APPENDIX D ANALYSIS OF: STATE OF CALIFORNIA "EVALUATION OF IN-HOME SUPPORTIVE SERVICES PROGRAM" MAY, 1983 PROGRAM REVIEW BUREAU INTRODUCTION A number of Home Health Agencies in California have been committed to improving the availability and quality of home health care for those with long term health care needs. A significant segment of the home care provided to those with long term health care needs has been done by Homemakers-Home Health Aldes, nurses' aides, family members, relatives and companions. In recognizing the role of the non-professional in long term care, these agencies have been developing recruitment, training. and supervisory standards for non-professional home-health care personnel in order to provide the public with assurances concerning agency quality controls, appropriateness of services and accountability for their long term care patients. -- In-Home As a part of this activity these agencies have for years been critical of the California Title XX Program Supportive Services. In California, some 96,000 frail elderly, blind and disabled people are receiving in-home supportive services. Of these 96,000 individuals, approximately 60,000 people in 27 counties have access to home care only through "Individual Providers" The term "Individual Provider" (IP)* is a State Department of Social Services coined euphemism describing an unskilled, untrained, unsupervised and unmonitored person who the service recipient allegedly employs to perform home and health care services. For many years, the State Department of Social Services has held that these "Individual Providers" are quasi-private contractors and that the client is the employer. However, the courts have found (United States Court of Appeals, D.C. No. 75-1812-MHP Eleanor Bonnettte, et al, Plaintiff, United States of America, Intervenor versus California Health and Welfare Agency, et al) that the Independent Provider is actually a co-employee of the State and the County. · The These concerned agencies have been advocates for quality assurance, appropriateness of service and utilization, and accountability in the use of non-professionals in home care. largest employer of this group of people however, is the State of California which promulgates those very concepts that are abhorrent to those interested in long term home care. The State Report and this Analysis will use the initials "IP" from time to time to refer to "Individual Providers". The following is an analysis by concerned Home Health Agencies of a service mode study commissioned by the State Department of Social Services. Using these State generated statistics and findings we wish to more thoroughly acquaint the public with the In-Home Supportive Services Program. Visiting Nurse Association of San Francisco, Inc. Visiting Nurse Association of Pomona-West End The In-Home Supportive Services (IHSS) Study Report states In the introduction that the purpose of the Program Review Bureau 3. 4. Evaluate the difference in quality, if any, among the different modes and combination of service delivery; and Recommend changes in program direction for improvement and cost effectiveness. The Report is extremely confusing in that the four objectives, the purpose, of the study were not dealt with in a clear and concise fashion. It appeared that the reporters had reached their conclusions and recommendations prior to the accumulation and study of the data. The results of this study draw the thoughtful and analytic reader to conclusions that make the Report's recommendations less than rational, logical, efficient or cost effective. The aforementioned concerned agencies' analysis of the data in the Report will start with the study objectives as stated PURPOSE 1. Determine if Significant Coat Differences Exist Among the Different Modes of Service" The first objective of the study was in the data. The numbers are clear. It is shown that "significant cost differences exist among the modes of services". The Report however chose to downplay this result by paying a great deal of attention to the "Disability Index". The "Disability Index" was developed in the IHSS Equity Demonstration Project. It is an assessment guide and functioning scale that has been criticized as inappropriate, simplistic, unscientific and wrong. developed under a contract with the School of Social Welfare without the participation of experts in medicine, disability, health rehabilitation, home or community care, nursing or gerontology. In short, the disability Index is not respected by colleagues in the field but continues to be utilized like flawed and incorrect Intelligence tests which do great harm to people It was between P mode, county welfare department mode, or contracted modes are sitticoat serce each Toce seems serve a different crlentele." The Report says Page 2 Para. 41 ".. one at +me Since the oregoing statement $ quite mportant 1 regaring evaljat 30 27 COTT quality and cost effectiveness ot services among the three major modes of delivery." Cscond. Page 2, para. 2. ** general, process provides counties that spent more per -ecrarent ast year "ore money to spend again this year. Thts condition, COMBI ed 3 acr ct statewide assessment and quality standards, produces varying county and noce costs #+** Ired 301 to aan WAeTTer the differences are justified.” - Page 5, Para. 2 reciatEATS Tay receive extra services en 453 program award;...! Fourt, Page 5, Para, 5, 12s are genera # reluctant a work cnty 3 Firth, Page 5. Para. 5. "** **e Q hours ar each recipient.... nade, hours are Comet TES jwar jed tor specific tasks when need in fact, receive no IHSS services at all, due to the difficulty of finding individual providers who will provide services for minimum hours of pay." The following tables, using Report dafa, throw a different light on the conclusions reached in the study. TABLE 11 Distribution of clients by the Disability Index comparison between an all IP mode county and an IP/contract mode county. |