TO: Interested Advocates
FROM: Dale Mentink, Elissa Gershon - Toll Free/TTY/TDD: (800) 776-5746
RE: IHSS and Supported Living Services (Gordilla v. Anderson, Christenson v. Anderson judgments)
DATE: September 7, 1998 (Update 10/05/98)
In recent cases settled by Protection and Advocacy, Inc. (PAI) and the Department of Social Services (DSS), regional center clients may not be denied In-Home Supportive Services or Personal Care Services Program (IHSS-PCSP/IHSS) because they receive supported living or independent living services funded by the regional center. The cases were originally filed because several consumers who moved into their own homes were immediately denied IHSS simply because they received IHSS-like services pending their assessment and receipt of IHSS services. Under the terms of the settlement, this is no longer a reason for denying IHSS to a regional center consumer.
What does this settlement mean?
1. The county may not deny eligibility for or reduce the number of hours for IHSS-PCSP/IHSS to regional center consumers who receive interim emergency regional center funded services, which are similar to IHSS-PCSP/IHSS, on the grounds that the regional center services are "alternative resources," if the regional center reports that:
2. Regional center funded services that support consumers in their own homes, such as supported living and independent living services, which are different from or in addition to IHSS-PCSP/IHSS, cannot be used as a basis to deny eligibility for or reduce the number of hours of IHSS-PCSP/IHSS at any time.
3. The county must fund IHSS-PCSP/IHSS back to the date of application, unless the interim services have been provided at no cost to the consumer.
Why is this settlement important?
Regional center consumers may only live in supported living arrangements if the supported living services are "cost-effective." The regulations define cost-effective as a "cost-cap," or, a maximum budget that the regional center will pay for supports and services in a supported living arrangement.
Most regional center consumers are also eligible for IHSS-PCSP/IHSS, which pays for attendant care for people who live in their own homes. Consumers often need both IHSS-PCSP/IHSS and supported living services, which are different and sometimes more than the services allowed under IHSS-PCSP/IHSS. Depending on the number of hours of IHSS-PCSP/IHSS that a consumer receives, these services can reduce the cost to the regional center by up to $1,600 per month.
Without combining both IHSS-PCSP/IHSS and regional center funded services, the cost to support many consumers in their own homes would exceed their cost cap. The regional center could then deny supported living services and these consumers would instead be forced to remain in institutions, group homes, or in their parents' homes.
How can advocates ensure that regional center consumers are not illegally denied IHSS-PCSP/IHSS?
The terms of the settlement establish that regional center services and IHSS-PCSP/IHSS are separate and distinct.
Both IPP's and ISP's should clearly state which services are interim emergency services that the regional center will fund until IHSS-PCSP/IHSS begins and which are supported living or independent living services that the regional center will continue to fund. Attached are lists of each type of service and a sample IPP.
If the regional center intends the interim emergency services as a "loan" to the consumer, there must be a written agreement to that effect. Any amount the consumer must pay back to the regional center would be limited to the retroactive cash amount, if any, from the county for services the regional center actually provided during the period between application for IHSS and when the county begins funding IHSS-PCSP/IHSS services.
PAI is interested in hearing about problems with implementation of the settlement and is available to conduct trainings or provide assistance in individual cases. Please contact either Elissa Gershon in Oakland or Dale Mentink in Sacramento at 1-800-776-5746.
SUGGESTED POINTS TO INCLUDE IN THE IPP:
1. Statement of Goal: Independent or supported living.
2. Schedule of type, amount, and vendor of services:
|
Type |
Amount |
Vendor |
|
Supported Living Services not covered by IHSS |
Fill in number of hours |
S.L. Agency/ILS Agency |
|
Personal care and other services available under WIC §12300 et seq. |
Maximum amount eligible for (fill in # hours) |
IHSS |
3. Can/should reference and prepare separate ISP or support plan to designate division between IHSS and Supported Living/ILS hours. This information could also be contained in the IPP if that is how the regional center handles it.
4. When a consumer is moving into his or her own home:
Be sure that accessing IHSS is a generic service listed in the IPP.
Plan on temporary payment for IHSS-type services until the assessment is complete.
Let the IHSS worker know that the payment is temporary and in lieu of IHSS until service is established. The only reason another agency is funding the services is because the IHSS evaluation is not done until the consumer is actually in the home. This means someone must temporarily fund the services, otherwise the consumer would never be able to move into his or her own home.
Be sure the continuing role of the regional center/supported living services agency is not to provide services that are available through IHSS.
(NOTE: Rate of pay to IHSS worker cannot be supplemented for IHSS funded services; however, rate of pay can be higher for all non-IHSS services.)
IDEAS FOR ISP AND IPP DESIGNATIONS:
SUPPORTED LIVING VERSUS IHSS SERVICESServices Covered by IHSS
(For more information on exceptions to coverage of some services, see "What About IHSS?", available from the Department of Developmental Services).
* Assistance with ambulation
* Bathing, oral hygiene, and grooming
* Dressing
* Consumption of food and drink
* Care and assistance with prosthetic devices
* Bowel, bladder, and menstrual care
* Repositioning, skin care, range of motion exercises, and transfers
* Feeding and assurance of adequate fluid intake
* Respiration
* Assistance with self-administration of medications
* Sweeping and vacuuming
* Washing kitchen counters
* Cleaning bathroom
* Storing food and supplies
* Taking out garbage
* Dusting and picking up
* Cleaning and defrosting refrigerator
* Cleaning oven and stove
* Bringing in fuel for heating or cooking purposes
* Changing bed linens
* Preparing meals, serving meals, cutting up food
* Meal clean up and menu planning
* Laundry, mending, ironing, sorting, folding and putting away clothes
* Shopping for food
* Other errands
* Heavy cleaning
* Transportation to medical appointments and alternative resources
* Yard abatement
* Protective supervision (available for monitoring behavior of non self-directing, confused, mentally impaired, or mentally ill persons, with the following exceptions: (a) Does not include friendly visiting or other social activities, (b) Not available when the need is caused by a medical condition and medical supervision is required, (c) Not available in anticipation of a medical emergency, and (d) Not available to prevent or control anti-social or aggressive behavior. See DSS §30-757.17.
* Teaching and demonstration (up to 3 months maximum if client can become independent in that area)
* Paramedical services (e.g. catheterization, injections, range of motion exercises)
Services Covered by Supported Living
Supported Living services should include all services needed by the consumer that are not covered by IHSS. Examples include the following:
* Facilitation and support with friends and relationships
* Community integration, recreation
* Transportation (non-medical)
* Companionship services
* Training in household budgets, money management
* Health training
* On-going supports and participation in activities
* Interpreters
* House finding
* Help with choosing furniture
* Facilitating circles of support
* Development of employment goals
* Behavioral support
* Living skills training and support (be careful not to overlap with IHSS)
* Provision of emergency response systems
* Maintaining equipment and supplies
* Assisting consumers in recruiting, training, and hiring individuals to provide personal care, including in-home supportive services workers, or other services
* Wrap-around services for the times between IHSS-funded tasks
* Protective supervision hours not covered by IHSS, including hours which fall outside of the IHSS definition of protective supervision,
(1) and including additional hours over the IHSS-granted maximum of 283 hours per month* Advocacy or advocacy training
* IHSS-like services, such as personal care, domestic services, and paramedical services, when there is a documented need beyond the maximum number of IHSS hours (195 for nonseverely impaired or 283, for severely impaired recipients). Services covered by supported living are not available, however, to supplement a county grant of hours which is less than 195 or 283, as the case may be. In this situation, the applicant should ask the county to reassess and/or file an appeal.
* Any other services not covered by IHSS
1. Protective supervision is only available from IHSS for non self-directing, confused, mentally impaired, or mentally ill persons. Furthermore, protective supervision is not available from IHSS for the following purposes: (a) friendly visiting or other social activities, (b) medical supervision needs caused by a medical condition, and (c) supervision in anticipation of a medical emergency, and (d) supervision to prevent or control antisocial or aggressive behavior. These needs should therefore be met by the Supported Living agency. See DSS §30-757.17.
For a copy of the:
call 1-800-776-5746 and ask for PAI document #5289.01.