Advocates call for improvements to vital in-home support services in San Mateo County

When in need of assistance, seniors and those with disabilities can turn to In-Home Support Services, a program funded by state and local dollars and operated by the county. But insufficient wages may be scaring away potential caregivers, leaving some clients scrambling to find care without a solid backup system in place. 

Developed in the 1970s, IHSS was intended to enable seniors and disabled people to live as independently as possible. Through the program, family members, friends and other care providers could be financially compensated for the hours they spent assisting with personal care routines, cleaning, cooking and daily errands. 

But since the program’s inception, much has changed in the county and not as much has changed for the program. 

Chris Rodriguez, deputy director of the San Mateo County Aging and Adult Services, has spent his entire career in the field, spanning more than 30 years. Looking back, Rodriguez said challenges in the system were first noticed in the late ’90s when cost of living began to balloon in the county. 

Today, the county’s median household income is more than $136,500 compared to the state’s median household income of $82,565, according to San Mateo County All Together Better, sponsored by County Health’s Public Health Policy and Planning Division. 

Since the late ’90s, finding a workforce has been a challenge faced by similar agencies across the nation but particularly in expensive areas like San Mateo County, Rodriguez said. Base pay in the county for IHSS workers starts at $16.70, one of the highest rates in the state. 

“It’s very difficult to find individuals wanting to do this work and those who do I have to give a lot of credit,” Rodriguez said. “The pay is low, the job is very difficult and you deal with human behaviors but they do it through their hearts. They’re very caring people for the most part.” 

Though the pay is greater than the county’s minimum wage of $15.62 and the state’s at $14, Rodriguez said the local agency is routinely considering how to increase the rate. Like other employers in the area, competitive pay is necessary for attracting and maintaining a strong workforce. 

And the program is competing, Rodriguez said, but the rate is still falling short of meeting the needs of the region, especially in San Mateo County, which is home to one of the state’s fastest aging populations. 

“They’re legitimate concerns and they’re concerns of ours,” Rodriguez said. 

‘Out of sight, out of mind’

Zuniga has witnessed the struggles of the employee shortage firsthand, having been a quadriplegic since sustaining a severe spinal cord injury in 2009. The Peninsula native and mother of two adult sons is a member of the San Mateo Union High School District Board of Trustees, and has remained busy as a member of various commissions, boards and organizations before and after her injury, the main difference now being her need for daily assistance. 

Finding and retaining a caregiver has always been difficult. Each IHSS participant acts as the employer and is responsible for interviewing, hiring and training a caretaker on their specific needs. Some may need less intimate assistance with tasks like shopping and cooking while others may need a caretaker to help them bathe, dress or use the bathroom. 

Care recipients are also responsible for ensuring their care providers do not go over their allotted hours decided by a case manager. Zuniga noted she’s frequently been granted insufficient time for basic tasks, requiring her to meticulously plan her weeks and sacrifice some steps of care. 

“We have to consider not only the wages but we have to think of the type of work we’re getting,” Zuniga said, noting clients can face penalties for going over their hours, potentially losing their care for six months. 

Going without care for extended periods of time can be a matter of life or death for many in IHSS, especially those new to the program and uninformed or unable to fully manage their care. Again, Zuniga knows from experience how devastating the experience can be, having gone more than three months without a care provider due to the pandemic. 

“Out of sight, out of mind. Because we’re out of sight, people don’t think about it and because COVID we’re even more out of the community,” Zuniga said. “It’s horrible. It feels like you’re going nuts.” 

Finding care 

May Sahouria is a San Mateo resident and full-time employee with a mobility disability that has made her wheelchair dependent. Before COVID, she lived by a tight schedule that required her to wake up by 6 a.m. to complete her morning routine before catching Redi-Wheels to work by 7:45 a.m. 

During the pandemic, Sahouria has been able to work from home, loosening her schedule and reducing her need for daily care. But doing so has forced her to compromise on the parts of her routine that make her feel good, like showering daily or doing her hair. 

She’s also had to rely more on her husband and sister for assistance. While the program was meant to function this way, Sahouria said leaning on family members for frequent and intimate care can strain relationships, noting relatives often have other jobs and responsibilities. 

“He’s my husband. He’s not my house cleaner so it got hard,” Sahouria said. “What it did was remind me that I have a disability. … It can be very difficult.” 

Now that Sahouria is preparing to return to the office, she’ll again need to hire a care provider who will need to arrive early and work efficiently and safely. 

Having had negative experiences with IHSS caregivers, Sahouria said she previously turned to online platforms like Craigslist to find support. There she was able to vet candidates and often found nursing students and recent graduates who were eager to provide high-quality care.

If she went through IHSS, Sahouria would only be offered a list consisting of the names and contact information of screened providers, Rodriguez said. Aside from CPR training, care providers are not required to have a medical background and undergo just one orientation on caretaker expectations and payroll. 

Sahouria and Zuniga both called for similar IHSS improvements. Ideally, clients would have access to a digital registry of providers and more detailed biographies. The system should also be better fit to rapidly deploy a care provider in case another fails to show, an issue with which both women said they had to contend. 

Long term, Zuniga said the program should benefit from offering a sliding pay scale that would provide greater rates for more demanding services. And additional training is vital for ensuring care workers fully understand the demands clients have and that clients are better equipped to manage the hours they’re granted. 

Pushing for solutions 

In 2019, change felt closer than ever, Zuniga and Rodriguez said. State leadership was finally discussing a larger plan for California’s Department of Aging and developing a goals document called the Master Plan for Aging.  

But the pandemic soon struck in early 2020, derailing conversations. Those have since restarted, Rodriguez said, sharing hope for the future of aging and adult services. The state’s 2021-22 revised budget also includes funding for many called-for improvements including a $5 million “No Wrong Door” system meant to provide clients with information, person-centered planning and care management. 

Sustainable improvements are needed at the state level but Zuniga argues that county leadership can also play a major role on the advocacy front by standing by disability advocates in their push for a more robust system. 

“There are problems and I wish people would acknowledge that,” Zuniga said. “We do want autonomy but we want support too. Things need to change.” 

sierra@smdailyjournal.com 

(650) 344-5200 ext. 106