Can I Receive IHSS if I Live in a Care Facility?

In-Home Supportive Services (IHSS) is a program offered by the state of California to help low-income individuals, including seniors and people with disabilities, live independently in their own homes. The goal is to allow individuals to receive assistance with everyday tasks such as personal care, domestic chores, and mobility so that they can remain in their homes and avoid institutional care. However, a common question among those considering IHSS is whether they can receive services if they live in a care facility, such as a nursing home, assisted living, or residential care facility (RCF).

In this blog post, we’ll explore the answer to this question and provide you with the key details about IHSS eligibility when living in a care facility.

1. IHSS Eligibility and the Home Setting Requirement

One of the foundational principles of In-Home Supportive Services (IHSS) is that the program is designed to support individuals who live in their own homes or other non-institutionalized settings. IHSS services are generally not availableto individuals living in licensed care facilities, such as:

• Nursing Homes
• Assisted Living Facilities (ALFs)
• Residential Care Facilities for the Elderly (RCFEs)

This restriction is in place because IHSS is intended to support people who live independently and need assistance to remain at home, rather than individuals residing in institutional settings where 24-hour care is typically provided.

2. Why Don’t People in Care Facilities Qualify for IHSS?

People who live in care facilities generally do not qualify for IHSS because these facilities are already equipped to provide 24-hour care and assistance. In these settings, residents receive services such as:

• Assistance with activities of daily living (ADLs): such as bathing, dressing, and eating.
• Medical care: which can include nursing care, medication management, and physical therapy.
• Meals: Typically provided on-site as part of the care package.

Since these facilities are staffed to meet the daily care needs of residents, the state does not offer IHSS services to individuals who live in them. The goal is to ensure that individuals in facilities receive care from the facility staff, which can include medical professionals and trained caregivers, rather than being served by the IHSS program.

3. Exceptions: Can IHSS Be Used in Some Facilities?

There are some limited exceptions to the general rule that IHSS cannot be used in care facilities. If you are receiving services in a care facility, you may still be eligible for IHSS under specific circumstances:

A. Assisted Living with an IHSS Provider

While IHSS is generally not available in licensed facilities, there may be exceptions in cases where individuals receive care in a non-licensed or board-and-care facility that does not provide the level of care offered in a nursing home or assisted living setting. In such cases, if you are living in a facility that does not provide the necessary daily support and you're unable to get help from the facility staff, you may be eligible for IHSS.

For example, if you are in a residential care facility but require additional assistance that the facility cannot provide, you may still qualify for IHSS services to help fill the gap. However, the facility needs to meet specific criteria, such as not providing 24-hour care or having limited support services, for IHSS to be an option.

B. IHSS for People Transitioning from Institutional Care

IHSS may also be available to individuals who are transitioning from institutional care (such as a hospital or nursing home) back to the community. The program can offer support during this transition, which may include assistance with home modifications, help with daily activities, and short-term caregiving services until the individual adjusts back to home living. In these cases, IHSS is designed to help people return to an independent living situation rather than remain in a facility.

C. Medi-Cal Waiver Programs

Some Medi-Cal waiver programs, like the Home and Community-Based Alternatives (HCBA) waiver or the Multipurpose Senior Services Program (MSSP), provide funding for individuals who would otherwise qualify for institutional care but want to remain at home or in a community-based setting. These waivers can provide additional support for those living in a care facility or transitioning out of one. In such cases, the programs may include services similar to IHSS, but with more flexibility in terms of where care is provided.

4. What About Other Types of Assistance in Care Facilities?

If you live in a care facility and are not eligible for IHSS, there may be other assistance programs available to help you manage your care needs. Some options include:

• Medi-Cal: For individuals with limited income, Medi-Cal covers many types of medical and personal care services that might be needed in a care facility.
• Supplemental Security Income (SSI): SSI provides financial support to individuals with disabilities and those aged 65 or older, which can be used for living expenses, including some costs related to care.
• Long-Term Care Insurance: If you have long-term care insurance, it might cover additional services provided in care facilities.
• Other State or Local Programs: There may be state-funded or county-specific programs that can assist individuals in care facilities with personal care or other needs.

5. What Happens if I Move Out of a Care Facility?

If you move out of a care facility and back into your own home or a non-institutionalized setting, you may qualify for IHSS services, assuming you meet the eligibility requirements. These requirements include needing help with personal care or other daily activities due to age, disability, or illness, and meeting income and asset criteria.

The transition from a care facility to home may require a reassessment by your county social worker, who will evaluate your needs and determine the level of IHSS support you may qualify for. This can include assistance with personal care, domestic help, medical tasks, and more.

6. How Do I Apply for IHSS Once I’ve Moved Out of a Care Facility?

To apply for IHSS services after moving out of a care facility, you can:

• Submit an IHSS application to your local county IHSS office.
• Undergo an eligibility assessment: A social worker will evaluate your care needs, determine your eligibility for services, and assign the appropriate number of hours based on your needs.
• Receive assistance: If you qualify, your caregiver (which can be a family member, friend, or hired caregiver) can start providing the necessary services, and you will begin receiving benefits.

Conclusion

In most cases, IHSS is not available for individuals residing in care facilities because these settings are already equipped to provide the necessary level of care. However, there are some exceptions where IHSS may still apply, such as in non-licensed facilities or when transitioning back to home care. If you or a loved one is currently in a care facility and in need of additional assistance, it’s important to explore other options for care, such as Medi-Cal, long-term care insurance, or local programs that can supplement facility services.

If you are considering transitioning out of a care facility, IHSS may be a valuable program to help support independent living. Contact your local IHSS office or a social worker for more information on eligibility and the application process.

Need help? In California, the In-Home Supportive Services (IHSS) program provides crucial financial help for families raising children with special needs. American Advocacy Group is on the front lines every day, making positive change happen for people diagnosed with autism, Down syndrome, and a range of diagnoses across the continuum. As a leading advocate for all people with intellectual and developmental disabilities and their families, and the premier provider of the support and services people want and need, we understand the system and know how to take action regarding your best interests.

CONTACT US FOR HELP. Dial (877) 762-0702 or email us at [email protected].