Analysis of the California In-Home Supportive Services (IHSS) Plus Waiver Demonstration Program. Recipients Age 3-17


Minor children in IHSS generally have at least one parent in the home. Consequently, for most of these children, the choice of Parent/Non-Parent provider was possible and the choice made by families was for a Parent provider (70% overall and 80% when a parent was present in the home). Hispanics had the highest proportion selecting Parent providers (81%) and the least selecting Non-Relatives (9%). Blacks were the least likely to have paid Parent providers (60%), and comparable with Whites in the proportion selecting Non-Relatives (20%). The decision of families to seek IHSS versus other service options was outside the scope of this study.

There were few differences by provider type in the number of ADL/IADL and cognitive limitations among minor children IHSS recipients. However, proportionately more minor children with paid Parent providers were dependent on human assistance with breathing (this includes assistance with self-administration of oxygen, and the cleaning of this equipment), and had more chronic health conditions (including mental retardation, seizure disorders, and paralysis). These conditions have been shown to be associated with nursing home use in minor children (Fries, Wodchis, Blaum, et al., 2005), and may be indicative of the Parent provider’s willingness and or greater ability to assume the demanding care responsibility associated with these conditions. Contributing to this ability may be that parents are legally permitted to perform “skilled nursing” tasks that would not be permitted by other providers. Investigation of the “cause” of this pattern is outside the scope of the current study.

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