County Home-Care Rules Cut Over Criticism

The Los Angeles County Department of Public Social Services, under growing pressure to control spending for in-home assistance to the elderly, blind and disabled, quietly issued guidelines in August to set new standards of efficiency for fiscal 1985-86.

The standards were designed to be used by eligibility workers as an average in determining how many hours a week a county-paid employee can work in a beneficiary’s home. More time can be allotted only with a supervisor’s written approval.

The guidelines say, for example, that program beneficiaries should be allotted five minutes of assistance “per occasion” to go to the bathroom. Up to six such “occasions” per day of “bowel and bladder care” assistance for the severely disabled are allowed under the rules.

The guidelines also allow 27 minutes a day of “ambulation,” 10 minutes every other day of shaving and 15 minutes twice a week for baths.

“Essentially what this tells elderly people is that if you can’t evacuate your bowels in less than five minutes, you’re up a creek,” said Judith Neel, director of the Senior Norwalk Action Program, after hearing about the new guidelines.

“And if a person needs more than two baths a week, a social worker has to deal with a huge bureaucracy to get an exception.”

County officials, reacting to such criticism almost as quickly as it arose, called a meeting of community advocates Tuesday to notify them that the short-lived guidelines were being withdrawn and that any cutbacks suffered by beneficiaries would be restored.

“As a result of these concerns, we have withdrawn the material and instructed the social workers to operate the program as they did before,” David Fox, division chief in charge of adult services for county Department of Public Social Services, said after the meeting at the Legal Aid Foundation of Los Angeles.

Fox said social workers had been given the “time-for-task” guidelines in mid-August to help “bring greater uniformity and consistency” to the large program. Asked whose idea the guidelines were, he said: “I’ll take the credit or the blame.”

He said the time guidelines were devised after consulting workers, medical literature and other counties to determine just how much time each task normally takes.

Social workers had used the “time-per-task” guidelines since mid-August on an estimated 3,000 new applications for benefits and in several thousand more reassessments of current cases in the program, he said.

He said those reports will be reviewed and any cuts made in benefits because of the guidelines will be restored.

He said any cuts made in the program because of the guidelines would have come through social workers’ “misinterpretation” of the guidelines as “caps” on the time to be spent.

Elena Ackel, special projects attorney with Legal Aid, charged Tuesday that it was the county that had misinterpreted state law in issuing the guidelines in the first place.

“The law makes it very clear that you cannot use time-for-task guidelines for personal services,” she said. “So when we heard of these rules, we sent the county a demand letter telling them we planned to sue if they did not rescind the guidelines.”

The state Welfare and Institutions Code says, “Counties shall not use time-for-task guidelines in assessing the need of eligible individuals for the services described in subdivision (e) of Section 12304.” That section of the code refers to personal services, such as bowel and bladder care, dressing, bathing and other personal services.

Fox denied that the guidelines had been rescinded because of the demand letter.

The program, officially called In-Home Support Services, is part of a $343-million statewide program that serves 100,000 elderly, disabled and blind people. The state-funded program, which is administered by the counties, is designed to give such people enough paid help to remain safely in their homes instead of nursing homes.

Nearly half the beneficiaries, or 47,000 people, live in Los Angeles County. The county has been under increasing pressure from the state to reduce its expenses for the program, which are estimated to be 10% higher per person than the average elsewhere in the state.

The average amount of money paid per case statewide per month is $259.12. The average case per month in Los Angeles is $286.61. Officials say expenses are often higher in Los Angeles County because more severely disabled people move to Los Angeles to take advantage of specialized medical care here.

This year, the county estimates that it will have a $27.5-million shortfall in its budget for the program. The county Board of Supervisors formally appealed to Gov. George Deukmejian on Sept. 6 to make up the shortage. The governor has not responded to that request.

Linda McMahon, director of the state Department of Social Services, said in an interview Tuesday that the Deukmejian Administration is considering the request and expects to make a decision “relatively quickly.”

“We’re not going to continue to pump money and pump money and pump money into this program,” she added.

Legislators also have expressed concern over cuts in the program. State Sen. Diane Watson, chairwoman of the Senate Committee on Health and Human Services, has scheduled a hearing for December on the budget issues.

Lt. Gov. Leo T. McCarthy called Tuesday for a freeze in any cuts for homemaker services until the Legislature reconvenes in January and has a chance to appropriate more money.

“The Legislature thought it was fully funding the IHSS (In-Home Supportive Services) program,” McCarthy said at a press conference. “I think some faulty math was done on this program, and I don’t want the elderly and disabled to pay for someone’s calculating error.” BB TIMING THE COUNTY’S HELP These examples show guidelines established by the Los Angeles County Department of Public Social Services for beneficiaries of the In-Home Support Services program. Service Time/Frequency Bowel and bladder care 5 mins./occasion Up to six times a day Feeding 15 mins./day Up to three times a day Dressing 15 mins./day Ambulation 27 mins./day Combing hair 8 mins./day Shaving 10 mins./every other day Shopping 1 hr./weekEB