Orange County provider Valeri Dillon and her client Roger

Your client’s monthly IHSS hours are based on a social worker’s assessment of the kinds of care they need and guidelines on how long this care should take.

But this assessment may not reflect all the work you do for your client, or all the hours of care they truly need.

To find out if your client is eligible for more hours, you first need to record all the hours you work for them. Track everything you’re doing down to the minute, from tying shoes to changing bed linens. Then, fill out the worksheet, provided by Disability Rights California, which will help you calculate if your client is receiving all the hours of care they need.

Protective Supervision
Protection supervision is assessed when a client is a possible harm to him or herself when at home. People eligible for protective supervision are always given the maximum number of hours—at least 195 for non-severely impaired individuals or 283 for severely impaired individuals.

Your client may be eligible for protective supervision if they:

• Show severe mental impairment, poor judgement, confusion or bad memory
• Your client wanders or may get hurt if left home alone
• You client must be supervised 24 hours a day or dangerous behaviors will occur

IHSS Paramedical Services
Paramedical services are prescribed by a doctor and require some training to perform, like injections, colostomy irrigation, catheter care, and tube feeding. Make sure you ask for enough time to complete these tasks, from preparation to clean up. The county can’t cut service hours ordered by a doctor.

Your client may be eligible for IHSS paramedical service hours if:

• They can’t perform the service at all
• The service is necessary to maintain their health
• The service requires judgment and training to perform

Filing an appeal for more hours
If you believe your client needs more hours of care, or if you think they may be eligible for protective supervision or IHSS paramedical services, you may file a request at any time. If you have received a Notice of Action that hours are being cut or terminated, you must request a hearing within 10 business days to keep your benefits during the appeal process. If you miss the deadline, you still have 90 days to file an appeal but will lose your benefits during the process. Here’s how you can appeal for more hours:

1. 1. Request an appeal. Fill out the back of the Notice of Action form or send a letter to:
      IHSS Fair Hearing
      State Hearings Division
      Department of Social Services
      744 P Street, Mail Stop 9-17-37
      Sacramento, CA 95814
      Be sure to say that you want a fair hearing because you believe your client has not been given enough hours, and give your client’s name and state identification number. You can also call 1-800-743-8525 to request a hearing.
   2. Get everything in writing. You’ll need written documentation from your client’s doctor stating their needs and the type of care they require. If your client needs protective supervision or paramedical services, make sure that is in the documentation.
   3. Prepare for your hearing date. If your appeal requires a hearing, prepare the points you plan to make ahead of time, and make sure all of your documents are in order. Ask for a copy of the original assessment and the county’s position statement.
   4. Attend the hearing. At the hearing, the county will go first to say why hours were cut or why your client shouldn’t receive more hours. They will give lots of evidence. The most important thing for you and your client to do is stick to your explanations of why your client needs more hours. Be prepared to show all the documents you prepared.
   5. Get a decision. Any change in hours from the appeals process will be effective as soon as the county gets the decision from the appeal.

UDW caregivers can help!
Do you need help with this process? You are not alone, and your fellow caregivers are here to help!

Call your local UDW office to get personalized help, or find out when an advocacy workshop is happening near you. Our advocacy workshops can help you prepare for your client’s annual assessment, apply to have his or her Functional Index Score reassessed, prepare for unannounced home visits, understand a Notice of Action, and more.

We can protect our clients’ care together!