Our Vision Statement: Disability Rights California will create individual and family supports, chosen and directed by the person with a disability

The Sacramento Bee

December 9, 2009

Editorial: No easy answers for caregiver costs

A small part of state and local budgets just 10 years ago, the cost of In-Home Supportive Services has ballooned in recent years.

The Legislative Analyst's Office estimates that IHSS will cost the state $1.5 billion this fiscal year, close to triple what it cost a decade ago. By 2014-15, costs are projected to rise to $2.3 billion. Sacramento County has experienced a similarly dramatic uptick in IHSS cost. It spent $5.9 million for the program in 2001-02 and $23.5 million last year.

Not surprisingly, economically struggling state and county governments are scrambling to reduce costs. To that end, they've focused greater attention on fraud. The Legislature has allocated about $36 million to pay for increased IHSS fraud investigations and prosecutions, and to provide more training, fingerprinting and paperwork for caregivers and recipients.

The administration predicts that anti-fraud efforts will save the state $160 million this fiscal year, a figure the Legislative Analyst's Office says is optimistic. The LAO places potential savings at a much more realistic $40 million.

Clearly, better anti-fraud efforts are warranted. IHSS has worked pretty much on an honor system in the past. Up until this year some fraud had been easy to detect and control, as when a recipient dies or is hospitalized and the caregiver continues to receive payments.

But no one should kid themselves. In a program such as IHSS, where 62 percent of caregivers are relatives and 48 percent live in the same household as the disabled person who employs them, fraud is a difficult thing to detect. Everyone in the household has an incentive to exaggerate the level of disabilities because it increases the household income.

How is a social worker supposed to determine whether the elderly, incontinent mother needs more bathroom help or the wheelchair-bound child can feed herself, and is that really what we want social workers to do?

As stories in The Bee and elsewhere have shown, some family members who once cared for their impaired parents or siblings for no compensation have lost their jobs in the recession and are now signing up to become paid IHSS workers. That's not fraud. That's a result of the poor economy, and as long as the recession lasts it's likely to continue.

A more straightforward and honest way for government to deal with the rising costs of IHSS is simply to acknowledge that the cost of the program has become too great a burden and cut compensation to caregivers. That means it may be essential for the county to negotiate a leaner contract with the union that represents IHSS workers.

That will be hard to do.

As the demonstration by members of the Service Employees International Union-United Healthcare Workers West staged before county supervisors this week shows, IHSS caregivers and their disabled clients will lobby vigorously for their share of county support.

Finally, government as a whole must do a thorough reassessment of the original goals of this program, which was to keep the elderly and infirm out of high-cost nursing homes. Has that goal been achieved? Are taxpayers better served, and do the disabled live happier, healthier lives because IHSS has expanded?