Health System: IHSS Public Authority (5800P)

Program Outcome Statement

Keep people at home with caregiver support.


The Public Authority (PA) supports low-income seniors and people with disabilities to remain safely at home by maintaining a registry of potential caregivers that in-home support services (IHSS) recipients may choose to hire. IHSS caregivers assist with tasks of daily living such as toileting, bathing, dressing, and feeding. The caregivers may also provide services such as cooking, laundry, and accompaniment to medical appointments. The PA manages 5,000 caregivers for over 4,300 beneficiaries by recruiting caregivers, maintaining a registry, conducting background checks, conducting caregiver orientations and training, and managing caregiver wages and health benefits. Since 2005, there has been an 60% increase in number of caregivers in the County. Without these caregiver services, these seniors and people with disabilities may require institutional care, which would diminish the quality of life for the clients and have a significant negative impact on the entire Health System. In addition, the orientation and training provided for the caregivers increase the quality of care to clients, allowing clients to remain in the community for a longer period of time.

IHSS Costs for County Component Above Target

Number of Days it Takes to Get IHSS Services Exceeding Target

Average Number of Days it Takes for an IHSS Recipient to Hire a Registry Caregiver Meeting Target

FY 2017-18 Year-End Story Behind Performance

Number of Days to Get IHSS Services

The number of days for a client to receive IHSS services is derived from a combination of IHSS and Public Authority procedures, the time it takes for a client to identify a provider and the time is takes for a provider to comply with completing enrollment requirements. In fiscal year 2017-18, we reduced the number of days to complete the process compared to the prior fiscal year by 16 days . We attribute this improvement to on-going coordination between the IHSS Public Authority and IHSS staff as well clients and caregivers.

IHSS Costs

The fiscal year 2017-18 target for IHSS costs reflects an estimated seven percent increase in IHSS hours year over year. The County cost target was set based on the new IHSS maintenance of effort (MOE) requirement. We did not meet the County cost target because the State has reduced the allocation to cover IHSS and Public Authority administration by 11 percent and 26 percent respectively, which in turn shifts additional costs to the County. We exceeded our administrative allocations by $700K. We adjusted the targets for fiscal year 2018-19 based on our current understanding of the IHSS MOE, caseload growth, and funding structure.

Average Number of Days it for an IHSS Recipient to Hire a Registry Caregiver

Since fiscal year 2016-17 there has been a 40 percent increase in the number of IHSS recipients without caregiver resources who are being served by the Registry. In addition, with the termination of our IHSS contract-mode of service, difficult to serve IHSS recipients are now being referred to the Registry. The combination of an increased workload and more challenging population to serve has increased the number of days it takes for an IHSS recipient to hire a Registry provider, yet we were able to meet the target of 13 days for fiscal year 2017-18.

Future Priorities

  • Provide workshops to improve job readiness of IHSS providers.
  • Increase the number of IHSS home care providers in the Public Authority registry by continuing targeted recruitment of IHSS providers to join the registry and to increase language capacity to meet the needs of IHSS clients.

Author: Gina Wilson, Chief Financial Officer, Health System     Contact Email:    Last Updated: 08-20-2018