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HomeMy WebLinkAboutMINUTES - 05061997 - D6 To: BOARD OF SUPERVISORS s. Contra I / f FRGM: � Costa Finance Committee -: DATE: May 6, 1997 County SUBJECT: � IN-HOME SUPPORTIVE SERVICES PUBLIC AUTHORITY SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATIONS: 1. RECOGNIZE the possibility of financial risks of establishing a Public Authority for the In-Home Supportive Services Program as described in the attached report by the Social Services Department. 2. ACKNOWLEDGE that the financial impacts of establishing a Public Authority for the In-Home Supportive Services Program are unclear and uncertain given the pending implementation of Federal Welfare Reform. 3. ACKNOWLEDGE the Committee's concern with the following issues: • the ability of the County to cap the costs of the IHSS Program if a Public Authority is established; • the extent of County health care costs from IHSS clients; • tfie extent of tort liability if basic registry services are contracted out. • that based upon the financial concerns the Finance Committee did not reach the question of the merits of establishing a public authority. 4. REFER this item and the attached reports to the Family and Human Services Committee where the programmatic elements can more appropriately be reviewed. 5. ELIMINATE this item as a Finance Committee referral unless significant changes occur in the financing of the IHSS Program. CONTINUED ON ATTACHMENT: YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTH p� �l ` SIGNATURE(S): �� a S e B' ' kema ACTION OF BOARD ON APPROVED AS RECOMMENDED X_ OTHER See addendum for list of speakers. VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS(ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED Contact: PHIL B T ELOR,CLERK OF THE BOARD OF CC: Social Services Director SUPERVISORS AND COUNTY ADMINISTRATOR County Counsel Human Resources 0 CAO - Claude Van Marter BY- rL 001Aj ,DEPUTY } Page 2 BACKGROUND: On January 27 and again on April 21, the Finance Committee discussed the issue of creating a Public Authority for the In-Home Supportive Services Program. On both occasions, the Director of Social Services prepared a written and oral report for the Committee. Attached are Department reports dated January 22 and April 16 along with a Board order dated November 19, 1996. At these two meetings, the Committee heard testimony from a variety of parties including members of the IHSS Task Force, members of the Advisory Council on Aging, IHSS providers and clients, labor unions and County Counsel. On April 21, the Committee recognized the significant financial risks of establishing a Public Authority as well as acknowledged the difficulty of identifying the financial impact because of the uncertainties of Welfare Reform. In addition, the Committee identified several issues of concern with the IHSS Program. Finally, the Committee determined that improving the programmatic elements of the IHSS program and creating a Public Authority would more appropriately reside with the Family and Human Services Committee. ADDENDUM TO ITEM D. 6 MAY 6, 1996 On this date, the Board of Supervisors considered the Finance Committee recommendations on the issue of In-home Supportive Services Public Authority. The following persons presented testimony: Maggie Dee, 426 W. 11th Street, Pittsburg; Dana Simon, 81 Montell Street, Oakland; Paul DeMange, 3811 Alhambra Avenue, Martinez; Enrique Madrinan, 3811 Alhambra Avenue, Martinez; Kagey Doroz, 1015 Nevin #102, Richmond. j. SOCIAL SERVICE DEPARTMENT CONTRA COSTA COUNTY TO: Board of Supervisors Finance Committee DATE: April 16, 1997 FROM: John Cullen, Director / SUBJ: IN-HOME SUPPORTIVE SERVICES PUBLIC AUTHORITY As directed by the Board Order of November 19, 1996, Social Service staff have been gathering information to prepare an assessment of a Public Authority for the In-Home Supportive Services (IHSS)Program in Contra Costa County, with the Board of Supervisors acting as the authority which includes a cap on county costs and liability and a sunset clause. Moreover, as also directed by that same Board Order, the Social Service Department has instituted actions within the existing IHSS program to address desires to improve services via a registry, provider training, and enhancement of consumer input. The following are our recommendations and overview, background information, specific findings, and an update on program improvements. RECOMMENDATIONS AND OVERVIEW 1. We recommend that the Board of Supervisors NOT adopt an ordinance establishing a Public Authority for the IHSS program in Contra Costa County. Our assessment reveals that establishment of any form of Public Authority at this time poses significant financial and legal risks to the County due to administrative costs and collective bargaining obligations which under current State law the County would assume. 2.We recommend that the Board of Supervisors instruct the Social Service Department to regularly report back on progress in developing improvements to the existing IHSS program as already authorized in the Board Order of November 19, 1996 to develop a registry, link providers to training resources, provide for consumer and public input into the program, and to develop client/provider support services. The Social Service Department agrees with the proponents of the Public Authority that the IHSS Program in Contra Costa County is in need of underlying program improvements in the areas of a provider registry, provider training, consumer input, provider wages, and client/provider support services. The main issue before the Finance Committee is whether or not the Public Authority is the appropriate vehicle for implementation of those improvements and enhancements in Contra Costa County. Overall we have found that the County has the ability through the Social Service Department to provide enhanced services in the IHSS program without creating a new governmental entity in the form of a Public Authority. In essence, the only program element that a Public Authority offers that cannot otherwise be provided under our existing IHSS structure is a mechanism to create collective bargaining arrangements where none currently exist. However, under the authorizing State legislation and allocation processes there are excessive funding consequences to counties when establishing Public Authorities. For example, counties are fully liable for all non-Federal 1 costs of any wage and fringe benefit costs resulting from a Public Authority's collective bargaining agreements. Our research reveals that the establishment of a Public Authority causes further bifurcation of programmatic responsibility, administrative complexity, and results in both additional liability and costs for the County. At the same time, creation of a Public Authority will not relieve the Board of Supervisors and the Social Service Department from mandated fiscal and programmatic responsibility for IHSS. In undertaking an assessment of an IHSS Public Authority as instructed by the Board of Supervisors in the November 19, 1996 Board Order, we have analyzed this option from three major aspects: 1)financial issues, 2) service delivery and'program accountability issues, and 3) labor relations and legal issues. We have consulted with the California Department of Social Services; Public Authority staff in San Mateo, Alameda and San Francisco counties; Social Service Department and IHSS program staff in Santa Clara, San Mateo, San Francisco, Sonoma, Alameda, Sari Francisco, and Los Angeles counties; and conferred with County Counsel and County Human Resources staff in our county and outside labor relations experts. In addition to the work of this assessment, staff have met monthly with the IHSS Task Force and with the Long Term Care Committee of the County Advisory Council on Aging. We also conducted a public meeting on December 18, 1996 regarding IHSS program changes which included a discussion of preliminary plans to develop registry and provider support services. Included at the latter part of this report is a summary of program improvement activities. BACKGROUND INFORMATION 1. IHSS SERVICE DELIVERY The In-Home Supportive Services program is a Federal/State mandated program that provides domestic and personal care services to eligible aged, blind, and disabled persons who, without such service, could not remain safely in their own homes. State of California law and regulations provide that counties must administer the IHSS program through one or a combination of three service delivery modes. These modes are: • Independent Provider mode under which the client hires and supervises a private individual in an independent contractor relationship • Contract mode in which the provider of service is the employee of a private company or independent non-profit agency which has won a•contract to manage IHSS within a county • County Homemaker mode in which the provider of service is a County employee. Contra Costa County uses the Independent Provider mode exclusively. All California counties offer the Independent Provider mode with six counties supplementing Independent Providers with County Homemaker staff and nine counties supplementing Independent Providers with the Contract mode. 2 Within all the various modes of service delivery, counties are responsible for eligibility determination and assessment of service hours. Under California State law, Independent Providers are paid minimum wage. Wages are not specified under the Contract or County Homemaker modes. With the recently adopted increases in Federal and State minimum wage, Independent Providers have received two wage increases in the past six months and will receive additional increases in 1997-98. Hourly wages increased from $4.25 to $4.75 on October 1, 1996; and increased to $5.00 on March 1, 1997. Future schedule:! hourly increases will be $5:15 on September 1, 1997 and $5.75 on March 1, 1998. Since 1993, with the advent of Federal Medicaid funding availability for some of the costs of the IHSS program, we have operated two parallel programs for fiscal claiming purposes. The IHSS Personal Care Services Program(PCSP) claims Federal Medicaid funds for eligible client services which are matched by State and County funds. The IHSS Residual Program claims no Federal Funds and is funded by only State and County funds. The PCSP funding ratios are 50%Federal, 32.5% State, and 17.5% County. The Residual funding ratios are 65% State and 35% County. About 66% of the client service hours are eligible for PCSP claiming. In Contra Costa County, we serve approximately 4,100 clients every month. Annually, we spend approximately $24 million on provider wages and approximately $3.3 million on administration, eligibility determination and services staff which together include a total County share-of-cost of approximately$6.7 million. The Federal and State governments provide over $20.6 million in program revenue. Over 60% of Contra Costa Independent Providers are family members hired by the client. Both staff and community advocates have long recognized the need to improve the manner in which IHSS clients, who do not have family members available, are matched with a provider. Approximately 5,000 providers are currently serving our IHSS clients. At any one time approximately 4.5% or 185 clients in Contra Costa County are without providers. This is due to turnover, time delays pending the provider's availability, client's terminating existing providers, immediate unavailability of providers, etc. The limited registry services in the community have not been able to adequately meet the needs of these clients. The Independent Provider mode of service delivery that we operate in Contra Costa County maximizes the free choice of clients in selecting providers of care. However, the program is sometimes not fully satisfactory for those clients unable to find providers or who have difficulty managing the employer/employee relationship between themselves and their providers. Counties operating Individual Provider programs, who wish to enhance the functioning of the program for clients with the problems noted above, have had the option to provide Supported Independent Provider(SIP) services to assist clients who need help in finding, employing, and retaining providers. Under the SIP model, counties provide both registry services and provider support services to assist IHSS clients who need help in finding, employing, and retaining providers.. In 1996-97 the Social Service Department developed a budget initiative in the amount of$50,000 to pilot registry and provider support services which was approved by the Board of Supervisors to meet this long recognized gap in the program. As envisioned, registry services will include recruitment of providers; assessment of provider's skills; matching of prospective providers with specific client needs; and identifying training opportunities for providers. Provider support services will monitor ongoing client/provider matches; assist IHSS clients who need help in 3 performing their employer functions; assist providers who need help in meeting their employee obligations; and link contract registry services with IHSS social workers. The Department is now ready to begin implementation of registry activities as authorized in the November 19, 1996 Board Order. 2. PUBLIC AUTHORITY LEGISLATION The In-Home Supportive Services Public Authority, as defined in 1993 California legislation(SB 35) and in the 1996 State Budget Trailer bill (SB 1780), is a new entity which can be created by county ordinance to provide employee bargaining rights to Independent Providers. The Public Authority offers counties an alternative structure for managing the Independent Provider mode of IHSS. Public Authorities must provide a registry of providers, perform background checks, develop a referral system, and provide for training. None of these services are required under the Independent Provider mode. The Public Authority primarily serves as the "employer of record for purposes of collective bargaining." Whereas, the existing Independent Provider mode relies on State statute for salary and benefit setting. As with the Independent Provider mode, the Public Authority legislation purportedly preserves the client's right to hire, fire, and direct their own providers. The legislation purportedly protects the Public Authority from being deemed the employer of IHSS providers "for purposes of liability due to negligence or intentional torts of IHSS personnel." County Counsel has informed us that absent judicial construction of the legislation, these protections are uncertain. Under the legislation, the Board of Supervisors may-appoint a consumer majority Public Authority, or the Board may establish themselves as the Public Authority, with a consumer advisory committee. State legislation does not allow any additional State funding for creation of a Public Authority, and the State limits its funding share of Public Authority services (i.e. registry, background checks, etc.)to,emsting administrative allocations to counties. Recent budget trailer bill legislation requires that counties fund the State's share of any additional salary or benefit costs authorized by a Public Authority. FINDINGS REGARDING MAJOR IMPLEMENTATION ISSUES 1. FINANCIAL ISSUES The financial issues regarding the impact of a Public Authority on the IHSS program in Contra Costa County revolve around a) claiming mechanisms for the administrative costs of a Public Authority; b) additional County costs related to any collective bargaining agreements negotiated by the Public Authority; c)the potential impact of Welfare Reform changes on IHSS; and d) fiscal accountability. We have consulted with Social Service managers and Public Authority staff in San Mateo, Alameda, and San Francisco, the only three counties with functioning Public Authorities, regarding the financial aspects of operating and funding their operations. In addition, we have consulted with the California State Department of Social Services regarding the various fiscal policy issues noted above. Our principal findings are noted below. 4 a) Administrative Cost Claiming Based upon the experience of the existing Public Authorities, the minimum staffing level required to operate a Public Authority in Contra Costa County, given the size and configuration of our IHSS program, would be a full time manager, full time secretary, and one and one half registry coordinators assigned to the three regions of the county. The manager would be responsible for overall administration including providing staff assistance to the gu verning/advisory body, negotiating and monitoring labor contracts and supervising registry staff. The secretary would provide clerical support to the other staff and for the governing/advisory body. The registry coordinators would be responsible for recruitment and screening of providers; referral of providers to training opportunities; and matching providers' skills and abilities with requests from individual IHSS clients. The direct administrative costs of operating a Public Authority would consist of the wages and benefits for these 3.5 full time equivalent (FTE)Public Authority employees along with the various space, equipment, and overhead costs associated with this additional staff. The annual salary and benefit costs for these positions plus space, utilities, equipment, and overhead costs will bring the total direct costs to approximately$370,000 annually. Additionally, from information gained in the research counties.the existence of a Public Authority will require an increased management workload for Human Resources, County Counsel, County Auditor, and County Social Service staff which may not be absorbed without additional staffing resources. We estimate these indirect costs to be the equivalent of 2.5 FTE's and will run in excess of$250,000 annually. Very troubling is the fact that the California Department of Social Services (CDSS) has still not issued claiming regulations for creation of Public Authorities, so we have been unable to assess the precise financial impact on the County by running projected costs through an administrative claiming process. Absent new regulations to legitimize the claiming of additional Federal dollars, the County General Fund would have to absorb the entire amount of these new costs totaling approximately $620,000 annually. The existing Public Authorities have been operating in the absence of these State claiming regulations. In addition to County General Funds, they have been paying for their administrative costs from a variety of interim sources such as State start-up funds, surplus IHSS administrative funds, and outside grants. None of these interim options are available to our county. State start- up funds are no longer available; we do not have any surplus IHSS administrative funds; and outside grants have not been identified. CDSS has been involved in complex discussions with San Mateo, San Francisco and Alameda counties for many months over the establishment of an hourly rate setting methodology for funding of the administrative operations of their Public Authorities. The three counties are seeking an arrangement whereby this rate setting will allow them to charge a significant portion of their Public Authority administrative costs to the Federal share of Medicaid which funds the Personal Care Services Program(PCSP) portion of IHSS. However, no agreement has been reached, and it is unknown when or if the State will issue draft regulations for this rate setting methodology. Moreover, recent Clinton Administration proposals to cap State allotments for Medicaid call into question the long range likelihood of Federal financial participation in the administrative costs of a Public Authority. 5 In any event, State legislation does not permit State financial participation in the operating costs of a Public Authority if that results in increased State costs beyond existing levels of State funding allocations for IHSS administrative costs. As Contra Costa fully expends the existing State 4dministrative allotment for IHSS social work costs, we can expect, at a minimum, that the County would have to cover both the County and State share of Public Authority costs. If CDSS issues regulations at some future date that make it possible to claim Public Authorit," administrative costs from the Federal share of Medicaid, given our current proportion of Federally eligible PCSP cases, we would have to use County funds to cover approximately 67% or $248,000 of the projected annual direct costs of operating the Public Authority administrative structure alone. Indirect costs for additional County staffing identified earlier would require approximately $250,000 more in all County funds. Thus, even if Federal funds can eventually be claimed for Public Authority direct operations, the costs to the County will at a minimum be almost $500,000 annually. b) Costs Resulting from Collective Bargaining Agreements Under the authorizing State legislation, the Public Authority is responsible to negotiate wage and fringe benefit agreements with labor organizations representing IHSS providers. However, there is to be no State financial participation in the costs of any wage and benefit increases granted by a Public Authority. Unlike the administrative costs of the Public Authority, the Federal Medicaid program would continue to cover 50% of any increased costs for PCSP provider services. As noted above, recent Clinton administration proposals to cap State allotments for Medicaid would threaten ongoing Federal participation in these additional wage and benefit costs. However, given our current mix of Federally eligible PCSP vs. non-Federally eligible Residual IHSS cases, Federal funding would cover only about 33% of the costs of any collectively bargained wage and benefit increases. Thus, new County funds would be required to cover at least 67% of any wage and benefit increases (rather than only 23.5% if there were State participation) for the 5,000 IHSS providers. Based on the size of our current annual payroll costs for IHSS providers and our existing PCSP/Residual case ratios, every $.50 per hour of increase in wage and benefit costs would cost over $1.6 million in additional County funds on an annual basis. c) Welfare Reform Fiscal Impact It is not possible at this time to identify the fiscal impact of Welfare Reform on IHSS with accuracy, let alone the impact that Welfare Reform may have on the costs of operating a Public Authority. However, pending action by the State Legislature and Governor regarding the implementation of Federal Welfare Reform in California, the methodology for claiming administrative costs for income maintenance/welfare programs, which influences the administrative claiming for IHSS and other county social service programs, will change. A greater or lesser proportion of general overhead costs will shift over to the non-income maintenance programs such as IHSS. Any increase of overhead costs for IHSS will become all new County costs as we currently fully expend our State allocation for IHSS administration. Any decrease of overhead costs might make available currently expended State IHSS administrative dollars for IHSS program enhancements. However, it will not be possible to accurately identify the dollar impact of these changes until State Welfare Reform legislation is implemented. 6 We do know that IHSS clients will be directly affected by the Federal Welfare Reform changes in the Supplemental Security Income (SSI) program. This cash assistance program for elderly and disabled individuals who meet the Federal income and asset guidelines will be terminating all non- citizens currently receiving benefits beginning in August, 1997. In California, eligibility for IHSS is linked to SSI. Unless the State law is changed, which is being proposed by such bills as AB 67 (Escutia) and SB 809 (Johnston), non-citizens currently receiving IHSS will lose their IHSS benefits at the same time that they lose their SSI. Based upon a survey of SSI recipients in our Contra Costa County, we estimate that as many as 15% of our approximately 4,100 IHSS clients may lose their IHSS benefits because of this change. We are concerned that this decrease in eligible clients will also decrease our administrative allocation for operating the program. Another element of Federal Welfare Reform included an across the board cut in Title XX Social Service Block grant funding. These funds have been used in California, in part, to fund costs of the non-Medicaid eligible, or Residual, portion of IHSS provider costs as well as for social work administrative costs in IHSS. At this time CDSS is attempting to determine the impact to the counties of this change. Possible scenarios include the State contributing more State general funds to IHSS; counties being required to back fill the Federal reduction; or, mandatory program reductions. Until the State Legislature and Governor take action to adopt new legislation in response to Federal Welfare Reform and adopt the 1997-98 State Budget, the above Welfare Reform issues related to IHSS funding remain unanswered questions. It is not possible to know at this time whether the revenue sources currently available to us for both IHSS administrative and direct service costs will change markedly because of Welfare Reform. In light of these impacts, any action to increase administrative costs, as with a Public Authority, is premature and could lead to even more significant revenue challenges for the County General Fund. d) Public Authority Fiscal Accountability As mentioned, CDSS has not yet issued Public Authority fiscal claiming regulations to counties which authorize activities eligible for funding. Until CDSS issues these regulations, we are unable to explore with the County Auditor how best to establish appropriate fiscal control mechanisms to assure fiscal accountability. Once the claiming regulations are issued we can meet with the County Auditor to determine what the shared responsibilities would be for both the Social Service Fiscal Unit and the Auditor's staff to maintain ongoing fiscal oversight of the Public Authority. It is our expectation that under any new IHSS claiming regulations the Social Service Department and the Board of Supervisors will remain financially liable for the costs of a Public Authority. 2. SERVICE DELIVERY/PROGRAM ACCOUNTABILITY ISSUES As previously noted, our staff have consulted with Social Service and Public Authority staff in San Mateo, Alameda, and San Francisco, the only three counties that have operating Public Authorities. In addition, we have compared and contrasted the registry services available under the San Mateo and Alameda Public Authorities with those available under private non-profit registries in Santa Clara and Sacramento counties and the Sonoma County Supported Independent Provider program operated by county IHSS staff. Also, we have reviewed the provider support services operated by both Sacramento and Sonoma IHSS staff. 7 a) Registry and Provider Support Activities In comparing and contrasting our observations of these other counties' programs, it is clear that basic registry services can be operated successfully under a Public Authority, or through a contract with non-profit social agencies, or directly by County IHSS staff. Each of these counties have adapted their registry services to their chosen organizational model. All of the registries provide the same basic functions: • Ongoing recruitment of prospective IHSS providers • Maintenance of current list of prospective providers • Assessment of providers' skills, abilities, and training needs • Provide for reference checks and review of qualifications • Refer prospective providers to IHSS clients by matching provider profile with clients' needs • Identification of training opportunities in the community for providers In Sacramento and Sonoma counties, the additional provider support activities provided by in- house IHSS staff include the following elements: • Ongoing monitoring of the success of provider/client matches • Assisting IHSS clients in the performance of their employer functions of hiring, scheduling, supervising, and directing providers • Assisting providers in performing their employee functions and obligations • Linking registry services and provider support activities into a working partnership with IHSS social work staff It is our conclusion that for Contra Costa, the successful enhancement of our IHSS program requires the development of both registry and provider support services. Registry services are a first step in addressing the problems encountered by those IHSS clients who are without providers. As a follow on, we believe that there should also be a support system in place to assist providers and clients who need help in maintaining a successful employer/employee relationship. There will usually be a certain proportion of frail, vulnerable or confused IHSS clients who cannot manage their employer relationship with their provider without some outside help. Providers can also benefit from the intermediary assistance of provider support staff to mediate their employee relationship with difficult clients. As Public Authorities are authorized under SB 35 to develop only the registry component for enhancing IHSS (not support services), establishment of a Public Authority in Contra Costa County will not fully address the programmatic and service delivery needs which cannot 8 adequately be met by our current Independent Provider program. We believe that it is necessary to develop provider support services and make them an integral component of our existing service delivery system. b) Program Protocols and Standards Lacking the promulgation of either program or fiscal claiming regulaL:ons by CDSS, it has not been possible to develop draft protocols for a projected working relationship and oversight of a Public Authority. However, from our contact with.the three operating Public Authorities we are aware of some of the issues which need to be addressed concerning the working relationship between our department and an IHSS Public Authority. These issues include the following: • development of monitoring and/or supervision standards for Public Authority registry operations; • development of standards and procedures for sharing confidential casework information regarding IHSS clients; • defining how to effectively provide for timely and appropriate communication between Department social work staff and Public Authority staff regarding IHSS provider needs and problems; • establishing procedures for problem solving and conflict mediation between the Public Authority and IHSS program staff that balances the needs of both IHSS providers and recipients; and, • establishing protocols and procedures for Human Resources/Labor Relations and County Counsel consultation and representation services. c) Consumer and Public Input The Public Authority model provides for consumer input through creation of a governing body with a consumer majority as is done in San Francisco or alternatively with creation of a consumer majority advisory body if the County Board of Supervisors establishes itself as the governing body of the Public Authority as is done in San Mateo and Alameda counties. Given the focus of the Public Authority on registry services and collective bargaining with provider labor representatives, consumer input is necessarily focused on those two aspects of the IHSS program in those three counties. From our contacts with San Mateo, Alameda, and San Francisco counties, we have observed that they all have been successful in using the Public Authority as a vehicle for bringing consumer and public input into the IHSS program. Also, we have noted that the collective bargaining process that has ensued in Alameda, San Mateo, and San Francisco counties with the union representatives of the providers presents another major complication in this complex network of consumer and public input. The Public Authority takes on a difficult role with its charge to collectively bargain with labor organizations representing the IHSS providers at the same time it seeks to provide for consumer input into the program. Thus, any vehicle for effective consumer and public input regarding the operation of the IHSS program must be able to balance these disparate constituencies in order not to produce a skewed perspective of public or consumer 9 concerns about the program. 3. LEGAL AND LABOR RELATIONS ISSUES Staff have consulted with County Counsel, Human Resources and labor relations staff, plus management staff in other counties regarding the legal and labor relations issues connected with establishment of a Public Authority. The issues of concern of which we have been made aware are: a)the legal and organizational status of a Public Authority; b)the legal concerns regarding an alternative contract registry as opposed to a Public Authority; and c)the impact of IHSS provider collective bargaining on labor relations. a) Public Authority Status Under the enabling legislation, counties wishing to establish a Public Authority may establish a consumer majority independent body or designate the County Board of Supervisors as the Public Authority and appoint a consumer advisory committee. San Mateo and Alameda counties have designated the Board of Supervisors as the Public Authority. San Francisco has established an independent Public Authority. Should the Board of Supervisors choose to establish a Public Authority in Contra Costa County, we recommend that the Board designate itself as the Public Authority and not create another agency for four primary reasons. 1) The funding and administrative management of IHSS provider costs will continue to be Social Service Department responsibility. Since the Board of Supervisors will determine funding for the Public Authority, it should not surrender to an independent governmental body the power to determine the amount of funding that will be required. This is of special concern because of the significant additional County costs that will result from any administrative developments, or wage and benefit agreements made by the Public Authority. 2) The Social Service Department will legally be responsible for supervision and direction of the operations and services of the Public Authority. With the Board of Supervisors as the Public Authority, as opposed to an outside governing body, our department will be better able to exercise direct authority over Public Authority staff and IHSS matters for which it bears responsibility. As the Social Service Department must also exercise administrative oversight over the activities of the Public Authority in such areas as fiscal control, service accountability, corrective actions, etc., it is preferable that this new entity be under direct County control. Also, working under the same governmental entity, Public Authority registry staff and Social Service social work staff will be better able to work cooperatively to assure that the clients' provider needs are met. 3) The creation of a totally separate governmental agency will entail extra expenses, above the $370,000 in direct costs estimated earlier, if the Public Authority is not able to operate under the administrative umbrella of the Social Service Department. From our review of the free-standing governance structure in San Francisco, we found that the Public Authority would need one additional staff member to focus on separate governance issues. 4) The Board of Supervisors may find it easier to exercise the discretion offered by any sunset clause to terminate the existence of a Public Authority at some future date if the Board itself has 10 been designated as the Public Authority. Abolition of a separate governing body, in all likelihood, may prove to be a politically more difficult task. L�) Alternative Registry Option The Public Authority is not the only option available for delivering registry services in an Independent Provider IHSS program. County Counsel has advised Ls that registry services may also be provided through a contract with an outside agency thereby maintaining the independence of the employer/employee relationship between IHSS clients and the providers they hire after referral from an outside registry. It is not necessary to take on all of the costs, obligations, and risks of operating a Public Authority in order to provide needed registry services to assist IHSS clients find suitable providers. Moreover, County Counsel has advised us that contracting with an outside agency for registry services, supported by insurance, would additionally insulate the County from tort liability for the actions of IHSS providers in a similar fashion to the legislative protection from tort liability offered to Public Authorities in the authorizing legislation. c) Collective Bargaining In San Mateo, San Francisco, and Alameda Counties establishment of a Public Authority has been followed by union representation for IHSS independent providers. The Public Authorities have in turn engaged in collective bargaining in all three counties. In San Francisco, within the first year of establishment of the Public Authority, the county approved a wage increase for which the county is liable for the entire non-Federal snare with no State financial participation. San Francisco is currently paying $5.29 per hour to independent providers ($.29 above the current minimum wage), which requires the county to spend approximately$1.79 million annually in local general funds to cover their share of these additional costs. The Public Authority has stated that its goal is to increase provider wages to $8.00 per hour plus health care benefits. Also, the San Francisco Public Authority has agreed to an agency shop whereby all independent providers pay union dues, including family member providers. There has been discontent expressed among some family member providers regarding their monthly union dues deduction. In San Mateo County, the Public Authority is considering offering limited health care benefits to certain independent providers under the county's health plan, at a cost of$150 per year per individual, for which there can be no State participation. In Alameda County, under the tentative labor agreement reached through collective bargaining, the Public Authority has agreed to a reopening clause regarding future wage increases above minimum wage for independent providers. Establishment of a Public Authority in Contra Costa County would make the Public Authority the employer of record for collective bargaining purposes of a unit of approximately 5,000 IHSS independent providers, both family members and non-family member providers,with an annual payroll now exceeding $24,000,000 for both provider wages and benefits. In the opinion of County Counsel and labor relations experts we consulted, the County would be exposed to the full range of collective bargaining obligations regarding public employees under the Meyers- Milias-Brown Act for these independent IHSS providers if we create a Public Authority. The full labor relations implications of such action are unknown at this time, but this change certainly will greatly expand the scope of responsibility of County labor relations staff and consultants. We 11 estimate the additional workload will require the services of at least one additional FTE. The Public Authority will be responsible for implementation of a wage and benefit structure for these 5,000 employees even though the IHSS clients will retain the right to hire and fire their individual providers. This unique employee status for IHSS providers under a Public Authority will necessitate the development of new employer/employee relations policies applicable to their situation. The long range policy ramifications of establishing this unique, untested class of employees are essentially unknown at this time. UPDATE ON IMPROVEMENTS TO CURRENT IHSS SERVICE DELIVERY SYSTEM As per the plan approved by the Board of Supervisors on November 19, 1996, Social Service Department staff are developing a pilot project to offer registry services and provider support services to help address some of the problems regarding retention of skilled providers for IHSS clients that the public and staff have identified. Also, we are moving forward with actions to offer additional opportunities for consumer and public input regarding IHSS program operations. 1. REGISTRY SERVICES Social Service Department staff are in the process of developing a competitive procurement process to select an outside agency to establish a contract registry for IHSS that can find appropriate Independent Providers for those clients unable to find providers through their own resources. Primary is the development of a registry which will link IHSS clients with Independent Providers whose skill and experience are consistent with each client's service needs. This contract registry will provide the basic registry services identified in our study of registries in the neighboring counties. The services to be provided by the contract registry will include recruitment of providers; maintenance of current lists of providers; assessment of providers' skills, abilities, and training needs; providing for reference checks and review of qualifications; referring prospective providers to clients matched to clients' needs; and identifying training opportunities in the community for providers. Social Service Department will furnish computer hardware and software for operation of the registry. We have budget approval for$50,000 to pilot registry and support services, which when operated via the Social Service Department can qualify for 70%Federal/State reimbursement. Therefore, our budget currently includes $15,000 in County funds for this purpose. 2. PROVIDER SUPPORT SERVICES As noted earlier, from our investigation of neighboring counties who offer provider support services as well as registry services, we have determined that registry services alone are not sufficient for meeting the needs of IHSS clients without providers. Thus, Social Service staff are in the process of developing a proposal for a provider support pilot project. The pilot project will add one and one-half FTE paraprofessional staff, approximately half-time in each region of the county, to facilitate effective working relationships between IHSS clients and providers where there is a need for third party assistance. We plan to submit our proposal to CDSS for funding consideration. As identified in our review of successful provider support programs in Sonoma and Sacramento counties, the pilot project staff will be responsible for monitoring of client/provider matches; 12 assisting IHSS clients who need help in performing their employer functions; assisting providers who need help in meeting their employee obligations; and linking contract registry services with IHSS social workers. The provider support staff will serve as a critical link among the registry staff, the client, provider, and department social workers. We believe that the provider support staff are the critical linchpin for ensuring the successful implementation of registry services whether under a Public Authority or contractor agency. Following establishment of registry services, spending any additional funds on provider support services, rather than on the additional administrative costs of a Public Authority is our next highest priority for the IHSS program. 3. CONSUMER AND PUBLIC INPUT In the Contra Costa County IHSS program with over 4,100 clients and over 5,000 independent providers, it is a complicated process to develop effective channels for input from consumers, the public, and providers. However, we have taken a variety of steps in recent years to develop avenues for outside advice regarding the program, including: • Social Service staff have been meeting on a regular basis with the IHSS Task Force consisting of community advocates, providers, union representatives, and program clients for the past four years regarding needed improvements to the program. • With the consolidation of the Area Agency on Aging and Adult Social Services under a single management structure two years ago, the County Advisory Council on Aging has become involved in providing oversight to the IHSS program primarily through the work of its Long Term Care Committee. • Social Service staff are working with an ad hoc Long Term Care Coordinating Committee initiated by the Advisory Council on Aging in 1996 to develop planning recommendations regarding development of a countywide community based long term care system of which IHSS would be key program element. • December 18, 1996 the Social Service Department held a public meeting regarding the development of registry services and the use of new needs assessment guidelines in the IHSS program. Moreover, in the coming 1997-98 fiscal year, we propose to take the following additional steps to enhance consumer and public input for IHSS: • Social Service staff will recommend to the Advisory Council on Aging that the monthly meetings of its Long Term Care Committee provide the opportunity for hearing ongoing consumer and public concerns about IHSS program operations and that the committee sponsor two public meetings annually regarding the IHSS program seeking to gain public input regarding such issues as the operation of contract registry services, the development of provider support services, and dealing with the impacts of Welfare Reform. • Social Service administrative staff will develop survey instruments and sampling techniques that would offer individual IHSS clients, providers and family members the opportunity to provide structured feedback and comments to the department incorporating these efforts into the existing quality control activities of staff. 13 Thus, we propose to further develop our existing efforts to provide for a broad range of consumer and public input into the IHSS program without the necessity of creating the separate administrative structure of a Public Authority. We can build upon the existing activities of the County Advisory Council on Aging and department staff thereby expanding opportunities for consulting with consumers and the public as an integral part of IHSS program administration. CONCLUSION After having Social Service staff gather the data for this study and reviewing all of the information currently available, we conclude that the fiscal, programmatic, legal and collective bargaining realities and uncertainties posed by establishment of a Public Authority make it an unsuitable alternative for our county. Meanwhile, needed improvements to the IHSS program to assist clients to find and maintain suitable Independent Providers can best be provided through the development of registry and provider support services under the current administrative structure. As evidenced by our 1996-97 budget initiatives, IHSS program development efforts, and by our actions to enhance opportunities for consumer and public input regarding the program, we are well on the way to implementing changes that will address the major concerns raised by the proponents of the Public Authority. Moreover, recent and future increases in the minimum wage are raising provider wages, albeit less than anyone would like. Although requested to do so in the'November 19, 1996 Board Order, the Department cannot give any assurances that County costs can be capped in relation to an IHSS Public Authority. With a Public Authority, there will be major direct and indirect administrative costs. Additionally, provider wage and benefit increases which will result from collective bargaining will become primarily the County's responsibility under State law, rather than being limited to a fixed share of the minimum wage as is the case under the current program arrangement. Although the Board of Supervisors may adopt a cap on County costs, bargaining in good faith under the Meyers-Milias- Brown Act may result in obligating the County to expenditures exceeding any cap. The direct administrative costs of administering the Public Authority will be approximately $370,000. Additionally, from our contacts with social service staff in Public Authority counties, we have learned that there will be a considerable involvement of time required on the part of Human Resources and Labor Relations staff, County Counsel, as well as Social Service managers overseeing and interrelating with the Public Authority and its activities. These indirect administrative costs must be planned for unless these overseeing departments can absorb the workload. It is not unrealistic to estimate 2.5 FTE of County oversight totalling approximately $250,000 annually as an additional cost to the County. Thus, when adding together the estimated $370,000 of direct costs attributable to the Public Authority and the annual estimated indirect costs, the additional County cost for IHSS administration could equal $620,000. The improvements and enhancements that are being developed for the IHSS program, namely establishing a contract registry and planning for a provider support program, involve a prudent expenditure of County funds. Department operation of these services allows us to qualify for State and Federal funding. On the other hand, State law prohibits use of any additional State funds for additional costs associated with a Public Authority. In summary, our review has revealed that a Public Authority in Contra Costa County is not 14 advisable since: • creation of the Public Authority administrative structure is not necessary to provide additional service delivery opportunities, only the responsibility to do collective bargaining; • the general fund costs of a Public Authority are estimated tc;-exceed $370,000 in direct costs and $250,000 in indirect costs without any guarantee of Federal and State reimbursement; and additionally a Public Authority would bind the County to future general fund expenditures for the State's share of wage and benefit increases; • the State government has not issued fiscal or programmatic regulations which define the allowable cost reimbursements or programmatic responsibilities; • development of a Public Authority does not relieve the County of any risk or responsibility in managing the State mandated IHSS program; and • the impacts of Welfare Reform will benefit from a single administrative approach versus bifurcated responsibility that would occur with a Public Authority. Given these issues, we urge the Finance Committee to take no action at this time in regard to establishment of a Public Authority and to continue support for department activities to implement program enhancements in accordance with the earlier Board Order of November 19, 1997. 15 CONTRA COSTA COUNTY Social Service Department DATE: January 22, 1997 TO: Board of Supervisors Finance Committee FROM: John Cullen, Director SUBJECT: In-Home Supportive Services (IHSS) Update The following is an update regarding recent actions taken by the Social Service Department per the direction of the Board of Supervisors on November 19, 1996, to assess a Public Authority, and to institute IHSS program changes. I. ASSESSMENT OF A PUBLIC AUTHORITY WITH THE BOARD ACTING AS THE AUTHORITY WHICH INCLUDES A CAP ON COUNTY COST AND LIABILITY AND A SUNSET CLAUSE. Social Service Department staff are in the midst of gathering information regarding the viability of a Public Authority for our County in accordance with the work plan adopted by the Board of Supervisors on November 19, 1996. Our analysis is considering the financial issues, service delivery, accountability, labor relations, and legal impacts associated with Public Authorities. A) Financial Issues • We have met with administrative staff from San Mateo, San Francisco and Alameda County Public Authorities to gather descriptive information about their individual funding and claiming mechanisms and cost impacts. • Claiming instructions and regulations have not been issued from the State, precluding us from determining the financial consequence of a Public Authority in our County. Without State rules, we are unable to clarify how a Public Authority will be supported fiscally, and the impact of a Public Authority on our Administrative allocation which may affect Social Worker caseloads. • We are working with local and State staff to identify the impact of Welfare Reform changes upon IHSS Program cost. • The Department is continuing discussions with the California Department of Social Services (CDSS) regarding availability of additional State or Federal revenue to support a Public Authority. Memo to: Board of Supervisors Subject: In-Home Supportive Services Update Page 2 • We are working to identify language for a Board of Supervisors' Resolution which can legally limit County costs and liabilities. B) Service Delivery/Program Accountability Issues Staff have met with Public Authority staff in San Mateo, San Francisco, and Alameda counties to gather information about service delivery and accountability in a Public Authority environment, and met with Social Services staff in Sonoma to review SIPs. Some of the areas that we have gathered impact information on include: • Staffmg levels in existing Public Authorities. • Payroll's relationship to IHSS and/or Public Authority. • Training opportunities and requirements. • Providers wage scales. • Orientation requirements. • Reference check requirements. • Client and provider matching and monitoring processes. • Providers recruitment and assignment. • Provider work rules. • Intake process. • Timeliness of client service. • Quality Control. • Complaint resolution. Our staff will continue to: • Meet at least monthly with both the IHSS Task Force and Advisory Council on Aging Long-Term Care Committee to offer updates regarding our Public Authority assessment. • Meet with the Long-Term Care Coordinating Committee regarding impacts of IHSS on Long-Term Community-Based System of Care. • `i Memo to: Board of Supervisors Subject: In-Home Supportive Services Update Page 3 C) Labor and Legal Relations Issues We are still awaiting State regulations to determine the consequences of naming the Board of Supervisors as the Public Authority. Social Service staff have consulted with County Counsel and Human Resources, who are continuing to gather information and/or offer opinions on the following issues: • Potential implications for collective bargaining, wages and fringe benefits that a Public Authority would create in relation to independent IHSS providers. • Board of Supervisors legal relationship to Public Authority and any potential liability issues. • Liability Insurance requirements. • Obtain information from Labor relations experts on Public Authority impacts. • Clarify need to develop a new County Administrative wage and benefit structure for 5,000 additional employees. • Clarify need to develop new employee/employer relations policy for Public Authority. II. IMPROVEMENTS TO CURRENT IHSS SERVICE-DELIVERY SYSTEM As per the plan approved by the Board of Supervisors on November 19, Social Service Department staff is developing a Supported Independent Provider (SIP) pilot project to help address some of the issues the general public and staff have identified as problems in the IHSS program. Primary is the development of a registry which would help link IHSS clients with independent providers whose skill and experience are consistent with clients' service needs. We seek to support clients in performing their employer role to the best of their ability and to support providers in performing their employee functions to the best of their ability. • Social Service Department staff completed research on the development and use of SIPs and registry services. • The program design for the pilot project will include: recruitment of IHSS providers; maintenance of current lists of available providers; assessment of providers' skills, abilities and training needs; provision for reference checks and qualification reviews; identify training opportunities in the community for providers; referral of available providers to IHSS clients; assist IHSS clients in their employer functions of hiring, scheduling, supervising, and directing providers; and support providers in performing their employee functions. Memo to: Board of Supervisors Subject: In-Home Supportive Services Update Page 4 • We conducted a public meeting in December where we received community input regarding the proposed program design. • We have arranged for office space in our East, Central, and West County offices for the pilot project. • Computer hardware and software for the pilot project is being ordered. • We are currently hiring three part-time provider coordinators, one in each region of the County. • We have written a letter to CDSS informing them of our interest and progress in developing a Supported Independent Provider(SIP)program. CDSS has recently announced interest in helping counties financially to develop SIPs. We will continue to move ahead with implementation of the Supported Independent Provider (SIP) pilot project and gather information regarding establishment of a Public Authority. We expect to have a final report available for the Finance Committee on our assessment of a Public Authority by late March meeting, contingent on State financial and programmatic regulations being issued. JBC:sjb PAIHSS97.JAN To: BOARD OF SUPERVISORS Contra _'•.� FROM: Finance Committee Costa 2�• .,QS PATE: November 19, 1996 County �; ` H•ri SUBJECT: ASSESSMENT OF A PUBLIC AUTHORITY FOR THE IN-HOME SUPPORTIVE SERVICES PROGRAM SPECIFIC REQUESTS)OR RECOMMENDATION($)&BACKGROUND AND JUSTIFICATION RECOMMENDATIONS: 1. ACCEPT the report from the Director of Social Services on the issue of creating a Public Authority for the In-Home Supportive Services program. 2. SUPPORT the recommendations of the Director of Social Services for instituting actions with the existing IHSS program by establishing a registry, assessing provider training, and enhancing consumer input. 3. REQUEST the Director of Social Services to prepare an assessment of a Public Authority, with the Board acting as the Authority, which includes a cap on County cost and liability and a sunset clause. (Timetable Attached) BACKGROUND: On October 29, the Finance Committee reviewed and discussed the attached report from the Director of Social Services. The report was requested at the October 7 Finance Committee meeting. CONTINUED ON ATTACHMENT: YES SIGNATURE: � --� RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVEOTHER �` SIGNATURE(S): Vark&DeSaulnier Tom Torlakson ACTION OF BOARD ON November 19 , 1996 APPROVED AS RECOMMENDED X OTHER _X__ The Board heard comments from the following speakers on the proposed program: A.C. Hollister, M.D. 14 Boles Court, Pleasant Hill; Trudi Riley, Co-Chair Housing Committee, Advisory Council on Aging, Long-term Care Cte, Advisor Council on Aging, Member of IHSS Task Force, 47 Rich Court, lbraga; Edith Lawenstein, President of Advisory Council on Aging, 3324 Ptarmigan, #4C E 20, Walnut Creek; Joanne Best, Independent Living Resource, 3811 Alhambra Ave., Martinez; Kagey Dorosz, IHSS Task Force, Richmond; - Paul DeMange, IHSS Task Force, 3811 Alhambra Ave., Martinez; Helen Hall; Lucille Adler; and Jeanine Meyers Rodriquez, SEIU, 1007 7th Street, Sacramento; All persons desiring to speak having been heard, THE BOARD ORDERED that the above recommendations are APPROVED; and the County Administrator is DIRE= to provide a report to the Finance Committee in January, 1997, on the issues raised today. VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS(ABSENT --- ) AND CORRECT COPY OF AN ACTION TAKEN AYES: T IV V & 11 NOES: n o n e AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: T I T ABSTAIN:n o n e OF SUPERVISORS ON THE DATE SHOWN. ATTESTED November 19 , 1996 Contact: PHIL BATCHELOR,CLERK OF THE BOARD OF cC: John Cullen, Social Services SUPERVISORS D COUNTY ADMINISTRATOR Sara Hoffman, County Administrator BY DEPUTY Page 2 The Committee took lengthy testimony from a number of interested parties including the consumers and providers of IHSS services, members of the IHSS Task Force, members and past members of the Advisory Council on Aging, and labor unions. The testimony ranged from support of an IHSS Public Authority to opposition - with a variety of suggestions on how the current system can be improved. Most participants acknowledged the uncertainty in the current Social Services environment brought about by Federal Welfare Reform. The Committee decided to recommend action along two tracks. First, to accept the Social Service Director's report and encourage the department efforts at improving the current IHSS service delivery system, as outlined in the Director's report. Second, to request Social Services to assess the pros and cons of a Public Authority, with the Board of Supervisor's as the Authority. The assessment should consider a sunset clause and a cap on County cost and liability. The Social Services Director was requested to prepare a work plan and schedule for the Public Authority assessment. Attached is the proposed timetable. SOCIAL SERVICE DEPARTMENT CONTRA COSTA COUNTY TO: Finance Committee DATE: 10/29/96 FROM: John Cullen, Direc or cc: SUBJ: Status Report - Development of IHSS Public Authority As per the Finance Committee's October 7th direction, the Social Service Department has begun a review of a proposal submitted by the IHSS Task Force, Service Employees International Union, and Keeslar &Associates, recommending adoption of an ordinance establishing a Public Authority to administer the In Home Supportive Services Program in Contra Costa County. Due to the far reaching impacts of such a proposal, and our desire to initiate program improvements, we have divided our review and recommendations into three sections. Section I provides information on the IHSS program and our service delivery options in California, local program demographics, and information regarding Public Authorities. Section II delineates areas for IHSS program improvements that are identified in the Task Force proposal and provides status updates on Department plans to address these issues. Section III presents a listing of the major issues of concern regarding a Public Authority on which the Department is gathering information/conducting analysis. It is absolutely essential from financial, service delivery,program accountability, labor relations and legal perspectives that these issues be fully explored prior to the development and approval of any ordinance to create a Public Authority. CONCLUSIONS/RECOMMENDATIONS • Accept this report as one step in thoroughly exploring the feasibility of creating a Public Authority for IHSS in Contra Costa County. • Support the Social Service Department's recommendations for instituting actions identified in Section II of this report which will improve the program in areas of registry services, training, consumer input and wage changes. • Continue on referral to Finance Committee status reports on research regarding financial, service delivery, accountability, labor relations & legal impacts of Public Authorities as listed in Section III. I - 1 - SECTION I IHSS SERVICE DELIVERY The In-Home Supportive Services (IHSS) Program is a Federal/State-mandated program that provides domestic and personal care services to eligible aged, blind and disabled persons who, without such service, could not remain safely in their own homes. State of California law and regulations provide that counties must administer the IHSS Program through one or a combination of three service delivery modes. These modes are: ,--� independent Provider mode under which the client hires and supervises a private p�. individual in an independent contractor relationship. • Contr ct mode in which the provider of service is the employee of a private company or independent non-profit agency which has won a contract to manage IHSS within the County. • County Homemaker mode in which the provider of service is a County employee. Contra Costa County uses the Independent Provider mode exclusively. Within all the various modes of service delivery, counties are to be responsible for eligibility determination and assessment of service hours. Under California State law, Independent Providers are paid minimum wage. Wages are not specified under the Contract or County Homemaker modes. With the recently-passed increase in Federal minimum wage, Independent Providers have received an increase ih 96/97 and again in 97/98. All California counties offer the Independent Provider mode with six counties supplementing Independent Providers with County Homemaker staff and 9 counties supplementing Independent Providers with Contract modes. Under current Federal and State laws, the IHSS Program operates as an entitlement with varying Federal, State and County shares-of-cost, depending on whether or not services are reimbursable under Medicaid. In Contra Costa County, we serve approximately 4,100 clients every month; annually, we spend approximately $20 million in provider salaries and approximately $3 million in administration which together includes a total County share-of-cost of approximately $5.5 million. Over 60% of Contra Costa Independent Providers are family members hired by the client. Both staff and community advocates have long recognized the need to improve the manner in which IHSS clients who do not have family member providers are matched with a provider. Approximately 5,000 providers ar(:'currently serving our IHSS clients. At any one time approximately 4.5% or 185 IHSS clients in Contra Costa County are without providers. This is due to turnover, time delays pending the providers' availability, clients terminating existing caretakers, immediate unavilability of providers, etc. The limited existing registry services in the community have not been able to adequately meet the needs of these clients. - 2 PUBLIC,AUTHORITY The In Home Supportive Services Public Authority, as defined in 1993 California legislation (SB 35) and in the 1996 State Budget Trailer Bill (SB 1780), is a new entity which can be created by county ordinance to provide for the delivery of IHSS. The Public Authority offers counties an alternative structure for managing the Independent Provider mode of IHSS. Public Authorities must provide a registry of providers, perform background checks, develop a referral system, and provide for training. Whereas, these services are not required under Independent Provider modes. The Public Authority primarily serves as the "employer of record for purposes of collective bargaining." Whereas, Independent Provider programs rely on state statute for salary and benefit setting. The Public Authority legislation also preserves the consumers' right to hire, fire, and direct their own providers. The legislation protects the Public Authority from being deemed the employer of IHSS providers "for purposes of liability due to the negligence or intentional torts of IHSS personnel." Under the legislation, the Board of Supervisors may appoint a consumer majority Public Authority or the Board of Supervisors may establish themselves as the Public Authority, with a consumer advisory committee. State legislation no longer allows any additional funding for creation of a Public Authority, and the state now limits its share of additional services (i.e. registry, background checks, etc.) to current administrative allocations. Recent budget trailer bill legislation also requires local government to fund the state's share of any salary and benefit costs authorized by a Public Authority. SECTION II PROPOSED.IHSS PROGRAM IMPROVEMENTS Those advocating for creation of a Public Authority, as well as the Social Service Department, agree that underlying program improvement areas include the need for a provider registry, provider training, consumer input and provider wages. The Social Service Department has budgeted $50,000 and one full-time staff person to begin addressing some of these underlying issues this fiscal year. ESTABLISHMENT OFREGISTRY Staff has interviewed managers in Santa Clara, Alameda, Sonoma and San Mateo counties to gather information on registry structure, provider/client processes and technology used by each registry. After reviewing these registries, a preliminary report and findings have a been developed. A Registry Program would provide: • Ongoir;, recruitment of prospective IHSS workers; • Maintenance of a current list of prospective workers; • Assessment of workers skills, abilities and training needs; • Provide for reference checks and review of workers qualifications; - 3 - • Monitoring of client/provider match; • Identification of training opportunities in the community; • Assist IHSS recipients in their employer function of hiring, scheduling, supervising, and directing providers; • Integration of the IHSS registry into the IHSS unit; and, • Ongoing evaluation of registry services. Presently 60% of the IHSS providers are family members and 40% are recruited from the general population. At any given time a small number of clients are without a provider and are in need of registry service. Therefore a registry only needs to be developed to accommodate a very small portion of our population. We plan to work with the Advisory Council on Aging Long Term Care Committee and IHSS Task Force to initiate Registry Services this fiscal year. PROVIDER TRAINING Department staff will soon begin an inventory of available training resources offered within Contra Costa County for the benefit of Individual Providers, Social Workers, and other community professionals serving IHSS clients. Linkage of training resource information with Idependent Providers will be a priority, with details being disseminated regularly. The Department will coordinate this activity with local advisory bodies. CONSUMER INPUT The County Advisory Council on Aging, through its Long Term Care (LTC) Committee, is a vehicle for providing ongoing input from IHSS clients and providers and from concerned community advocates regarding IHSS program operations. This body is overseeing the development of a longterm care program (which includes IHSS as a key component). Their mission is to develop and support coordinated and high quality home, community, and institutional based long-term care systems within the county by: • Linking adult programs ( Health and Social Service); • providing consumer choices and self determination; • providing service flexibility to respond to the needs of the individuals, their families and caregivers; and, • advocating for consistent policies within local, state and federal organizations serving adults. We believe that the creation of a "system of services" for all eligible clients in Contra Costa County in need of any level of long term care supportive services will allow for a coordinated -4 - and more efficient service system. Additionally, consumer input will be increased through the involvement of consumers, community groups and agencies involved in this continuum of services. The LTC committee is demographically and regionally representative of Contra Costa County. The LTC committee includes consumers, caregivers, and health care professiona` . Additionally, we will continue to participate on the IHSS Task Force. PROVIDER WAGES AND BENEFITS Provider wages are based in California statute on Federal and State minimum wage standards. As of October 1, 1996, federal mandated minimum wage went to $4.75. Sept. 1, 1997, it will increase to $5.15 per hour. A current State Ballot Proposition (if passed) would increase California minimum wage to $5.75 in January 1997. Any wage increase for Independent Providers above minimum wage is not eligible for state reimbursement. SECTION III PUBLIC AUTHORITY ISSUES OF CONCERN The complex and relatively untested concept of a Public Authority raises a host of financial, service delivery, program accountability, labor relations and legal issues of concern to the Department. These various issues need to be explored, and answers obtained in the coming weeks and months in order for a decision to be made on the appropriateness of a Public Authority. Social Service Department staff has/will take the following actions to gather necessary information regarding primary areas of impact: F NAN IAL • Study the cost of staff, structure and programs of the Public Authority over which the Board of Supervisors will not have direct control. Run suggested costs through a claim process. Consult with San Francisco, Alameda and State Department of Social Services. J • Confer with State Department of Social Services to clarify whether any state or federal dollars are available above or beyond our current IHSS administrative allocation for support of a Public Authority. • Review State Department of Social Services claiming regulations for Public Authorities, when issued, to assess financial impact. • Identify with the State Department of Social Services the impact of Welfare Reform/TANF funds on the IHSS program. • Identify with the State Department of Social Services the impact of Welfare Reform on IHSS client eligibility. • Identify with State Department of Social Services any IHSS Funding cuts due to Title XX Block Grant changes caused by Welfare Reform. - 5 - Identify with State and County Auditor how to assure fiscal accountability of an IHSS Public Authority. SERVICE DELIVERY/PROGRAM ACCOUNTABILITY Meet with San Francisco, San Mateo, and Alameda Public Authorities, County Auditor, County Counsel, and Social Service staffs to review the following service delivery and program accountability issues: Coordination and duplication issues resulting from split authority between Social Service Department and Public Authority; • Staffing needed to oversee Public Authority in order to maintain county mandated program and fiscal responsibilities; Confidentiality issues regarding sharing of information with Public Authority; How to assure compliance of Public Authority with state audit requirements; • Gather information and advice on the experiences of these counties in launching Public Authorities. • Consult with IHSS Task Force, Advisory Council on Aging Long Term care Committee, and other interested parties to clarify their divergent views regarding the Public Authority; LABOR & LEGAL RELATIONS Confer with County Counsel and County Human Resources Departments regarding initial legal and labor relations issues that have been raised, including: • Board of Supervisors legal relationship to independent Public Authority; • Determination of employer of record of Independent Providers; • Determine County exposure to a broad new range of collective bargaining and meet and confer obligations; • Determine if Public Authority would create a new County administrative wage and benefit structure for 5,000 additional employees; • Consult with labor relations experts on Public Authority; • Determine need to develop new employer/employee relations policies for Public Authority; • Compare conflicting legal opinions regarding Public Authorities. - 6 - C� o o G� f o- N o o W r Tl t N o o ?� D C 0�- 3N z ca cv ^ 3 .• nCO) � NO CD � t�D o � 0 '3 co �• ?,33•�m v rs?► ?, C) 14D uu:), O Q„ tD CD (C N N i {p (00 to. 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G ( THREE (3) MINUTE LIMIT) ff—S Complete this form and place h in the box near the speakers' rostrum before addressing the Board. T� Name: �C�`� �' s Z Fhone: -Cityl; C,,/�o X40 I am speaking for myself_ or organization:L� CHECK ONE: /`/ S T/�/c r-,: of asnntration) S /r4/ZCG- 1 wish to speak on Agenda Item f= Date: My — ents will be: general _fbr_nWnst . 1 wish to speak on the subject of o I do not wish to speak but leave these comments for the Board to consider: p Request to S eak Form ( THREE (3) MINUTE LIMIT) Complete this form and place it in the box near the speakers' na►stnim before addressing the Board P(� V 2 Name: VILIc L phone: ,v-Z- Address: /� A,)WA17,4 ,1r, I am speaking for myself.or organization , Owns of orpnbadmg CHE�C ONE: 1 wish to speak on Agenda Itan My Uments will be: general _for_"WroL._.. _.�,. 1 wish to speak on the subject of _ 1 do not wish to speak but leave these comments for the Board to consider: i Request to Speak Form �. ( THREE (3) MINUTE LIMIT) gwVlete this form and place it in the box near the speakers' i +ostrum before addressing the Board. i Name. aL ✓ �/�� phone: Address: Cit�r 1 am speaking for myself or organization: ane of ordom" CHECK ONE: 1 wish to speak on /agenda Item #.SL. Date: My comments will be: general _for—."W . o I wish to speak on the shied of 1 & not wish to speak but leave if comments for the Board to consider. Request to Speak Form D, ( THREE (3) MINUTE LIMIT) Complete this form and place it in the box near the speakers' , m before addressing the Board. Name: ��� qt-mm `661- 2218 Addmss.- L i �by\1-6U-, 1 am speaking for myself_ or organization: SHd�o� iso Omm of On 4 CHECK ONE 1 wish to speak on Agenda item #�1_= pate: Mr comments will be: general _for_asainst 1 wish to speak on the subject of o, i do not wish to speak but leave these comments for the Board to consider. Request to SPeak Form ( THREE (3) MINUTE LIMIT) Complete this form and place it in the box near the speakers' estrum before addressing the Board. Name: i o I � *hone: 4,:,-4 -c Z ig 1 am speaking for myself+ or organization: *% rw of 01awnhatioN CHECK ONE: wish to speak on Agenda Item #= ��(s�- My comments will be: general for_ftainst . 1 wish to speak on the subject of 1 do not wish to speak but leave these commerrts for the Board to consider. MAY-05-1997 1648 SOCIAI- SERUICE ANTIUCH 510 7o6 45ol P.02 Social Service Department Contra �Wr . CWftmia gym Cul, Costa . OW Cou mySEC--- et `f`` =• _ 6t9g1 _ Kgo�aos ASC°. c� TO: Maggie Dee 5-5-97 FAX # 473-0700 FROM: Evelyn Gillmore f FAX # 706-4501 I apologize for the delay in response to your request of 4-16-97. All applicants for 1HS5, regardless of age, are cleared for fiscal eligibility to IHSS_ The SSI applicant is assigned to a Social Worker. If not an SSI the applicant is concurrently assigned to the Eligibility worker. Once it is detemi.ned, that theclient is financially eligible, the Social Worker schedules an intake Hone Visit. The applicants IRS9 needs are assessed, the plan is written up and approved as appropriate. CI9T-appl-icanteand client pr f rani opt to have a -istiv* Cdr _,�`riend _i�s�tihe3 r gravid r._ _We r_ef-er__t o wlxa dcs nt:t hav+a �pr-oy derto_Independent_Aving' Resource Curter [1-8E�(3-x.33.--4 44 +fix Cth.�?�8 c�.iesxi�rtes e�].oraactheo�rcogntsatct-s (t-h4�s4a- .9v_eWe also,he3 /(223-9200- Gre-GOnniy - -py such as their �chur� Thank you for your patience in waiting far this response_ TOTAL. P.02 ­,%n-14-1996 11:38 Tom Todakson . . �:V_ 300 rpt Leland Road SuMmisor, RistriCt Five SUM 100 Camra Cwt$county Pittsburg,Calffornia 94566-4961 Board of Supervisors (610)427-8138 MEMORANDUM DATE: August 14, 1996 M Bob 5essler, Director, Area Agenoy oVAging F Moria Omanla, Chief Assistant Sjfflj: CARE CONNECTION Maggie Dee Dowling contacted our office last week and related her experience in utilizing the services offered by Care Connection. She registered with Care Connection to find minimum wage earners to work for her under the IHSS program. She was informed by Care Connection that they don't.have any people who will work for minimum wage nor any people who will work in East County. Mrs. Dowling is asking why the county is contracting with a program that cannot meet the needs. In our discussion, you indicated that flare Connection has been able make referrals at a higher wage level of$6 -$7 per hour in other areas of the county. You acknowledged there is a concern about the difficuities in recruiting Individuals to work at minimum wags to serve-the East County elderly and disabled. I understand the Board of Supervisors just approved funding that will allow your Office to look at options to address this problem_ Please provides Ms. Dowling and I with detalled Information about these efforts. Thank you for your assistance. :gra cc: Maggie Dee Dowling John Cullen, Social Servioes Director Phil Batchelor, County Administrator TOTAL P.01