In-Home Supportive Services
One must be over 65 years of age, or disabled, or blind to be eligible for an I.H.S.S. CareReceiver AND meet the financial limit. An S.S.I. recipient may qualify for I.H.S.S. services too, but one need not receive an S.S.I. check in order to qualify.
I.H.S.S. is a large program statewide, provided in all 58 Counties in California and with over 194,000 people receiving services monthly. More than $700,000,000/year is paid out by California at the minimum wage rate for such services. The Care Receiver is aided by the care, and the Care Giver earns taxable income from the payment, with California as the Payor.
I.H.S.S. funds enable a person over 65 years of age, or disabled, or blind, to remain at home with assistance based on the number of hours needed for personal needs [ex: ADL’s/Actitivies of Daily Living, for eating, bathing, dressing, bladder care, and transfer (ex: bed to chair) for personal care] and paramedic services and/or meal preparation, laundry, grocery shopping, cooking, and cleaning. Such home-care is a less expensive monthly expense to the state than institutionalization of the Care Receiver.
I.H.S.S. is a 3-party payment system: The relationship is established by the County and the CareReceiver/”Employer”. The employment relationship is solely between the CareReceiver/”Employer” and their independent “Employee” who is someone willing to accept Minimum Wage employment in exchange for providing the services. Keeping the employment relationship independent from the payment relationship ensures payroll deductions (for subsequent UIB and DIB benefits, when unemployed or injured), Social Security contributions, as well as supporting patient autonomy and preventing fraud.
The CareReceiver/”Employer” may hire or fire the Employee at will. The government does not supply the Employee. The homebound CareReceiver/”Employer” must locate their own Employee. Sometimes a County may provide a list of agencies but without endorsement of any agency or staff. Sometimes an eligible CareReceiver/”Employer” may have difficulty in locating a qualified Employee.
The County determines the number of hours, using the disability documentation as a base for application of government statistics about what kinds of services are needed AND how much time is needed to provide each such service. California pays the CareProvider/”Employee” for those hours. the CareReceiver/”Employer” does NOT pay the CareProvider/”Employee”.
The County Social Worker interviews the I.H.S.S. Applicant who wants to become the CareReceiver/Employer. The County Social Worker reviews relevant medical documentation, and makes the determination of the number of hours per week that services are needed. The County pays that sum at the minimum wage rate to the Applicant/CareReceiver/Employer, who has the same mandatory duties as any other employer of any other Household Employee: to file the appropriate federal and state tax and employment records. (Such record-keeping and filing is beyond the scope of this article, but classes may be taught at the local Senior Center, or assistance may be available on designated days from volunteers, or other local resources recommended by the Geriatric Care Manager.)
The Applicant/CareReceiver/Employer pays the Employee the minimum wage plus the additional amount needed for taxes, which is figured into the County’s calculations.
Failure to pay the Employee does not involve the County, but is a theft, can be reported to the police by the Employee, and if not handled shortly, can be cause for a tax fraud issue later, with prosecution.
A different problem arises when the Employer pays the Employee, but the Employee fails to return. That too is a theft, but of a failure to provide services, with the varying consequences depending on the many other demands being then made on the slim resources of the local constabulary.
A family member can be paid for I.H.S.S. services of personal care, only, not for family work. If the Employee is a family member, I.H.S.S. will not pay for the family-type functions of cooking and cleaning which benefit the household, as such services are expected to be provided by any co-tenant family member occupying the home. House-work is part of being a family; the family member would be cooking and cleaning for himself. But personal care tasks are another matter: I.H.S.S. will pay a family member to perform personal care tasks, such as bathing, bladder care, dressing, grooming and personal items.
Consequently the total number of hours allowed for a family member will be less than the total number of hours allowed for a non-family member as a caregiver. The risk of theft by a stranger may be reduced, but the risk of theft itself may not be reduced, depending on the family dynamics.