Wages Adjusted for Inflation: Over the past decade, inflation-adjusted median hourly wages for Nursing Aides, Orderlies, and Attendants in California increased by 17 percent, from $8.40 to $9.86. Real wages for Personal Care Aides increased by only 5 percent while those for Home Health Aides declined.
Employer-Sponsored Insurance: Compared to the national civilian workforce, significantly fewer of California’s direct-care workers have access to and use employer-sponsored insurance. Some work for employers that do not offer health insurance. Others work for employers that limit eligibility for health insurance to full-time employees. This creates a barrier for many direct-care workers, especially those in home and community-based settings, who often work only part-time due to the episodic nature of direct-care work. Even workers who do have access to insurance from their employer may find the co-pays and premiums unaffordable.
AB 1612/SB 852 (IHSS “Provider Tax”): Upon federal approval, this bill imposes a sales tax on In-Home Supportive Services (IHSS) providers – most commonly referred to as a “provider fee.” This tax would allow the State to access additional Federal Medicaid matching funds to support the IHSS program. The provider will be held harmless, however, in that the state will cover the amount of the tax on behalf of the provider. (Adopted October 19, 2010)
AB 1682 (WIC 12302.25): This legislation, adopted in 1999, requires each county in the state to create an employer of record for independent providers providing services and supports under the In-Home Supportive Services (IHSS) Program, California’s largest in-home care program. The employer of record must: establish a registry of potential IHSS workers; provide potential worker referrals to IHSS consumers; conduct background screening of IHSS workers; and make available training for IHSS workers and consumers.
PHCAST Grant: California is one of 6 states awarded a 3-year grant by the federal government to develop a training and credentialing program for personal care attendants (PCAs), as part of the Personal and Home Care Aide State Training Program, a provision of the Affordable Care Act of 2010.
Direct Support Professional Training: The California Department of Developmental Services, in cooperation with the Department of Education, has established a mandatory competency-based training program for all direct support staff working in licensed community care facilities. The training is divided into two 35-hour segments to be completed in successive years. DSPs may elect to take a challenge test for each segment of the curriculum, but must pass in order to be exempted from training. The curriculum is free and available for download.
San Francisco Public Authority: Since 1996, the San Francisco IHSS Public Authority has served as the employer of record for home care workers providing services and supports under the In-Home Supportive Services (IHSS) program in San Francisco. IHSS is a statewide publicly-funded program providing personal assistance services to low-income people with chronic and disabling conditions. The Authority has advocated for raising worker wages, and provides health and dental insurance. It also operates a matching service registry to provide lists of screened workers to IHSS consumers for potential in-home employment, and arranges training and support services for both workers and IHSS consumers.
Costs and Benefits of In-Home Supportive Services for the Elderly and Persons with Disabilities: A California Case Study (PDF): This 2010 briefing paper examines the cost-effectiveness of California’s state-funded IHSS program, which facilitates in-home services and supports for low-income with chronic and disabling conditions. Among other things, it argues that cutting the IHSS program in order to lower the state’s deficit is short sighted because money spent on the IHSS program has huge multiplier effects since 85 percent of the spending goes directly to pay for the wages of IHSS workers. One billion dollars spent by the state on the IHSS program generates 216,000 full-time equivalent jobs and contributes $360 million in state income tax revenue.
Impact of California’s Medi-Cal Long Term Care Reimbursement Act on Access, Quality and Costs (PDF): This 2008 report from the PAS Center at UCSF evaluates the initial impact of California’s new nursing home reimbursement system, created by the Medi-Cal Long Term Care Reimbursement Act of 2004 (AB 1629), on access to services, quality of care, and the finances of freestanding nursing homes accepting Medi-Cal residents. Among other things, the Act increased average hourly wages for direct-care staff.
Impact of Medical Benefits on the Los Angeles County IHSS Workforce: A Five-Year Study: In Los Angeles County, personal care workers (PCW) who meet eligibility requirements can receive healthcare benefits. Since 2003, the Personal Assistance Services Council (PASC) of L.A. County has commissioned annual studies (the results of which are posted here) to examine how these benefits have affected retention and quality.
PHI State Facts: California’s Direct-Care Workforce (PDF): This PHI Fact Sheet on California, released in November 2010, outlines demographics, employment projections, and policy issues related to the direct-care workforce in California.