Paralyzed below the shoulders, Michael Condon is dependent on his caregiver for daily tasks: Brushing his teeth, dressing his 6-foot-3-inch frame, bathing.
Without a caregiver, the 60-year-old would likely be in a skilled nursing facility, caregiver Joey Riley said, and Condon wouldn’t have the freedom he enjoys now in his Grantville home. He lives on less than $900 a month and he can’t afford to pay for in-home care privately.
“The tasks are my entire life,” Condon said. “(But) I can go outside. I can enjoy the sunshine. It’s more like a life with human dignity.”
Riley is paid through a county-run program called In-Home Supportive Services, which serves as an alternative to nursing facilities for low-income elderly, disabled or blind people. Across the state, about 350,000 people work as caregivers and about 397,000 people receive services. In San Diego County, there are about 21,000 caregivers and about 25,000 recipients.
But the program that provides Condon his freedom has been the target of funding cuts that have cast doubt on its future. At the same time, the program has received added scrutiny for what the governor and others cite as its potential for fraud. IHSS is the fastest-growing major social services program in the state and, at a time when the state faces a $20 billion budget deficit, it is among the many areas being targeted for savings.
In January, Gov. Arnold Schwarzenegger proposed deep cuts to the program. His proposal would eliminate services for about 87 percent of IHSS recipients and reduce state funding in caregivers’ wages and benefits. And he proposed eliminating IHSS as a whole, among several programs, if the state doesn’t receive $6.9 billion in federal funding by mid-July. The governor’s revised budget is due Friday.
The program was also targeted last year, when the Legislature reduced or cut services for many recipients and reduced state funding for caregivers’ wages and benefits. Courts stopped those changes from going into effect.
Condon is among those in the IHSS community concerned about what could happen to the program, which accounted for $291 million in this year’s county budget. Living at home allows Condon to sit on his patio and paint with a paint brush stuck in a bamboo stick in his mouth or go to the beach with his dog. He also volunteers, counseling newly injured quadriplegic veterans on their options.
Riley has cared for Condon for the past 23 years. Condon wouldn’t lose his benefits unless the program was cut as a whole, Riley said, but the thought that the program could be cut causes her anxiety.
Advocates say the worries are constant. “Having the constant threat of in-home services being taken away is terrifying people,” said Deborah Doctor, a legislative advocate at Disability Rights California, an advocacy group for disabled Californians.
The program has also been criticized by Schwarzenegger and others for its potential fraud and waste. The state passed several anti-fraud measures last year, including unannounced visits to recipients’ homes and requiring fingerprinting for caregivers and recipients. Caregivers are also now subject to criminal background checks.
Riley said she hasn’t fulfilled the enrollment requirements yet. After working for Condon for so long, she said she feels criminalized by the requirements and thinks they could be a turnoff to caregivers looking for work.
“I find it insulting,” Riley said. “You can get a better job flipping burgers.”
Caregivers here make a wage of $9.50 an hour. In 2009, San Diego County had the third-lowest average hourly wage for caregivers out of the state’s 12 largest counties, according to a study conducted by the Rose Institute of State and Local Government at Claremont McKenna College in conjunction with voiceofsandiego.org.
Growth and oversight in the program have become focuses of county attention.
Supervisor Dianne Jacob highlighted it last year as a program whose costs had grown and needed to be reined in. Schwarzenegger has claimed a fraud rate as high as 25 percent in the program.
A 2007 San Diego civil grand jury report said the program seemed to be “riddled with inefficiencies” and listed some instances of possible fraud, including one where a caregiver did not work the full amount claimed. The report recommended more thorough background checks for providers as well as unannounced visits to recipients’ homes.
Because the program provides care inside of someone’s home, it can be difficult to monitor. Caregivers could claim they worked more hours than they did, for example, if a recipient was not actually receiving services because they were in a hospital or even deceased. Recipients have also exaggerated the need for services when they are actually in better condition.
But in a written response, the District Attorney’s Office noted that evidence was not given to back up fraud claims or to demonstrate that they were representative of the larger program.
While the governor has warned of the program’s potential for fraud, few cases have been prosecuted here.
In fiscal years 2008 and 2009, the San Diego District Attorney’s Office received 99 referrals of alleged IHSS fraud, 31 of which went to prosecution, said Ken Freshwater, supervising investigator with the San Diego District Attorney’s Public Assistance Fraud Division. Freshwater said he believes there could be more widespread fraud than the numbers show, such as when caregivers do not provide the services they claim.
“Is there fraud in the system? Yes. Is there a window for fraud? Yes. Are we prosecuting a lot of fraud cases? No,” Freshwater said. “Unfortunately, we live in a society where people take advantage of programs like this and people take advantage of other people and so thus there needs to be some check and balance in that program.”
Last fall, the Board of Supervisors approved a plan to implement state anti-fraud measures to increase oversight of IHSS, develop a database to better track fraud and prepare better long-term care options for the population served.
The county received about $1.4 million from the state to allow social workers to make unannounced visits to recipients’ homes to make sure services are being given, said Ellen Schmeding, the county’s assistant deputy director of Aging and Independence Services.