s/dementia care, cultural/linguistic services, or tech-enabled home monitoring.
Talk to a licensing expert to map payer mix (private pay vs. Medi-Cal) and build a county-specific launch plan.
Final Word
If you’re planning to open a home care agency in California in 2026, the best counties are Sonoma, Shasta, Riverside, and Kern. They combine high senior demand, lower competition, and long-term growth potential.
Urban hubs like Los Angeles and the Bay Area remain massive markets but are extremely competitive. To succeed there, you’ll need a strong brand and niche services.
For nurses, doctors, or investors, California offers both the nation’s largest senior market and some of its most underserved regions—a powerful combination for those who choose their location wisely.
Book a licensing consultation and start your county selection, application timeline, and policy build-out.
Licensing & Policy Resources
- CDSS Home Care Services Branch (HCSB) — Licensing Home Care Organizations (HCOs), Home Care Aide Registry, and compliance.
- HCO Application Process (CDSS) — Steps and forms to apply.
- HCS 281 Application Instructions (PDF) — Packet and fee instructions.
- DHCS Medi-Cal Waivers — Overview of programs that support HCBS.
- AARP Home & Community Preferences Survey — National aging-in-place preferences.
FAQs
Do I need a license to start a non-medical home care agency in California?
Yes. Non-medical home care agencies must obtain a Home Care Organization (HCO) license from the California Department of Social Services (CDSS) Home Care Services Branch. Start with the HCO application process.
Which payer sources should I plan for?
Most agencies begin with private-pay clients in affluent counties and add Medi-Cal waiver clients in rural or inland regions. Review HCBS waiver options and local referral networks as you choose a county.
How can I assess county saturation and positioning?
Use publicly available data (county senior population, % 65+, income, existing HCOs) and compare with your service model. Consider a licensing consultation for a tailored county analysis.