Analysis of the California In-Home Supportive Services (IHSS) Plus Waiver Demonstration Program. Recipients Age 18-64


Spouse providers were rarely available as a choice to the non-aged adults participating in IHSS. Most IHSS recipients in this age group were either not married or their spouses were also IHSS recipients or otherwise not able physically/mentally to be paid caregivers. However, when spouses were available and able, the “preference” for them appears to be strong (90% among those with an available/able spouse). Parents were more readily available than spouses to non-elderly adults, and more recipients of this age group selected parents as paid providers. The availability of parents beyond those selected as paid providers is unknown in the IHSS data. There were discernable ethnic differences in the propensity to select Parent or Spouse providers. Hispanics were most likely to select Parent providers (26%) and the second most likely to select Spouse providers (9%). Asian were the most likely to select Spouse providers (11%) and second most likely to select Parent providers (18%). Blacks were the least likely to have either a spouse (2%) or parent (10%) as a paid provider. More than half of the Blacks and Whites relied on Non-Relative providers. This contrasted with about a third among Hispanics and Asians.

In general, recipients with paid Parent or Spouse providers had more limitations in ADL and cognitive functioning, and a comparable number of chronic health conditions, than recipients with other providers. However, those with paid Parent providers had higher rates of mental retardation/developmental disability, central nervous system injuries/disorders (such as quadriplegia, paraplegia, other extensive paralysis or spinal cord disorders), and seizure disorder) -- conditions shown by Fries and associates (2005) to have higher risk of nursing home placement.

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