Many of the direct-care workers who provide consumer-directed care in California cannot access workers’ compensation assistance when they are injured on the job, according to a recent study. And that finding has “important implications for workers’ health and the sustainability of consumer-directed programs-within and beyond California,” according to authors Teresa Scherzer and Nicole Wolfe of the University of California, San Francisco, PAS Center.

The problem will only grow worse as consumer-directed programs gain in popularity, the authors warn, unless systems are put in place to ensure that injured workers get the help they are entitled to. “Building on the recommendations we present to more effectively respond to occupational injury would be a feasible first step,” they write in “Barriers to Workers’ Compensation and Medical Care for Injured Personal Assistance Service Workers.”

Scherzer and Wolfe conducted in-depth interviews with a number of independent providers who assist consumers who direct their own care through California’s In-Home Supportive Services (IHSS) program.

For comparison’s sake, they also interviewed several agency-employed home care workers who provide personal assistance services (PAS). The agency-employed workers generally knew they were eligible for workers’ compensation and were able to access it promptly when needed, they found, but the independent providers often did not.

“A key finding is that, while both agency employees and independent providers shared certain barriers to workers’ compensation and medical care, independent providers faced numerous difficulties due in part to the absence of a traditional ‘employer’ or ‘identifiable management,’” said Scherzer in an email exchange.

Independent providers were often reluctant to report their own injuries. Some simply didn’t know help was available, but most who hesitated to file a report either feared the loss of income from missed work, felt an obligation to their clients to report to work, or feared that they would hurt their chances of continuing to provide PAS if they filed a claim.

But even when they did try to access assistance through workers’ compensation, independent providers were often given “the runaround” by IHSS personnel, who had too many workers to manage and no protocol to follow in responding to injury reports. The resulting delays often lasted for weeks, even months.

As a result, the authors write, “access to workers’ compensation often depended on a combination of knowledge about independent providers’ eligibility, skill or persistence in dealing with bureaucracies, assistance from the union, English language proficiency, and the sheer luck of connecting with a responsive individual at IHSS.”

The report includes personal histories that outline what individual workers went through, describing misunderstandings about eligibility on the part of workers and consumers and the lack of formal structures within IHSS to assist injured workers.

The authors recommend that agencies coordinating consumer-directed PAS have a designated “worker support” office or staff independent providers can contact about injuries and other work-related issues. They also recommend having workers report to that office when hired, since a face-to-face meeting with the staff could “help educate workers about their responsibilities and rights, procedures for reporting occupational injury, and introduce this office as a potential resource for assistance should problems arise.”

They also call for more research on the topic – especially in other states. The barriers to assistance for independent providers is likely to be worse elsewhere, they note. This is partly because IHSS, unlike many publicly funded independent provider programs, is guided by a coalition of stakeholders that provides “a collective voice for both consumers and workers,” and partly because California is one of only 15 states in which independent providers are eligible for workers’ compensation.

The report was published in Home Health Care Services Quarterly, Volume 27, Issue 1. It is free to subscribers only; others must pay.

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org