Analysis of the California In-Home Supportive Services (IHSS) Plus Waiver Demonstration Program. Household Size and Living Arrangements

07/01/2008

Table 5a, Table 5b and Table 5c show the distribution by age and provider type for selected living arrangements. Gender of the recipient is also shown here because of its association with provider type. Except among children, females are the most common recipients: 59% among non-aged adults, and 69% among the aged. However, when considered by provider type, females are less likely to have Spouse or Parent providers than males, and much more likely to have Other Relatives and Non-Relatives as their provider. This pattern is present for both new and continuing IHSS recipients.

Gender differences widen by age group, however women age 18-64 are more likely to have Other Relatives than Non-Relative providers. This pattern persists but narrows among those over the age of 65. These shifts may be associated with changing racial/ethnic mix in the population evident among the age cohorts.

Household size also ranges widely, but somewhat in association with recipient age. More than two-thirds of the children live in households of four or more persons. This pattern holds across all family-related provider types and among both new and continuing recipients. Among recipients age 18-64, two and three person households predominate (about 50%) with those living with a spouse or parent, but substantial proportions of the remaining recipients live in households of more than three persons. Those having Other Relative and Non-Relative providers tend to be in smaller households, with almost 40% of those having Non-Relative providers living alone. Recipients age 65+ generally live in smaller households, with two person household predominating for those with a Spouse or Other Relative. Almost half of the recipients having Non-Relative providers live alone. For both adult age groups, the preceding patterns are consistent comparing new and continuing recipients.

Houses and apartments predominate as the type of residence, but as with household size, the distribution varies by age of recipient. Apartments gain prominence as recipients get older (and household sizes tend to be smaller). There are minor differences within age group and provider type between new and continuing recipients. One interesting pattern is that mobile homes and other forms of housing (e.g., residential hotels and boarding homes) combine for 5%-8% of all units seem to be increasing among new recipients in all age groups, but they continue to be used more frequently by those age 18-64. Whether this is a function of geography is not known.

Another living arrangement characteristic of interest is the status of spouses and parents as potential personal assistance providers. Among the adult recipients, the prevailing pattern (70%-80%) is for there to be no spouse present. However, even when there is a spouse present they are not always considered by the IHSS social worker as “available and/or able” to be PAS providers. Particularly notable is the proportion of spouses who are themselves IHSS recipients. Among those age 65+, 21%-23% of IHSS recipients have a spouse who is also a recipient. This is almost 80% (70% among new recipients) of the aged households with a spouse present. Among recipients age 18-64, the percentage of households with a spouse present (about 10% for those without spouse as paid providers) is lower than among the aged, but the number and proportion who are also IHSS recipients account for about one-third of the households with a spouse. These patterns may be influenced by Medicaid eligibility. Medicaid rules do not readily allow separation of a couple’s assets when they live together in community settings. The proportion of spouses who are IHSS recipients is somewhat lower among new recipients than those continuing. Except in situations where spouses are the paid providers, IHSS social workers have determined that fewer than 5% (much fewer among those age 65+) are able and available as PAS providers.

Within the CMIPS assessment, the role of parents is more completely enumerated and differentiated for minor children than for adult recipient groups. Among children, more than 80% of the parents available are said to be providing some or all IHSS-related services. Seventy percent are paid as IHSS providers. This pattern holds for both new and continuing groups. The information available for parents of adult IHSS recipients is much more limited. Except for those paid as IHSS providers (e.g., non-aged adults 16.6% are paid providers among continuing recipients, 9% among new recipients), the number of parents available is not well documented. The factors contributing to the decline in the proportion of parents as paid providers between continuing and new recipients are not readily apparent in the CMIPS data. However, some of this difference may be associated with an increase in the proportion of recipients with Other Relative providers. These provider choices are not affected by the incentives in the IHSS Plus Waiver to pay legally responsible relatives.

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