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CAMPAIGN
BACKGROUND
  
California's In-Home
Supportive Services History
IHSS
was created in 1973 to enable elderly and people with disabilities
to live independently in the community.
IHSS is the largest personal assistance services program in
the United States.
IHSS provides various personal care and domestic services
for elderly and people with disabilities who are unable to
remain safely in their homes without assistance.
More than 200,000 elderly and people with disabilities in
California are served by the IHSS program.
Current law allows counties to deliver IHSS services in a
number of different ways, including:
| 1 |
Individual providers (IPs) hired by the
recipients; |
| 2 |
Private agencies under contract with the
county; or |
| 3 |
County social services staff. |
IHSS beneficiaries and counties have overwhelming favored the
IP mode, which now covers over 96% of the IHSS caseload. However,
IP mode beneficiaries have often faced challenges in recruiting,
training and otherwise managing the work of their providers.
To address these problems a number of counties have adopted
the "Public Authority" model of service delivery.
The 1992 Public Authority Act allowed counties to establish
a public authority or nonprofit consortium to administer the
IP mode of IHSS. The public authority and nonprofit consortium
provide assistance to IHSS beneficiaries by recruiting and screening
potential providers, operating a provider registry and referral
system, providing for training of providers and recipients,
providing other support services and performing other necessary
functions. These bodies also act as the employer of record for
purposes of collective bargaining. The Public Authority legislation
was strongly supported by consumers, providers, advocacy organizations
for the elderly and persons with disabilities and the Service
Employees International Union, which has sought to organize
many of the state's IHSS workers.
Public authorities are in different stages of implementation
in seven counties: Alameda, Contra Costa, Los Angeles, San Mateo,
Santa Clara, San Francisco and Monterey. A Public Authority
ordinance is under consideration in Sacramento County, pending
further information regarding how it will be funded. A key concern
that many counties have about creating public authorities is
the existing limitations on state sharing of costs for the authorities.
Public authorities now cover 59% of the state's IHSS caseload.
A barrier to wider adoption of the Public Authority model has
been the refusal of the state to share fully in the cost of
a fair wage and benefits for providers. State law, for example,
requires counties to pay the entire cost of any wage increase
or benefits for providers.
The vast majority of IHSS providers still earn the minimum wage
and do not receive health insurance or other benefits. Low wages
and no benefits have caused a shortage of workers and high turnover
in the homecare field. As a result IHSS recipients continue
to experience significant difficulty finding and retaining homecare
workers. This situation puts consumers at greater risk of illness,
injury, hospitalization and premature institutionalization.
Consumers, providers, disability and senior advocates and
labor unions support wage increases for IHSS workers.
A statewide coalition of IHSS consumers and workers -- known
as IHSS Agenda 99 -- supported legislation this year (AB 16
- Mike Honda) that would have required the state to fully share
in the costs of wage and benefit improvements for IHSS workers.
Under this bill, the state would pay 65% of the cost and the
counties 35%, the same sharing rate for all other IHSS costs.
The bill also provided state assistance to counties who wished
to improve wages and benefits for IHSS workers.
AB 16 cost sharing language was eventually incorporated into
the budget passed by the legislature as trailer bill AB 1682,
but was changed and funding was reduced by Governor Davis.
Governor Davis did agree to state sharing of costs only up to
fifty cents above the minimum wage and only for one year through
July 2000. By next July, unless the Governor acts differently,
this .50 cent raise will go away.
Although wage increases for IHSS workers would appear to be
primarily a labor issue, IHSS consumers and providers, and disability
and senior advocates are strongly supportive of AB 16 because
they believe that existing low wages make it harder to recruit
and retain high quality workers. They also believe that requiring
the state to share Public Authority costs on the same sharing
ratios as other IHSS delivery methods will make the Public Authority
model more attractive to counties. These advocates are strongly
supportive of the public authority concept because it is the
model that is most supportive of consumer-directed services.
There are two primary delivery methods for IHSS - a Public Authority
or a contractor. Consumers prefer the mode of service offered
by a Public Authority because it gives them maximum control
over their lives.
With a Public Authority, consumers are the employer and are
in charge of hiring, firing and supervising homecare workers;
with a contractor, the consumer does not retain all of these
employer rights.
However, current state law: Limits the most preferred and
least costly Public Authority to minimum wage for homecare workers;
while fully funding the least preferred and more costly contract
mode.
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