Motion by Supervisor Zev Yaroslavsky

July 29, 1997

MOTION BY SUPERVISOR ZEV YAROSLAVSKY

In-Home Supportive Services (“IHSS”) is a valuable program which serves 81,000 Los Angeles County disabled or elderly residents. This program provides personal services caregivers to low income seniors and people with disabilities, thus enabling them to remain safely and independently in their own homes and avoid costly institutionalization. Since its establishment in 1973 IHSS has allowed thousands of our seniors and people with disabilities to maintain their dignity and a decent quality of life. It is especially important that we build on the strengths of IHSS at this time, while the County and health providers generally are aggressively moving to restructure the healthcare system in the direction of home- and community-based delivery systems. Yet, after more than 20 years, no serious efforts have been made to analyze the strengths and weaknesses of the County operated IHSS program.

Recognizing the importance of IHSS to the County’s human service safety net, the Board of Supervisors commissioned a study of the program using available State funds. That study, by RTZ Associates, was completed earlier this year and included surveys of both consumers and providers of services as well as interviews with numerous interested parties. It revealed that the IHSS program faces many critical problems and short-comings, and calls for retooling the system to ensure that the elderly and disabled receive quality, well-trained help.

The Board’s consultant, RTZ Associates, recommended that IHSS be restructured and reformed to give the County, recipients and the providers better protection. RTZ recommended that the County establish a Personal Assistance Services Council (“PASC”), as provided for under State law, to administer the IHSS program. According to RTZ, a Personal Assistance Services Council (“PASC”) in Los Angeles County, could provide the following improvements in the IHSS program:

1. Maintain and enhance consumer control and preserve the consumer’s right to hire, fire and direct providers.

2. Establish a consumer leadership group to guide program and policy improvements.

3. Provide cost-effective support services (e.g. registries, emergency provider replacements, etc.) for those consumers who need help in order to receive IHSS services.

4. Consolidate County programs which now fund or provide services to persons with disabilities to coordinate services, reduce duplication and increase service funds.

5. Develop options for increasing worker wages and benefits.

6. Contain County costs by seeking new sources of funding for improving services.

7. Build a broader community based long-term care system which incorporates IHSS and other community based services as part of an integrated service delivery and financing system.

RTZ also concluded that establishment of the PASC as recommended would enable the County to access available State start-up funds in the amount of $1,760,000. Use of these funds will enable the County to maximize services to the elderly and disabled.

In establishing the PASC, the County must be careful to preserve those aspects of the existing IHSS program which are beneficial. In particular, the PASC system must preserve the “Independent Provider” mode through which each recipient has the authority to hire, fire and supervise the provider of his or her choice. We must avoid exposing the county to fiscal and tort-liability risks we cannot afford. We must guarantee that service hours will never be cut for the purpose of increasing wage and benefit expenditures. Finally, we must guard against the risk of strikes to the greatest extent possible.

With these protections, the County can establish a PASC that immeasurably improves the availability and reliability of trained, screened and dedicated providers for our homebound elderly and disabled. The establishment of a PASC is an unprecedented opportunity for IHSS consumers, providers and the County to work together to make fundamental improvements in home and community-based services.

I, THEREFORE MOVE THAT

I. The Board instruct the Department of Public Social Services (“DPSS”), the Auditor-Controller and the County Counsel to prepare and present for Board consideration on September 30, 1997, a comprehensive approach, including an implementation timetable, to improve IHSS services in Los Angeles County at no increase in net County costs, unless new revenue is identified. DPSS shall seek input from all major interest groups and stakeholders, including recipients, providers and advocates in the development of these recommendations.

II. The Board instruct County Counsel to prepare and present for Board consideration on September 30, 1997, an ordinance that establishes a Public Authority under Welfare and Institutions Code §12301.6, to be known as the Personal Assistance Services Council (PASC), at no increase in net County cost. The ordinance should include the following provisions:

A. Protection and preservation of the Individual Provider mode and continued guarantee of the right of recipients to hire, fire and supervise their providers;
B. Utilization of all available start-up funds made available to the County under Welfare and Institutions Code §14132.95 and maximization of any available matching federal funds or other available grant, foundation, state or federal funds;
C. Provision that the PASC will be the employer of record for providers;
D. Maximum protection from tort liability for the County, including, but not limited to, a requirement that the PASC maintain an appropriate level of liability insurance.
E. Creation of a separate PASC Board, no fewer than 50% of whose members are to be current or past users of personal assistance services paid for through public or private funds, or recipients of services under the PASC; appointed by the Board of Supervisors pursuant to Welfare and Institutions Code Section 12301.6(b)(4).
F. Stipulations requiring adherence to applicable state laws and regulations, including a prohibition against service hour cuts for the purpose of increasing wage and benefit expenditures;
G. Absolute County budget and cost control protection which includes language requiring the PASC to adopt budgets under the same laws, rules and policies as the Board of Supervisors and prohibits it from adopting any budget unless it is fully funded with reasonably expected revenues, using the Board’s IHSS appropriation as an absolute limit on County cost. Further, the PASC would prohibit collective bargaining agreements that would increase County costs over that appropriated by the Board of Supervisors.
H. Require a non-strike clause in any collective bargaining agreement of the PASC which shall continue at least one year beyond other provisions of such contracts and provide that the PASC take court action to bar any strike by providers.
I. The above conditions should be non-severable from the enabling ordinance creating the PASC, and any violation shall serve to immediately repeal the enabling ordinance and dissolve the PASC.