FAIRFIELD — Additional staffing, training and better record-keeping are critical for the county’s In-Home Supportive Services moving forward more efficiently and affectively, the 2018-19 Solano County grand jury concluded.
“The 2018-2019 Solano County grand jury . . . assessed changes and improvements in the Quality Assurance/Quality Improvement and Program Integrity Unit/Anti-Fraud functions of the IHSS,” the summary of the report released Thursday states. “While the grand jury acknowledges there have been advances, we believe increased staffing, better distribution of duties and ongoing training would serve IHSS well in facing future challenges.”
Gerald Huber, director of the county Department of Health and Social Services, does not disagree with the grand jury and is not likely to object to its findings, but said the report does not reflect the complexity of the program.
“The thing I’ve said consistently to the grand jury is that In-Home Supportive Services is a very complicated program,” Huber said.
He noted that some quality assurance responsibilities fall on the state, but those are not always differentiated from the county’s duties. There is also the issue that the person receiving the care hires and fires the caregiver.
The county has no control over who gets hired, and the vast majority of the caregivers are family members.
Still, Huber said his department is trying to better train its own personnel to better train the caregivers so the program does meet the desired standard of care and reporting.
The report on In-Home Supportive Services was one of three grand jury reports released Thursday. The others were on the fiscal viability of what is termed Other Post-Employment Benefits offered by Vacaville, and one on alternate uses for treated wastewater.
The IHSS has a long history of grand jury review, with published reports in 2007, 2009, 2013 and 2017.
The latest report notes the responsibilities for “management and supervision of the Quality Assurance/Quality Improvement and Program Integrity Unit/Anti-Fraud functions” was transferred in December 2018 from Older and Disabled Adults Services to the Public Authority, which has oversight of program providers and services.
Huber said that is not true. He said there are personnel who have responsibilities within the Public Authority, but the management and supervision of the Quality Assurance/Quality Improvement and Program Integrity Unit/Anti-Fraud functions remain primarily with the Older and Disabled Adults Services.
The report cites the 2017-18 program budget at $93.19 million, of which the county paid $12.95 million. The remainder was split between the federal ($49.79 million) and state ($30.45 million) governments.
The grand jury issued five findings, the first of which was that employee turnover within IHSS and “changes in positions and duties” have impaired the quality of performance.
“Cross-train the staff to assist management in preparing for planned vacations, illness and possible additional turnover. Periodic assessment of potential increase in caseload by management is an additional tool for planning purposes,” the grand jury recommended.
The second recommendation was to hire an additional social worker to meet a finding that the IHSS program integrity/anti-fraud unit needs additional staff.
The third finding showed how unannounced home visits have increased in recent years, for a high of 23 through the first nine months of 2017-18, and thus the grand jury recommends the program, “Continue to focus on state mandates, including unannounced home visits, as well as verification of the receipt and quality of services to the recipients, their well-being and any related concerns.”
The grand jury further concluded that, “The quality of IHSS services could be improved with (quality assurance) targeted reviews and quality improvement efforts.”
So it recommended, “Complete targeted reviews (although optional by state requirements) and perform quality improvement efforts with corresponding outcome reports.”
Finally, the grand jury noted that missing, incorrect or incomplete state and county forms continue to be an issue, so it recommends the program, “Strive for more accurate and complete reports.”
June 29, 2019
Daily Republic
By Todd E. Hansen
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