Privatization of In Home Supportive Services: Not a realistic way to save state resources or care for the needy
Surprisingly, some Republicans in the Legislature have come out against cutting In Home Supportive Services (IHSS) as Governor Brown has proposed. The surprise was short-lived when we learned they wished to privatize the program’s administration. The theory goes that private agencies assigning IHSS contract workers will find opportunities to consolidate services and discover new efficiencies. While there is no reason why such consolidation and efficiencies couldn’t be found with the existing public administration, still I commend my colleagues for their desire to protect these most vulnerable individuals. But, as a test case in Tulare County demonstrated, privatizing these services is not the best way forward.
Our current system of IHSS administration is known as “individual provider mode.” Under this system, an individual who qualifies for IHSS assistance is assessed by a social worker, assigned a certain number of hours of assistance per week, and then hires a provider. The recipient sets the work schedule and supervises the provider; the provider is paid by the state. Given the intimate nature of many of these services provided to these vulnerable recipients, the provider is often a family member who foregoes most other paid employment to help the recipient.
A privately-administered system of IHSS is known as “contract mode”. Under this system, an individual who qualifies for IHSS is assessed by a social worker, assigned a certain number of hours of assistance per week, and then the case is referred to a private contractor that coordinates the administration of the recipient’s care needs.
Using “contract mode” to administer these services has been shown to be ineffective. Not only does it present a number of problems for the care recipients, but under the findings of a large study performed in California, this mode of administration is less efficient and less effective than individual provider mode.
First, usually under “contract mode”, the private administrator chooses who tends to the recipient’s most intimate and personal care needs. Theoretically, that power to choose gives the administrator the supposed ability to consolidate and find efficiencies. But given the intimate nature of the services provided, the recipient’s choice of caregiver should be respected.
Further, “contract mode” has already been tested and shown to be ineffective and inefficient. In 1992, the California Department of Social Services began a test project to see if IHSS could be effectively delivered via contract mode and potentially save the state resources. The results of the project found that the private contractor cut hours of service for recipients and pushed family and relatives to administer care the contractor refused to provide, in some cases leaving the needy individual to just go without. Additionally, administrative costs increased dramatically in Tulare County under the private contract system. The report concludes: “With hourly program costs 60% higher than the statewide average, managed care in Tulare was less efficient, less effective in serving the neediest population, and far more expensive than the state and its comparison counties.” The project ultimately showed contract mode to be more costly to the state and less effective at delivering better quality of care. Factor in the profit expected by the private administrator and it is difficult to see how IHSS could possibly be administered for less cost and in a more humane manner.
I am grateful my Republican colleagues are presenting proposals as to how we can save resources and preserve services. Privatizing IHSS administration, unfortunately, will do neither.
