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JewishJournal.com

March 23, 2010

Proposed State Cuts in Funding Pose In-Home Care Threat

http://www.jewishjournal.com/health/article/proposed_state_cuts_in_funding_pose_in-home_care_threat_20100323

Suzanne Heredia, 39, spends most of her days caring for her daughter. Born with cerebral palsy and congenital hydrocephalus, a condition that causes pressure within the brain due to excess fluids in the brain, Priscilla, 13, needs round-the-clock care. Heredia does everything from changing IVs to repositioning Priscilla’s body.

Through income provided by In-Home Supportive Services (IHSS), a state-funded program that allows clients to receive ongoing medical care in their homes, Heredia manages to care for her daughter, even as a single mother with four other children.

But in the throes of the ongoing budget crisis, Gov. Arnold Schwarzenegger recently suggested eliminating IHSS altogeher. The possibility leaves Heredia and many others wondering where they would turn.

“[Priscilla] is my baby,” she said. “It would be devastating to the family if I lost the in-home care.”

With state funding of nearly $5 billion, IHSS funds 350,000 caregivers who serve 450,000 California residents. Priscilla represents the minority of clients — 37 percent are disabled, while 63 percent receive help based on their status as seniors who are over 65.

By providing funds directly to consumers, IHSS allows clients to hire a caregiver that best meets their needs. Some go through state-sponsored providers or nonproifts. Others, like Heredia, opt to stay within the family.

By receiving a paycheck, many make caring for a sick or elderly realtive their full-time job.

Depending on their needs and the funds that the state deems necessary for their care, consumers may hire a caregiver for up to seven days a week or may need to parcel out their care — planning, for instance, to buy groceries for the weekend if they will be left home alone.

Because so many IHSS consumers are low-income — 90 percent are below the poverty line — they qualify for full assistance from the state. Those who are above the poverty line split the cost of care between IHSS funds and whatever out-of-pocket income they have.

If the proposed budget cuts go through, Los Angeles County, which accounts for 40 percent of the IHSS population with 185,000 IHSS consumers, would be hit particularly hard.

“The most current proposal would pretty much wipe out the IHSS population in L.A. County,” said Hortensia Diaz, IHSS program director.

Anthony Jaimez, 42, would be among those left with few options.

Left paralyzed at 19 after a violent attack, Jaimez relies on his older brother to care for him. But without the guarantee of a paycheck, his brother would have to find another full-time job.

“I would probably have to go into a convalescent home,” said Jaimez, although he doesn’t have the insurance to cover it. “To be honest with you, I wouldn’t even begin to know how to go about it. It would just completely change everything around for me.”

Senior citizens who receive IHSS funding would also face unique difficulties.

“A family member would have to rearrange their lives, otherwise they’d go to assisted living,” said Paul Castro, executive director and CEO of Jewish Family Service of Los Angeles, many of whose clients are senior citizens and receive IHSS funding. “That’s if there are beds available.”

For many, the change would present more than a hassle. Because of the cost, a majority of consumers would simply not be able to afford to move out of their homes and so would stay and risk injury.

“People will be doing things they aren’t supposed to do,” Diaz said. “They will have accidents in their home and no one will find them.”

Some insiders also wonder if the proposed cuts would have the cost-saving effects promised by lawmakers.

According to Diaz, the cost to Medi-Cal — which many IHSS consumers have — of putting someone in a nursing home is $5,698 a month. The average cost to the state for IHSS care is $850 a month.

“The assumption and premise [of IHSS] is that it’s cheaper to bring services into the home than to go to nursing homes,” said Castro, adding that emergency rooms would likely also become much more crowded. “When seniors are in a position of crisis, they would have to go to the ER, and it would be a much greater expense for the state.”

Jaimez agreed, saying, “If they have a big influx of people that will have to go rushing to convalescent homes, how is it going to affect them? Are they gonna be able to handle those people? They want someone to blame [the budget crisis] on, and they’re going to go after the old and the weak first.”

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