County of Sacramento California For the Agenda of: June 16, 2009*

R1

1 Add a supplemental timesheet with clock hour implements (sic) versus the current block time accounting to be put in the recipient's file. A County supplemental timesheet would not require any computer system reprogramming, and the cost would be insignificant. RESPONSE IHSS Public Authority – Disagree The State of California Department of Social Services (CDSS) regulates the IHSS program and is responsible for the design and any changes to the design of the timesheet. At a recent legislative hearing, a CDSS spokesperson noted that no changes would be made to the timesheet because the new software system, CMIPS II, that is to go on line in 2010, has been designed with the current timesheet configuration and any changes would be very costly. Further, with the implementation of CMIPS II in the near future, all timesheets will be processed by the State of California at a central location. With regard to a county supplemental timesheet, this is impractical. The IHSS payroll staff now processes over 20,000 timesheets every two weeks. A supplemental time sheet, as recommended, would require some type of reconciliation, which would be labor intensive and impractical with ever decreasing staff resources. It is unclear how a supplemental timesheet would be used to identify or reduce fraud. Such a timesheet would not preclude completion in a pro-forma manner. Current timesheets reflect sick leave/vacations simply by a reduction of hours worked.

R2

1 Establish an independent pool of physicians to periodically review recipient files of Medi-Cal and mental conditions to provide both quality control and certification of claimed needs and services, RESPONSE IHSS Public Authority - Agree A physician currently reviews targeted IHSS cases, however this position is slated for elimination as part of the FY 09-10 budget reductions.

R3

1 Create an operationally independent task force composed of the County Sheriff's Department and the County District Attorney's Office to conduct fraud investigations. It would be funded by $1 million currently being expended on fraud by IHSS. RESPONSE IHSS Public Authority - Disagree The current fraud investigation unit is separate from the IHSS program, with the investigators being provided by the Department of Human Assistance. The investigators are experienced, law-enforcement professionals, many with prior experience working in a District Attorney's office as investigators. The current agreement is that any case referred to the District Attorney be "prosecution ready" meaning that no additional work is needed to take the case to trial. It is important that the investigation unit stay as close as possible to the IHSS unit and its staff to best identify potential fraud. Fraud unit personnel communicate routinely with the DA staff to determine which of the cases will proceed to prosecution now. Enhancing communication is always of benefit, so encouraging the fraud unit and the DA to continue meeting and enhance their interaction would be positive.

R4

2 Require reliability assessment of social worker training on the Needs Assessment to achieve greater uniformity on recipient needs assessment and hours granted. RESPONSE IHSS Public Authority - Disagree The State of California has mandatory training on uniform needs assessment, time for task, and hours granted. All social workers must already attend this training.

R5

1 Require that all current providers undergo a face-to-face meeting with an IHSS representative to verify identification and to receive a program orientation that is verified by providers' signatures. RESPONSE IHSS Public Authority - Agree The revised Provider Enrollment form when implemented in the fall 2009, will require a meeting vis-à-vis with county/public authority staff. All current providers and all new providers will be required to sign and have a meeting vis-à-vis with staff when implemented. This meeting can be used as an opportunity for provider orientations. This will be a challenge as both IHSS staff and Public Authority staff are slated for reductions and the program currently has 20,000 providers and enrolls about 7,500 new providers each year. <b>RECOMMENDATION 5.2</b> Revise the provider application to include name, date of birth, driver's license number, address, photo, and thumb prints, a question regarding any convictions, a question regarding whether he/she has ever been a provider elsewhere, used any other name, alias, or security number, and sign a perjury statement that the information provided is correct. RESPONSE IHSS Public Authority - Agree Again, this will be accomplished with the revised state-mandated Provider Enrollment form set to be implemented in the fall 2009, except for the thumbprint requirement. <b>RECOMMENDATION 5.3</b> Requires all providers to have and pay for a fingerprint-based criminal background check and the results to be given to recipients so they can make an informed judgment about their provider. RESPONSE IHSS Public Authority - Disagree 6 The IHSS program is unique in that the employer-employee relationship is between the recipient and the provider for purposes of hiring and firing. Fingerprinting is now done for all registry providers. For non-registry providers, it is up to the recipient as the employer to request fingerprinting and a background check. Fingerprinting of all providers would require a change in state policy and is not within the scope of the county. The IHSS Public Authority is mandated to establish a registry and is required to investigate the qualifications and background of potential providers before the provider is enrolled on the registry. As noted in Recommendation 1.6, DOJ background check availability is already provided to all IHSS recipients and is at the discretion of the recipient. IHSS recipients by regulations can hire whomever they choose. Since most IHSS recipients hire family members or friends, requiring DOJ background checks for all providers will likely have limited impact on IHSS recipients' hiring patterns. Requiring providers to pay for fingerprint-based background checks is a negotiable condition of employment. The processing time for the DOJ to process and send background checks, which ranges from 24 hours to several weeks, could delay provider availability for IHSS recipients. <b>RECOMMENDATION 5.4</b> Require all providers to pass a tuberculosis test. RESPONSE IHSS Public Authority - Agree in concept TB testing could be a useful screening process, however, it will have a cost. The Public Authority in its infancy explored making this a requirement but the costs were limiting. Again, this would be a negotiable condition of employment if the providers were expected to pay for such screening. In the years since its inception, the Public Authority has not been advised of one instance where TB has been transferred from the provider to the recipient. TB tests would delay a new provider's availability by a minimum of three days.

R6

The IHSS Information Technology Department is commended and should be recognized for their accomplishment. RESPONSE IHSS Public Authority Response — Agree The IHSS Information Technology staff should be recognized for this accomplishment. The IHSS IT staff and management should also be recognized for the development of a timesheet scanning tool implemented in 2001. This tool has hastened the processing of timesheets and greatly reduced complaints associated with timesheet processing.

R7

Encourage the County Board of Supervisors to evaluate the Registry functions, workload and level of funding: RESPONSE IHSS Public Authority - Disagree The registry is only one component of the IHSS Public Authority and the $1.6 million cited is the staffing cost for the entire Public Authority not just the registry. The Public Authority, established by the Board of Supervisors in 2000, is mandated to act as the employer of record for collective bargaining; assist IHSS recipients in hiring providers; investigate the qualifications and background of potential providers; provide training for both recipients and providers; and perform other functions related to the delivery of IHSS services. Currently the Caregiver Registry, as part of the Public Authority, has four registry specialists who screen potential providers and then match them with recipients who are in need of a The providers must complete a screening tool; be accepted into the two-part caregiver. orientation, complete an application providing references, be cleared through review of Sacramento Superior Court records and Megan's Law list, and complete a DOJ background check before they are enrolled on the registry. IHSS consumers must complete an oral application that identifies the number of hours needed, and preferences in relation to a host of needs. When a consumer needs a caregiver, a computer database generates a list of best matches based on IHSS consumer's needs and preferences. The IHSS recipient may use this list to hire a caregiver. Effective July 1, 2009 due to a reduction in funding, the registry will have only three registry specialists lengthening the time to create lists, reducing the time available to assist with hiring, and reducing the number of new providers brought onto the registry. Most recipients hire family and friends. Of those that do not, the registry serves 1,000 recipients yearly, but produces 1,500 lists. Often additional lists are needed as the recipient finds it difficult to maintain a provider for a number of reasons. The registry is advertised in newsletters and a registry packet is given to each new IHSS recipient and at annual reassessments. In addition, a social worker works closely with the registry when there is a need for urgent care due to the unexpected absence of a recipient's caregiver. Before the contractual services for urgent care are used, the registry and the social worker work to find a registry provider who is willing and can work on short notice. Registry staff is also available to provide DOJ background checks upon the request of any IHSS recipient. This is an infrequent occurrence although this service is regularly publicized. The Public Authority does all of the background checking and provides training to all registry providers fulfilling the grand jury recommendation 1.6. In addition to the registry specific activities detailed above, the IHSS Public Authority staff has negotiated four agreements with the union representing IHSS caregivers, IHSS Public Authority staff administers programs of health and dental insurance for over 3,000 IHSS caregivers, as well as COBRA continuation coverage for those who have lost health benefits and elect to continue that coverage under the group plan at their own expense. Since its beginnings in 2000, the IHSS Public Authority has coordinated the education of over 10,000 IHSS caregivers and recipients in over 570 classes. Staff has published two quarterly newsletters delivered to over 27,000 IHSS households. IHSS Public Authority provides staff support to the IHSS Advisory Committee and their various subcommittees. And, finally, the presence of the IHSS Public Authority, as an entity separate from the County of Sacramento, insulates the county (and the state) from negligent or willful activities of IHSS providers. . . • . Attachment B <b>IHSS Public Authority</b> Curriculum List 3D's Delirium, Delusions, Depression 4 D's-Dementia, Delirium, Delusions, Depression Adult & Infant/Child First Aid/CPR/AED-Spanish Adult First Aid & CPR Adult First Aid & CPR with Russian Translation Adult First Aid/CPR (Spanish) AIDS/HIV Overview Alcohol and Other Drugs Alzheimer's & Dementia Back Injury prevention and chemical hazards Balance and Fall Prevention Beat the Heat Bipolar, Depression, Suicide, and others Bowel, Bladder & Wound Care (Spanish Translation) Bowel, Bladder and Wound Care Bowel, Bladder and Wound Care (Russian) Brain Power: How to Keep It Cancer Hypertension and Heart attacks Cancer, Hypertension and Heart Attacks (Hmong translation) Caregiver Job Skills Caregiver Job Skills (Russian) Caregiver Skills Follow-up Training for Registry Caregivers Only Caregiver Support Groups Caregiving with Class Caregiving with Class and Stress Management Caring and Communicating with Class Caring for Acute and Chronic Illnesses Child/Infant First Aid/CPR Chronic Diseases Clutter Control Coming Clean with Ruthie Communicable Diseases Communication Skills for Caregivers Community Resources to the Rescue Community Resources to the Rescue with Russian Translation Congestive Heart Failure Consumer Classes Coping with Cancer Dental Care and the Link to Physical Health Dementia and Preventing Falls Dementia and Preventing Falls (Hmong Translation) Dementia and Preventing Falls (Russian) Dementia and Preventing Falls (Spanish Translation) Diabetes and Infection Control Diabetes and Infection Control (Russian) Diabetes and Infection Control (Spanish translation) Dining with Diabetes/High Blood Pressure/Heart Disease Disaster Preparedness Disaster Preparedness II Don't Let Talk of the Flu Fool You Driving Your Consumer with Care Eat Well, Be Well Elder Abuse Prevention (consumer class) ACC Greenhaven Terrace Family Caregiver Orientation File of Life (Greenfair Apartments) First Aid/CPR (Russian ONLY) First Aid/CPR (Spanish ONLY) First Aid/CPR English Food Safety Foot Care Grief and Loss Hazards of Homecare and Bloodborne Pathogens Health & Safety Part 1 - Hazards in Homecare Health & Safety Part 2-Workplace Violence Prevention Healthy Living, Hypertension & Heart Attacks Hearing Loss Hmong Women's Center Outreach Homecare Health and Safety - Part 1 Homecare Health and Safety-Part 2 How to be a Nutrition Wizard How to Identify and Report Suspected Elder Abuse How to Make the Best of Your Doctor's Appointment (Mandarin & Cantonese Translation) Humor For the Health of It Improve Mobility and Transfer Safety Introducing IHSS Introducing IHSS (Russian) Laughter is the Best Medicine Let's Talk – Communication Skills for Caregivers Living with Chronic Illnesses Living with long term Illness Loss of Vision, Hearing, and Mobility Lupus & Navigating Through the Health Care System Make Safe Serve Safe Making Peace Through the Power of Forgiveness Managing Arthritis, Gout, and Joint Disease Managing Arthritis, Gout, and Joint Disease (Hmong translation) Managing Chronic Diseases Medi-Cal & Long Term Care Medicare Part D-The Prescription Drug Benefit Program Memory Maintenance Mental Health Bipolar and depression Mental Health Overview Mobility and Transfer Safety Moving from Patient to Person/Chronic Pain Myths and Facts About Aging Neurological Diseases Neurological Diseases(Parkinson's and Seizure Disorders) Nurturing the Caregiver's Mind and Body Nurturing the Caregiver's Mind and Body Nutrition Wizard Obsessive Compulsive Disorder (OCD) Organizing Workloads and Medical Records Orientation Orientation for Family Caregivers Overview of HIV/AIDS Paratransit Personality Disorders Podiatry - Steps for Keeping Feet Fit Points for Providing Personal Care Points for Providing Personal Care (Spanish Translation) Points for Providing Personal Care Including Wheelchair Users Presenting IHSS & the IHSS Public Authority Preventing Identity Theft Preventive Health for Women Protect Your Consumer and Yourself from IHSS Fraud Providing care for children Providing Personal Care for Wheelchair Users Risk Mapping and Blood borne pathogens Rx for Communicating with Doctors & Medication Mgmt. (English with Spanish translation) Rx for Communicating with Doctors and Medication Management Rx for Communicating with Dr's and Med Management Schizophrenia SEIU Health and safety p1 SEIU Health and Safety p2 SEIU Health and Safety p3 Self Care for the working caregiver Senior Health, Part 1 Senior Health, Part 2 Senior Safety & Crime Prevention Senior Wellness Skin Care and Infection Control Skin Care and Pressure Sore Prevention . Sleep Disturbances Stomach and Digestive Disorders Survival Guide for the Holidays Taking charge of your health care Tax Information for IHSS Caregivers The Soothing Effects of Art Understanding and Caring for Cardiovascular Disorders VITA Tax preparation Watt Avenue Caregiver Support Group When Behavior is Difficult Women's Health Women's Health (Russian) Women's Health Issues-Consumer Outreach (English and Russian) Workplace Violence Prevention Total Count = 146 Classes . • . . .