Activities and RecommendationsBy the Council On Aging Silicon Valley and Advisory Board tothe Santa Clara County Public Authority Governing Board

July 1, 2008 – June 30, 2009

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Council on Aging Silicon Valley

2115 The Alameda, San Jose, CA 95126-1141

tel: 408.296.8290 | fax: 408.249.8918 | e-mail: info@coasiliconvalley.com

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 Valley

2115 The Alameda, San Jose, CA 95126-1141

tel: 408.296.8290 | fax: 408.249.8918 | e-mail: info@coasiliconvalley.com

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2115 The Alameda • San Jose, CA 95126-1141408.350.3206 • Fax 408.296.8340 • info@coasiliconvalley.com

GOVERNING BOARD: Don Gage • George Shirakawa • Dave Cortese • Ken Yeager • Liz Kniss

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

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Introduction

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.

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.

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.

InsideLetter from the COA Board Chair . . . . . . . . . . . . . . . . . . . . . . . . 2

Letter from the Advisory Board Chair . . . . . . . . . . . . . . . . . . . . . . . . 3

Introduction . . . . . . . . . . . . . . . . . . 4

IHSS Public Authority Mandates . . 4

Advisory Board . . . . . . . . . . . . . . . . 5

Independent Provider Recognition 5

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

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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.

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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

• CPR

• Caregiver Resources

• Mental Health

• Last Phase of Our Life

• Personal Care Services Level 1

• Pre Paramedical Level 2

• Overcoming Depression

• Diabetes

• Nutrition

• Tips for Transfers & Range of Motion

• Disability Awareness and the Independent

Living Philosophy

• Alzheimer’s & Dementia

• Mental Health Awareness

• Basic Internet Skills

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Home Care ConneCtion

· Volume 3 · Issue 1 · January 2010

YourFuturePaychecksdependonthi

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ProvidersMUStbeFingerprintedbefo

reJuly1,2010!

Pageone:importantnews:ForProvide

rs

PagetWo:ContinuedProvidernews

Pagethree:BudgetCuts

PageFoUr:importantPhonenumber

s

inSert:trainingSchedule

inthisissue:

Fingerprinting is only one of several steps that all

IHSS providers must complete before July of this

new year as a result of new laws in the State of

California. Please read this article carefully – your

paycheck depends on it. This article will describe

how you can complete the four steps that are

required to keep being paid as an IHSS provider.

See the page 2 that briefly describes the steps.

You have each received a letter from the State

of California in October with the new Provider

Enrollment Form and instructions. This article

gives you NEW instructions on how to complete

the steps described in that letter. Please use this

article as your guide.

There are over 15,000 IHSS care providers in

Santa Clara County and it is a very big job to meet

with each of you in person as required by the new

regulations. The COA Public Authority Services

will be handling this IHSS provider enrollment

process for Santa Clara County. Because

you must meet with us IN PERSON to

complete the steps we need to schedule

some people each week and spread this

work out over the next 6 months between

now and July 1, 2010. The most important

instruction we have for you right now is:

“WAIT UNTIL WE NOTIFY

YOU BY MAIL OF YOUR

APPOINTMENT TIME”

... Continued on page 2

CoaPublicauthorityServices

advisoryBoardMembers:Sondra Corday, Bharat Desai, JoAnne Disbrow, Cindy Faulkner,

Kai Lu, Richard Patterson, James Ramoni (ex-officio), Mary Jane Whiteford

COA Public Authority Services

2115 The Alameda

San Jose, CA 95126

(p) (408) 350.3206

(f) (408) 296.8340

(e) info@publicauthoritysantaclara.org

(w) www.publicauthoritysantaclara.org

importantPhonenumbers:

Important new instructions for IHSS

providers are enclosed.

Your IHSS paycheck depends on it.

Please carefully read this information!

COA Public Authority Services: Call for information concerning provider benefits, Eco Pass,

training or other services of the Public Authority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (408) 350-3206

COA Public Authority Services Registry: Call if you want to join the Registry or to report any changes if

you are already listed on the Registry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (408) 350-3251

IHSS Social Services: Call for information regarding authorized hours and services or to speak

with a social worker. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (408) 975-4899

IHSS Payroll: Call for any payroll matters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (408) 975-4899

UNION SEIU Local 521: Representing providers. Call for information about the Union &

payroll deductions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (408) 678-3300

Adult Protective Services 24-hour Hotline: Call for help if you or someone you know

suspect abuse of a senior or dependent adult . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (408) 975-4900

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 (800) 414-2002

Council on Aging Silicon Valley Information and Assistance: Call to obtain information

on available services in Santa Clara County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (408) 296-8290

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (In county only) 1 (800) 510-2020

Communications

Under its Management Services Agreement, the Council On Aging provides quarterly and bi-

annual 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.

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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.

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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.

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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.

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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.

We anticipate that the growth in missed deductions will continue in proportion to the number

of IPs with insurance.

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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.

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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.

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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.

IHSS Public Authority Santa Clara County2115 The Alameda, San Jose, California 95126TEL . 408 .350 .3206www .publicauthoritysantaclara .org