“…Jerry Brown has recommended four sweeping cuts to IHSS, in line with his across-the-board reductions in spending, to fill the $25.4 billion budget shortfall…”

By Joseph Szydlowski, Redding.com

In 2005, Tami Orr’s mother suffered a stroke and could no longer care for Tommy, Orr’s mentally disabled brother.

Orr had to abandon days of educating preschool children in Redding for nights of calming her brother during his violent epileptic seizures, which cause him to thrash about, covering his bed with bodily fluids.

“Sometimes, every blanket and sheet in the house is dirty,” she said. “I have to use towels to cover him. Some days, all I do is laundry.”

Meal time is just as grueling, she said, and bathing Tommy, a hefty man in his 50s, can take at least an hour and lead to injuries — he’s broken her leg twice.

“When Tom moves, it’s such a slow, lumbering process,” said Nicole Land, an In Home Supportive Services worker who helps fellow IHSS worker Orr. “(Orr’s) a petite woman. She has to plan everything.”

Orr and her husband, who works in the ailing construction business, rely heavily on the IHSS paycheck to care for her brother and help her support her mother, who receives only $100 a week in Social Security.

Under Gov. Jerry Brown’s budget proposal, which contains $486 million in cuts to IHSS, they could lose some of that paycheck — and California would lose $727 million in matching federal grants.

STEEP CUTS FOR A STARK SITUATION

The IHSS program has existed in various forms for more than a half century. Its current incarnation pays workers to visit and provide basic services for poor elderly, disabled or blind individuals in California.

Under current law, a county worker and a social worker examine an applicant’s financial and physical state. If the social worker thinks the person needs IHSS, and the county worker finds the applicant’s income low enough, the social worker assigns the applicant up to 283 hours of in-home health service a month.

Different hours are associated with different tasks, such as grocery shopping, bathing, laundry and cooking. The wage is $9.30 an hour for the 2,855 home care workers across Shasta County in December, according to the Public Authority.

Statewide, at the beginning of 2010, 430,000 Californians received care through IHSS to the tune of $5.5 billion.

The county picks up 17.5 percent of the tab, while state government covers 32.5 percent, and the federal government pays for the rest.

Jerry Brown has recommended four sweeping cuts to IHSS, in line with his across-the-board reductions in spending, to fill the $25.4 billion budget shortfall.

“I’m talking about achieving savings while maintaining a core level of service,” said H.D. Palmer, the State Department of Finance spokesman. He said that the budget doesn’t target any specific program — almost every part of the state budget will take big hits.

“For example, CalWorks, the governor’s not proposing elimination, he’s proposing to reduce the grant level,” Palmer said.

The governor is proposing an 8.4 percent cut in hours for IHSS caregivers. That would follow a previous 3.6 percent cut. Jerry Brown also proposes requiring a physician’s approval to get on the list for IHSS and ending compensation for certain services if a physically capable adult lives with the recipient. The former two save around $130 million apiece, while the latter saves $237 million.

Assemblyman Jim Nielsen wouldn’t comment on specific parts of the budget, but said, “It’s incumbent on us to look at the macro impact on the budget, and everything we can do to review it.”

He said he also worries about shifting too much burden to the county level.

State Sen. Doug LaMalfa’s office did not return calls for comment.

California will lose $727 million in matching federal funds next year because of its cuts, Palmer said. However, he added that without cutting many programs, the state budget will remain a fiscal nightmare, and not cutting IHSS means more drastic cuts for other social services programs.

‘SHE’D DIE WITHINTHE HOUR’

When Gary Love’s mother fell outside a grocery store in Taft, doctors found an aortic aneurysm and gave her just a few weeks to live before placing her in hospice.

The Redding resident began taking care of his ailing mother, who has developed Alzheimer’s.

Using his background as a certified nursing assistant, he brought her back from the brink until she was removed from hospice, saving $12,500 in weekly hospice costs, he said.

She still needs constant care.

“If she knows no one’s there watching her, she’s like a little child,” he said. Three months ago, he took her to the hospital for broken ribs after she tried to sneak a few chocolate granola bars.

“I had to reach way up,” he said, standing on his tiptoes and stretching his arm into the air, “to hide them. She got a foot stool out to get up and get those chocolate bars out.”

Love spent eight hours in the emergency room with his mother after she fell.

She requires constant supervision, not only because Alzheimer’s has forced a childlike naiveté on her but also because her aortic aneurysm could burst at any time.

“She’d die within the hour,” he said.

He and his wife split the hours that they care for his mother, and his wife works a second job. They have to schedule when each of them is taking care of her.

IHSS, he said, is his family’s primary cash flow, meaning he wouldn’t be able to get by if the cuts get too steep, and would probably have to put his mother in a nursing home.

Orr, however, said that she would take care of Tommy regardless of how much funding is cut.

Palmer said that the state is counting on individuals to continue taking care of individuals without that compensation, but still picking up household chores. The budget removes compensation for “domestic and related services (which include housework, shopping for food, meal preparation and cleanup, and laundry.)” This accounts for about a third of the duties the LAO lists for IHSS workers and for the 48 percent of IHSS caregivers who live with the recipient.

“You’d clean your house even if you didn’t have another individual living there,” he said.

Tristan Brown said that will happen, even with the cuts.

“These domestic hours are going to be done by someone in the household,” he said.

But that creates a conundrum, said Tristan Brown, political director of the Shasta County IHSS Workers union. If people are taken off IHSS, how many will go into nursing facilities, which cost almost five times what IHSS does?

IS IT COST-EFFECTIVE?

In January 2010, the Legislative Analyst’s Office released its study of the IHSS program, and it had found a dichotomy.

It cost about $12,287 to care for an IHSS recipient in October 2009, as opposed to $51,100 to put the person in a nursing home, according to the report.

IHSS, the report stated, was probably not economically efficient when considering both state and local governments’ budgets. Almost 60 percent of the non-developmentally disabled recipients in IHSS would have to move into an institution for it to save taxpayers money.

But when the LAO examined just the state budget, it found that if only a third of those recipients entered a nursing facility, it would begin to cost the state money.

That’s because the county picks up part of the tab for IHSS but not for nursing homes, the report stated.

An LAO review of Jerry Brown’s budget pointed out that the cuts have limitations — it warns they could be overly optimistic, that they could be derailed by litigation, and that across-the-board cuts do affect the highest hour IHSS consumers.

Palmer said that those who need the most care can be excused from the governor’s proposed hour cutbacks.

CUTTING BACK

Orr said she understands that some cuts are necessary, but should only focus on the few who could manage without their two or three hours of care per week.

Palmer said that some of the cuts are designed to avoid increasing rates of people moving to nursing homes. The doctor mandate, which requires that a doctor sign off on the need for a caregiver, will cut down on the number of individuals who have service only for a few hours a week or month, he said.

Cutting the advisory boards, he said, will save $1 million while not directly impacting care. The boards act as liaisons to counties’ board of supervisors, board member Betty Berg said.

She acknowledged that the previous two years she’s served on it, the advisory board “accomplished nothing, strictly speaking.”

But she said that the annual IHSS dinner that the board helped organize breathed new life into home care workers and recipients, who often suffer from loneliness.

Love has seen that personally. After his mother’s aneurysm was diagnosed, he said, she initially moved in with his brother and sister-in-law.

“They reached the burnout point,” he said. “He told me, ‘Either you take care of her or you put her in a nursing home.’”

Tristan Brown said that is common among workers — caregiving is a stressful job. He said that he’s hoping California extends the tax rates, which Jerry Brown is proposing, to avoid more drastic cuts. The Legislature must act by the end of March to put on a June special election. Jerry Brown has promised more severe austerity if the tax rates are not extended.