Yolo County's Public Authority for In Home Supportive Services:
Gateway to the "Longevity Revolution"
By Dave Rosenberg, Yolo County Supervisor, 4th District
Thirty years ago, the State of California created a program designed to assist qualified seniors and persons with disabilities to avoid premature out-of-home placement and remain safely in their own homes with basic assistance. The In Home Supportive Services (IHSS) program provides the services of visiting homecare workers who help the elderly and the disabled with a variety of domestic, personal care, and paramedical services. Today, the California IHSS program is the largest of its kind in the nation, with a state caseload approaching 300,000 and growing.
California's IHSS program can be described as "three legs of a stool". The first leg is the consumer, the second, the county social services department, and the third and newest leg is the county's "Public Authority" for IHSS. Let's look at each of these component parts to see how they help support this program:
The Consumer. Individuals who are aged, blind, or disabled, who also meet low-income eligibility and who have an assessed need for domestic and/or personal care assistance to remain safely in their own homes may be eligible for IHSS services. IHSS is an entitlement program funded by federal and state dollars and administered by counties.
The County Social Services Agency. Every county has one. In Yolo, it is called the Department of Employment and Social Services (DESS). IHSS is one among many programs administered by DESS. There are currently 10 staff members working in IHSS.
Anyone can make a referral to IHSS, but generally, referrals come from medical professionals, family members, and even self-referrals. Once a referral comes in, a case is opened and assigned to an IHSS Social Worker. Within two weeks, the applicant is contacted to set-up an appointment for an in-home assessment.
The IHSS Social Worker then meets with the applicant and completes a State-directed assessment of his or her ability to function within the home. The applicant's financial information is reviewed to assist in determining program eligibility. If the applicant-the consumer-meets both functional and financial eligibility, then hours of IHSS service are established based on the in-home assessment. The maximum number of hours of allowable IHSS service is 283 hours per month, with an annual review. If either functional or financial needs change, a reassessment can be done earlier.
The consumer is notified within 30 days of the date his or her case opened of how many hours of service have been authorized. At that point, the consumer then needs to locate, hire and train a homecare worker to provide IHSS services.
The Public Authority for IHSS. Until a few years ago, the story pretty much ended at that point. Although California's IHSS program had noble intent, there were many aspects of the program that needed improvement. Imagine being a frail elderly person or someone newly disabled, having to find someone to come into your home and assist you or your loved one with some of the most intimate tasks imaginable. How would you find a worker? For years, finding a qualified homecare worker was a difficult and often frustrating process.
The good news is that in 1999, Governor Gray Davis signed AB 1682 into law. This bill, sponsored by then Assemblyman, now Congressman Mike Honda, required all California counties with 500 or more IHSS cases to "act as or establish an employer-of-record" for IHSS homecare workers by January 2003. Although the law maintains the consumer's right to hire, train, supervise, or fire his or her homecare worker, AB 1682 created a new entity in each threshold county -- the Public Authority for IHSS - to serve as the focal point for IHSS consumers and providers to come together for improved services.
So, the Public Authority for IHSS establishes, once and for all, a central focus for all homecare workers and consumers in any threshold county. There are now 54 Public Authorities in California's 58 counties. AB 1682 also established, for the first time, the right of homecare workers to form unions and to collectively bargain for wages. Before AB 1682, homecare workers were paid by law only minimum wage with no benefits, making the development and retention of a stable homecare workforce quite challenging. In Yolo County, provider pay is currently $9.50 per hour, and for those eligible, medical, vision and dental benefits.
The Yolo County Public Authority for IHSS was established on August 28, 2001, one of the first in the state to comply with AB 1682 requirements. The Yolo County Board of Supervisors sits as the Board of the new Public Authority, and is advised by a community advisory committee comprised of IHSS consumers, providers, a representative of the County, and community agency representatives.
The Public Authority staff includes its Executive Director, a Program Administrator, 2 Registry Specialists, and 2 support staff. Currently, there are 1,128 consumers in Yolo County, and 1,134 homecare providers. Of these, 180 are on the Yolo County Public Authority Registry. Currently, the law considers the registry voluntary, and thus, family members who make up the majority of IHSS providers in Yolo County are not required to register.
In order to "go on the registry", however, a provider must 1) complete an application; 2) attend orientation; 3) provide 3 references; 4) take and pass a TB test; and 4) clear a local and regional court record background check. In the near future, the Public Authority will add Dept. of Justice fingerprinting and drug/alcohol testing to registry requirements.
The Public Authority Registry basically matches consumer needs with provider skills. Each consumer who requests assistance in finding a homecare worker receives a list of from 3 to 6 qualified providers to be contacted and interviewed. Follow-up services include calls to the consumer 3 days, 3 weeks, and 3 months after a provider is hired. The Public Authority also conducts an annual consumer survey and "as needed" on-site quality control visits.
IHSS Works Like a 3-Legged Stool. The largest long-term care services program in California has been around for three decades. In recent years, stunning improvements have been made to this vital program through collaboration among consumers, consumer and worker advocates, local and state government and policy-makers.
The 54 Public Authorities for IHSS have formed a new statewide organization, the California Association of Public Authorities (CAPA), and have registered as a Corporate Affiliate of the California State Association of Counties (CSAC). The California Welfare Directors Association (CWDA) also recognizes CAPA.
Eligibility and assessments for IHSS services are still the domain of county social services agencies. IHSS Social Workers remain the initial "point-of-service" in determining whether or not an applicant is entitled by income and functional need to become a consumer of IHSS services. Further, IHSS providers still submit their timesheets for payrolling purposes to the county social services IHSS program.
Since 1999, however, providers of homecare services have a focal point in the Public Authority, a registry, access to training, and an entity through which they can be more easily matched with consumers in need of homecare assistance.
The consumers, and families of consumers, are the biggest winners in these exciting developments in home- and community-based care. The Public Authority exists to help providers, but also to serve the consumer by facilitating the matching of qualified workers to enable the frail elderly and persons with disabilities to remain in their own homes for as long as possible.
The Public Authority is a gateway for consumers and providers to find each other as we experience the "longevity revolution", this unique time in our history when so many more of us are living longer and are quite clear about the services we will require to "age-in-place".
To contact the IHSS program in the Yolo County Department of Employment and Social Services, call 916-375-6239 or toll free 1-888-675-1115. Reach the Yolo County Public Authority for IHSS at 530-661-2676 or toll free 1-800-630-2224.
And stay tuned for continued improvements to the IHSS Program in California.