HomeMy WebLinkAboutMINUTES - 07102012 - SD.4RECOMMENDATION(S):
CONSIDER approving the response to Civil Grand Jury Report No. 1207, entitled, "In-Home Supportive Services,
Home Alone" and DIRECT the Clerk of the Board to forward the response to the Superior Court no later than July
10, 2012.
FISCAL IMPACT:
No fiscal impact.
BACKGROUND:
On May 10, 2012 the 2011/12 Civil Grand Jury filed the above-referenced report, which was received by the Board
of Supervisors on May 22, 2012 and subsequently referred to the County Administrator for response. The attached
response clearly specifies:
APPROVE OTHER
RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
Action of Board On: 07/10/2012 APPROVED AS RECOMMENDED OTHER
Clerks Notes:SEE ADDENDUM
VOTE OF SUPERVISORS
AYE:John Gioia, District I Supervisor
Candace Andersen, District II
Supervisor
Mary N. Piepho, District III
Supervisor
Karen Mitchoff, District IV
Supervisor
Federal D. Glover, District V
Supervisor
Contact: Dorothy Sansoe,
925-335-1009
I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the
Board of Supervisors on the date shown.
ATTESTED: July 10, 2012
David Twa, County Administrator and Clerk of the Board of Supervisors
By: June McHuen, Deputy
cc:
SD. 4
To:Board of Supervisors
From:David Twa, County Administrator
Date:July 10, 2012
Contra
Costa
County
Subject:Response to Grand Jury Report 1207: In-Home Supportive Services, Home Alone
BACKGROUND: (CONT'D)
Whether a finding or recommendation is accepted or will be implemented;
If a recommendation is accepted, a statement as to who will be responsible for implementation and by what
target date;
A delineation of the constraints if a recommendation is accepted but cannot be implemented within a six-month
period; and
The reason for not accepting a finding or recommendation.
Please see the attached response.
CONSEQUENCE OF NEGATIVE ACTION:
In order to comply with statutory requirements, the Board of Supervisors must provide a response to the Superior
Court no later than July 10, 2012. The Board must take action today in order to comply with the statutory
deadline. Should the Board fail to take action, staff will contact the Grand Jury and request an immediate
extension.
CHILDREN'S IMPACT STATEMENT:
Not Applicable.
CLERK'S ADDENDUM
APPROVED the response to Civil Grand Jury Report No. 1207, entitled, "In-Home Supportive Services, Home
Alone" as amended today to include in the finding remarks noting that the program is a state and federal
program administered by the County, in which the County has little input regarding data collection and that
the County will be forwarding a copy of this report and responses to our State and federal representatives so
that they may consider legislative changes; and DIRECTED the Clerk of the Board to forward the response to
the Superior Court no later than July 10, 2012.
ATTACHMENTS
Grand Jury Report No. 1207
Response to Grand Jury Report No. 1207
BOARD OF SUPERVISORS RESPONSE TO
GRAND JURY REPORT NO. 1207:
In-Home Supportive Services, Home Alone
FINDINGS
1. The program lacks data on outcomes, such as reducing nursing home admissions,
making it difficult to measure success in the provision of services and in identifying
cost savings.
Response: The respondent agrees with the finding.
The In-Home Supportive Services (IHSS) Program collects data through the State’s
Case Management and Information Payroll System (CMIPS I). However, since IHSS
is an entitlement program, outcomes such as reducing nursing home admissions are
not tracked. The current long term care system is fragmented and is not a
performance based model that can effectively track cost savings.
2. It is unclear what steps the County’s IHSS program might take to adjust its
operations, caseloads, staffing, procedures, and payments to providers to reflect
proposed funding cuts.
Response: The respondent disagrees with the finding.
Operational adjustments to the IHSS Program are dictated by funding adjustments
and regulation changes by the Federal and State governments. The County follows
clear direction from these entities regarding staffing, procedures and payments to
providers. There are currently no caseload standards.
3. Social workers have large caseloads, diminishing their ability to monitor changes in
client needs and making any needed adjustments to care plans.
Response: The respondent agrees with the finding.
Each of the three Public Integrity/Quality Assurance staff persons is expected to
monitor services to approximately 2,300 clients each month, decreasing IHSS’ ability
to identify and deal with fraud.
4. Manual signature verification is time-consuming and may not be cost-effective.
Response: The respondent agrees with the finding
5. Fraud prevention and detection could be improved by maintaining client photos,
establishing a complaint hotline and increasing unannounced visits to the home
during authorized service hours.
July 10, 2012 Contra Costa County Board of Supervisors 51
Response: The respondent disagrees with the finding.
There is no evidence that fraud prevention and detection would be improved by
maintaining client photos. There is currently no funding for unannounced visits
during authorized service hours which would burden an already overloaded system of
high caseloads. Targeted, unannounced visits by Quality Assurance staff are already
taking place within the program.
RECOMMENDATIONS
1. EHSD should consider developing, tracking and annual reporting of quantitative
outcome objectives that address service delivery and cost savings, which result from
diverting clients from more costly institutional care.
Response: The recommendation will not be implemented because it is not
reasonable. The funding is not available through the IHSS Program for such
activities. The IHSS Program is currently an entitlement program and is not
performance based to track outcomes.
2. IHSS should consider developing contingency plans that spell out how it will adjust
to proposed State funding reductions.
Response: The recommendation will not be implemented because it is not warranted.
Once the State budget is enacted, the California Department of Social Services will
provide guidance to counties regarding the implementation of reductions contained in
the budget. The IHSS services will be based on the level of funding available and the
guidance provided.
3. IHSS should consider decreasing social worker caseloads by recruiting, training and
placing volunteers who could relieve social work staff of paperwork, record review,
phone follow-up with clients and other administrative tasks.
Response: This recommendation will not be implemented because it is not
reasonable. Funding is not available through the IHSS Program for such activities.
The activities involved – recruitment, training, supervising, etc. – requires County
staff time and costs. While there may be some cost savings through the use of
volunteers, it would be outweighed by the unfunded cost of providing the necessary
oversight.
4. IHSS should consider having social workers make more of their regular home visits
unannounced and provide reports of these visits to supplement the efforts of the
Program Integrity/Quality Assurance staff.
July 10, 2012 Contra Costa County Board of Supervisors 52
Response: This recommendation will not be implemented because it is not
reasonable. Social workers already have very high caseloads (300 cases per worker).
Making regular unannounced visits may not prove cost effective considering the
possibilities of the client not being available. Targeted unannounced visits by the
Quality Assurance staff already occur.
5. IHSS should consider the costs and benefits of automating signature verification
functions.
Response: The recommendation will not be implemented it is not reasonable.
Signature verification would require a functional interface with CMIPS. Currently,
no such interface is available to accomplish this function. The development and/or
study to determine the feasibility would be cost prohibitive.
6. EHSD should consider identifying funds to cover incremental costs to use the existing
Information and Assistance Program hotline to handle complaints.
Response: This recommendation will not be implemented because it is not
warranted. The Information and Assistance (I&A) Unit is designed to serve clients
over the age of 60. There is no funding source available to serve clients under the age
of 60. In addition, it is not a hotline/complaint line, it provides information and
referral assistance only.
7. IHSS should consider maintaining photos of clients for use during home visits to
monitor for possible identity theft and to find or identify a client should the need
arise.
Response: The recommendation will not be implemented because it is not
reasonable. Maintaining photos of clients is not dictated in current State and federal
regulations. There is no funding available for the maintenance of this type of
photographic record.
July 10, 2012 Contra Costa County Board of Supervisors 53