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Legal-Ease: An Attorney’s Perspective: What Is In-Home Supportive Services?

By August 24, 2018March 28th, 2019No Comments

Judd Matsunaga

By Judd Matsunaga, Esq.

[dropcap]I[/dropcap] want to start off with some good news! People in America today can expect to live longer than ever before. If you’re lucky enough to make it to 65 years of age, you can expect to live another 19.3 years (on average) according to the Centers for Disease Control and Prevention.

However, those extra 19 years could include managing chronic conditions such as: (1) arthritis — the CDC estimates that it affects 49.7 percent of all adults over 65; (2) heart disease — the leading killer of adults over age 65; (3) cancer — the second-leading cause of death among people over age 65; and (4) respiratory diseases — the third most common cause of death among people 65 and older.

Other common health concerns for seniors are Alzheimer’s disease, osteoporosis and diabetes. The CDC estimates that 25 percent of people ages 65 and older are living with diabetes, influenza, pneumonia, falls, obesity and depression.

As Americans get grayer, their families are taking the lead role in providing care for aging adults. An estimated 43.5 million adults in the U.S. have provided unpaid care to an adult in the prior 12 months (Source: Caregiving in the U.S. 2015 — Executive Summary).

Adults ages 45-64 are the most likely to be caregivers. In fact, 23 percent of adults ages 45-64 cares for an aging adult. On average, they have been in their role for four years, with a quarter having provided care for five years or more (24 percent). Higher-hour caregivers are twice as likely to have been in their caregiving role for 10 or more years.

Adults help their parent(s) with errands, housework or home repairs. Caregivers may perform a range of activities, such as providing companionship, assisting with housework or providing medical and other forms of physical care. Relatively few caregivers say they helped with personal care, such as bathing or getting dressed.

The sad news is that our country’s 40 million unpaid family caregivers devote a large portion of their own money toward the care of their loved ones. Family caregivers report dipping into savings, cutting back on personal spending, saving less for retirement or taking out loans to make ends meet.

More than half of family caregivers reported a work-related strain, such as having to take unpaid time off. They’re spending an average of $6,954 a year — nearly 20 percent of their income — on out-of-pocket costs related to caregiving (according to a new AARP study, “Family Caregiving and Out-of-Pocket Costs: 2016 Report”).

But wait — there’s help! What if I told you that your 45- to 64-year-old adult child could get paid for their services (at least in part). “Say what? Do you mean that my 60-year-old daughter who is providing us ‘unpaid’ care can get paid?” You bet! It’s a little-known public program called In-Home Supportive Services.

The goal of the IHSS program is to allow you to live safely in your own home and avoid the need for out-of-home care, i.e., nursing homes. Services almost always need to be provided in your own home or the home of a relative (such as a son or a daughter). That’s right, IHSS will pay friends, family members and, in some instances, spouses, for help with housework, meal preparation and personal care.

Fortunately, most IHSS recipients can hire, fire and supervise their own caregivers under the Independent Provider mode of service. Most IP’s are relatives of the client. In other words, that means that IHSS will pay your son or daughter for your caregiving. Or, better yet, you can hire outside care so that your son or daughter can “visit” rather than “caretake.”

Since IHSS is run by the Department of Social Services, all you have to do is first qualify for Medi-Cal. “But Judd, I was told I don’t qualify since I have more than $2,000 in the bank.” Not true. You are legally allowed to convert nonexempt assets into exempt assets, “spend-down” excess assets or transfer them to a trusted adult child without triggering a three-year waiting period.

Judd Matsunaga is the founding attorney of Elder Law Services of California, a law firm that specializes in Medi-Cal Planning, Estate Planning and Probate. He can be contacted at (310) 348-2995 or The opinions expressed in this article are the author’s own and do not necessarily reflect the view of the Pacific Citizen or JACL. The information presented does not constitute legal or tax advice and should not be treated as such.