Grand jury investigation finds abuse, fraud in in-home caregiver program

By Karen Brainard

Taxpayers are paying a high price for an in-home caregiver program that has been found inefficient and subject to fraud and abuse, according to a San Diego County grand jury report released Tuesday.

In-Home Supportive Services (IHSS), a state- and federally-mandated entitlement program funded with federal, state and local taxes, was the focus of the investigation. While the intent of the IHSS program is to provide non-medical services to low-income aged, blind and disabled individuals so they may remain safely in their homes, it is also a complex bureaucracy with overlapping state and federal laws and regulations, the grand jury report stated.

Due to loopholes and flaws in the regulations, IHSS staff has been unable to validate the hours that caregivers state they work and to verify services were provided, the investigation revealed, and only about 20 percent of those receiving services are considered severely impaired and unable to care for themselves.

“The caregiver unions actively lobby state legislators to prevent any changes to these regulations, claiming that unannounced home visits and validating time cards ‘violate the consumer’s privacy,’” said the report.

The grand jury learned of many incidents where IHSS consumers were physically and emotionally abused, or financially ruined because the program’s rules and regulations do not offer enough oversight. The current law permits the IHSS caseworker only one mandated follow-up visit, by appointment, to verify the continuing need for services, said the report. Because eligibility for the program has grown, caseworkers must handle 300 or more caseloads each, preventing close monitoring.

Statistics in the report showed that approximately 25,000 San Diego County residents receive IHSS services with 22,000 caregivers assisting them with domestic and personal care. Of those caregivers, 67 percent are family members, friends or acquaintances.

Until 2009, most potential caregivers were not required to undergo a background check, which allowed those with an undetected criminal history to be caregivers.

In 2009-10, the county’s contribution to the IHSS program was about $53 million of the $305 million to run the program. Data provided by the county showed costs have increased approximately 9 percent per year since 2000.

San Diego County board of supervisors has determined the costs of the program are unsustainable and that the loopholes could lead to fraud and waste, according to the report.

Grand jury recommendations include the following for the county supervisors:

•Write legislation, in collaboration with local state legislators, revising the eligibility requirements for IHSS to ensure consumers need such services, and to revise time card management regulations.

•Direct the Health and Human Services Agency to encourage the state Legislature and appeals court to implement the existing law that will prevent convicted felons from working as IHSS caregivers.

•Direct Health and Human Services to form a county task force to coordinate and evaluate cases of elder neglect and abuse and caregiver fraud.

The grand jury also recommends that Health and Human Services develop an internship with local universities that educates future social workers to handle routine tasks, freeing caseworkers so they can pay more attention to at-risk consumers.



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