In-home supportive services will help those in need of aid

By Rita Baum

Five mornings a week, 39-year-old Ben watches the minute hand on the wall clock from his bed, confident that before the clock strikes eight, his home care worker, Marna, will open the door and call out, "Hi Ben ... how're ya doin' today?"

Marna works for the Council On Aging of Silicon Valley (COA), the agency contracted by the Social Services Agency of Santa Clara County to provide In-Home Supportive Services (IHSS) for approximately 1,400 elderly, blind or disabled recipients of all ages. As the program's youngest client, Ben suffers from multiple sclerosis.

Marna started helping him when the disease had progressed to the point that he could no longer work or support himself and became Medi-Cal eligible. She assists Ben out of bed and helps him with personal and household tasks five days a week; his working parents take over on weekends. Ben is considered severely disabled and qualifies for 113 hours of IHSS care per month.

Ben isn't the only client Marna helps. Jamie, 86, is generally in good mental and physical health and says he gets along fine in his mobile home. But his severe vision impairment prevents him from doing grocery shopping, meal preparation, laundry and other tasks that the COA home care worker performs three afternoons per week.

Marna also lends a helping hand to 87-year-old Alice, who lives alone in the home she has owned for 45 years. Alice still volunteers for causes she supports--one of her favorites, reading at children's story hour at the library--but severe arthritis in her hands limits her volunteer work now and makes it hard for her to handle many personal and household tasks.

Marna's clients qualify for free in-home care services because Medi-Cal's support for the needy extends beyond the doctor's office and the skilled nursing facility to include community-based, long-term care. IHSS is a federal/state/county-funded program managed by the Santa Clara County Social Services Agency, Department of Aging and Adult Services.

"The program offers an alternative to institutional placement, giving elderly people the opportunity to remain among family and familiar surroundings," says IHSS program manager, Jim Maroni. "It's designed to help people with special needs remain safely in their own homes when they are no longer able to fully care for themselves."

IHSS provides for a variety of in-home services, including routine housekeeping for as few as six hours per month. Others receive extensive assistance with the most basic non-medical personal care services, including setting out medications, feeding, bathing, bowel and bladder assistance, and respiration up to 283 hours per month for the most severely disabled. The majority of participants are over age 65, and 24 percent are over age 80. Sixty-seven percent are female.

To receive IHSS services, an individual must be elderly (65 or older), blind or very low vision, or disabled and meet the criteria for low income and property limits. As with other Medi-Cal programs, a house and some other resources are considered exempt assets. Participants must be mentally competent to live alone or live with a competent relative.

Supplemental Security Income (SSI) recipients are automatically eligible for Medi-Cal, IHSS and food stamps. SSI is available to persons who are very low income (less than $750 per month), aged, blind or disabled. They receive a monthly check that raises their income above the poverty level. Individuals who do not qualify for SSI because they are over the income eligibility level may still qualify for In-Home Supportive Services but the excess income must be used to pay a share of costs.

The first step in the IHSS application process is similar to other Medi-Cal programs. A mail-in eligibility packet, completed by the applicant, follows a preliminary telephone screening. An intake worker makes a home visit to assess the applicant's condition, environment and ability to carry out the activities of daily living. A public health nurse may also make a home visit to determine if the applicant is able to remain safely in the home. If eligibility is granted there is no waiting for service to begin.

The County Social Services Agency is responsible for the daily implementation and delivery of IHSS programs. In Santa Clara County, 5,900 elderly, blind and disabled people receive in-home services, 1,200 under the contract agency mode of service and 4,700 from independent providers. The Social Services Agency contracts with the Council On Aging of Silicon Valley (COA), the county's Area Agency on Aging, which hires, trains, assigns and monitors home-care workers to provide in-home services under the contract mode of service. COA's home care workers receive seven hours preliminary training by a registered nurse and on-the-job training, as well as an annual all-day training in home care. All IHSS staff members are fingerprinted before hire.

In-home supportive service recipients may also hire, train and supervise their own independent provider workers to furnish the authorized hours and services. They may hire a friend or family member, or the services may be provided by an IP selected from a list of names furnished by the public authority's registry.

According to most recent data, Santa Clara County is one of only 13 of 58 counties in the state of California (six are Bay Area counties) to establish a public authority to represent independent providers of IHSS. The public authority functions independent of the Social Services Agency, to serve as the employer of record, advocate for the IPs, establish a registry for matching IHSS recipients to IPs, provide access to training, and negotiate wages and benefits. Independent providers have long complained of overwork and underpay, but they now enjoy higher wages and benefits as a result of the public authority's representation and advocacy on their behalf and membership in the Service Employee International Union (SEIU).

California has the largest IHSS program in the country, with nearly 214,000 recipients in 2001 compared to 87,000 in New York, the second largest state personal care services program in the United States.

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Rita Baum is a Los Gatos resident. She has a master's degree in gerontology and has worked in the field of aging for more than 20 years.

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