In-home care cost rapidly mounts

More Californians need state program that aids elderly and disabled.

By Clea Benson - Bee Capitol Bureau
Published 12:00 am PST Sunday, November 19, 2006

When Gov. Arnold Schwarzenegger first took office in the midst of a budget crisis in 2003, he put In-Home Supportive Services high on his list for cuts, citing it as one of the state's fastest-growing programs.

The Republican governor backed off after an outcry by users of IHSS, which pays care workers to help poor elderly and disabled Californians with daily tasks at home so they can stay out of institutions.

Today, the program is still growing rapidly, according to new projections that the Legislature's nonpartisan budget adviser released earlier this month.

The federal government pays for about half of the program, with the state and local governments picking up the rest.

State costs alone will be about $1.4 billion this year, up by more than 14 percent between the past two fiscal years. That amount will rise by about 60 percent over the next five years, the Legislative Analyst's Office projected.

The increases reflect a growing number of Californians who need the services, upticks in the average number of hours of care each client uses, and raises for care workers, the LAO said.

The number of people enrolled in the program has increased by about 70,000 over the past three years, to 375,000. Though wages vary county by county, the state contributes a portion of rates up to $11.10 per hour.

Advocates say the program is an important element of efforts to keep people with disabilities out of nursing homes and living the most active lives possible.

"People are getting older and more people are going to be needing this service," said Deborah Doctor, a lobbyist for Protection and Advocacy Inc., a nonprofit group representing people with disabilities.

States are under a U.S. Supreme Court mandate to provide more services that allow people with disabilities to live in their communities. The court, in its 1999 Olmstead decision, ruled that the disabled have a right to live in the least institutional settings possible.

Though the costs of IHSS are mounting, the price of keeping people with disabilities in their own homes is also less than the cost of institutional care, Doctor said.

Meanwhile, the state recently implemented a program to monitor more closely the number of hours of in-home service each client gets per month. The maximum number of hours of home care allowed each month is 283.

With 16 employees, the quality assurance unit of the Department of Social Services is trying to make sure that the state's 58 counties have standardized ways of determining how much help someone needs.

Eva Lopez, deputy director of adult programs in the Department of Social Services, said the effort is already helping restrain the size of the program.

"As a result of the quality assurance activities, we are beginning to see a slower rate of growth," she said.

Doctor said advocates are concerned that the monitoring program could leave some consumers without enough help.

"From the perspective of people who use the services, quality assurance was an euphemism for putting some uniformity and controls on the program, but it was not about necessarily asking consumers whether the program served their need," Doctor said.

Lopez said the state will be watching closely to see whether the quality assurance program is affecting services.

"We are going to be reviewing how the program works," she said. "We're reviewing the data that's coming in to ensure that the goals of the administration are being fulfilled."

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