Only in California! In-home care in peril

Beginning Nov. 1, until they are officially enrolled, new providers of In-Home Supportive Services (IHSS) to low income seniors, the blind and the disabled will not be paid their wages, even if their client needs immediate attention and may be institutionalized without an IHSS provider’s care.

And why will these newly hired caregivers not be paid? Because effective Nov. 1, these workers are supposed to have completed a new process of enrollment before they receive their wages.

So what is the problem? Why have 18 counties sent letters of protest to Department of Social Services Director John Wagner, saying it is impossible for them to comply with the new procedures?

The problem is that the counties have not received the new requirements from Republican Governor Arnold Schwarzenegger’s administration – the actual enrollment materials, the new provider orientation materials and forms, criminal background check forms, materials for fingerprinting. Nor have they received the instructions for implementing the new requirements, or the funding to hire staff needed to do so. Nor anything to indicate an appeals process.

Some of the instructions the counties have received are contrary to state law. All material so far is in English – no Spanish, no Chinese.

The new enrollment requirements were passed by the legislature and signed by the governor in late July as part of the 2009-10 revised state budget. The state has had three months to fulfill its responsibilities to the counties, which administer the program.

Last week a handful of Republicans In the state Senate defeated a bill the Assembly had passed, 68-0, to give counties the time and resources needed to fulfill the requirements.

So what needs to be done? The governor – as advised by the secretary of California’s Health and Human Services agency – needs to delay implementation until the counties have received instructions and orientation materials. Schwarzenegger has delayed implementation of IHSS policy changes before; he can do it again.

The governor says many of the new requirements were intended to discover fraud and abuse. Is it not abusive to deny poor seniors and the disabled the services for which they are eligible?

In 2007, Schwarzenegger claimed fraud in the use of IHSS funds had reached 25 percent. But his own “IHSS quality assurance” investigations found approximately 1 percent overpayment. In Sacramento County, 0.2 percent of suspected overpayment cases were accepted for prosecution. So where is the fraud now?

About 460,000 Californians currently receive services through IHSS – the blind, the deaf, adults and children with disabilities and mental health issues. And about 70,000 Californians become IHSS recipients each year. We must do better than this!

On Nov. 5, I attended an oversight hearing at the State Capitol. It was the second such hearing by the Assembly Budget Committee in its attempt to deal with the problems caused by the Nov. 1 deadline. The hearing room was almost empty. Eight committee representatives were present. Half a dozen observers were scattered around the room; a few more came in later. But no one was there from the state. Finally a young woman, Patricia Houston, arrived to represent the California Department of Social Services, and to apologize for the absence of Director John Wagner.

Throughout the hearing her answers to the committee’s questions were along the lines of: “We have been monitoring,” “we are listening,” “it takes a while,” “we deliberate and communicate,” “we’ll get back to you.”

Committee chair Noreen Evans, D-Santa Rosa, opened the hearing with a moving description of the problems facing new IHSS recipients. For example, the newly-double amputee who wants to return home but no care provider can be found because of the confusion over hiring a new provider. So will the new amputee stay in the hospital or go to a nursing home?

An important point: either the nursing home or the hospital is much more expensive than the in-home care provider.

Another case: A woman is losing the caregiver she has relied on for 17 years. Every morning she needs help for an hour to have her bowel movement and take her shower. What will she do now? Go to a nursing home?

Late last month a federal judge delayed implementation of IHSS funding cuts that would have ended services to 40,000 recipients. In the legislative Democrats’ Oct. 31 radio address, Evans said the governor’s action regarding the providers “raises a basic question: Is the administration trying to root out fraud or trying to intimidate the IHSS community?”

One reason we haven’t heard more about these problems is that IHSS’ importance has simply not been apparent to relatively healthy Californians. But as the “baby boomers” retire and grow older, these services will become even more necessary. They will also become more expensive, leading to more cost cutting attempts by the state.

Some cuts may be inevitable, but some cuts can kill.

Photo: / CC BY 2.0




Nell Ranta
Nell Ranta

The late Nell Ranta was a Unite Here retiree and longtime activist on home care issues. Devoted mother, superb artist, journalist, and political activist, that’s how she was known ​in the labor movement and community circles. Those who knew her saw the depths of her personal and political commitment, her extraordinary courage, compassion, and toughness.