A protester of California's cuts to home care. (photo by Steve Rhodes)

California’s ongoing budget disaster edged nearer to some sort of resolution last week as state lawmakers approved a proposal to close the $25.3 billion gap through a package of 29 pieces of legislation.  The bills included spending cuts, revenue solutions, borrowing, and fund shifts. The state’s In-Home Supportive Services program (IHSS), long recognized as one of the most generous home care programs in the nation, lost $226 million in funding.

The IHSS budget cut is expected to remove 40,000 elderly people and individuals with disabilities — nearly 10 percent of all recipients – completely from the program, to cause 85,000 more recipients to lose domestic services (e.g., laundry, meal preparation, transportation to medical appointments), and to raise the monthly cost for care by as much as $200 for many others.

This  despite the fact that, as stated by The Modesto Bee — in words echoing those of numerous home care advocates — “The program, which in many cases pays family members to help their loved ones with bathing, dressing and using the bathroom, has proved to be far less expensive than caring for the patients in nursing homes” (“Safety net for poor, disabled in tatters after plan’s cuts, health care advocates say,” July 22).

Budget agreement

Both houses of the California legislature approved the budget plan at the end of last week, and it is expected to be signed into law by Gov. Arnold Schwarzenegger on Tuesday. On Monday the Associated Press reported that there was speculation among human services advocates that the governor would issue line-item vetoes to cut even more funds from health and welfare services, specifically in the area of administrative funding.

In addition to IHSS, other health care and health-related programs that suffered significant cuts in the new budget were Healthy Families, California’s low-cost health insurance for the working poor( $144 million); Medi-Cal, the state’s Medicaid program( $1.3 billion); and Developmental Services, the state agency that provides services and supports to individuals with developmental disabilities ( $334 million).

Senate President pro tem Darrell Steinberg (D-Sacramento) said in a press release, “There are a whole host of decisions on the cuts side that pain me greatly — deep cuts to education, to health and human services and to local government.  Given the circumstances, I am grateful for all the things we were able to save.”

Impact on consumers and workers

PHI spoke with several individuals in California to assess the impact of IHSS cuts on direct-care workers and IHSS consumers.

Donna Calame, executive director of the San Francisco IHSS Public Authority, said home health workers in San Francisco are covered by a local minimum compensation ordinance, which means they will likely not have their wages reduced “unless the budget situation really becomes untenable.” But she pointed out that San Francisco may be the only place in the state that has such an ordinance, and in any case, “The budget pressures are so tough that we may have to ask the union and workers for some shifts in the benefits.” Furthermore, she said that since the state has proposed cuts to services and certain groups of people, there are likely to be fewer jobs for IHSS workers.

She also said that since since “about half” of the IHSS program is staffed by family members who may not have a lot of interaction with their union or other sources of program information, there’s a likelihood that at least some of them won’t be aware the cuts are approaching, even though the media coverage of the budget crisis is intense. “A lot of folks are going to be totally shocked when they either lose their IHSS service or have their service hours reduced, and/or their worker gets a smaller paycheck than expected,” she said.

Beth Capell, lobbyist for the SEIU state council, also spoke about the impact on families. “It’s not just about jobs,” she said. “A majority of caregivers are family members who quit other jobs to care for loved ones who have severe disabilities or severe limits on their abilities due to age or dementia. This work is very hard, and these workers get paid very little for it. Just ask our President.”

Evan LeVang, executive director of Independent Living Services of Northern California, noted that the new budget is going to mean thousands of job losses, a lot of them IHSS workers.  He called the budget agreement “a real job killer’ and “an anti-stimulus” at a time when California is already reeling from job losses.

But even so, he says there’s a positive angle to be found in the situation: “It could have been much worse. The original proposals several months ago had much worse cuts to IHSS and Medi-cal and other programs, some of them as much as 90 percent. So compared to what was possible, what we actually got is a pretty good outcome.”