Thursday, May 31, 2018

Mendocino County grand jury suggests improvements on In-Home Supportive Services program for seniors

The Mendocino County grand jury found in a 2017-2018 report that more needs to be done by the county to make sure that the In-Home Supportive Services program effectively operates for the growing aging population in Mendocino County.
The In-Home Supportive Services program is designed to help elderly and disabled individuals stay safely in their own homes with the assistance of a caregiver and is expected to increase in importance in the future as Mendocino County’s aging population increases.
To be eligible for the program, people must be Medi-Cal eligible and have a statement of need from a physician. The program’s ability to keep 1,774 people in their homes in 2015-2016, according to the report, shows how important the program can be to the county.
Despite its importance, there were problems with some of the details of the program. The report stated that the public is generally unaware of the function and benefits of the In-Home Supportive Services program due to a lack of easily accessible information online.
Some of the talking points and directions to find a caregiver are vague or not available on the website. The grand jury looked for an application form online and didn’t see any links available on the county website. The jury found a listing on the state website, but the link from the state to the county didn’t have a phone number or other contact information.
The report found that the Mendocino County’s IHSS program was rated last of the 58 counties in 2016 for failure to timely file state-required reports. In 2017, Mendocino County improved to 97 percent compliant in meeting the reporting standards due in part to an increase in some staffing.
Under the current system, recipients of IHHS hire and fire caregivers, sign caregivers’ timecards, monitor activity and give instructions. Those incapable of monitoring may designate a guardian to take on those responsibilities.
The 1,557 caregivers in Mendocino County, the majority of whom are family, take care of personal and domestic tasks like laundry, cleaning and shopping. The caregiver base pay rate in Mendocino County is currently $11 an hour.
Other people involved in the program are social workers, home care coordinators and nurse case managers. Social workers assess the recipient’s needs and visit annually to make sure problems are not appearing. The Home Care Coordinator/Social Worker Assistant makes a home visit two weeks after the program starts and then monthly after that.
The Nurse Case Manager is a crucial position that coordinates lists with social workers. They also evaluate clients, review current files, create nursing files, complete various documents, update treatment plans, and consult with officials of other agencies. However, the grand jury found that many of these positions in the county are still not filled.
The report stated that “As of the date of this report, there are no nurse case managers in IHSS. It is not clear that all or any of these tasks are being completed in the absence of nurse case managers. According to Mendocino County Human Resources, the nurse case manager in Ukiah left the position on July 29, 2017. This position has not been filled and, as of August 1, 2017, the request to fill the position was withdrawn and replaced by a Social Worker III position. The Fort Bragg incumbent left the position on November 18, 2017. The Fort Bragg position was requested to be filled on December 18, 2017. As of the date of this report, the position has not been filled.”
In total, the grand jury found that:
1. The continuous vacancies within all levels of IHSS impairs the ability of this department to function as intended and required.
2. The non-competitive salaries are a major factor in the vacancies.
3. The public is generally unaware of the function and benefits of this program.
4. Caregivers may choose from a variety of helping tasks and may exclude tasks they are not comfortable performing, which is helpful in recruitment.
5. Currently, IHSS staff expends the effort needed to cover vacant positions.
6. The lack of an IHSS nurse case manager causes deficiencies in the services offered by the program.
7. The website does not provide adequate information, which is a barrier to anyone trying to access the program.
The report recommended that:
1. All IHSS vacancies at the county level be filled in order to implement and manage this program effectively.
2. Adjust salaries to be competitive with other rural counties.
3. Increase public awareness of the IHSS program through marketing strategies.
4. Emphasize flexibility in choosing tasks when recruiting for providers.
5. Change the website to include all pertinent contact information, forms, and complaint procedures and phone numbers.
May 29, 2018
Ukiah Daily Journal
By Curtis Driscoll


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