CALIFORNIA PERFORMANCE REVIEW

HHS02: Realigning the Administration of Health and Human Service Programs

HHS32: Transfer the In-Home Supportive Services Program to the Department of Health Services

August 20, 2004
San Diego , CA

The United Domestic Workers of America (UDW) has taken an active role in policymaking at the state level ever since its beginning in 1977. Our advice has been important in the adoption of several reform measures relating to the In-Home Supportive Services (IHSS) program, including sponsoring AB 1682, the 1999 statute requiring counties to develop procedures for screening prospective IHSS home care workers, set up advisory committees which enable IHSS clients to speak directly to county policymakers, and establish a local Employer of Record to provide an administrative structure to ensure program accountability, eliminate fragmentation of service delivery, implement program standards and establish an orderly process for labor relations. These changes are making it possible to address longstanding IHSS deficiencies and thereby improve the quality, safety and reliability of care under this program.

UDW appreciates Governor Schwarzenegger's interest in IHSS, clearly in evidence during the current legislative session . Approval earlier this month of his Independence Plus waiver application will protect critical services and draw down a more equitable share of federal dollars, saving California taxpayers $1.7 billion over five years, including $200 million to the state in 2004-05 alone. UDW is proud to have been one of the first to call for the waiver as a responsible, proactive solution to the budget crisis. The Governor's Quality Assurance Initiative, after review by stakeholders and adoption by the Legislature, should also help ensure more uniform care for IHSS clients and further improve cost effectiveness

This month the Governor released his California Performance Review (CPR), encompassing all facets of California state government. The two recommendations affecting California 's IHSS program include shifting financial and management responsibility from California 's 58 counties to the state¹ and shifting IHSS program operations from the California Department of Social Services (CDSS) to the California Department of Health Services (CDHS).² Currently, IHSS is funded through a combination of federal, state and county funds. The rationale put forth for this recommendation is: "Moving full responsibility and funding for IHSS to the state would address the gap that currently exists in the continuum of services administered by the state for seniors and disabled persons who are at risk of institutionalization in a nursing facility [and] centralize the full range of acute, in-home, day care and institutional services at the state level..."

These changes will have significant and widespread consequences for the 359,000 elderly and disabled individuals receiving services under IHSS, the home care workers who provide their care and the various county and state departments that administer this program. A serious, comprehensive analysis of the impact of these proposed changes is required before a determination of their propriety can be made . UDW has the following questions to initiate this process.

1. How would these revisions strengthen and protect the guarantees in AB 1682 that Public Authorities assist IHSS clients in obtaining reliable and safe home care workers and provide necessary training programs? One important provision in the 1999 statute is the requirement that each Public Authority assist IHSS consumers in finding locally available workers through the establishment of a registry of potential IHSS workers who have been screened through background checks and other means. Another is the requirement to establish training programs for workers and clients. Clarification is needed regarding the continuation of these local functions under any statewide management.

2. Would county advisory committees continue to provide input on program design and implementation? AB 1682 requires IHSS advisory committees in each county. These committees are required to have a voting majority of IHSS consumers/clients and are charged with reviewing county IHSS policy and making recommendations to their county Board of Supervisors and employers of record. For the first time at this level, IHSS clients have a formal role in making IHSS policy and administration of the program that provides the services that keep them alive, at home, safe and independent.

3. What impact would this have on California 's exposure to liability for IHSS client injuries? Restricting liability to IHSS Public Authorities and providing immunity for the state and counties was a priority behind the enactment of AB 1682. This exposure can be particularly acute in a situation involving the decentralized, in-home care of 350,000 aged, blind and disabled individuals, each of whom hires his or her own caregiver. This issue has been raised in both Humboldt and San Diego County in recent years.³

 

¹ The recommendation for moving the responsibility to the state (operated through counties) apparently stems from the fact that although counties have a perceived financial stake in IHSS, they have no stake in the next higher level of care, nursing home facilities, which cost several times as much. This could result in referring high-need IHSS clients to nursing homes when remaining in their homes is possible under IHSS rules.Return to text above

² CPR, HHS02, Section B.Return to text above

³See especially the 2003-04 Humboldt Grand Jury report, An Investigation into Humboldt County's Adult Protective Services and In-Home Supportive Services http://www.co.humboldt.ca.us/grandjury/ and download the 2003-2004 Final Report