2008-2009 - Public Authority Services

Activities and Recommendations
By the Council On Aging Silicon Valley and Advisory Board to
the Santa Clara County Public Authority Governing Board
July 1, 2008 – June 30, 2009
Message from Bob Obrey, President, Board of Directors
On behalf of the Council On Aging Silicon Valley Board of Directors, I am pleased to provide the Public
Authority Governing Board with this annual report outlining the accomplishments made under the long
standing Management Services Agreement between the two entities. This agreement was established to
meet the various mandates outlined in Assembly Bill 1682.
The Council On Aging’s interest and involvement in the In-Home Supportive Services (IHSS) program
predates the establishment of Public Authorities. As a result of an extensive planning effort funded by
a consortium of foundations the Council On Aging assumed responsibility for service provision under
the contract mode of IHSS over 10 years ago. Substantial positive changes were made during the time
Council On Aging administered this contract, all of which benefited consumers of this vital service. When
the contract mode was eliminated, key aspects of the contract mode of service were incorporated into the
Public Authority Registry.
Working closely with former County Supervisor and later Assemblyman Mike Honda, staff of Council
On Aging along with other stakeholders assisted the legislature in crafting AB 1682. As a result of these
efforts the final bill creating Public Authorities statewide reflects a balance between the needs of the
Independent Provider workforce and the consumers they serve. It is to the governing board’s credit that the
Public Authority model implemented in this County serves as a statewide model. For example, under the
Management Services Agreement COA staff has developed a number of training and advocacy materials
that have been adopted by a number of other Public Authorities. Many of these materials were developed
with funding provided by the Council On Aging.
Regrettably, the current financial crisis confronting California has not left Public Authorities unscathed.
However, despite an approximate 44% reduction in funding for management services, the Council On
Aging working closely with staff of the Department of Aging and Adult Services has been able to preserve
the most important components outlined in the Public Authority enabling legislation. Almost all of these
responsibilities directly benefit persons with disabilities and frail older persons, the latter of whom make
up the majority of IHSS recipients. Hopefully the legislative advocacy efforts of the Council On Aging
and others will result in limited, to no further funding reductions to IHSS, the corner stone of California’s
home and community based service delivery system.
I again want to thank you, the Public Authority governing board for your foresight in developing this
unique model of providing In-Home Supportive Services. I know you will find the information provided in
this report to be reflective of the caring and concern shared by both you and the Council On Aging Silicon
Valley. We look forward to a continued close working relationship in the challenging years ahead.
Sincerely,
Bob Obrey, President
Board of Directors
Council on Aging, Silicon Valley
Council
on Aging
Silicon
Council
on Aging
Silicon
ValleyValley
Alameda,
San Jose,
CA 95126-1141
21152115
The The
Alameda,
San Jose,
CA 95126-1141
408.296.8290
| fax:
408.249.8918
| e-mail:
info@coasiliconvalley.com
tel:tel:
408.296.8290
| fax:
408.249.8918
| e-mail:
info@coasiliconvalley.com
2
Dear IHSS Public Authority Governing Board:
The IHSS Advisory Board appointees of Santa Clara County are pleased to report back to you about the
accomplishments of the Public Authority in Santa Clara County for the fiscal year 2008-2009.
The Advisory Board continues to be very knowledgeable and involved in the IHSS system in Santa Clara
County and in the State. We are very fortunate to have a wonderful, collaborative relationship with the
Public Authority, the IHSS Department, and the Adult Services Department in the County. We are also
thankful for the support the Board of Supervisors has shown by the active participation of their staff at
our meetings.
The Advisory Board also appreciates the commitment the Governing Board has demonstrated by
continuing to support a very effective Public Authority. Your willingness to maintain wages and benefits
for Independent Providers has improved the ability of Consumers to hire and maintain reliable, quality
home care. Your continued support of consumer and provider training, our urgent care and regular
registries, and public education about the program remains essential in the lives of so many Santa Clara
County residents who require and depend on IHSS. With your support Santa Clara County’s IHSS
system is considered a model for the State.
As you so well know, IHSS has come into very difficult times. The Advisory Board is committed to
advocating for IHSS consumers to preserve this vitally necessary program at the state and local level.
We stand ready to collaborate with the Governing Board and County staff in continuing to work toward
preserving and strengthening this vital community service. Reduction or elimination of services to
consumers will result in dire and life threatening situations for many IHSS consumers and will have a
drastic impact on providers and their families.
We are pleased to provide you with this report and to also fulfill our legal mandate by offering our
recommendations for the future.
Sincerely,
Janie Whiteford, Chair
IHSS Public Authority
Advisory Board
2115 The Alameda • San Jose, CA 95126-1141
408.350.3206 • Fax 408.296.8340 • info@coasiliconvalley.com
GOVERNING BOARD: Don Gage • George Shirakawa • Dave Cortese • Ken Yeager • Liz Kniss
3
Introduction
Inside
Letter from the COA Board
Chair . . . . . . . . . . . . . . . . . . . . . . . 2
Letter from the Advisory Board
Chair . . . . . . . . . . . . . . . . . . . . . . . 3
Public Authority services in Santa Clara County are carried out
through a Management Services Agreement between the County
and Council on Aging. This partnership, originally established
in 1999, provides enhanced services to both consumers
and providers of IHSS. This report highlights some of these
enhancements.
Introduction . . . . . . . . . . . . . . . . . . 4
IHSS Public Authority Mandates . 4
Advisory Board . . . . . . . . . . . . . . . 5
Independent Provider Recognition 5
Specifically this report provides a summary of COA Public
Authority service activities carried out over the last fiscal year.
It also includes Advisory Board recommendations to the Santa
Clara County Board of Supervisors in their role as the Public
Authority Governing Board.
Consumer Training . . . . . . . . . . . . 6
Independent Provider Training . . . 6
Communications . . . . . . . . . . . . . . 7
IHSS Registry . . . . . . . . . . . . . . . . . 8
Benefits Administration . . . . . . . 11
Surveys . . . . . . . . . . . . . . . . . . . . . 14
Recommendations to the Board of
Supervisors 2009 . . . . . . . . . . . . . 15
IHSS Public Authority Mandates
Assembly Bill 1682 requires the IHSS Public Authority to do the
following:
• Act as the Employer of Record for the county’s IHSS
program. This includes negotiating the wages, benefits,
terms and conditions of employment for Independent
Providers (IPs) serving IHSS consumers in Santa Clara
County.
• Provide a Registry to assist IHSS consumers in locating
suitable providers.
• Screen providers listed on the Registry.
• Provide access to training for IHSS consumers and providers.
The Council on Aging, in order to meet these mandates
provides Public Authority services, through a Management
Services Agreement with the County of Santa Clara. Under this
agreement, the Council On Aging is not the employer of record,
however, provides staffing to carry out all other functions
required under AB 1682.
4
Advisory Board
The Public Authority Advisory Board, mandated by AB 1682, is composed of eleven members
of whom at least 50 percent are current or past users of personal care assistance. The
Advisory Board studies, reviews, evaluates and makes recommendations to the IHSS Public
Authority Governing Board, IHSS county administrative staff and the Council on Aging staff.
The Advisory Board also serves as the voice of consumers and providers as they interact with
various components of the IHSS system.
The Advisory Board has taken a strong leadership role in the development of CICA (California
IHSS Consumer Alliance). The purpose of this coalition is to aid all county Advisory Committees
to develop their highest potential and to become knowledgeable about all aspects of the IHSS
system and their mandates. Advisory Board members have participated as presenters and
panelists at the past three CICA conferences. During the several years of CICA’s formation, the
Council On Aging served as its fiscal agent. Among other things, COA collected membership
dues, advanced funds for the annual CICA conferences and paid other expenditures.
Independent Provider Recognition
The Advisory Board sponsored the Independent Provider Recognition Event in November
2008. This event was used both to recognize IPs for their dedication to consumers they serve
and provide an opportunity for the Advisory Board to interact with them in order to get
input regarding IHSS. This is an annual event held each November to coincide with National
Caregiver Month. The Advisory Board and Council On Aging would like to express appreciation
to the Santa Clara County Board of Supervisors for proclaiming November 9 – 15, 2008 as
Santa Clara County IHSS Caregivers Week.
5
Consumer Training
Consumer education continues to be challenging because it is difficult for many consumers of
IHSS to attend group training sessions. One new approach to solving this problem has been to
encourage consumers to bring their Independent Provider to the training classes. Experience
has shown that the learning experience becomes much richer with participation from both
perspectives of the home-care relationship. Feedback from participants during these sessions
has been extremely positive.
During the past fiscal year training was provided to 214 consumers. Topics covered were:
• The IHSS Assessment, Reassessment and Appeal Process
• IHSS System Introduction: “What is it and how does it work?”
• Obtaining Your Independent Provider
• Managing Your Independent Provider
Independent Provider Training
Training classes for Independent Providers (IPs) are provided primarily under a partnership
with the Sunnyvale/Cupertino Adult Education Center. Curriculum for a series of nine classes
was developed to meet the needs of consumers and better equip IPs with the skills necessary
to provide quality home care services. When IPs finish the entire nine class series they are
awarded a certificate of completion. A graduation ceremony was held in March 2009.
In addition to the Council On Aging, additional training sessions are provided by other
community organizations such as the Alzheimer’s Association and Family Caregiver Alliance.
During the past fiscal year 1698 IPs received training by attending one or more of the following
classes:
• First Aid
• Diabetes
• CPR
• Nutrition
• Caregiver Resources
• Tips for Transfers & Range of Motion
• Mental Health
• Last Phase of Our Life
• Disability Awareness and the Independent
Living Philosophy
• Personal Care Services Level 1
• Alzheimer’s & Dementia
• Pre Paramedical Level 2
• Mental Health Awareness
• Overcoming Depression
• Basic Internet Skills
6
Communications
Under its Management Services Agreement, the Council On Aging provides quarterly and biannual newsletters to all IHSS Consumers and Independent Providers respectively. Newsletters
provide up-to date-information about a variety of topics including specific areas that the
Advisory Board members are working on. Newsletters are available for downloading from the
Public Authority website at: www.publicauthoritysantaclara.org
The Public Authority website is another valuable format for locating information concerning
the Public Authority and services it provides. Information available on the website includes:
Advisory Board meeting agenda and minutes, newsletters, consumer and provider training
schedules, annual reports, provider benefits information, upcoming events, a library with
streaming videos, and consumer handbooks in English, Spanish, Vietnamese and Chinese.
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Public Authority Registry
The Registry is a mandated element of the Public Authority, and its primary purpose is to assist
IHSS consumers to find and hire an Independent Provider (IP). These consumers are either
without family members or friends available or able to assist them with their activities of daily
living that would ensure their safety and comfort in their homes. The Registry accomplishes
this by recruiting, and screening experienced IPs for referral to these consumers. Individuals
interested in joining the Registry must have prior caregiving experience, attend a 3 hour
orientation, be interviewed one-on-one by Registry staff, have their references checked, and
pass the California Department of Justice criminal background check. Well-qualified and
reliable individuals are a critical part of the success of the Registry’s mission.
The Registry established additional instructional opportunities for IPs through development of
Informational Sessions. Care Coordinators presented the following sessions:
• Understanding IHSS and the Public Authority Registry
• How to Find Clients & Professionalism
• Time sheets, Paychecks, and Benefits
The year was a success in that while the number of new client intakes rose by just 4% over the
previous fiscal year, the number of matches rose by 26% due in large part to the quality of the
IPs listed on the Registry.
The Regular Registry staff and Care Coordinators provide interventions which assist consumers
and IPs in problem resolution in many aspects of the employer-employee relationship. There
was an 8% increase in the number of interventions provided during the past fiscal year.
8
Personalized Services
Under the Management Service Agreement the Council On Aging provides services that are in
addition to those mandated under AB 1682. These services are outlined below:
• Coordinated Care
This service is designed to help those IHSS consumers who are experiencing difficulty
in hiring an Independent Provider directly from the Registry. Care Coordinators conduct
home visits to assess consumer needs. In addition, assistance is provided to help the
consumer with all aspects of the Independent Provider hiring process.
• These interventions play a major part in making long lasting matches between
the consumer and Independent Provider. The home visits clarify expectations and
responsibilities that might have been forgotten or not fully understood.
• During the past fiscal year 130 new intakes were received, however, the number of home
visits was reduced due to the effectiveness of the training and guidance provided by the
Care Coordinators.
9
Urgent Care Registry
The Urgent Care Registry (UCR) is staffed from 6:00AM to 10:00 PM seven days per week
annually. Its purpose is to provide a safety net for IHSS consumers with critical personal care
needs when their regular IP is unable to come to work on short notice to perform the tasks
that would ensure the consumer is safe and clean. In order for an IHSS consumer to qualify
for assistance from the UCR, an IHSS consumer normally needs to be authorized a minimum
of 50 hours of IHSS services.
10
Benefits Administration
The Council On Aging, under its Management Services Agreement is responsible for
administering benefits for IHSS Independent Providers (IPs) in Santa Clara County. Benefits
staff notify new IPs monthly of the benefits they may be eligible for, sends application forms
to those that wish to apply, and helps them by telephone and in person to understand their
benefit options and to complete the application process for the various benefits. Benefits
include Valley Health Plan, Liberty Dental, and Vision Services Plan. IPs working for at least
one IHSS consumer are also eligible for a transit pass for all Santa Clara VTA (Valley Transit
Authority) busses and light rail. Another provider benefit is the ability to join the Santa Clara
County Federal Credit Union. An IP must work at least 35 hours per month for the two most
recent months in order to enroll in and maintain eligibility for the health, dental, and vision
benefits.
The number of IPs taking advantage of these benefits continues to grow as shown in the
following chart.
The Benefits Administration staff also identifies each month those IPs whose insurance premium
of $11 was not deducted from their paycheck. There are several reasons why a deduction may
not be taken from an IP’s paycheck and in that case the COA Public Authority Services must
generate a bill, and directly collects those premiums from the IPs. This significantly increases
the number of telephone calls and other communication with IPs to return their account to
normal status. A deduction is missed most often due to payroll issues such as submitting time
sheets late or when an IP stops working and is no longer paid while their insurance continues
for a few months.
11
We anticipate that the growth in missed deductions will continue in proportion to the number
of IPs with insurance.
Continuous Process Improvement
To accommodate the ongoing significant growth in this program without growing staffing,
the Benefits group is continuously reviewing and updating the process and methods for
better efficiency in handling the volume. This year marks the completion of the transition to
a paperless filing system for all IP benefits profile information. The availability of an online
record of each IPs file provides quick access to IP information during telephone inquiries.
Last year the enrollment process and application forms were simplified and computerized to
speed operations. This year several of the letters and documents sent to providers have been
reviewed and improved to include answers to some of the more common questions received
on the phone.
12
A Profile of IHSS Consumers
The following charts provide a profile of the Consumers in the IHSS program in Santa Clara
County. As this report is being prepared there are very significant cuts proposed by the
Governor’s Budget plan. The budget proposal would eliminate all services for IHSS Consumers
who have a “Functional Index Score” less than 4. As the chart illustrates, such a change would
affect 15,311 of the 16,629 cases in the county. That would amount to a reduction of 92.1%
and would almost eliminate the program entirely.
13
Surveys
The Advisory Board commissioned the professional research firm, Strategic Marketing +
Communications to survey IHSS consumers and Independent Providers (IPs) in Santa Clara
County for a second year in April 2009. There were two survey tools adapted and used to
obtain information. One tool was used for IHSS consumers and a similar questionnaire tailored
for IPs. The surveys were mailed to random samples of 1,750 IHSS consumers and 1,750 IPs
to obtain statistically valid samples. Response rates far exceeded the required amount to
achieve a reliable sample size. The consumer response rate was 27.8 % and IP response rate
was 26.7%. The surveys contained Likert scale (rating 1-5, with 5 the best) questions, multiple
choice questions and one open ended question. In addition this year all Consumers and all
Providers on the Registry were surveyed to allow comparison between the groups.
The overall results of the consumer survey rank very high with a score of 4.52 out of a 5 point
scale with five being the best. This represents an increase from last year’s score of 4.48. The
important predictor questions for consumer satisfaction with IHSS indicate:
• IHSS services were explained to me by the social worker.
• My primary provider treats me with courtesy and respect.
• My primary provider is willing to provide the authorized services on the days and times
agreed upon.
• IHSS contributes to quality of life.
Indicators of concern and that need to be addressed as issues for consumers were:
• My primary provider (does not) treat me with courtesy and respect.
Overall results of the Provider survey were good with a rank of 3.99 out of a 5 point scale
with five being the best. This represents an increase from 3.94 last year. Important predictor
questions regarding IP satisfaction with IHSS were:
• IHSS timecards requirements were explained to me.
• I find the Public Authority staff to be helpful in assisting me with my needs.
It is significant to note that last year the predictors of dissatisfaction for both consumers and
providers highlighted “Phone calls being answered promptly” as a top issue. That issue is
gone from the list of top items in both surveys this year.
The Advisory Board established a committee to review the survey results to identify issues that
could be addressed. They used these discussions to develop recommendations to the Board
of Supervisors as the governing body of the Public Authority.
14
Recommendations to the Board of Supervisors 2009
1.During these difficult economic times the IHSS Advisory Board understands the fiscal
constraints of the Board of Supervisors and the limited available funds. However, the
Advisory Board recommends maintaining funding for the Public Authority at the highest
level possible. Consumers assisted through the Public Authority are those most in need of
help and are unable to maneuver the complexities of being an employer without additional
assistance and these people generally have no family to assist.
2.In light of the reduction in hours and elimination of service for IHSS consumers approved
by the legislature and signed by the Governor; the Advisory Board recommends the
Board of Supervisors direct IHSS and Public Authority staff to make available information
regarding alternative community resources to consumers and/or their family when hours
or services are reduced or eliminated. (This service reduction has been stopped via an
injunction through a lawsuit however the AB wants this maintained as a recommendation in
case the lawsuit is lost and the service reductions are implemented.)
3.The Advisory Board recommends that the new provider enrollment mandates be
augmented with critical information beyond the state requirements. Information to
be included would be basic such as: universal precautions, establishing boundaries,
expectation agreements, health & safety, etc.
4.The Advisory Board wishes to express appreciation for the participation of the Board
Aides over the past year in our meetings. The Advisory Board recommends continued
participation in order to maintain critical information flow regarding changes and issues in
the IHSS program.
15
IHSS Public Authority Santa Clara County
2115 The Alameda, San Jose, California 95126
TEL. 408.350.3206
www.publicauthoritysantaclara.org