Q. Our 90 year-old mother is frail but wishes to remain at home. She has limited financial resources, so my sister is living with her and providing care without pay.  Are there any government programs that might help us hire a caregiver and give my sister some relief?

A. Yes. There are a number of programs, but one that may be of special interest is the In-Home Supportive Services Program (“IHSS”). It is designed for persons of limited financial means who are blind, disabled or over age 65, and who are unable to live safely at home without assistance.  For qualifying individuals, it provides nonmedical services such as meal preparation, cleaning, laundry, bathing, feeding, dressing, grooming, toileting, and monitoring for persons with cognitive impairments who are at risk of injury at home.

It works like this: following an application, an in-home assessment is made by a social worker to determine the number of hours of care needed. This can be up to 195 hours per month for a non-severely impaired applicant and up to 283 hours per month for one who is severely impaired.  Upon approval, the beneficiary then selects and hires a caregiver and the IHSS program pays the worker for the  approved hours per month, currently (in 2021) at the rate of $15.75 per hour in Alameda County, $15.00 per hour in Contra Costa County, and $17.50 per hour in San Francisco County.

Resource Limits:  The program is designed for persons of very modest resources who are eligible to receive Supplemental Security Income (“SSI”) or Medi-Cal.  To qualify, the applicant must generally have less than $2,000 in savings if single, and less than $3,000 if married.  Note:  for those persons with excess assets, there may be lawful strategies to accelerate eligibility without the need to first spend down the excess. Also, for couples where only one spouse needs care, the Spousal Impoverishment rules may permit the “well spouse” to retain much more in the way of savings or other non-exempt assets.

Income Limits:  For persons with low monthly incomes, the benefit is available without a share of cost (“co-pay”).  However, for persons whose monthly income is above certain levels (currently, in year 2021:  above $1,481 for a single person and $2,004 for a married person), the applicant will have a share of cost that must be paid to the worker before the IHSS program pays the balance.  Thus, the program only works well for persons with low incomes, or persons with great need who are awarded hours close to the maximum.

In many cases, the caregiver may hire a family member, whether a spouse or an adult child.  Also, for the caregiver who works at least 80 hours per month, the program makes healthcare available at a nominal monthly premium, a valuable benefit to the worker.

If your mother qualifies for IHSS, she could hire your sister so she could receive both a modest salary and health insurance.  Also, to give your sister some relief each month, your mother could split care hours, hiring your sister part-time and another caregiver for the balance of approved hours.

To find out more, call the Alameda County Area Agency on Aging at 510-577-1800, or go to www.AlamedaSocialServices.org.

Reference:  See the website of the California State Department of Social Services, especially IHSS rates of pay in different California Counties: