CONSUMER HANDBOOK
The In-Home Supportive Services (IHSS) Program
Acknowledgements
The In-Home Supportive Services (IHSS) Consumer and Provider Handbooks were the product of
many people’s efforts. The topics covered were determined by input from the IHSS Enhancement
Initiative Task Force, focus groups of consumers, providers, social workers, and public authority staff in
three counties (Los Angeles, Sacramento and Tehama), telephone interviews with similar persons in
18 other counties, and meetings with union staff in Los Angeles, Sacramento and the Bay Area. The
Task Force was comprised of IHSS consumers, providers, county and public authority staff, state
agency personnel, representatives of advocacy organizations and homecare provider unions.
Many of the subjects included in the handbooks were covered in training materials already developed
by counties and public authorities throughout the state. Treatment of these topics in the handbooks
depends heavily on the preexisting training materials. We are grateful to all of those who generously
shared their materials for this purpose.
Four review committees selected the best treatments of individual topics within their area of
responsibility. The review committees were made up of consumers, providers, county, public
authority and union staff, and a representative from Resources for Independent Living. The Institute
for Social Research then outlined and wrote the two handbooks, while borrowing liberally from the
presentation of topics in the shared materials. In addition, we developed new material on topics
identified in the needs assessment as important, but missing in the existing literature.
The following counties and public authorities gave permission for their materials to be adapted for use
in this effort:
• Alameda County IHSS Public Authority
• Butte County IHSS Public Authority
• Calaveras County IHSS Public Authority
• El Dorado County IHSS Public Authority
• Napa County IHSS Public Authority
• Riverside County IHSS Public Authority
• Sacramento County IHSS Public Authority
• San Diego County IHSS Public Authority
• San Diego County Aging & Independence Services
• San Francisco County IHSS Public Authority
• San Joaquin County IHSS Public Authority
• Santa Clara County IHSS Public Authority
• Sonoma County IHSS Public Authority
In addition, IHSS consumer Fay Mikiska gave permission for distribution of the task grid and its
inclusion in the handbooks.
It is our hope that the products of this collaborative process will enhance the quality of life for IHSS
consumers and providers and assist county and public authority personnel in their supporting roles.
CONSUMER HANDBOOK
The In-Home Supportive Services
Prepared for the California Department of Social Services
By the
CALIFORNIA STATE UNIVERSITY,
SACR AMENTO
Institute for Social Research
Carole Barnes
Valory Logsdon
Sandie Sutherland
Erin Gonzales
September 2006
Consumer Handbook i
IHSS Consumer Handbook
Contents
1. Understanding IHSS
Goals and Limitations of the Program . . . . . . . . . . . . . . . . . . . . . . . . 1
How IHSS Differs from Other Agencies and Services. . . . . . . . . . . . . . . 3
Who is Eligible for IHSS? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
How to Apply for IHSS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
What Happens Next? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Division of Responsibilities for Supervising and Paying Providers . . . . . . 5
Rule Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
IHSS Consumer’s Rights and Responsibilities . . . . . . . . . . . . . . . . . . . 10
IHSS Provider’s Rights and Responsibilities. . . . . . . . . . . . . . . . . . . . . 11
2. Assessment and Authorized Services
Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Authorized Hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Program limitations: Unmet need and alternative resources . . . . . . . 15
Parents and spouses as providers . . . . . . . . . . . . . . . . . . . . . . . . 15
Reassessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Getting a Correct Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Appeals 17
Tasks Covered by IHSS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Domestic services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Personal care services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Services directed or provided by a licensed
health care professional . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
Other miscellaneous services . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Unauthorized Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
ii Consumer Handbook
Contents
3. The IHSS Public Authority
What the Public Authorities Do . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
How the Registry Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
How Providers Are Included on the Registry. . . . . . . . . . . . . . . . . . . . 27
How Providers Remain on the Registry . . . . . . . . . . . . . . . . . . . . . . . 28
Provider Removal from the Registry . . . . . . . . . . . . . . . . . . . . . . . . . 28
General policy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Minor offenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Major offenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Submitting a complaint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
IHSS Public Authority Contact List . . . . . . . . . . . . . . . . . . . . . . . . . .30
4. The Consumer’s Role as an Employer
Consumer Responsibility for Hiring and Firing . . . . . . . . . . . . . . . . . . 35
Finding a Homecare Provider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
The Hiring Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Preparing for the interviews. . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Questions for the telephone interview . . . . . . . . . . . . . . . . . . . . . 38
Questions for the face-to-face interview. . . . . . . . . . . . . . . . . . . .40
Reference checking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Selecting a provider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Enrolling the provider. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Deciding When to Fire a Provider . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
5. Getting Started with a New Provider
Starting Off on the Right Foot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Issues to Discuss with a New Provider . . . . . . . . . . . . . . . . . . . . . . . 46
Identifying responsibility for transportation to medical
appointments and errands . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Paramedical services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Disclosing infectious diseases. . . . . . . . . . . . . . . . . . . . . . . . . . .48
Job Agreement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Task Grid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Consumer Handbook iii
Contents
6. Supervising Your Provider
Setting Priorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Communicating Preferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56
Maintaining Reasonable Expectations. . . . . . . . . . . . . . . . . . . . . . . . 56
Providing Feedback. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Giving praise. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Offering correction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Appropriate Use of Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Documenting Expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60
7. Communication
Communicating with Your Provider . . . . . . . . . . . . . . . . . . . . . . . . . 63
Communicating with Others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
8. Setting and Maintaining Boundaries
Setting Boundaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Restrictions on tasks and hours . . . . . . . . . . . . . . . . . . . . . . . . . 67
Professional behavior when the workplace is a home . . . . . . . . . . .68
Protecting your privacy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Handling Money Appropriately . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Keeping Belongings Safe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Recognizing Abusive Behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Physical or sexual abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Financial abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Neglect by the provider or family members . . . . . . . . . . . . . . . . . 72
Psychological abuse or intimidation . . . . . . . . . . . . . . . . . . . . . . 72
Reporting Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
iv Consumer Handbook
Contents
9. Enrolling and Paying Your Provider
The Enrollment Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
The Consumer’s Timesheet Responsibilities . . . . . . . . . . . . . . . . . . . . 76
How to Fill Out a Timesheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Common Timesheet Mistakes . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80
Share-of-Cost. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80
Payroll Deductions and Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Deductions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84
10. Safety
Universal Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Home Safety and Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . .90
Chapter 1
1. Understanding IHSS
Consumer Handbook 1
Chapter 1
Understanding IHSS
Goals and Limitations of the Program
The In-Home Supportive Services program (IHSS) allows low-income elderly,
blind or disabled people to hire someone to help them with housework,
meal preparation and personal care. With help, people who receive IHSS can
remain safely in their own home and do not need to move into a care facility
or institution.
The IHSS program is supported by federal, state and county funds. These
funds are used to pay homecare providers for specific services. These services
are authorized by the county for someone who they determine is eligible to
receive IHSS. The consumer (also called the recipient or client) chooses the
care provider, supervises the provider’s work, defines how tasks will be done,
and can fire the provider if the consumer wishes. The IHSS consumer signs
the care provider’s timesheet twice a month, but in most cases, the paycheck
comes from the State. Sometimes, the consumer pays a share of the wages
directly to the provider.
1
IHSS pays providers (also called caregivers) to provide personal care, such
as feeding and bathing; household tasks such as laundry, shopping, meal
preparation and light housecleaning; transportation; protective supervision;
and certain paramedical services ordered by a physician. However, the IHSS
program cannot pay for all the things that are necessary for someone to live
independently in his/her own home.
1
This handbook is intended for the vast majority of IHSS consumers who are served through the
Independent Provider mode. A small number of consumers are served by a private contractor.
Hiring, firing, supervision and payment may be different in this situation.
2 Chapter 1 Consumer Handbook
Understanding IHSS
IHSS does not pay for the following services:
• General gardening or yard clean-up that does not present a hazard
• Feeding, cleaning up after, or exercising a pet
• Moving or lifting heavy furniture, boxes, etc.
• Washing windows
• Transporting anyone but the consumer
• Paying bills
As the consumer, you can only ask the provider to perform those tasks that a
social worker has authorized for your care. Your provider should only perform
the assigned tasks. In addition, you should never ask the provider to work
more than the maximum number of hours the social worker has authorized. If
the provider does this, the provider will not be paid for the extra hours unless
the county determines that the extra time was necessary due to extenuating
circumstances. Finally, consumers with more than 173 authorized hours per
month should employ two or more providers so that no single provider works
more than 40 hours per week. A county social worker must approve payments
to a consumer’s sole provider for hours in excess of 40 per week.
Individual providers may choose to work more than 40 hours per week if they
work for multiple consumers. However, all of these hours will be paid at the
regular hourly rate.
No consumer can receive more than 283 hours per month of authorized
services. The IHSS program does not provide 24-hour assistance. Someone
with mental limitations who needs continuous supervision – called protective
supervision – 24 hours a day, or who needs round-the-clock nursing care, may
be denied IHSS coverage unless family, friends or other community resources
volunteer to cover the unpaid hours.
Consumer Handbook Chapter 1 3
Understanding IHSS
How IHSS Differs from Other Agencies and Services
Other community agencies offer services that complement the household and
personal care IHSS provides.
• Most communities have organizations that deliver hot meals to
homebound adults or offer surplus food to low income families.
• The Multipurpose Senior Services Program (MSSP) helps people
65 and over who are Medi-Cal eligible and at risk of nursing home
placement remain in their homes.
• Linkages serves functionally impaired adults 18 and older who are at
risk of nursing home placement and ineligible for other programs.
• Adult Protective Services (APS) serves seniors and dependent adults
who are harmed or threatened with harm. They investigate neglect,
abandonment, and physical, financial, or sexual abuse.
• The Public Administrator handles the estates of people who die
without a will, or who do not have able executors. They also assist
families that request help with estate administration and they oversee
burials for people who die without money to pay for end-of-life
expenses.
• The Public Guardian acts as the legally-appointed conservator for
adults who cannot take care of themselves and do not have family to
help.
• Health Insurance Counseling & Advocacy Program (HICAP) provides
Medicare beneficiaries with health plan counseling, advocacy, education,
and legal help with Medicare appeals.
• Adult Day Care offers non-medical services and activities for people
60 and older in need of some supervision and assistance. This program
provides a respite for family caregivers.
• Alzheimer’s Day Care Resource Center provides day care for persons
suffering from Alzheimer’s or other dementia as a respite for family
caregivers.
4 Chapter 1 Consumer Handbook
Understanding IHSS
• Regional Centers purchase services to help individuals with
developmental disabilities remain in their homes. These services can
complement those that are provided by IHSS.
You and your family members can consult a local resource guide for the phone
numbers of these programs in your community. If you have access to the
internet, information about resources is available at the following websites:
• California Department of Aging www.aging.state.ca.us
• California Department of Rehabilitation www.rehab.ca.gov
• Network of Care www.networkofcare.org
Who is Eligible for IHSS?
To be eligible for IHSS, a person must be a California resident who is over 65,
disabled or blind, is unable to remain safely in his/her own home without
assistance and meets one of the following conditions:
• Currently receives Supplemental Security Income/State Supplementary
Program (SSI/SSP) benefits.
• Meets all SSI/SSP eligibility criteria including income, but does not
receive SSI/SSP benefits.
• Meets all SSI/SSP eligibility criteria except his/her income exceeds SSI/
SSP eligibility standards. In this case, the person will have to pay a share
of the cost of receiving IHSS.
• Has a chronic disabling condition expected to last at least a year or to
result in death within a year and is eligible to receive Medi-Cal under a
categorically needy program.
In addition, disabled individuals who work may also be eligible for IHSS if they:
1) received SSI in the past;
2) still suffer from the impairments on which their SSI was based;
3) are ineligible for SSI because they are working; and
4) need IHSS for personal care services.
They will have to pay a share of the cost of IHSS but it is calculated in a way
that provides an incentive to keep working.
Consumer Handbook Chapter 1 5
Understanding IHSS
How to Apply for IHSS
You can find out if you are eligible for IHSS by calling IHSS intake at the County
Welfare Department. This phone number can be found in the county listings
under Social Services or Health and Human Services. Under these listings, look
for “Adult Programs” or “IHSS.” Ask to speak with an IHSS social worker who
can assess IHSS eligibility.
The social worker will ask for some basic information to assess your need for
services and your eligibility. You have the right to file a written application and
receive a written determination within 30 - 45 days.
What Happens Next?
A social worker will come to your home and complete an assessment of your
functional abilities. The social worker uses a statewide uniform assessment
process to determine which functions of daily living consumers are unable to
perform on their own. For more information on the assessment process, please
see Chapter 2 of this handbook.
The social worker then authorizes a number of hours of service per week for
each of the tasks that you have been determined to need. These tasks and
hours will be summarized in a “Notice of Action” – a State form that is mailed
to you to communicate the social worker’s decision regarding your care.
When you select a provider, you should tell the provider what tasks have been
authorized for your care and the number of hours per week you have for a
provider to complete these tasks. The IHSS program will not pay for more than
the authorized number of hours.
Division of Responsibilities for Supervising and Paying
Providers
Employer functions affecting homecare providers in the IHSS program are
divided among three entities: the IHSS consumer, the State of California and
the county’s IHSS Public Authority.
• The consumer selects, hires, supervises and trains the provider and can
fire the provider for any reason. If the consumer has more than one
6 Chapter 1 Consumer Handbook
Understanding IHSS
provider, the consumer decides how many hours each provider will work
of the total authorized.
• The State pays the provider for the hours the provider has worked each
pay period and provides some benefits. The benefits include State
Disability Insurance (SDI), Unemployment Insurance (UI), and Workers’
Compensation insurance.
• The IHSS Public Authority negotiates with the unions representing
homecare providers to set wages, benefits, and other employment
conditions. The Public Authority also maintains a Registry of providers
who are interested in working for IHSS consumers and offers access to
training for both consumers and providers. Whether or not you hire a
provider from the Registry, you can attend training classes offered by
the Public Authority. You may also ask to receive a copy of the Public
Authority newsletter, if the Public Authority in your county produces one.
Rule Summary
Two state agencies, the California Department of Social Services (CDSS)
and the Department of Health Services (DHS) make the rules for the IHSS
program. Understanding these rules will help you and your homecare provider
cooperate and enjoy your working relationship.
Authorized hours are awarded by the county social worker to the consumer
based on the consumer’s need for care. These hours belong to the consumer,
not the provider. Pay is received for actual hours worked. The total authorized
hours are the maximum that the State will pay; the provider will only receive
pay for the maximum number of hours if the provider works those hours. If,
for example, either the consumer or the provider goes on vacation, then no
hours can be reported for pay covering the vacation period. If the consumer is
hospitalized, no hours can be reported or paid for that period.
Providers must complete an enrollment form when they first start working for
a new consumer. This form must be given to the county person that handles
provider enrollments. This could be the consumer’s social worker, the IHSS
payroll office, or someone at the Public Authority. If a provider works for
multiple consumers, the provider must complete a separate enrollment form
Consumer Handbook Chapter 1 7
Understanding IHSS
for each consumer. The provider will not be paid until the new enrollment
form has been completed and filed.
Providers can only be paid for performing the tasks authorized by a social
worker for a particular consumer. Certain types of tasks are never covered
under the IHSS program (see list on page 2 of this handbook). Other tasks
are covered for IHSS consumers who need the service, but are not covered
for consumers who do not need the service. For example, a provider would
not be paid to assist a consumer with bathing if that consumer is capable of
bathing without help. It is important for the consumer to tell the provider
what tasks have been authorized for the consumer’s care. The Notice of Action
form shows the number of hours of service for each authorized task. It is
very helpful to write these tasks down on a job agreement (see Chapter 5 of
this handbook). Then if there are any questions about performing a task, the
provider and consumer can refer to the job agreement to see if that task is
paid for by IHSS.
You, as the consumer, should never ask your provider to perform tasks that
are not authorized. If you ask your provider to provide a service that is not
authorized, you are asking the provider to volunteer the time needed to do
it. If the provider is comfortable volunteering his/her time for that task, that is
okay. However, if the provider reports that time on the timesheet – and you
sign for it – you are both breaking the rules.
If transportation to a medical appointment is an authorized task for you, it
is important to understand that IHSS pays for the driving time but not the
waiting time for your provider. Your provider could either do other needed
tasks such as short errands or grocery shopping in the immediate area, or plan
personal activities while you are at the doctor’s office.
Timesheets are used to summarize the hours the provider worked each day
during a pay period. At the end of a pay period, the consumer signs the
timesheet, indicating that the hours reported accurately summarize the hours
worked. This can be easy if the provider and consumer maintain a task grid
(see Chapter 5 of this handbook), noting the hours worked at the end of each
day. Both should sign each day’s hours on the task grid, while it is fresh in their
memory. At the end of the two-week pay period, the provider simply transfers
8 Chapter 1 Consumer Handbook
Understanding IHSS
the number of hours from the task grid to the timesheet. The daily summary
of hours protects the consumer because the provider’s signature indicates
the provider’s agreement with the number of hours listed as worked that day.
It also protects the provider because the consumer has agreed by his/her
signature that those hours were worked that day. It is unlawful for a provider
to enter more hours on the timesheet than the provider actually worked, and
it is unlawful for a consumer to sign for more hours than the provider worked
during that pay period.
Pay for the hours a provider worked belongs to the provider, not the consumer.
A consumer does not have the right to ask a provider to share his/her pay. If
a consumer makes this request, the provider should report the request to the
consumer’s social worker.
If a consumer’s needs for care change, IHSS rules allow the consumer to
request a reassessment. A provider may encourage the consumer to request
a reassessment. A provider may also help the consumer communicate his/her
needs to the social worker, if the consumer wants the provider’s assistance.
Consumer Handbook Chapter 1 9
Understanding IHSS
The diagram below illustrates the relationship between the consumer and the
agencies assisting the consumer.
Union
• Negotiates wages,
benefits, and working
conditions for providers
• Collects dues for union
membership from providers
• Provides input on issues
affecting providers
County
• Determines
consumers’ hours
• Collects timesheets
• Maintains payroll
• Inputs timesheets into
State computer
State of California
• Issues paychecks to
providers
• Sets rules for the IHSS
Program based on State
and Federal laws
IHSS
Advisory
Committee
Provides advice and
recommendations to the
IHSS Public Authority on
IHSS issues related to service
delivery and program
administration
IHSS
Public Authority
Registry
Training
Benefits
Employer of record
for negotiations
Consumer
10 Chapter 1 Consumer Handbook
Understanding IHSS
IHSS CONSUMER’S RIGHTS AND RESPONSIBILITIES
1. The consumer is the employer of the provider for the purposes of
screening, hiring, supervising, training; and, if necessary, terminating the
employment of the provider.
2. The consumer has the responsibility to abide by non-discrimination
policies on the basis of race, religion, gender, age or disability.
3. Consumers are responsible for letting their social workers know when
a provider is hired or terminated. If a Registry provider is involved, they
must also inform the Registry’s Payroll staff.
4. The consumer is responsible for giving the provider a two-week notice
when terminating the provider’s employment unless the provider is
abusive.
5. The consumer is responsible for keeping a record of hours worked and
limiting provider hours to the number authorized per month.
6. The consumer is responsible for verifying and signing the provider’s
timesheet.
7. The consumer has the responsibility to be clear and reasonable about
what is expected; to be consistent, fair, and patient, and to give praise as
well as criticism.
8. The consumer and the provider have the responsibility to let the IHSS
social worker know immediately if the provider is injured on the job.
9. The consumer has the right to ask the IHSS social worker for a
reassessment of hours if the consumer’s condition changes.
10. The consumer has the right to appeal any decision by the IHSS program
that the consumer does not agree with.
11. If a Registry provider is involved, the consumer has the right to ask the
Registry for assistance with problems the consumer may have with the
provider that the consumer cannot resolve.
Consumer Handbook Chapter 1 11
Understanding IHSS
IHSS PROVIDER’S RIGHTS AND RESPONSIBILITIES
1. The provider has the responsibility to be dependable, to arrive on time,
and be ready to work.
2. The provider has the responsibility to inform the consumer, well in
advance, if the provider will be late or unable to work.
3. The provider has the responsibility to provide reliable, safe, high-
quality services as authorized by the social worker and directed by the
consumer.
4. Providers have the responsibility to respect the consumer’s dignity,
privacy, property, religion, and culture. Respectful providers come to
work without family members, bring their own food rather than eat the
consumer’s food, refrain from using the consumer’s property for their
own needs, and do not ask for extra pay when they volunteer more than
the authorized hours. Respectful providers do not conduct personal
business when they are at work and do not watch television or spend too
much time talking with the consumer when they should be performing
the needed tasks. Respectful providers are not verbally or sexually
abusive.
5. The provider has the responsibility to keep personal information about
the consumer confidential.
6. The provider has the responsibility to inform the social worker of any
changes in the consumer’s condition. If the provider was hired through
the Registry, they should also report these changes to Registry staff.
7. The provider has the responsibility to keep track of hours worked and to
submit accurate and complete timesheets twice a month.
8. Registry providers are responsible for informing the Registry every 30
days of any change in their situation, address, phone number and hours
available.
9. The provider is legally responsible for reporting suspected abuse of
dependent elderly, disabled persons and children.
10. When quitting their job, providers are responsible for giving the
consumer a two-week notice and informing the Public Authority if they
are listed on the Registry.
12 Chapter 1 Consumer Handbook
Understanding IHSS
11. The provider has a right to understand the IHSS work assignment and
receive fair, respectful treatment.
12. The provider has the right to expect training opportunities.
13. Registry providers have the right to know why they are being removed
from the Registry, should this occur.
14. The provider has the right to quit work without a two-week notice if the
consumer’s home is a dangerous environment.
15. If the provider is listed on the Registry, the provider can ask the Registry
for assistance with problems the provider may have with the consumer
that the provider cannot resolve.
Chapter 2
2. Assessment and
Authorized Services
Consumer Handbook 13
Chapter 2
Assessment and Authorized Services
Assessment
An aged, blind or disabled person who applies for help with domestic and
personal care services through the IHSS program must first establish that
s/he meets the program’s requirements. This information is contained in
an Applicant Packet that is reviewed by an IHSS Social Worker and an IHSS
Medi-Cal Eligibility Worker. If the program requirements are met, an IHSS
social worker will arrange to visit the applicant at home in order to assess the
person’s needs and functional abilities.
The need for care is affected by a person’s medical conditions and functional
abilities. People need more care if they need assistance getting out of bed
or moving about their home, or if they need help with bathing, dressing,
grooming, eating, or other daily activities described later in this chapter. In
general, the more limited a person’s functional abilities are, the more hours
that person is authorized to receive.
The hours of service authorized for a person’s care is affected by his/her living
arrangement and the assistance that person may be receiving from family,
friends, or other community resources. For example, a person who lives with
other family members has some needs met when family members prepare
meals, clean the house, or do the laundry. The IHSS program will only cover
the consumer’s portion of household tasks. IHSS does not pay a provider to
perform these tasks for other household members.
During the initial home visit, the social worker will question the applicant
about their medical conditions and functional abilities, and ask about other
14 Chapter 2 Consumer Handbook
Assessment and Authorized Services
household members. The social worker will also observe what the applicant
is capable of doing. The social worker will confirm the applicant’s medical
conditions and capabilities with his/her doctor. This process is called a
“needs assessment.” The social worker uses a statewide uniform assessment
process to determine which functions of daily living consumers cannot do
for themselves. The purpose of the assessment is to find out at what level the
consumer can function and the services the consumer may need. It is based
on the consumer’s functional ability in his/her own home and not just on a
medical diagnosis. Two persons with the same medical diagnosis may differ
greatly in their abilities.
The consumer should be sure to alert the social worker making the assessment
of any special needs caused by a medical condition and/or living situation.
For example, incontinence requires frequent sheet changes and creates
more laundry. The consumer should be sure to realistically estimate what the
consumer needs. The social worker also takes into account other resources the
consumer receives. For instance, the consumer may not need help on the days
s/he goes to an Adult Day Health Center.
The outcome of the assessment is a recommendation by the social worker
about which domestic and personal services are needed and how often they
are to be provided. State guidelines and formulas are used to determine which
services are allowed. This decision is summarized in a Notice of Action (NOA)
which is mailed to the applicant. The Notice of Action describes the specific
tasks that have been authorized for a particular IHSS recipient and the number
of hours per month allotted for the performance of each task.
Authorized Hours
Information from the Notice of Action on authorized tasks and hours is
important to the homecare provider. The authorized hours limits the number
of hours a provider can be paid to work for a given consumer. The provider
should not work more than the authorized hours because the provider will not
be paid by IHSS for the extra hours.
Consumer Handbook Chapter 2 15
Assessment and Authorized Services
Program limitations: Unmet need and alternative resources
There is a maximum number of hours the consumer may receive each month.
Sometimes a consumer needs more hours of service than the maximum
allowed under IHSS. This is called “unmet need.” Unmet needs may be met by
Adult Day Health Centers, family members, other agencies and/or volunteers.
If you have an unmet need, you can ask your social worker for a referral to an
agency that might help. Friends, relatives or agencies can volunteer for unmet
need hours without affecting IHSS eligibility.
If the social worker determines that the unmet need cannot be filled and
the consumer “cannot remain safely at home,” the social worker may deny
the application for IHSS support. For example, IHSS cannot provide 24-hour
coverage for someone who needs round-the-clock nursing care.
Parents and spouses as providers
IHSS will pay spouses of consumers and parents of minor children to provide
care under certain circumstances. Every IHSS case is evaluated separately so
the circumstances under which these services are granted vary greatly.
When an IHSS consumer has a spouse who does not receive IHSS, the spouse
shall be presumed able to perform certain specified tasks unless the spouse
provides medical verification of his/her inability to do so. An able spouse of an
IHSS consumer shall also be presumed available to perform certain specified
tasks except during those times when the spouse is out of the home for
employment, health or other unavoidable reasons; and the services must be
provided during his/her absence. The county determines whether or not the
consumer’s spouse is able and available. Having an able and available spouse
limits what the IHSS program will pay for because the spouse can perform the
necessary tasks.
A parent cannot be paid as a provider for providing age appropriate
supervision and care. (For example, a baby would need constant supervision
by a parent regardless of whether the infant was disabled or blind.) The parent
provider can be paid for performing those tasks listed as authorized on his/her
child’s Notice of Action letter.
16 Chapter 2 Consumer Handbook
Assessment and Authorized Services
Reassessment
The county is required to do a reassessment every year to determine whether
a consumer’s needs have changed. An IHSS consumer must request a
reassessment at any time if his/her needs change. This change could occur as
a result of a different living arrangement, hospitalization, improved health, or
a new physical condition. An observant provider can encourage the consumer
to request a reassessment if the provider feels it may be warranted. Either the
consumer or the provider can call the consumer’s social worker to make this
request.
Following an assessment or reassessment, the consumer will receive a Notice
of Action on a state approved form. The Notice of Action describes the
following:
1. The hours allotted to each service authorized; or
2. After a reassessment, the old and new hours and any increase or
decrease in each service.
Hours may not be decreased without proper notice to the consumer.
A consumer should immediately notify the provider if the consumer’s
authorized hours have changed, particularly if the hours have been reduced.
A reduction in hours could affect the provider’s eligibility for health insurance.
Getting a Correct Assessment
It is important to portray your abilities and limitations accurately when
the IHSS social worker comes to your home for an initial assessment or re-
assessment. Be clear when describing your needs. Do not exaggerate your
need for assistance. On the other hand, do not overstate your ability to provide
your own care. It may be helpful to prepare a list of your needs and any special
requirements you have. This will help you prepare for the social worker’s visit.
It will also help you to overcome any embarrassing feelings you may have
when sharing personal information.
Consumer Handbook Chapter 2 17
Assessment and Authorized Services
Consider the following points:
• The IHSS social worker does not know about your particular needs.
Be clear and specific and realistic.
• Consider how much time it takes to complete each task and how often
each task must be provided. You might want to track your tasks for a
month in preparation.
• Every question the social worker asks may be related to the time you
will be granted.
• Be sure you understand the questions. They can affect the number
of hours you may be authorized. If necessary, ask the social worker to
repeat the question.
• Do not expect hours for services you are already getting from another
source such as laundry or meals provided by a relative or another
agency.
• There are ways to be employed and still receive IHSS. If you are
currently employed or are considering employment, ask the social
worker about this possibility.
Appeals
The consumer may appeal any denial or reduction in hours and services,
including a refusal to allow the full number of hours the consumer feels
s/he needs. The consumer also has a right to appeal a Share-of-Cost (SOC)
determination (a decision asking that you pay a share of the cost of your in-
home care because your income is above the SSI threshold.) The best way to
proceed is to follow these steps:
1) Contact your IHSS social worker to discuss your concerns. If this does not
resolve the issue,
2) Contact your social worker’s supervisor and discuss the situation with
them. If this does not resolve the issue,
3) Ask for a Fair Hearing. This must be done within ten days of the date
on the Notice of Action.
18 Chapter 2 Consumer Handbook
Assessment and Authorized Services
To request a Fair Hearing see the instructions below:
• Fill out the back of the Notice of Action form and send it to the
address on the form; or
• Call the toll free number, 1-800-952-5253, or TDD for
• For hearing and speech impaired, 1-800-952-8349
• Send a letter to:
California Department of Social Services
State Hearing Division
PO Box 944243, Mail Station 19-37
Sacramento, CA 94244-2430
If a consumer requests a fair hearing prior to the effective date of the notice
to reduce or terminate his/her hours and services, these benefits will continue
at the previous level until the hearing decision is made. For help with appeals,
contact legal services, Independent Living Centers (ILC), Protection and
Advocacy, Inc. (PAI) for disabled persons (1-800-776-5746) or other advocacy
groups for seniors and/or persons with disabilities.
Consumer Handbook Chapter 2 19
Assessment and Authorized Services
Overview of IHSS Process
Recipient Intake and completion of
IHSS application,
Review by Social Worker
Assessment
Approved
Denied
Select family
or friend as
provider
Contact IHSS Public
Authority to select a
registry provider
Advertise in the
community-at-large
for a provider
Complete
Provider
Enrollment Form
Appeal
(if feel wrongly
denied)
Notice of Action Mailed
20 Chapter 2 Consumer Handbook
Assessment and Authorized Services
Tasks Covered by IHSS
The following tasks are covered by IHSS. They can be categorized into four
groups: 1) domestic or household services; 2) personal care services; 3) services
directed or provided by a licensed health care professional; and 4) other
miscellaneous services. IHSS consumers only receive hours for those tasks that
they cannot perform on their own. Hours per task will vary depending upon the
consumer’s abilities. Providers should determine which tasks are covered for the
consumer when they first begin working for the consumer.
Domestic services
Housework. Sweeping, vacuuming, and washing floors, kitchen
counters, and sinks; cleaning the bathroom; storing food and supplies;
taking out garbage; dusting and picking up; changing bed linen (usually
once a week); cleaning oven and stovetop, cleaning and defrosting refrigerator
and waxing floors (usually once a month), and miscellaneous domestic
services such as changing light bulbs, cleaning wheelchairs or recharging
wheelchair batteries (when necessary to remain safely in the home).
Preparation of meals. Planning meals; removing food from the
refrigerator or pantry; washing/drying hands before meal preparation;
washing, peeling, and slicing vegetables; opening packages, cans, and
bags; measuring and mixing ingredients; lifting pots and pans;
trimming meat; reheating food; cooking and safely operating the stove;
setting the table, serving the meals; pureeing food; and cutting the food
into bite-sized pieces. A few IHSS consumers receive a restaurant meal
allowance in lieu of time for meal preparation.
Meal clean-up. Washing, rinsing, drying dishes, pots, pans, utensils, and culinary
appliances, and putting them away; loading and unloading the dishwasher;
storing/putting away leftover foods/liquids; wiping up spills and tables, counters,
stoves, and sinks; and washing and drying hands.
Laundry. Washing and drying laundry, mending, ironing,
folding, and storing clothes in closets, on shelves or in
drawers. Extra time is given if laundry facilities are outside
the home.
Consumer Handbook Chapter 2 21
Assessment and Authorized Services
Reasonable food shopping. Limited to the nearest available stores
or other facilities consistent with the consumer’s income and needs.
No additional time is authorized for the consumer to accompany the
provider. Food shopping includes the tasks of making a grocery list,
travel to/from the store, shopping, loading, unloading, and storing food.
Other shopping/errands. Other shopping/errands includes the tasks of making
a shopping list, travel to/from the store, shopping, loading, unloading and
storing supplies purchased, performing reasonable errands such as delivering a
delinquent payment to prevent a utility shutoff or picking up a prescription. This
does not include travel to pay monthly bills since these can be mailed.
Heavy cleaning. Thorough cleaning of the home to remove hazardous debris
or dirt is only authorized when someone first receives IHSS and the home’s
conditions constitute a threat to the consumer’s health or could lead to the
consumer’s eviction. This service must be pre-approved by a supervisor.
Personal care services
Bath, oral hygiene and grooming. Bathing includes cleaning the body in
a tub or shower; obtaining supplies and putting them away; turning on/
off faucets and adjusting water temperature; assistance with getting in/
out of tub or shower; assistance with reaching all parts of the body for
washing, rinsing, drying, and applying lotion, powder, and deodorant;
and washing/drying hands. Oral hygiene includes applying toothpaste,
brushing teeth, rinsing mouth, caring for dentures, flossing, and washing/
drying hands. Grooming includes hair combing/brushing; hair trimming
when the consumer cannot get to the barber/salon; shampooing, applying
conditioner, and drying hair; shaving; fingernail/toenail care when these
services are not assessed as paramedical services for the consumer; and
washing/drying hands.
Routine bed baths. Cleaning basin or other materials used for bed sponge
baths and putting them away; obtaining water and supplies; washing, rinsing,
and drying body; applying lotion, powder and deodorant; and washing/drying
hands before and after bathing.
22 Chapter 2 Consumer Handbook
Assessment and Authorized Services
Dressing. Washing/drying hands; putting on/taking off corsets, elastic
stockings, and braces and/or fastening/unfastening; buttoning/unbuttoning;
zipping/unzipping; and tying/untying of garments and undergarments;
changing soiled clothing; and bringing tools to the consumer to assist with
independent dressing.
Care and assistance with prosthesis and assistance with self-
administration of medications. Care and assistance with prosthetic devices
includes assistance with taking off or putting on, maintaining or cleaning
prosthetic devices and vision/hearing aids as well as washing and drying
hands before and after performing these tasks. Assistance with self-
administration of medication consists of reminding the consumer to take
prescribed and/or over the counter medications at appropriate times and
setting up Medisets or filling syringes.
Bowel and bladder care. Assistance with using, emptying, and cleaning bed
pans/bedside commodes, urinals, ostomy, enema and/or catheter receptacles;
application of diapers; positioning for diaper changes; managing clothing;
changing disposable gloves; wiping and cleaning consumer; assistance with
getting on/off commode or toilet; and washing/drying consumer’s and
provider’s hands.
Routine menstrual care. Limited to external application of sanitary napkins
and positioning for sanitary napkin changes; using and/or disposing of barrier
pads; managing clothing; wiping and cleaning; and wiping/drying hands
before and after performing these tasks.
Rubbing skin, repositioning, range of motion, etc. Rubbing of skin to promote
circulation; turning in bed and other types of repositioning; and range of
motion exercises.
Ambulation. Assisting the consumer with walking or moving from place
to place inside the home including to and from the bathroom; climbing
or descending stairs; moving and retrieving assistive devices such as
a cane, walker, or wheelchair, etc.; and washing/drying hands before
and after performing these tasks. Ambulation also includes assistance
to/from the front door to the car including (getting in/out of car) for
medical accompaniment and/or alternative resource travel.
Consumer Handbook Chapter 2 23
Assessment and Authorized Services
Transfer. Transfer includes assisting from standing, sitting, or prone position to
another position and/or from one piece of equipment or furniture to another.
This includes transfer from a bed, chair, couch, wheelchair, walker, or assistive
device generally occurring within the same room.
Feeding. Consumption of food and assurance of adequate fluid
intake consisting of feeding or related assistance to consumers
who cannot feed themselves or who require other assistance
with special devices in order to feed themselves or to drink
adequate liquids. Feeding includes assistance with reaching
for, picking up, and grasping utensils and cups, and washing/
drying hands before and after feeding.
Respiration. Limited to non-medical services such as
assistance with self-administration of oxygen, assistance with
setting up CPSP machine, and cleaning IPPB and CPAP machines.
Services directed or provided by a licensed health care
professional
Protective Supervision. Observing consumer’s behavior in order to safeguard
the consumer against injury, hazard, or accident. Very strict rules apply for this
service. Consult with the consumer’s IHSS social worker for further information.
Paramedical Services. Paramedical services are activities that the consumer
would normally provide for him/herself but cannot due to physical limitations.
They are provided when ordered by a licensed health care professional and
provided under the direction of the licensed health care professional. In order
to provide paramedical services, the county must have a signed statement
of informed consent saying that the individual has been informed of the
potential risks arising from the receipt of the services.
Other miscellaneous services
Accompaniment to medical appointments. Authorized when the recipient
needs help getting to and from the doctor, dentist, or other health
practitioner’s office. (Time is not authorized for waiting during the visit.)
24 Chapter 2 Consumer Handbook
Assessment and Authorized Services
Providers are not required to provide transportation. If they do provide
transportation, reimbursement for gas and other travel expenses must be
negotiated between the consumer and the provider.
Accompaniment to alternative resources. Authorized when the recipient
needs help getting to and from alternative resources where IHSS recipient
receives services in lieu of IHSS. This could mean Adult Day Care of Respite
Programs. (Time is not authorized for waiting during the visit.) Providers are
not required to provide transportation. If they do provide transportation,
reimbursement for gas and other travel expenses must be negotiated
between the consumer and provider.
Teaching and demonstration services. Certain teaching and demonstration
services enable the consumer to perform for themselves domestic or
household services, personal care services or miscellaneous services such as
travel to/from medical appointments and/or alternative resources.
Yard hazard abatement. Removal of grass, weeds, rubbish, ice, snow or other
hazardous items.
Unauthorized Services
The following services are not covered by IHSS. Consumers should not ask their
providers to perform these services. The State will not pay for the time spent
in performing these services and the provider is not protected by Workers’
Compensation for any injury that might result from performing them.
IHSS does not pay for the following services:
• General gardening or yard clean-up
• Feeding, cleaning up after or exercising a pet
• Moving or lifting heavy furniture, boxes, etc.
• Washing windows
• Transporting anyone but the recipient
• Paying bills
Chapter 3
3. The IHSS Public Authority
Consumer Handbook 25
Chapter 3
The IHSS Public Authority
What the Public Authorities Do
Nearly every county in California has an IHSS Public Authority that negotiates
with the local homecare providers’ union to set wages, benefits, and working
conditions for IHSS providers. These benefits are summarized on the provider’s
pay stub. Depending upon the county, they may include a deduction for
health care in addition to union dues. The Public Authorities offer the
following services to IHSS consumers and providers:
• They maintain a homecare provider Registry that consumers can use to
find a suitable provider.
• They investigate the qualifications and background of individuals who
wish to be listed on the Registry.
• They offer access to training for providers in caregiving skills and for
consumers in communicating with their providers.
• They help Registry providers and their clients work out difficulties in their
relationship.
• They provide staff support to each county’s IHSS Advisory committee,
which works to improve the Public Authority and the IHSS program.
If you would like information on training classes, call the Public Authority in
your county and ask them to send you a list of classes, their location and dates.
The Public Authorities’ telephone numbers are listed alphabetically by county
at the end of this chapter.
26 Chapter 3 Consumer Handbook
The IHSS Public Authority
How the Registry Works
In many counties, the IHSS Public Authority Registry maintains a computerized
referral list of homecare providers for IHSS consumers who want to hire
someone to provide them with personal care or household assistance.
Potential providers attend an orientation meeting and/or complete an
application process that includes providing references and giving permission
for the Registry to check references and/or work history and, in some
counties, conduct a criminal background check. If the provider qualifies to be
on the Registry, there is no charge for the Registry listing or referral to IHSS
consumers.
Registry staff interview potential providers and check backgrounds and
references. They enter this information into a computerized program that
matches providers with IHSS consumers. The program searches through
provider and consumer information and assembles possible matches.
Generally, the Registry then mails the consumers the names and contact
numbers for several providers who meet the consumer’s specific service needs
and preferences. Referrals are based on geographic location, language, service
needs and provider skills.
IHSS consumers call, interview and hire the provider of their choice. The
Registry does not hire or recommend providers; it only serves as a referral
service.
The Registry may refer providers to you who do not exactly match the type
of provider you told the Registry you needed. This can happen if you do not
tell Registry staff all of your needs and medical conditions. It is a good idea to
include in the interviewing process all potential providers who have the ability
to serve you. If, after talking with the provider, you are not interested in hiring
them for the job, you may politely let them know. Return all calls to providers,
even if you are not interested in hiring them, as that is the professional and
considerate thing to do.
It is against the law for a consumer to refuse to hire a provider because of
the provider’s age, race, religion, sexual orientation, national origin, ethnicity,
political affiliation, gender identity, marital status, or disability. It is also
Consumer Handbook Chapter 3 27
The IHSS Public Authority
unlawful for the provider to refuse to accept a job based on these same
factors. The only exception is for consumers who need personal care, such
as bathing, dressing, bowel, bladder or menstrual care. In this situation, a
consumer may request a list of workers of the same gender.
How Providers Are Included on the Registry
Individuals, including family members and friends of a consumer, may contact
the local Public Authority and follow their instructions on how to be included
on the Registry. In many counties, the provider will be asked to attend an
orientation session and complete an application.
The Public Authority may also
conduct a criminal background check. Persons who have been convicted of
welfare fraud or of adult or child abuse are not eligible to be an IHSS provider.
Depending upon the local Public Authority in a particular county, other
criminal convictions may prevent someone from being listed on the Registry.
To be included on the Registry, the provider will likely need:
• A Social Security card or other proof of the right to work in the
United States (U.S.).
• Proof of citizenship or legal immigration.
• A valid Driver’s License or other government-issued photo identification.
• Three references – a non-relative personal reference and two from
previous employers.
• Documentation or certificates for any training they may have had.
• A completed application form.
• To grant the Public Authority permission to do a criminal background
check to determine whether they have been convicted of any crimes
that would prohibit their employment as a Registry provider.
• To complete an interview with Registry staff and/or attend an
orientation for new providers.
If the provider is willing to transport the IHSS consumer to medical
appointments, they may have to provide proof of a current auto insurance
policy that includes liability, a copy of their Department of Motor Vehicles
(DMV) record and a valid Driver’s License.
28 Chapter 3 Consumer Handbook
The IHSS Public Authority
How Providers Remain on the Registry
If you have hired a Registry provider, call the Registry to let them know who
you have hired. They will place that person on the “inactive” list unless your
provider also wants to work for other clients. In that case, the provider would
need to call Registry staff each month to confirm that they wish to remain
active on the Registry and be referred to additional clients. They can do this by
leaving a message with their name, telephone number and any changes in the
times they are available to work.
Provider Removal from the Registry
General policy
The Public Authority reserves the right to remove a provider from the Registry.
The Public Authority may determine reasonable rules and regulations
regarding the appointment of providers to the Registry as well as their
removal from the Registry. Complaints concerning a provider may be given
verbally or in writing to Public Authority staff. Public Authority staff will
document all complaints.
Minor offenses
The Public Authority will remove a provider from the Registry after two
complaints of minor offenses reported by one or more sources within a
90-day period and deemed valid by Public Authority staff. Minor offenses
include, but are not limited to:
• Not appearing at scheduled interviews without notice.
• Being late for work without reasonable cause.
• Disrespect, rudeness or inappropriate behavior toward the consumer,
the consumer’s relatives or representatives, or to Public Authority staff.
• Refusal to do the authorized tasks agreed to upon hire.
• Not performing requested and authorized tasks during work hours.
• Inadequate job performance.
Consumer Handbook Chapter 3 29
The IHSS Public Authority
• Not returning the consumer’s phone calls or not returning Registry
phone calls.
• Failure to update Registry files.
• Quitting a Registry assignment (without good reason) without at least
a two-week notice.
Major offenses
The Public Authority will remove a provider from the Registry after one
complaint of a major offense that has been deemed valid by Public Authority
staff. Major offenses include, but are not limited to:
• Theft
• Sexual/physical abuse or neglect
• Dishonesty or misrepresentation related to job duties
• Intentional falsification of time sheets
• Unauthorized disclosure of confidential information
• Being intoxicated or being under the influence or possession of any
illegal substance while on duty
• Asking the consumer to supplement the allowable IHSS wage
• Possession of a firearm or other dangerous weapon while on duty
• Conviction of a crime that indicates unfitness for the job
• Knowingly putting the consumer in jeopardy
Submitting a complaint
Consumers may submit a complaint against their provider by calling the
Registry. Complaints should be specific and as detailed as possible. It is helpful to
include dates when the offenses occurred. Consumers should try to distinguish
disrespectful and threatening behaviors from minor irritations in a provider’s
personal and work habits. Consumers must weigh the seriousness of the offense
against the effort required to replace a provider. However, they should not accept
disrespect, dishonesty, or threatening behavior from a provider
.
30 Chapter 3 Consumer Handbook
The IHSS Public Authority
Alameda
Public Authority for IHSS in Alameda
County
6955 Foothill Blvd., 3rd Floor, Suite 300
Oakland, CA 94605
(510) 577-5621
Alpine
Health & Human Services, Alpine County
75A Diamond Valley Rd.
Markleeville, CA 96120
(530) 694-2235
Amador
Amador County IHSS Public Authority
255 New York Ranch Road, Suite B
Jackson, CA 95642
(209) 223-6781
Butte
Butte County IHSS Public Authority
202 Mira Loma Drive
Oroville, CA 95965
(888) 337-4477
Calaveras
Calaveras County IHSS Public Authority
509 E Saint Charles St.
San Andreas, CA 95249
(209) 754-6544
Colusa
Colusa County IHSS Public Authority
251 E. Webster St.
Colusa, CA 95932
(530) 458-0379
Contra Costa
Contra Costa County Public Authority
1330 Arnold Dr., #143
Martinez, CA 94553
(925) 957-7522
Del Norte
Del Norte County IHSS Public Authority
880 Northcrest Dr.
Crescent City, CA 95531
(707) 464-3191
El Dorado
El Dorado County Public Authority
694 Pleasant Valley Road, Suite 9
Diamond Springs, CA 95619
(530) 295-2748
Fresno
Fresno County Public Authority
2025 E Dakota
Fresno, CA 93726
|(559) 453-6450
Glenn
Glenn County IHSS Public Authority
PO Box 1201
Orland, CA 95963
(530) 865-6150
Humboldt
Humboldt County Public Authority
808 E. Street
Eureka, CA 95501
(707) 476-2115
IHSS Public Authority Contact List
Consumer Handbook Chapter 3 31
The IHSS Public Authority
Imperial
IHSS Public Authority of Imperial County
2999 S. 4th Street
El Centro, CA 92243
(760) 336-3945
Inyo
Community Service Solutions
308 W. Line Street Suite #5
Bishop, CA 93514
(760) 872-7604
Kern
Kern County IHSS Public Authority
5357 Truxtun Ave.
Bakersfield, CA 93309
(661) 868-1000
Kings
Kings County Public Authority
1400 W. Lacey Blvd.
Hanford, CA 93230
(559) 582-3211 x3610
Lake
Lake County Public Authority
926 South Forbes
Lakeport, CA 95453
(707) 262-0235
Lassen
Lassen County IHSS Public Authority
PO Box 1359
Susanville, CA 96130
(530) 251-8158
Los Angeles County
Personal Assistance Services Council of
Los Angeles County (PASC)
4730 Woodman Ave., Suite 405
Sherman Oaks, CA 91423
(818) 206-7000
Madera
Madera County IHSS Public Authority
PO Box 6009
Madera, CA 93639
(559) 675-2442
Marin
Public Authority of Marin
10 N. San Pedro Rd., Suite 1016
San Rafael, CA 94903
(415) 499-1024
Mariposa
Mariposa County IHSS Public Authority
5200 Hwy. 49 North
Mariposa, CA 95338
(209) 966-3609
Mendocino
Mendocino County Public Authority
PO Box 839
747 South State Street
Ukiah, CA 95482
(707) 463-7886
Merced
Merced County IHSS Public Authority
2777 North Hwy 59
Merced, CA 95340
(209) 383-9504
32 Chapter 3 Consumer Handbook
The IHSS Public Authority
Modoc
Community Service Solutions
308 W. Line Street Suite #5
Bishop, CA 93514
(760) 872-7604
Mono
Community Service Solutions
308 W. Line Street Suite #5
Bishop, CA 93514
(760) 872-7604
Monterey
Monterey County IHSS Public Authority
1000 South Main Street Suite 211C
Salinas, CA 93901
(831) 755-4466
Napa
Napa County Public Authority
900 Coombs Street, Suite 257
Napa, CA 94559
(707) 259-8366
Nevada
Nevada-Sierra Regional Public Authority
350 Crown Point Circle, Suite 115
Grass Valley, CA 95945
(530) 274-5601
Orange
Orange County IHSS Public Authority
1200 N. Main, Suite 700
Santa Ana, CA 92701
(714) 480-6446
Placer
Placer County IHSS Public Authority
11533 C Avenue
Auburn, CA 95603
(530) 886-3680
Plumas
Nevada-Sierra Regional Public Authority
350 Crown Point Circle, Suite 115
Grass Valley, CA 95945
(530) 274-5601
Riverside
County of Riverside IHSS Public Authority
12125 Day Street, Suite S-101
Moreno Valley, CA 92557
(888) 470-4477
Sacramento
Sacramento County IHSS Public
Authority
3700 Branch Center Road, Suite A
Sacramento, CA 95827
(916) 874-2888
San Benito
San Benito County IHSS Public Authority
1111 San Felipe Rd., Suite 207
Hollister, CA 95023
(831) 634-0784
San Bernardino
San Bernardino IHSS Public Authority
600 N. Arrowhead Ave., Suite 100
San Bernardino, CA 92415
(909) 386-5014
Consumer Handbook Chapter 3 33
The IHSS Public Authority
San Diego
San Diego County Public Authority
780 Bay Blvd., Suite 200
Chula Vista, CA 91910
(619) 476-6295
San Francisco
San Francisco County IHSS Public
Authority
832 Folsom St., 9th Floor
San Francisco, CA 94107
(415) 243-4477
San Joaquin
San Joaquin IHSS Public Authority
25 E. Harding Way
Stockton, CA 95204
(209) 468-1746
San Luis Obispo
IHSS Public Authority for San Luis Obispo
County
PO Box 3236
San Luis Obispo, CA 934023236
(805) 788-2501
San Mateo
San Mateo Public Authority for IHSS
225 37th Ave.
San Mateo, CA 94403
(650) 573-3901
Santa Barbara
In-Home Care Network, Santa Barbara
County IHSS Public Authority
1410 S. Broadway, Suite L
Santa Maria, CA 93454
(805) 614-1256
Santa Clara
Santa Clara County IHSS Public Authority
2115 The Alameda
San Jose, CA 95126
(408) 350-3206
Santa Cruz
IHSS Public Authority of Santa Cruz
County
1400 Emeline Ave., 3rd Floor
Santa Cruz, CA 95062
(831) 454-4036
Shasta
Shasta County IHSS Public Authority
1506 Market Street
Redding, CA 96001
(530) 229-8330
Sierra
Nevada-Sierra Regional Public Authority
350 Crown Point Circle, Suite 115
Grass Valley, CA 95945
(530) 274-5601
Siskiyou
Siskiyou County IHSS Public Authority
818 S. Main Street
Yreka, CA 96097
(530) 841-2738
Solano
Solano County Public Authority
470 Chadbourne Road, Suite 100
Fairfield, CA 94534
(707) 438-1773
34 Chapter 3 Consumer Handbook
The IHSS Public Authority
Sonoma
Sonoma County IHSS Public Authority
2280 Northpoint Parkway
PO Box 1949
Santa Rosa, CA 95402
(707) 565-5700
Stanislaus
Stanislaus County Public Authority
305 Downey Ave
Modesto, CA 95354
(209) 558-4787
Sutter
Sutter County IHSS Public Authority
543 Garden Hwy, Suite C
Yuba City, CA 95991
(530) 822-7618
Tehama
Tehama County IHSS Public Authority
PO Box 368
Red Bluff, CA 96080
(530) 527-0276
Trinity
Trinity County IHSS Public Authority
PO Box 1470
Weaverville, CA 96093
N/A
Tuolumne
Tuolumne County IHSS Public Authority
20075 Cedar Road
N Sonora, CA 95370
N/A
Ventura
Ventura County Public Authority
4245 Market St.
Ventura, CA 93003
(805) 652-7674
Yolo
Yolo County Public Authority
25 N. Cottonwood Street
Woodland, CA 95695
(530) 661-2676 or (800) 630-2224
Yuba
Yuba County IHSS Public Authority
6000 Lindhurst Ave., Suite 700-C
Marysville, CA 95901
(530) 749-6298
Chapter 4
4. The Consumer’s Role as
an Employer
Consumer Handbook 35
Chapter 4
The Consumer’s Role as an Employer
Consumer Responsibility for Hiring and Firing
The IHSS consumer is the primary employer of his/her homecare provider. In
most cases, the consumer does everything but negotiate pay and benefits
and write the check. The Public Authority negotiates with the local homecare
providers’ union to set wages, benefits and working conditions. Using federal,
state and county funds, the State writes the check. A few consumers, with
incomes above the SSI maximum, do pay a share of the cost of their IHSS care.
All other employer responsibilities are carried out by the IHSS consumer. These
responsibilities include hiring, training, supervising and, if necessary, firing the
provider.
The role of employer may be unfamiliar for some IHSS consumers. Hiring
or supervising others may be a new experience. Defining and prioritizing
tasks for someone else to do – and training them to do it – takes energy
and communication skills. Providing feedback and making suggestions
for improvement in how tasks are done requires compassion, courage and
patience. Hiring and firing demands good judgment in addition to all of the
above. The good news is that all of these qualities improve with practice and a
willingness to learn.
In addition, help is available through the Public Authority, Independent Living
Centers, your IHSS social worker, and sometimes case management agencies
in your community. The Public Authority maintains a Registry of providers,
which can simplify the hiring process by eliminating the step of advertising
for a provider. Many Public Authorities also offer employer skills classes for
consumers. Call your IHSS Public Authority to find out how they can assist you
36 Chapter 4 Consumer Handbook
The Consumer’s Role as an Employer
with your employer responsibilities. Family members and friends are another
resource. Consider including them when you interview prospective providers
to get another opinion on the best choice for your needs.
Finding a Homecare Provider
The most important – and maybe the most difficult – task is finding a good
homecare provider. With the right person, training and supervision are easier
and more like building a relationship than supervising an employee. It is worth
putting some effort into the search process and taking the time to make a
good decision.
As an IHSS consumer, you are free to hire anyone who can meet your needs.
The person could be a friend or family member or someone you find through
a provider Registry, advertising, or word of mouth. Here are some common
ways that consumers find a homecare provider:
• WORD OF MOUTH – Tell everyone you know, (friends, relatives,
neighbors, etc.) that you are looking for a homecare provider. Family and
friends are the most common source of homecare providers. Word of
mouth is one of the best forms of advertising.
• THE IHSS PUBLIC AUTHORITY REGISTRY – Call the Registry in your area.
They can provide you with a list of homecare providers who match your
needs and preferences. Public Authority services are free. For a current
list of public authorities and phone numbers, see the list at the end of
this handbook.
• FLYERS – Put up flyers or cards on local bulletin boards. You can find
bulletin boards in church lobbies, supermarkets, senior centers, schools
and libraries.
• LOCAL COLLEGES – Call and ask for the campus program that helps
students find work. Ask them to list your job opening wherever they
advertise employment opportunities for students.
• LOCAL PAPERS – Place an ad in the local newspaper. There is usually a
charge for this service, although some communities have “Penny Ads”
or “Magic Ads” that are very inexpensive.
Consumer Handbook Chapter 4 37
The Consumer’s Role as an Employer
• UNION – Contact the homecare provider’s union to see if they have a job
referral service or registry.
• EMPLOYMENT DEVELOPMENT DEPARTMENT (EDD) – Place an ad at the
local EDD office.
If you use flyers or ads, make sure that you are easily reachable by phone,
pager, cell phone or answering machine. Use a short, simple message on your
voice mail giving your family name and telephone number. Ask callers to leave
a message and return calls promptly.
The Hiring Process
Getting the word out that you are looking for a provider is the first step.
Finding and hiring the right person is more involved. There are five stages in
the hiring process:
1. Screen applicants through a telephone interview.
2. Meet for face-to-face interviews with the strongest candidates.
3. Check references.
4. Select a new provider and communicate your decision to those you have
interviewed.
5. Communicate your decision to your social worker to begin the provider
enrollment process and, if you have hired someone from the Public
Authority’s Registry, let them know as well.
Preparing for the interviews
Before talking with prospective candidates, it helps to write out a brief
description of the job and the questions you wish to ask the candidates for
your position. You can use the Notice of Action that you received from IHSS to
summarize what you want the provider to do and how many hours a month
you will need him/her to work. The Notice of Action describes the tasks that
have been authorized for your care and the number of hours per month
that IHSS will pay someone to provide those services. Remember that IHSS
providers are only allowed to help you with duties authorized by your IHSS
social worker. If you have any questions about what tasks are authorized, call
your social worker before you hire someone.
38 Chapter 4 Consumer Handbook
The Consumer’s Role as an Employer
Another important part of the job description is the days and times you want
the provider to come. This is for you to decide. If you can be flexible about
when the provider comes, you may have more options in choosing a good
provider. Finally, plan to tell the candidate in general terms where you live
and indicate any special requirements you have for the person you hire. For
example, indicate whether you want a non-smoker, someone who has their
own car and is willing to drive you to appointments or someone who can lift a
certain number of pounds.
Next, write out the questions you wish to ask candidates over the phone and
other questions that you want to ask those you interview in person.
Questions for the telephone interview
Here are some questions you might consider asking during the telephone interview:
• Can you tell me something about yourself?
• Are you available to work the days and times I need you?
• Would you have any problem doing the tasks I need done?
• Do you have experience performing these tasks?
• Have you had any training in home and personal care? If so, please
describe where you received this training and what it covered.
• Where else have you worked?
• Do you have reliable transportation for getting to work?
• Do you smoke?
• Do you use alcohol or drugs?
• Could you give me work and personal references that I could check?
I will need names and phone numbers and, if this is a work reference,
the dates of your employment and the type of work.
Consumer Handbook Chapter 4 39
The Consumer’s Role as an Employer
If you are not satisfied with the person’s availability, experience, or ability to
perform the needed tasks or get to your home on a reliable basis, thank the
person for his/her time and wish the person the best in finding a more
suitable position.
If the candidate’s responses are generally positive, but you have reservations,
tell him/her that you would like to check some of his/her references and
get back to him/her within a few days. Then, try to define and address your
reservations when you talk with the person’s references.
If, on the other hand, the person has the necessary experience, meets your
special requirements, and communicates well with you over the phone,
schedule a personal interview with him/her. This interview can take place
in your home or in a public place nearby. Be clear about the date, time, and
location of the interview (a cross-street is helpful) and make sure the candidate
has your name and phone number. Consider asking a friend or family member
to join you so that you can compare your assessments of the candidate. Ask
the candidate to bring the following items to the interview:
• A valid Driver’s License or California picture Identification Card.
• His/her Social Security card or green card indicating that s/he has
permission to work within the U.S.
• The names and phone numbers of at least three references. These
should include previous employers or instructors who are familiar
with his/her homecare skills.
• Proof of auto insurance if the provider will be driving his/her own
car as part of the job.
• A Department of Motor Vehicles (DMV) printout of his/her driving record
if the provider will be driving you to appointments in either his/her car
or yours. Printouts are available from their local DMV office for a $5 fee.
• Applicable training certificates, if any.
• TB test results indicating that s/he does not have the disease.
40 Chapter 4 Consumer Handbook
The Consumer’s Role as an Employer
If the candidates have a resume, it will be helpful if they can bring a copy to
the interview. It is a good idea to interview at least two or three candidates.
The process of comparing their strengths helps you decide what skills are most
important to you. Another good reason to interview multiple candidates is
that it is nice to have a back-up provider for times when your regular provider
is ill or has other unavoidable commitments. The back-up provider may also
serve as a second or subsequent provider if the person you hire moves on to
another job.
Consumers with a large number of authorized hours should consider hiring
multiple providers. Having multiple providers gives you a built-in back-up
provider and makes your job easier when you have to replace one of them.
Having multiple providers does place more responsibility on the consumer
to coordinate their schedules so that, together, they do not exceed the
total number of authorized hours. If they do, the person whose timesheet is
processed second will not be paid for some of the hours they worked. The
consumer should ensure that each provider works only the number of hours
s/he has been assigned.
Questions for the face-to-face interview
In the face-to-face interview, it is a good idea to review the tasks and work
schedule that you described over the phone. Make sure that the candidate is
comfortable with the tasks that have been authorized and that you can agree
on a work schedule. You can use the Sample Job Agreement that appears at
the end of the next chapter as a guide for your discussion. This will give you
an opportunity to discuss whether you will be paying a share of the cost of
your care directly to the provider and, if the provider will be driving you to
appointments in his/her car, who will pay for gas. Topics to cover during the
interview include:
1. IDENTIFICATION – Ask to see his/her identification. Examples include a
valid California Driver’s License or Identification Card with a picture and
social security card.
2. JOB DESCRIPTION – Review the job agreement or job description. Point
out any special requirements.
Consumer Handbook Chapter 4 41
The Consumer’s Role as an Employer
3. TASK LIMITATIONS – Ask if there are any tasks s/he will not perform.
4. REFERENCES – Ask for references, both personal and job-related. Make
sure you get names and current phone numbers so you can call the
references later.
5. EDUCATION AND EXPERIENCE – Ask for information on education,
training, and experience in homecare services.
6. DRIVER’S LICENSE – If you need the homecare provider to drive for you,
make sure the provider shows you a valid Driver’s License and ask to see
proof of insurance if the provider will be using his/her own car. Clarify
with the provider if you will be paying for gas and at what rate.
7. TRIAL PERIOD – Tell the homecare provider that for the first few weeks
you will be showing him/her how you want things done and seeing if
s/he learns the tasks well.
8. REASONS FOR FIRING – Explain what actions might require you to fire
the provider. Reasons may include using your belongings without your
permission, consistently arriving late, or being unable to meet your
needs. A complete list of reasons for firing can be found in Chapter 3
of this handbook in the section on major and minor offenses justifying
removal from the Registry.
Reference checking
Checking references is essential. It will give you valuable information about the
applicant. When calling references ask questions such as the following:
1. Did (name of applicant) work with you in (dates of employment)?
2. What kind of work did s/he do for you?
3. Why did (name of applicant) stop working for you?
4. Would you hire him/her again?
5. What were his/her strengths?
6. What could have been improved about his/her job performance?
42 Chapter 4 Consumer Handbook
The Consumer’s Role as an Employer
Selecting a provider
After you have interviewed a sufficient number of individuals, you will want to
choose the provider who will best help you with your needs. With a friend or
family member, compare the strengths and weaknesses of each candidate and
consider which of the candidates’ qualities are most important to you. Trust
your judgment. When you have made your decision, call the provider you
would like to hire and offer him/her the job. Remind the provider of the pay
level and number of hours, discuss a start date with the provider and obtain
his/her commitment to begin work on the agreed upon day.
If you interviewed other individuals, it is important to call them and inform
them that you have made your decision and have hired someone else. If you
liked another person, however, you may want to ask if you can keep his/her
number available in case you need a back up provider.
If you interviewed candidates from the Public Authority’s Registry, call the
Registry to let them know you have hired someone. They can assist you with
the paperwork and help you calculate the number of pro-rated hours that
your new provider can work during his/her first month on the job.
Enrolling the provider
The final step in the hiring process is for you to enroll your new provider as an
employee of the statewide IHSS program. This is done by calling your social
worker and giving your social worker the following information about your
new caregiver:
• Name as it appears on the individual’s Social Security card
• Telephone number
• Social Security Number
• Date of birth
• Date of the first day on the job
• Familial relationship, if any, to the consumer
• Provider’s preferred language
Consumer Handbook Chapter 4 43
The Consumer’s Role as an Employer
IHSS Payroll will then mail your new employee a provider enrollment
agreement for him/her to complete and mail back immediately to the address
given on the form. Sometimes, social workers give copies of this form to
consumers. If you have an extra enrollment agreement, you can give it to your
new provider and save them some time in the enrollment process. Providers
cannot be paid until Payroll receives and processes the enrollment form.
Deciding When to Fire a Provider
The decision to replace a provider should be considered carefully. It is difficult
and usually unpleasant to tell someone that you no longer need his/her
services. It is also hard work to find a new provider. So, there is reason to
invest some energy in making a list of the provider’s shortcomings, ranking
them in order of importance, and then respectfully discussing with your
provider the most important improvements you would like to see in his/her
job performance. You can enlist the aid of your social worker or someone
from the Public Authority in communicating your concerns to the provider. If
your provider is willing to work on his/her skills and willing to try to meet your
expectations, it may save you time in the long run to give him/her a chance.
On the other hand, if your provider is not being respectful or is treating you
in an abusive or threatening manner, you should end their employment
quickly, seeking help, if you need it, to do so. You may refer to the list of minor
and major offenses in Chapter 3 of this handbook to help you recognize
unacceptable behavior on the part of a provider. Your personal safety is most
important. Contact your social worker, the Public Authority’s Registry, friends
and family members to help you through the transition to a new provider.
If you have decided to replace a provider and the situation is tolerable, it is best
to give the provider a two-week notice. This gives them time to look for a new
position and it gives you time to start the process of finding a replacement.
Chapter 5
5. Getting Started with a
New Provider
Consumer Handbook 45
Chapter 5
Getting Started with a New Provider
Starting Off on the Right Foot
During your first meeting with a new provider, you should summarize many
of the things you discussed during the job interview. You will review the
authorized tasks that the provider will be doing for you, showing the provider
where necessary supplies are kept and how you would like things done, and
you will go over the provider’s work schedule so that you are both clear on
what days the provider will be coming and how many hours the provider
will work each day. Then, you will want to share with the provider all of the
information the provider needs to give you the best care and protect you if an
emergency occurs. Providers need to know the following information:
• Any health issues you have that will require special actions on the
provider’s part.
• How to correctly use any special equipment that helps you with your
daily activities or maintains your health.
• Any allergies or special dietary concerns and how you would like the
provider to respond to these concerns.
• If you need assistance with self-administration of medication, how
your medications are organized so that the provider can help you take
them correctly. If you do not already have a system for organizing your
medications, ask your provider to work with you in setting up a system
for managing your medications. The system should include a list of
medications, including the schedule and amount.
46 Chapter 5 Consumer Handbook
Getting Started with a New Provider
• Who to contact in case of an emergency. If you have a “File of Life” that
summarizes the names and telephone numbers for your doctor, social
worker, and key family members and friends, show the provider where
this is kept. If you do not have a “File of Life,” create one with the help of
friends, family members and your provider. This should include a list of
phone numbers for doctors, clinics, therapists, social workers, relatives or
friends to call in the event of an emergency.
• How to get out of the house in case of an emergency
• The best times for you to contact each other and all of the phone
numbers where each of you can be reached.
• How you will track the hours your provider works and how you will each
check to make sure that the hours worked are correctly entered on the
time sheet every two weeks. Consider using a task grid to assign tasks
and summarize hours worked on a daily basis. Task grids are discussed
later in this chapter. A sample task grid appears at the end of the chapter.
Issues to Discuss with a New Provider
There are some important issues that you should always discuss when a
provider begins work for you. Even if these issues were mentioned during the
job interview, you should talk about them again. Some of the issues affect the
health of both the consumer and the provider and some have been found
to lead to misunderstandings that can disrupt the relationship between
employer and employee. It is best to deal with any potentially difficult issues
in the beginning. This gives the provider a chance to change their mind if
some of the conditions of employment are unacceptable. It also gives you
an opportunity to change your mind if you cannot agree on the provision of
necessary services or if the provider discloses health conditions that make you
uncomfortable.
Consumer Handbook Chapter 5 47
Getting Started with a New Provider
Identifying responsibility for transportation to medical
appointments and errands
If you have authorized hours for accompaniment to medical appointments,
shopping or other errands, you and your provider need to know that IHSS
does not pay for the cost of gas, insurance, or public transportation. Since
IHSS does not cover these costs, it is important for you and your provider to
determine – at the time of hiring – who will pay these costs. This decision
should be included in the job agreement, which is discussed later in this
chapter. Being clear about this issue from the beginning will lessen the chance
of misunderstandings later.
If the provider will be driving his/her own car, you should discuss whether
you will pay for gas. Make sure that the provider’s insurance is up to date and
covers you as a passenger and ask to see a valid Driver’s License and a copy of
their DMV record. If the provider will be driving your car, you should provide
proof of current insurance that covers both persons in case of an accident
and ask to see the provider’s current Driver’s License and a copy of their DMV
record. If the provider will use public transportation to accompany you to
medical appointments and for shopping or other errands, you should discuss
whether you will pay for public transportation.
IHSS pays for the provider’s time to accompany you to and from medical
appointments, but it does not pay the provider to wait during the medical
appointment. You may want to suggest that the provider use this waiting time
to complete his/her own errands, phone calls or other personal business.
Paramedical services
If you require paramedical services, you should discuss this with the provider
during the job interview. Some providers will not want the responsibility that
comes with this type of care. The first day on the job is the time to review
the paramedical services you need and to make arrangements for the new
provider to be trained by your doctor or nurse in how to administer the
service. IHSS regulations require that a licensed health care professional order
and supervise paramedical services. The provider should not perform any
48 Chapter 5 Consumer Handbook
Getting Started with a New Provider
paramedical service unless a licensed health care professional has taught them
how to provide the service, explained the risks involved, and told them what
to do in an emergency if something goes wrong. Paramedical services include:
• Administering medication or giving injections
• Blood/Urine testing
• Wound care
• Catheter care and ostomy irrigation
• Any treatments requiring sterile procedures
• Enemas, digital stimulation, or the insertion of suppositories
• Tube feeding
• Suctioning
Disclosing infectious diseases
Consumers and providers are strongly encouraged to disclose to each other
whatever health conditions they have that may negatively affect the health
of the other. This includes all infectious diseases, including HIV, Hepatitis,
Tuberculosis (TB), and others. If you are concerned about your own possible
exposure to TB, you may ask to see proof of your provider’s negative test.
Make sure your providers use universal precautions against infectious disease
all the time, whether or not there is disclosure of a medical condition. (See
Chapter 9, Safety.)
If you have hired a provider from the Public Authority Registry, remind them
to let the Registry know that they have accepted a job. (You should do this
as well.) Unless they want to work additional hours for another client, they
should ask to be placed on the inactive list. When the provider stops working
for you, the provider can ask to be reinstated to the Registry’s active list. If the
provider wants to work additional hours for another client, the provider should
remain on the active list. To do this, the provider must call the Registry once a
month to confirm his/her active status. It would be helpful if you reminded the
provider that it is his/her responsibility to do this.
Consumer Handbook Chapter 5 49
Getting Started with a New Provider
Job Agreement
A clear understanding of job duties and work schedule at the beginning of a
job can reduce the likelihood of conflict or misunderstanding later. When you
put that understanding in writing, you have a job agreement or contract. You
can use the form on the next two pages as a basis for discussion with your
new provider. This discussion should cover:
• The duties to be performed within the authorized hours
• The expectations and standards you each have
• When and how the duties are to be performed
A completed and signed job agreement can be used to remind you and your
provider of your respective responsibilities.
50 Chapter 5 Consumer Handbook
Getting Started with a New Provider
IHSS CONSUMER AND PROVIDER JOB AGREEMENT
1. This job agreement is between:
Employer (Print consumer name) and Employee (Print provider name)
2. The consumer and provider agree to the following general principles.
The consumer agrees to:
• Assign and direct the work of the provider
• Give the provider advance notice, whenever possible, when hours or duties change
• Only ask the provider to do work for the consumer
• Sign the provider’s time sheet if it reflects the hours that were worked
The provider agrees to:
• Perform the agreed-upon tasks and duties (see duties and responsibilities below)
• Call the consumer as soon as possible if they are late, sick or unable to work
• Come to work on time (see hours of work below)
• Not make personal or long distance phone calls while at work
• Not ask to borrow money or ask for a cash advance
• Give the consumer a two-week notice, whenever possible, before leaving the job
3. The provider will be paid at the rate set by the county for IHSS providers.
4. The total number of hours per week for this job are ________.
5. The hours of work for this job are shown below. Changes in the scheduled days and
hours are to be negotiated by both parties, with advance notice.
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Start
End
6. Will consumer pay provider for gas
used to drive to shopping or medical
appointments?
___ No
___ Yes
7. Does consumer have a Share-of-Cost?
___ No
___ Yes
If yes, indicate maximum amount_________
IHSS CONSUMER AND PROVIDER JOB AGREEMENT
Consumer Handbook Chapter 5 51
Getting Started with a New Provider
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i
es an
d
respons
ibili
t
i
es
f
or t
hi
s
j
o
b
are s
h
own
b
e
l
ow. T
h
e consumer s
h
ou
ld
mark the tasks they need the provider to do and show how often the task needs to be
done (D=Daily, W=Weekly, M=Monthly, O=Other). If a task needs to be done on a
different schedule, the consumer should write this in next to the task.
D=Daily
W=Weekly
M=Monthly
O-Other
Meals
___
Prepare meals
___
Meal cleanup
___
Wash dishes
___
Help with eating
Cleaning and Laundry
___
Empty trash
___
Wipe counter
___
Clean sinks
___
Clean stove top
___
Clean oven
___
Clean refrigerator
___
Vacuum/sweep
___
Dust
___
Mop kitchen & bathroom floors
___
Clean bathroom
___
Make bed
___
Change bed linen
___
Routine laundry (wash, dry,
fold and put away laundry
___
Heavy house cleaning (one-time
only with approval from IHSS)
Shopping
___
Grocery shopping
___
Other shopping errands
Non-Medical
Personal Services
___
Dressing
___
Grooming and oral hygiene
___
Bathing
___
Bed baths
___
Bowel and bladder care
___
Menstrual care
___
Help with walking
___
Move in and out of bed
___
Help on/off seat or in/out of vehicle
___
Repositioning
___
Rub skin
___
Care/assistance with prosthesis
___
Respiration assistance
___
Other personal services:
_____________________________
Paramedical Services
___
Administration of medication
___
Blood sugar checks
___
Injections
___
Other paramedical services:
_____________________________
Transportation Services
___
Escorting to medical appointments
___
Escorting to alternative resources
The consumer and provider, by signing this document, agree to the terms outlined above.
If the agreement changes, both parties will initial and date the changes.
Consumer Signature Provider Signature
D
ate
Ph
o
n
e Nu
m
be
r D
ate
Ph
o
n
e Nu
m
be
r
52 Chapter 5 Consumer Handbook
Getting Started with a New Provider
Task Grid
The authorized tasks summarized on the job agreement can be checked off
on a task grid that you can use to direct your provider’s work. (See a sample
task grid on the following pages.) Each task grid covers a two-week period.
This allows you to change what tasks you want done on particular days and, if
you save the completed grids, gives you a permanent record of the hours your
provider worked. If you have multiple providers, you would have a separate
task grid for each provider with their assigned hours and tasks. This makes
it easy for you to check that together they are not working more than the
authorized number of hours.
To complete the grid, write the provider’s name, the month and total
authorized (scheduled) hours for the month in the top row. Then, fill in the
days of the week starting with the 1
st
or the 16
th
day of the month and the
number of hours scheduled for each day. Finally, check off the tasks you want
done each day in the column for that day. Columns for days your provider does
not work will be blank.
At the end of each day, both you and your provider should initial the total
hours worked that day in the spaces provided at the bottom of the task grid.
It is important to do this while the day is fresh in your mind. The “total hours
worked” row should sum to no more than half the number of authorized
hours for the month – assuming that you need help on a fairly continuous
basis. At the end of each two-week period, your provider can use the task grid
to complete their time sheet, copying the number of hours worked each day
from the task grid onto the time sheet. Remember that it is your responsibility
to ensure that the task grid accurately reflects the hours worked and the
time sheet accurately reflects the hours noted on the task grid. It is also your
responsibility to make sure that the total hours worked in a month by all
providers do not exceed the total hours authorized.
Consumer Handbook Chapter 5 53
Getting Started with a New Provider
IHSS Task Grid – Meals and Cleaning
Provider Name: ________________ Month:_____________ Total Authorized Hours for Month: ___
Day of the week:
Date:
Hours scheduled for day:
Meals
Meal preparation
Help with eating
Wash dishes and clean up kitchen
Menu planning/shopping list
Shopping for food
Cleaning
Empty trash
Clean kitchen surfaces/appliances
Throw out spoiled food
Make bed
Change linen
Clutter management/tidy up
Dust
Clean bathroom
Sweep/vacuum
Mop
Laundry/ironing
54 Chapter 5 Consumer Handbook
Getting Started with a New Provider
IHSS Task Grid – Personal Care and Other Services
Month:_____________
Day of the week:
Date:
Personal Care
Help with medication
Bathing/bed bath
Oral hygiene/grooming
Dressing
Bowel/bladder
Menstrual care
Shift body position
Rub skin/massage
Lift/transfer
Help with walking
Help with prescribed exercises
Help with breathing equipment
Other
Medical appointments
Other shopping and errands
Total Hours Worked
Provider Initials
Consumer Initials
Chapter 6
6. Supervising Your Provider
Consumer Handbook 55
Chapter 6
Supervising Your Provider
As an IHSS consumer, one of your on-going responsibilities is supervising your
provider. Supervision involves:
• Setting priorities for the tasks to be completed each day
• Communicating your preferences for how things are done
• Maintaining reasonable expectations for your provider’s job
performance
• Providing feedback on his/her work
• Making sure the provider uses his/her time appropriately
• Documenting expenditures
These responsibilities may feel awkward at first, but experience will build
confidence in your supervision skills.
Setting Priorities
One of your first supervisory responsibilities is to let your provider know which
tasks are most important to accomplish on a particular day. The provider may
not be able to complete all of the tasks that day, but you want the provider
to get to the most important ones. The task grid provided in Chapter 5 of this
handbook may help you organize your priorities for your provider. The task
grid starts out as a plan for things that need doing over a two-week period—
a plan that will probably be changed by medical appointments, variations in
your health status and unplanned events.
56 Chapter 6 Consumer Handbook
Supervising Your Provider
Communicating Preferences
For better or for worse, we all like things done a certain way, whether it’s
the way dishes are stacked in the dishwasher, toilet-paper spools out of the
dispenser, or stains are cleaned from the sink. A provider working in your
home should follow your preferences for how household and personal tasks
are accomplished. Each time your provider takes on a new task, it is helpful for
you to explain in detail how you would like him/her to do it. In the beginning,
you may need to remind the provider how you would like him/her to do the
task several times because the provider will be learning many new things at
once – and in a strange environment – so not everything you communicate
will “stick.” Be patient and don’t forget to praise your provider when s/he does
the task correctly. This helps to reinforce the way you would like things done.
Preferences, of course, include specific brands of foods and other household
items. Be as specific as you can in describing brand preferences, using brand
names and the volume desired (e.g., a 15-oz. can of Brand X tomato soup)
rather than “the small can with the blue label.” Write out a detailed shopping
list so that your provider has something clear to refer to and check off.
Let your provider know if have allergies to laundry detergents, bleaches, or
fabric softeners. You should also tell your provider about any preferences for
specific laundry detergent brands and let them know if you want them to use
bleach or fabric softener for some of your laundry.
If you are receiving assistance with personal care, it is particularly important
for you to communicate and demonstrate how you want tasks performed. You
may find it more comfortable to start with, the less personal tasks first—if you
have that luxury—when you are training a new provider. As you get to know
and trust each other, it will get easier to perform and accept this assistance.
Maintaining Reasonable Expectations
You should expect that it will take a new provider longer to complete the
authorized tasks than one who has been with you for some time. Adjust your
expectations accordingly and give a new provider time to “come up to speed.”
Remember, too, that medical appointments may prevent your provider from
completing other tasks that day – particularly if your appointment is a great
Consumer Handbook Chapter 6 57
Supervising Your Provider
distance from your home. One option that serves both of your needs is to have
the provider complete those tasks on another day.
Another reason to keep your expectations within bounds is that the hours
authorized by IHSS for a specific task do not necessarily reflect the time it
takes to accomplish that task in your household. If a task completed to your
satisfaction takes longer than the hours authorized, you should work on
accepting that the completed task may not meet your expectations. Flexibility
on your part may be required. You can also talk to your social worker if you feel
that the time assessed for a task is insufficient.
Providing Feedback
Giving praise
I
t is important to praise your provider when s/he is completing tasks the way
you like them done and when s/he is working efficiently – making good use of
his/her time and getting things accomplished. A couple of sentences are all that
is required. For example: “I liked the dinner you prepared today. It tasted really
great!” This tells the provider that you notice what s/he is doing, that you care
about how s/he does it, and that you appreciate his/her efforts to please you.
Offering correction
It is equally important to let your providers know when they are not doing
things correctly and to let them know sooner rather than later. In the end, it is
unfair to the provider to pretend that s/he is performing a task correctly when,
inside you feel the provider is not. It is hard not to get resentful if your provider
is not making the best use of his/her time or not doing things the way you
would like. It’s only fair to let the provider know so s/he can adjust his/her
behavior. Assume that your provider wants to do the best job possible.
• Discuss problems as they arise – don’t bottle them up. Discuss them
firmly and calmly.
• When offering corrections, first try to comment on a task that has been
done correctly. Then let the caregiver know pleasantly but firmly, how
you want the incorrectly performed task done.
58 Chapter 6 Consumer Handbook
Supervising Your Provider
• When making corrections, start by saying something positive, for
example: “I am happy to see the bathroom so clean. But next time, could
you please remember to rinse out the tub more thoroughly?”
• Explaining why you like a task performed a certain way or why you
need the provider to be reliable and prompt in showing up for work
also make the requests more acceptable. Sometimes, a provider may
not understand the consequences of being late or doing something a
different way.
• Avoid blaming or humiliating your provider. This will damage your
relationship and increase the chance that your provider will look for
another job. If you find it difficult to communicate with your provider, ask
for help from a family member or friend, your social worker or a Registry
Specialist at the IHSS Public Authority.
• Treating your providers with respect will encourage them to be
respectful of you in return.
Appropriate Use of Time
An important way to show respect for your providers is to confine their
work to the tasks authorized by your IHSS social worker. It is tempting to
ask them to help with other household jobs, but the IHSS program can only
pay for a limited range of tasks. If you need help with tasks not covered by
the IHSS program, you will need to identify family members, friends, church
volunteers, or others who can provide assistance. You may need to give up
some responsibilities if you cannot manage them on your own and no one is
available to help you. Maintaining a pet is one example. If you are unable to
walk a dog or change a cat’s litter box, you may have to give up pet ownership
unless you have a friend or neighbor who can help you with these activities.
You should not ask your IHSS provider to do unauthorized tasks. Doing so
puts providers in a difficult position and they may be afraid they will lose their
job if they refuse your request. It also puts them at risk because providers are
not covered by Workers’ Compensation Insurance if they are hurt while doing
unauthorized work.
Consumer Handbook Chapter 6 59
Supervising Your Provider
The following are examples of services that are not paid for by the IHSS program:
• Washing the dog. Scooping up dog droppings.
• Changing the cat litter box.
• Washing windows.
• Cleaning/shampooing carpets or rugs.
• Washing down cupboards, walls or window coverings.
• Watering plants, mowing the lawn, or any gardening.
• Weekly ironing, beyond just a few items.
• Cleaning the house while you are in the hospital or away from your
home on vacation or for other reasons.
• Cooking or cleaning for other family members in your home unless
they are also on IHSS.
• Transportation to do bill paying, unless it is to deliver a delinquent
payment to avoid a utility being shut-off.
• Paying bills.
In addition, IHSS does not provide reimbursement for:
• The time it takes a provider to get to your home.
• Bus fare for the provider to do your shopping or errands.
• Gas for the provider to do your shopping, errands, or to take you to
medical appointments. It is important to work out an agreement with
your provider about how you will handle the issue of gas money.
As your provider’s employer and supervisor, it is also your responsibility to
remind the provider that s/he is being paid to complete the authorized tasks
and that the provider should be using his/her time in your home to do these
tasks efficiently. The following are not appropriate provider activities during
work hours:
• Making personal telephone calls
• Watching TV
60 Chapter 6 Consumer Handbook
Supervising Your Provider
• Spending too much time talking with you
• Bringing children or others to work with them
• Reading or engaging in personal business or activities.
When a provider works a four-hour block of time, you are required to give him/
her a 15-minute paid break. It shows respect for your provider to encourage
him/her to take a break and to include that 15 minutes as time worked on the
timesheet.
Documenting Expenditures
If your provider is authorized to shop and run errands for you, in addition to
giving him/her a list of the items you need, you need to give the provider the
money to pay for the items. It protects both you and your provider to keep
a log of the amount of money given, the amount spent and the amount of
change returned. A notebook is useful for this purpose. You can have a column
for the date, a column for the amount of money given, a place for you and the
provider to initial that amount, a column for the amount spent as indicated by
the receipts, and a column for the amount of change returned along with a
place for your initials. A sample expenditure form is included at the end of this
chapter. The following is an example of how to fill out this form:
If you keep the receipts in a large manila envelope or folding file, you can
easily answer any questions that arise about the exchange of money. No
one’s memory is good enough to keep track of expenditures without
documentation. Keeping good financial records is a part of your supervisory
responsibilities as an employer. It is also an investment in the relationship with
your provider.
Date
Money given to
provider by consumer
Amount
Spent
(from
Receipts)
Change returned to
consumer by provider
Amount
$
Consumer
Initials
Provider
Initials
Amount
$
Consumer
Initials
Provider
Initials
10/15/06 $20 FM SS $16.85 $3.15 FM SS
10/22/06 $5 FM SS $4.25 $0.75 FM SS
Consumer Handbook Chapter 6 61
Supervising Your Provider
Sample Expenditure Form
Sample Expenditure Form
Date
Money given to
provider by consumer
Amount
Spent
(from
Receipts)
Change returned to
consumer by provider
Amount
$
Consumer
Initials
Provider
Initials
Amount
$
Consumer
Initials
Provider
Initials
Chapter 7
7. Communication
Consumer Handbook 63
Chapter 7
Communication
Your ability to communicate with your provider, social worker, doctor and
family directly affects the quality of care you receive. Learn to clearly express
your needs and do not hesitate to ask questions about things you do not
understand – whether these involve the IHSS program, your health, or
your provider’s approach to his/her job. Communication begins with good
observation and clarifying questions.
Communicating with Your Provider
The following tips can help you develop a good relationship with your provider:
• Take time to learn about your provider.
• Discover his/her favorite foods, clothes, games, music, animals, recipes,
or memories. Include these favorites in conversations when you are
supervising their work.
• Learn the name your provider prefers and use that name.
• Observe your provider’s use of humor.
• Learn about your provider’s perception of time and punctuality and be
clear about the differences, if any, in how you see things.
• Note how the provider uses and interprets body language.
• Note the provider’s preferred ways of greeting.
• Listen and show respect for your provider’s concerns. Take time to
understand the ways your provider interprets communication.
64 Chapter 7 Consumer Handbook
Communication
• Show your provider how you want him/her to help you with personal
tasks. It may be easier to start with the less personal tasks first. As you
get to know each other better, you will both become more comfortable
with these tasks.
There are several techniques to remember in communicating with your
provider.
Set a comfortable pace for conversation. Your provider may need time to
process the information you are giving them. Do not speak too quickly. Find
a pace that is comfortable for the provider. You can watch his/her facial
expressions to find out whether the provider fully understands what you are
saying. If you are not sure, ask.
“Please let me know if I am going too fast. I will be happy to slow down.”
Actively listen. Many cultures expect that people will make eye contact when
they are listening to someone else. Listening in this way communicates
interest and respect. Active listening is the first step in resolving problems.
Make “I” statements. Take responsibility for your own feelings and respect
your provider’s feelings. Remember – people’s feelings are their own and no
one can tell them they do not or should not feel a particular way. The pattern
for an “I” statement is: “I see/hear/feel (state the issue at hand). It makes me
feel (state your feelings). I need (state a possible solution).”
Accept your provider’s individuality. Accept your providers as they are and
be open to how they may change over time. Respect their right to be an
individual rather than criticizing them because they are different from you.
Sometimes cultural differences between a provider and consumer lead to
misunderstandings. Since there is no right or wrong culture, it is helpful to
identify when cultural preferences are behind a disagreement. Using “I”
statements, you can help each other understand how your separate cultures
do things. Keep in mind that you may be asking a provider to do things that
conflict with, or at least differ from, his/her culture’s way of doing things.
Expect that this may take some adjustment on his/her part.
Consumer Handbook Chapter 7 65
Communication
If you and your provider do not speak the same language, you may want
to get help translating key words and phrases that you both can use in
communicating. Be sure to include words and phrases that identify an
emergency so that your provider can take appropriate action.
Communicating with Others
Communicating effectively with your provider is one of your most important
responsibilities. A supportive provider can, in turn, help you communicate
with your social worker, doctor, nurse, and family. You can help your provider
do this by posting a list of their names and phone numbers in an easy-to-find
location and indicating which you should call first in an emergency.
It is helpful for your provider to know your health history, if you feel
comfortable sharing it with them. Ask your provider to help you note
significant changes in your condition and abilities and help you communicate
these changes to the appropriate person.
With your permission, your provider can also discuss with your doctor or
nurse any special dietary needs, preventive measures or danger signals that
they need to be aware of. The doctor or nurse can also tell your provider how
to respond in different emergency situations and how to administer certain
medical procedures, if these are required. You can also ask your provider to
read about universal precautions and other safety measures in the last chapter
of this book.
Finally, you should create a “Power of Attorney for Health Care” or advanced
directive and a will. The “Power of Attorney for Health Care” or advanced
directive states your wishes for resuscitation and end-of-life care and
authorizes a family member or friend to make decisions on your behalf if you
are unable to. A will indicates how your property should be distributed after
your death. If you want particular individuals to have a particular piece of
jewelry or a favorite quilt, you put that in your will and name an executor who
will see that your wishes are carried out. It is important to tell your provider,
family members and friends where these documents are stored in case of
an emergency and to give your doctors copies of the “Power of Attorney for
Health Care” or advanced directive.
Chapter 8
8. Setting and Maintaining
Boundaries
Consumer Handbook 67
Chapter 8
Setting and Maintaining Boundaries
The previous chapter focused on how consumers show respect for their
providers and build trusting relationships. Hopefully, providers, in turn, will be
respectful of their clients. This chapter discusses some ways in which providers
may, without meaning to, be disrespectful to their clients. The following
discussion is designed to help consumers recognize disrespectful treatment
and offers ideas about how to set reasonable limits to protect themselves from
inappropriate requests and behaviors. This chapter also considers the problem
of abusive behavior and recognizing and reporting these behaviors.
Setting Boundaries
Restrictions on tasks and hours
As an employer, you have the responsibility of supervising providers in the
performance of tasks that have been authorized by the IHSS social worker. It is
against the rules for an IHSS consumer to ask his/her provider to do a task that
has not been authorized. It is also against the rules for the consumer to ask his/
her provider to work more hours than have been authorized. These requests
are disrespectful of the provider because IHSS will not pay for the extra hours.
On the other hand, providers who do not have a good understanding of the
IHSS program may think that the authorized hours “belong” to the provider
and may ask their employer to pay them for the total number of hours,
whether they work them or not. This request is inappropriate and reflects
a misunderstanding of the program. If your provider makes such a request,
you can explain that, in the IHSS program, authorized hours belong to the
68 Chapter 8 Consumer Handbook
Setting and Maintaining Boundaries
consumer. Consumers do not need to use all of their hours each month.
Indeed, if the consumer is hospitalized or goes on vacation, no hours can be
reported or paid for that time. Paying a provider for hours they do not work is
fraud. If your provider has any questions about these rules, ask them to speak
with your social worker.
Professional behavior when the workplace is a home
Another boundary issue concerns the definition of your home as a workplace.
Providers with small children may want to bring their children to your home
when they come to work for you. This is unprofessional and unacceptable.
Children need supervision. The provider is being paid by the State to take care
of your needs. They cannot do that and care for their children at the same
time. Explain to your provider that your home is the provider’s workplace.
They should not accept a position as a homecare provider unless they have
someone to care for their children.
Similarly, it may be tempting for providers to spend too much time talking
with you or watching television when they should be performing the needed
tasks. It is sometimes difficult to be in a home without feeling like a guest
because most people don’t think of a private home as a place of work. Your
provider may need to be reminded, gently, that s/he is not being paid to keep
you company.
Providers should also respect a client’s property. They should bring their
own lunch or dinner if they will be working in the client’s home at meal time.
They should not use the client’s property or belongings for their own needs.
This means that providers should not use the client’s telephone or car for
personal business, nor borrow money, supplies, equipment, or household
goods. In cleaning and preparing meals for you, your provider should also use
your supplies and food efficiently. As the employer, you may have to explain
some of these limitations on the provider’s behavior and help the provider
understand that when the provider is in your home, s/he is an employee,
not a guest.
Consumer Handbook Chapter 8 69
Setting and Maintaining Boundaries
Protecting your privacy
Finally, providers should respect their client’s privacy. Your name, address,
health, family situation or behaviors should not be shared with anyone.
Consider carefully what information you share with your provider. It is
important for your provider to know about your health conditions because
you may have to depend upon your provider to take the right action in an
emergency. Providers should also know which family members to contact in
an emergency. But they usually do not need to know anything about you and
your family members’ lives or economic situation. Providers should not have
access to your check book or bank accounts, or to money kept in your home.
Valuable mementos should be kept in a private place. You do not need to
share either their existence or their location with your provider.
Handling Money Appropriately
IHSS consumers frequently ask their providers to shop for them. This involves
spending the consumer’s money and returning change from the purchases.
You can protect yourself by following these steps:
• If you ask the provider to take money from your purse or wallet, ask the
provider to bring the purse or wallet to you, and watch the provider
remove the bills.
• Verify the amount of money the provider is taking and record the
amount in a log book, on a note or on the shopping list. The log book
offers a more permanent record.
• When the provider returns, count the change and ask the provider to
initial the receipt.
• Do not loan money to the provider.
• Do not borrow money from the provider, even if the provider offers it.
• Never ask the provider to contribute to anything, join anything, or buy
anything.
Unless you are a relative or a close friend, you should not be involved in your
provider’s legal and financial affairs.
70 Chapter 8 Consumer Handbook
Setting and Maintaining Boundaries
Keeping Belongings Safe
Trust between an employer and an employee develops gradually in any
setting. In your home, you can help your provider respect your privacy and
your belongings – building trust between the two of you -- by clearly defining
boundaries for acceptable behavior and by limiting the provider’s access to
private papers and storage areas within your home. Here are some ways to
help define boundaries:
• Don’t let your provider sign your name at any time.
• Don’t sign a timesheet that is incorrect.
• Do not add your provider’s name to savings, checking or charge
accounts.
• Ask for a receipt if you give money to your provider to purchase
something for you.
• Do not leave valuables or important documents in a clearly visible
location.
• Keep an eye on things such as phone usage, medications, etc.
• Try not to get overly involved with your employee’s private life or lend
things like money, vehicles, or furniture.
Recognizing Abusive Behaviors
Sometimes a provider, family member or friend steps over the line and
becomes disrespectful or even abusive to an IHSS consumer. If you feel
uncomfortable around your provider because of disrespectful treatment,
or if you observe your provider taking advantage of you or mistreating you:
it is important that you let your social worker know about the situation
immediately. Describe the provider’s behaviors to friends, family members,
and your social worker; and ask them to help you evaluate whether you are
seriously at risk in keeping this provider.
In California, abusing a dependent adult or an elderly person is a crime
punishable by law. Criminal abuse of elderly and dependent adults includes
physical or sexual abuse, financial abuse, neglect, and psychological abuse or
intimidation. Some examples of each include:
Consumer Handbook Chapter 8 71
Setting and Maintaining Boundaries
Physical or sexual abuse
• Cuts, lacerations, bruises, welts.
• Any injury that is incompatible with the consumer’s health history or not
properly cared for.
• Poor skin condition or hygiene.
• Absence of hair and/or hemorrhaging scalp.
• Dehydration, malnourishment or unexplained weight-loss
• Cigarette burns or rope marks.
• Soiled clothing or bed.
• Physical coercion, confinement. A consumer may not be locked in rooms,
tied down, or overmedicated
• Unwanted sexual advances, including assault accomplished through
coercion, intimidation, force, or fear.
Financial abuse
• Unusual or inappropriate activity in the consumer’s bank account.
• Signatures on checks and other documents that do not resemble the
consumer’s signature.
• “Power of Attorney” signed, or recent changes in a will, when the
consumer does not remember making such decisions.
• Lack of amenities that the consumer can afford, such as clothing, food, or
medicine.
• Unpaid bills or overdue rent—when someone is supposed to be paying
the bill.
• Extortion or fraud
• Missing personal belongings such as silverware or jewelry.
72 Chapter 8 Consumer Handbook
Setting and Maintaining Boundaries
Neglect by the provider or family members
• Safety hazards in the environment.
• Unattended rashes, sores, lice.
• Inadequate food or water
• Insufficient heating or cooling
• Infrequent baths
• Infrequent changes of bedding and clothing
• Limited access to medical treatment
• Abandonment
Psychological abuse or intimidation
• The consumer may not be given the opportunity to speak for him/
herself.
• Family members or provider “blames” the consumer for incontinence,
stating that it is a “deliberate act” to get attention.
• Aggressive behavior (threats, insults, harassment) towards the consumer.
• Family member or provider problems with controlled substances
(alcohol, drugs).
• Deliberate social isolation from family or friends, or restriction of the
consumer’s regular activity.
• Conflicting accounts of incidents by the provider, family, supporters, and
the consumer.
• Unwillingness or reluctance by the provider or family members to
comply with care planning and implementation.
• Inappropriate defensiveness by the provider.
• Feelings of fear, depression or confusion on the part of the consumer.
Consumer Handbook Chapter 8 73
Setting and Maintaining Boundaries
Reporting Abuse
If you are being subjected to any form of abuse, report the situation
immediately to Adult Protective Services (APS) or the Sheriff’s Office. It is
important to get help, even if your abuser is a family member. There are
people and organizations in every community who want to keep dependent
and elderly adults safe. Don’t be afraid to reach out and let them help you.
Finally, homecare providers are, under California law, “mandated reporters.”
This means that they must report to APS or law enforcement any abuse
that they observe. If a provider observes abuse of his/her client by a family
member, the provider is obligated to report that abuse to the authorities.
So if you are being abused by a family member, seek help from your provider
in reporting that abuse. If you are being abused by a provider, seek help from
your family, friends or social worker in firing or otherwise controlling your
provider.
Chapter 9
9. Enrolling and Paying
Your Provider
Consumer Handbook 75
Chapter 9
Enrolling and Paying Your Provider
The Enrollment Process
When an IHSS recipient hires a new provider, the following information about
the caregiver needs to be communicated to IHSS Payroll:
• Name as it appears on the individual’s Social Security Card
• Telephone number
• Social Security Number
• Date of birth
• Date of the first day on the job
• Familial relationship, if any, to the consumer
• The provider’s preferred language
Some counties ask the consumer to report this information directly to their
social worker, who forwards the information to the Payroll office.
The provider will be mailed a provider enrollment agreement. The provider
should fill out this form completely and accurately and mail it immediately to
IHSS Payroll at the address given on the form. Providers must complete a new
enrollment form for each IHSS recipient they work for. Providers cannot be
paid until they send in a new enrollment form. A delay in returning the signed
enrollment form will cause a delay in receiving their paycheck. As the employer,
you can help your providers by reminding them to complete this form
promptly. This will reduce the time it takes for their first paycheck to arrive.
76 Chapter 9 Consumer Handbook
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When the IHSS payroll office receives the enrollment form, they will send the
provider a timesheet in the mail. Providers will need to complete a timesheet
at the end of each pay period. Both the provider and the consumer must sign
and date the timesheet, and it must be mailed to the address printed on the
timesheet.
Normally, your provider should receive their paycheck within 10 business
days or 14 calendar days from the date the completed timesheet is mailed
to Payroll. A timesheet for the next pay period is attached to each paycheck.
Let your new provider know that their first paycheck may not arrive for 3 to
6 weeks from the time they mailed the payroll enrollment form. Once IHSS
receives the enrollment form and verifies the information with the Social
Security office, timesheets are mailed to the provider, usually within two
business days. The provider will be sent all the timesheets they need to catch
up to the current pay period. IHSS pay periods run from the 1st of the month
through the 15th and from the 16th through the last day of the month.
When a provider signs the enrollment form, they are verifying that they have
not been convicted of fraud or abuse in government health care programs,
IHSS, or Adult or Child Protective Services. If a conviction is discovered later,
the provider will be excluded from serving an IHSS consumer and may be
subject to other legal penalties.
The Consumer’s Timesheet Responsibilities
As the on-site employer, the consumer is responsible for keeping track of the
number of hours a provider works each day and checking to make sure that
the correct number of hours are entered on timesheets. Maintaining a task
grid is one way to keep track of the number of hours worked. (See Chapter
5 for a sample task grid and a discussion of how to use it.) The provider can
copy hours directly from the task grid to the timesheet and the consumer can
compare the two to make sure they match.
If the consumer has multiple providers, they must also make sure that each
provider does not report more than the number of hours they have been
assigned. The assigned hours should be written on each provider’s task grid.
This helps the consumer and provider stay within the assigned number of
Consumer Handbook Chapter 9 77
Enrolling and Paying Your Provider
hours and helps the consumer when they are checking the accuracy of the
timesheet. Providers who work more than the assigned number of hours will
not be paid for the extra hours. Consumers who allow their providers to work
more than the authorized hours are taking advantage of their providers and
risk losing them.
Timesheets should be completed after the first pay period, which ends on
the 15th, and after the second pay period, which ends the last day of each
month. After you and your provider sign the timesheet, it should be mailed
immediately to the address given on the form. You can help your provider
receive their paycheck promptly by making sure that the timesheet is filled out
correctly, signing it, and encouraging the provider to mail it immediately.
Payroll inputs timesheets the same day or the day after they are received, but
incorrect timesheets take longer to process. If a timesheet has errors or is not
complete, the provider’s paycheck may be delayed. Incorrect timesheets may
be returned to the provider so they can be completed correctly. The consumer
and provider can avoid timesheet errors by reading the directions on how to
fill out timesheets correctly that Payroll sends with the initial timesheet. These
directions are also included in this chapter.
The provider’s paycheck is mailed from the State Controller’s Office in
Sacramento two business days after Payroll inputs the timesheet into the
computer (Saturdays, Sundays, and holidays are not business days). If the
provider loses their check or does not receive it within 10 business days from
the date they submitted the timesheet, the provider should call Payroll.
How to Fill Out a Timesheet
A provider’s regular timesheet is printed by a computer and should already
have the following information printed on it:
1. The consumer’s and provider’s name and address.
2. The consumer’s and provider’s identification numbers.
3. The number of service hours authorized for the consumer. The
timesheet for the first half of the month shows the hours for the whole
month. The hours shown on the timesheet for the second half of
78 Chapter 9 Consumer Handbook
Enrolling and Paying Your Provider
the month are the total hours for the month minus the hours paid in
the first half of the month. If a consumer has multiple providers, the
hours remaining include those assigned to other caregivers. It is the
consumer’s responsibility to let each provider know how many of the
remaining hours are assigned to them. The State has no way to know
how individual consumers assign hours to multiple providers. It is crucial
that the consumer assign these hours at the beginning of the two week
period, long before the new timesheet arrives. Otherwise, providers
could work more than the remaining number of hours. In that case, they
would not be paid for their work.
4. The dates of the pay period (including month and year).
5. The consumer’s Share-of-Cost (if any). This is the maximum amount of
money the consumer pays the provider directly for IHSS services during
the month.
6. Any reduction in the check for a prior overpayment.
7. The IHSS Payroll Address where the provider should mail the completed
timesheet.
8. The employee number of the consumer’s IHSS social worker.
If the timesheet is filled out correctly and submitted on time, the provider will
receive their paycheck within 10 business days from the time it was mailed.
The check will be delayed if the timesheet is torn, unreadable or incorrectly
completed. It will also be delayed if it is turned in too early – before the end of
the pay period – or too late.
Here are some tips to help you and your provider avoid timesheet problems:
Use black or blue ink only to write the hours worked. Numbers must be
readable. Timesheets completed in pencil will not be accepted.
Write the number of hours worked in the boxes under the dates. The provider
should fill in the number of hours s/he worked each day of the pay period on
the day worked unless s/he is doing this on a task grid.
Check to make sure the hours reported for the days worked during the pay
period are equal to, or less than, the hours authorized for that pay period.
Consumer Handbook Chapter 9 79
Enrolling and Paying Your Provider
Do not cross out or change provider or consumer names in the identification
boxes at the top of the timesheet. Acceptable timesheets are preprinted with
the consumer and provider names. These can be obtained from the local IHSS
payroll office.
Cross out mistakes in the hours reported and write in the correct information.
The consumer must initial the correction. Do not fix mistakes with correction
fluid or correction tape.
Sign and date the timesheet in ink at the end of the pay period, and not
before. Both the provider and the consumer must sign the timesheet after the
hours have been worked.
Tear off the “Statement of Earnings and Deductions” before mailing.
Mail completed timesheet to the IHSS Payroll Mailing Address given on the
form as soon as possible after the 15th and the last day of each month.
Send questions or inquiries to the consumer’s social worker in a separate
envelope.
The State asks that providers fill in the number of hours worked each day of
the pay period using decimals to designate partial hours. Each tenth (.1) of
an hour equals 6 minutes. To convert minutes into tenths of an hour, simply
divide the number of minutes worked by 6. For example, 2 hours and 48
minutes would be written 2.8. Or, you can use the conversion table below to
find the tenth of an hour that matches the number of minutes worked.
Minutes in tenths of an hour:
1 - 6 minutes = .1 31 - 36 minutes = .6
7 - 12 minutes = .2 37 - 42 minutes = .7
13 - 18 minutes = .3 43 - 48 minutes = .8
19 - 24 minutes = .4 49 - 54 minutes = .9
25 - 30 minutes = .5 55 - 60 minutes = .10
Example: If a provider works 1 hour and 42 minutes they should write “1.7”.
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Enrolling and Paying Your Provider
For days that the provider does not work, they may leave the box blank or put
an “0” or an “x” in the box. Sum up the total hours worked for the pay period
and put that number in the far right hand box of the “Hours worked” row.
Or, leave this box blank and IHSS Payroll will write in the total.
If the provider’s address changes, check the “yes” box where indicated on the
front of the timesheet and write the new address on the back of the timesheet.
Please note that it is a violation of IHSS regulations for the provider and the
consumer to submit a timesheet showing more hours than the provider
actually worked.
Common Timesheet Mistakes
• Information is left out.
• The timesheet is not signed by both the provider and the consumer.
• A pencil is used to fill out or sign the timesheet.
• The numbers cannot be read.
• A mistake is covered with correction fluid (white out).
• The number of hours worked in the pay period is not entered correctly.
• Some of the information on the timesheet was torn off when the pay stub
(the upper part of the form) was detached.
• The timesheet was mailed before the last day worked in the pay period.
• More hours are claimed than were authorized for payment.
Share-of-Cost (SOC)
Some IHSS consumers pay a share of the cost of their household and personal
care directly to their provider. This happens when an applicant’s age or disability
status qualifies them for IHSS, but their income is higher than the Supplemental
Security Income level. The State of California pays the remaining costs.
When you are interviewing a potential provider, you should tell them if you pay
a SOC for their services. The maximum amount of your SOC should be included
in your work agreement. This figure will be the maximum that you would pay
directly to the provider.
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Enrolling and Paying Your Provider
An IHSS consumer with a Share-of-Cost (SOC) pays the consumer’s share to the
provider when the consumer receives an “Explanation of Share-of-Cost Letter”
that identifies the amount of the SOC to be paid that pay period.
Typically, consumers will owe most, if not all, of their SOC for the first pay
period of the month. The provider’s paycheck for this period will arrive close
to the end of the month. Consumers may need to plan ahead to have monies
available if their monthly income arrives after the first of the month.
The State will deduct as much of the SOC as possible from the first pay period
check. If first pay period earnings are greater than the SOC, all of the SOC
will be deducted from the first pay period check. The consumer will pay the
provider the full SOC for the month when that check arrives. If first pay period
earnings are less than the SOC, the provider will receive a State paycheck for
$0.00 and the remaining SOC will be deducted from the second pay period
check. In this case, the consumer will pay the provider part of the SOC when
the first pay period check arrives and part when the second pay period check
is received.
For consumers who receive IHSS as part of their Medi-Cal benefits, the
consumer’s total SOC can be applied to both IHSS and Medi-Cal services. In
some months, the consumer may spend all of the SOC on Medi-Cal services.
In that month, the consumer will not pay any of his/her SOC to the provider.
Instead, the State will pay the provider for all the authorized hours the provider
worked during that month. Please note that the amount the consumer pays
to the provider may change with each paycheck issued, depending upon the
amount of medical payments made by the consumer each month.
Consumers who do not pay the requested SOC each month will be dropped
from the IHSS program. Providers are asked to notify the consumer’s social
worker if the SOC is not paid. Personal and household care will stop at the end
of the month in which failure to pay was reported.
A few IHSS consumers receive advance pay, which means IHSS pays the
consumer at the beginning of the month, and the consumer then pays the
provider (minus the withholding). If this applies to you, you will be notified
by Payroll.
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Enrolling and Paying Your Provider
Payroll Deductions and Benefits
If you are an IHSS consumer with a family provider, you may be interested in
knowing about the payroll deductions and benefits that affect your family
member. This section explains the payroll deductions and the benefits
available to all providers.
Deductions
IHSS providers are required to contribute to the federal Social Security system
and some are required or may elect to contribute to State Disability Insurance
(SDI). These contributions are deducted from the provider’s paychecks. Each
deduction is described in more detail below.
Social Security benefits are available if the provider becomes totally disabled
or retires and meets certain eligibility requirements. The benefits include a
monthly payment to the provider or their dependents from the Social Security
system. The size of the payment depends upon their lifetime earnings and
the number of years they contributed to the system. The provider will also
be contributing to Medicare, a federally sponsored health care program.
Medicare benefits will be available to the provider at age 65. They may qualify
for Medicare before age 65 if they are receiving Social Security Disability (SSD)
payments.
Federal Insurance Contributions Act (FICA). The Social Security deduction is
called FICA. It is deducted from the paychecks of all IHSS providers except the
parent provider of a child under 18 who is receiving IHSS. Your provider or
family member may contact your local Social Security Administration Office for
more information about Social Security and how to apply for it.
Medicare Tax. Medicare is the health and medical benefits that providers will
receive along with the Social Security benefits package. Contributions are
based on a percentage of their income.
State Disability Insurance (SDI). State Disability Insurance benefits are
available for people who become disabled and are prevented from doing
their regular work, if they meet certain eligibility requirements. SDI benefits
are available for a maximum of 52 weeks. Contact your local Employment
Consumer Handbook Chapter 9 83
Enrolling and Paying Your Provider
Development Department office for more information about SDI and, if
needed, how to apply for it. Caregivers who are providing IHSS services for
a parent, spouse, or child do not have to contribute to SDI. However, they
may choose to participate in the SDI program by applying for Elective State
Disability Insurance. Forms for Elective SDI coverage are available from the
county social worker. If caregivers providing services for a parent, spouse, or
child do not elect to participate in SDI, SDI will not be available to them should
they become disabled for work. All other IHSS providers are automatically
covered for SDI if they have IHSS quarterly wages in excess of $750.00. SDI
contributions are deducted from their paycheck.
Union dues. California’s homecare workers are represented by three
unions: the Service Employees International Union (SEIU), United Domestic
Workers/American Federation of State, County and Municipal Employees
(UDW/AFSCME), and California United Homecare Workers Union (CUHWU).
The unions bargain with the IHSS Public Authorities for wages and benefits.
Deductions for union dues are made from the paychecks of providers who
have worked 15 or more hours per month.
Health and Dental Insurance. In many counties, health and dental insurance
are available to homecare providers through the unions. To be eligible,
providers must pay union dues and pay a share of the premium for both types
of insurance. The specific plans and entry requirements vary by county. Call
the local union or your social worker to find out more about the coverage
in your county. Health and dental insurance can be terminated when the
provider’s hours drop too low. If provider insurance is terminated, there may
be a disqualification period before eligibility for benefits can be reestablished.
If your provider’s health care insurance is terminated, he/she may be eligible
for caregiver-paid coverage under COBRA.
• Is your provider without insurance?
If your provider does not have health insurance and needs assistance
while waiting to be enrolled, contact the Health and Human Services
Department in your county. This department has programs for
individuals who economically qualify for care under Medi-Cal and the
County Medical Services Program (CMSP).
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Enrolling and Paying Your Provider
• Does your provider already have health coverage?
If your provider has coverage now, they should carefully compare the
plans, co-payments and costs to decide which plan is best for them. If, for
example, they are covered by Medi-Cal, they may not have any monthly
contribution or co-payment when using a service. This comprehensive
health care system may be less expensive than the health insurance
offered to IHSS providers through the unions.
• Can spouses or dependents enroll?
Plans vary by county. Healthy Families offers low cost coverage for
dependent children of low-income families. Your provider can contact
Healthy Families staff at (800) 880-5305 or at: www.healthyfamilies.
ca.gov.
Benefits
Unemployment Insurance (UI). Unemployment Insurance (UI) benefits may
be available to IHSS providers if they become unemployed and are able and
available to work and meet certain eligibility requirements. UI benefits are
available for a maximum of 26 weeks. Your provider may contact your local
California Employment Development Department (EDD) office for information
about unemployment insurance and how to apply for it or call 1-800-300-5616.
UI benefits are not available to IHSS caregivers who are the parent or spouse of
an IHSS recipient. There is no paycheck deduction for UI.
Workers’ Compensation. If your provider is injured on the job or becomes ill
as a result of it, the State will pay for their medical care and an income stipend
through the State Compensation Insurance Fund (SCIF). To qualify, they
must meet certain eligibility requirements. There is no deduction from their
paycheck for the cost of Workers’ Compensation.
If your provider is hurt on the job:
• They should seek medical attention immediately. IHSS caregivers can
choose their own Primary Care Physician (PCP) for treatment as long as
the physician receives reimbursement from SCIF. This can be confirmed
on SCIFs website (http://www.scif.com/MPN/MPNHome.html).
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Enrolling and Paying Your Provider
• Then, notify the consumer’s social worker.
• Ask the social worker for a claim form to apply for Workers’
Compensation. The provider is required to file a form describing the
nature of the injury or illness, when it occurred, and how and where it
happened.
• Complete and return the form immediately to the IHSS office in the
return envelope provided. IHSS will send the form to SCIF. Then, a
representative from SCIF will contact the provider with an explanation of
any benefit entitlement or to deny the claim.
Earned Income Credit (EIC). The Earned Income Credit (EIC), also known as the
Earned Income Tax Credit (EITC), is a federal program that provides a credit
or cash supplement to low and moderate-income workers who qualify. For
those who are eligible, the EIC will either lower the amount of tax owed to the
federal government for the prior year or provide a refund for taxes already
paid. To qualify for the EIC:
• The provider (or their spouse) must have a job and file a federal tax
return with the IRS.
• Workers with no children must have an earned income below $12,490;
workers with one child must have an earned income below $31,338; and
workers with two or more children must be below $35,458. (2004 income
ceilings)
Claiming the EIC will not affect eligibility for other programs such as:
• Temporary Assistance to Needy Families (TANF)
• Medicaid (Medi-Cal)
• Supplemental Security Income/State Supplementary Payment (SSI/SSP)
• Food stamps
• Housing assistance
However, if the provider receives an Earned Income Credit (EIC) payment and
fails to spend it in a certain period of time, it might be counted as an asset and
affect their eligibility for these other programs. Immigrants who are legally
authorized to work may claim the EIC.
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Enrolling and Paying Your Provider
Income Tax Withholding. Income tax withholding for IHSS homecare providers
is strictly voluntary. If your provider wishes to have state and federal income
tax withheld from their paycheck, they should complete the Income Tax
Withholding Form (W-4) and mail it to your county welfare department.
All IHSS providers must file a tax return on or before April 15th of each year,
whether or not they have state or federal taxes withheld from their paycheck.
They should contact the consumer’s IHSS social worker if they need additional
W-4s, or if they need to change their withholding or determine the status of
their withholding. Contact your local California Franchise Tax Board (FTB) office
for additional information about state income tax withholding or your local
Internal Revenue Service Office (IRS) office for additional information about
federal income tax withholding.
Chapter 10
10. Safety
Consumer Handbook 87
Chapter 10
Safety
Universal Precautions
Universal precautions are methods that providers should use to protect
themselves and those they provide care for from getting ill. These precautions
should be followed by anyone providing a service which may involve contact
with blood or body fluids. Body fluids include saliva, mucus, vaginal secretions,
semen or other internal body fluids such as urine or feces.
Basics of universal precautions
• Have your provider use protective barriers such as gloves or facemask
depending on the type and amount of exposure expected.
• Remind your provider to be careful to always wash their hands before and
after tasks. This includes reminding your provider to wash their hands:
Before and after contact with you
Before and after preparing food
Before eating
Before putting on and after removing gloves
Before and after using the restroom
After removing protective clothing
After contact with body fluid or other contaminated items
After blowing nose, sneezing, coughing, etc
After cleaning
After smoking
After handling pets
88 Chapter 10 Consumer Handbook
Safety
• Encourage your provider to avoid accidental cuts or needle sticks and
to keep cuts covered.
• Remind your provider to use soap and water or bleach solution to clean
and disinfect any surfaces contaminated with blood or body fluids.
Hand Washing
➊ Make sure you have everything you need at the sink.
paper towels
➌ Rub palms together to make
lather. Scrub between fingers and
entire surface of hands and wrists.
Scrub hands for at least
10 to 15 seconds.
➍ Rinse hands thoroughly.
Point fingers down
so water does not
run up your wrists.
➎ Dry hands with clean towel
➏ Use a clean paper towel
to turn off the faucet. Use
hand lotion if available to
prevent chapping.
Scrub
wrists.
Clean fingernails
by rubbing the tips
of your fingers
against your palms.
liquid soap
trash can
➋ Turn on warm water.
HANDWASHING IS THE SINGLE MOST
IMPORTANT MEANS OF PREVENTING
THE SPREAD OF INFECTION
Keep warm water running
while washing your hands.
Consumer Handbook Chapter 10 89
Safety
Removing Gloves Safely
Assume that all used gloves are contaminated. When you or your provider
removes them, make sure to follow these steps so that the outside of the gloves
does not touch any bare skin.
➊ With one gloved hand,
grasp the other glove
just below the cuff.
➋ Pull the glove
down over your hand
so it is inside out.
➌ Keep holding the glove with
your gloved hand and crumple
it into a ball.
➍ With two fingers of the bare
hand, reach under the cuff of
the second glove.
Danger: do NOT touch
bare hand to dirty glove.
➎ Pull the glove
down inside out
so it covers the
first glove.
➏ Both gloves are
now inside out.
You can throw
them away safely.
➐ Wash your hands.
90 Chapter 10 Consumer Handbook
Safety
Home Safety and Emergencies
You and your provider should discuss the best ways to make your home a safe
environment. This includes talking about:
• Possible safety hazards in the home
• Finding ways to make things safer
• Knowing how to handle emergencies if they happen
Hazardous chemicals and cleaners, electrical cords, throw rugs and floor
coverings, walkways and water pose some of the most common home safety
hazards. By following these guidelines, you and your provider can make your
home safer.
Hazardous chemicals and cleaners
• Label all containers.
• Know what steps need to be taken if the chemical is swallowed, splashed
in the eyes, or comes in contact with the skin.
Electrical cords
• Do not use a cord if it is frayed or has exposed wires.
• Keep cords out of walkways. Do not place cords under rugs.
• Avoid overloading electrical outlets.
Throw rugs and floor coverings
• Secure all floor coverings to prevent tripping and falls.
• Repair loose threads or holes in carpets.
Walkways
• Keep walkways clear of clutter.
• Allow space for using walker, cane, or wheelchair.
• Keep walking paths well lit to prevent tripping.
Consumer Handbook Chapter 10 91
Safety
Water
• Clean spills immediately to prevent slips or fall.
• Keep electrical appliances away from water.
• Use handrails and bathmat in tub/shower to prevent slips or falls.
• Set maximum water temperature on water heater to 120 degrees to
prevent burns.
It is important for you and your provider to be prepared to deal with any
emergencies that may happen.
• Discuss with your provider a plan for handling emergencies.
• Make sure your provider knows the location of first aid kit or emergency
supplies.
• Have a list of numbers to call in an emergency (for example, family,
doctor, social worker).
• Have your medical information available for emergency response
personnel, and make sure that your provider knows where this is located.
• Know what exit routes to take in case an emergency evacuation is
needed, and go over it with your provider.
• Post your full address near all telephones, so it is available if calling 911.
• Make sure your provider knows if you have a living will, an advanced
directive or a “Do Not Resuscitate” (DNR) order, and where it is located.
This information is needed for any emergency personnel that may
respond to a 911 call.
If you or your provider need to call 911:
• Briefly describe the problem.
• Give address and the nearest major street or intersection.
• Stay on the phone and follow the directions of the emergency operator.
92 Chapter 10 Consumer Handbook
Safety
Preventing Falls
Wet, slippery surfaces make
bathrooms high-risk areas for falls.
• Use mats in showers
and tubs.
Raised seat
rests on
normal
toilet.
Two rails are better
than one.
• Use hand rails in tubs and
next to toilets.
Hand Grips
• Safety toilet seats make
standing and sitting easier.
Hand grips help prevent
falls. Special seats for the
bath are also available.
• All rooms should have
good lighting, especially
hallways and stairs.
• Stairs should
have a strong
hand rail and
be free of
clutter.
• Throw rugs are a serious trip
hazard - even if they have a
non-slip mat.
Watch for fall hazards.
Consumer Handbook Chapter 10 93
Safety
Fire Prevention – Watch for Fire Hazards
The graphics used in this chapter were adapted from the Revised Fundamentals of Caregiving,
Washington State Department of Social and Health Services.
Using damaged electrical cords
or plugging too many cords into
an outlet can start a fire.
• Lamp, appliance and extension
cords that are frayed,
discolored, or cracked.
• Cords under rugs - stepping on
them can break the cord and
start a fire.
• More cords in the outlet than it
is made to take.
This outlet
is made for
2 cords.
Sparks can
cause fires.
Outlet splitters
can cause fires.
danger
If you or your provider
smoke, encourage
smoking safety rules.
• No smoking in bed or
when sleepy.
• Smoking near
oxygen is like
smoking near a
bomb.
• Empty ashtrays when
ashes are cool. Hot
ash can cause fires.
• Move ashtrays away
from things that
burn easily, including
papers, drapes,
bedding, and cloth
furniture.
Smoke Alarms
• Batteries need to be
replaced twice a year.
