IHSS Paramedical and Personal Care Services | Undivided Training Series

If your child requires extensive care at home due to their medical needs, tune into this training video where Undivided Public Benefits Specialist Lisa Concoff Kronbeck teaches how to document your child's needs so that you can apply for extra IHSS hours to cover paramedical services.

Here are links to the Undivided articles and other resources included in the training:

• For more information on IHSS services, check out our article In-Home Supportive Services (IHSS) 101.

• Visit our IHSS Protective Supervision and Paramedical Services article for further insights on personal care and related services and for a link to the IHSS Annotated Assessment Criteria.

• Go to our IHSS Protective Supervision and Paramedical Services article and click the goal, “Apply for IHSS Paramedical Services,” within to add it to your roadmap.

• To download the SOC 321 form, visit our IHSS Protective Supervision and Paramedical Services article.

See also this Q&A with answers to common questions about paramedical and personal care services.

So today we are talking about personal care and paramedical services. Just the little the little preface, just be aware that the information that I'm giving you here is publicly available. Information does not constitute legal advice. We're here to help you navigate the system and sort of gain some confidence with the material, but we are not authorized to provide legal advice. You need legal advice, please consult with an attorney. So IHSS is a program that's available to elderly people and people with disabilities, and so there are certain rules that apply just to children with this program is also available to adults. So when we talk about the personal care and related services that might be available broadly speaking, there's domestic services, non medical personal care and related services, accompaniment, protective supervision, paramedical services and your abatement. However, some of these services are generally not available to children.

For example, domestic services, I guess they don't expect the kids to do chores until they're a little bit older. And then yard hazard abatement is also generally not available to minors. For non medical personal care and related services. Some are available based on age and some are available based on extraordinary need, and we will talk about that a little bit, and then accompaniment to medical appointments sometimes, but not always. And then we talked about protective supervision last week, and we'll talk about paramedical services this week.

So non medical services include sort of your your activities of daily living, your ADLs, so you've got walking, um, bathing, oral hygiene, grooming, dressing, bowel and bladder care, feeding transfer in and out of seats. Respiration help with prostheses or medical setup, medication setup, and that might also be glasses or hearing aids, menstrual care for for some people, and then also basic repositioning and rubbing skin, which is different from, for example, wound care or physical therapy exercises, where you're trained by a provider.

So those are the services that are going to be potentially available to to children based on age. And we're going to talk about what that looks like for related services. It's generally going to be based on extraordinary need, especially for something like laundry.

IHSS expects that laundry is parent responsibility for most children. However, if there is extraordinary need, for example, if your child has a feeding tube or is on medications that cause them to require more laundry than a parent would expect to do, particularly developing child, then you might be able to make a case for extraordinary need for laundry, meal prep. And meal cleanup is an example of something that can either be a personal care service or a paramedical service. If your child has a G tube, then meal prep might be preparing formula for their G tube. So we're going to talk about all that.

So the hours for each of these services are calculated based on your child's age as well as the level of assistance that they need for each task. You're not going to be asked to assign one of these ranks. I'm going to I'm going to talk about the different rankings. You're going to be asked to assign a rank to your child's need. However, it's it's really helpful if you go into it with an understanding of how they assign the rank, so that you know how to describe your child's level of assistance.

So you're not just saying, Oh, he needs a little help with this. You can say, Okay, well, he needs verbal prompts. He needs hand over hand. You can be you can describe it in the sort of terminology that they're looking for to assess.

Assess your child's level of need.

So this is a chart that I share a lot, and it can look really intimidating and confusing at first, but we're going to go over it so that when you we're going to come we're going to talk about what these numbers mean, and then by the time we come back to this screen, you'll be able to look at this chart and assess how your child might be allocated IHSS hours. So first of all, we're going to look at all these ones, any place where you see a one. Only a one is either. So for an adult at a rank of one, means that the person is able to do the task completely independently for a child, where it says a mandatory rank of one is generally going to be what's expected of a parent caring for a typically developing child at the same age without the disability.

So anywhere you see only one that is parent responsibility, wherever you see one or six here, it's either it's parent responsibility or it's a paramedical service, for example, for bowel and bladder care. You can see from zero, from age zero to three, it's either a one or a six. So that means either the parent is expected to change diapers anyway at that age, or the child has a catheter, the child has an ostomy, and what the parent is doing for their child is is a paramedical service that's above and beyond typical diaper changing. And then anywhere you see one to five or one four or five, that's going to be based on the actual rank of the child's need. So they might be a one if they're able to do the task independently, but I I just s, they'll look at your actual, your child's actual level of need, and calculate hours.

So like I said, rank one generally means that the person can do it independently, or the parent would be expected to perform the task. Ranks one through five is going to be based on your child's need. Rank six means that it's a paramedical service, so you know again, rank one means they can do it by themselves. Rank two, generally means that they're able to perform the task, but they need a little bit of reminding or guidance or verbal encouragement, but you don't actually have to physically intervene to help them with the task. Rank three means that they can perform the task, but they need a little bit of hands on help.

Rank four means they can do it for themselves, but only with a lot of help. And rank five means that they cannot do the task themselves, with or without assistance. So basically, they're completely dependent on the care provider to complete the task. So this is how this is how they assign.

And then there's an annotated assessment criteria guide that they provide to caseworkers. We're not going to go over that here because it's really long, but Kylie's going to stick the link in the chat if you'd like to review it later. For a little bit of light reading, you can take a look at that, and they have it broken down by each individual task and what the case workers might be looking for. So you know, it's not something that you have to read, but you know, if you're somebody who likes to to read up on things, it's, it's, it's a nice thing to look over before while you're preparing for your home visit.

And then once they assign a rank, this is another document that is part of the IHSS sort of caseworker toolbook, which is the hourly task guidelines. So you can see here that for each rank, they kind of have a low amount of hours that they award and sort of a mid level and a high rank. It's not completely married to like using these exact numbers, but very often, if you look at your Notice of Action, you'll see a number that corresponds to a category on this on this chart. And so you know, if you see that for bowel and bladder, you got an hour and 17 minutes per week, then you can see that it's sort of the mid range for rank two. And when you're thinking about how much help your child actually needs, you can kind of think about, well, do they only need verbal prompting, or do they need hands on prompting? Should it have been somewhere in the rank three or rank four range? So this is, sort of gives you an idea of about how much time they're going to allocate for a given task.

So coming back to this, we can look at some examples. And when you're trying to decide when you want to apply to IHSS for your child, this can be a really useful tool to kind of see if your child's at an age and a need level where they're going to allocate hours. So for example, if you look at bathing, oral hygiene and grooming, they're expecting that parents are going to assist their child with that task until, until the child turns eight, and then once the child turns eight, they'll look at it based on a rank of one to five for dressing themselves. They'll look at age five, so you can see the age the age column you can kind of move.

It across to the category, and you can see at what age they start awarding hours for each of these tasks. So, and a lot of people talk about like, oh well, my child's turning three, and that's a really big number. It can be for protective supervision. But as far as personal care services, kind of 4, 5, and 8 are sort of where some of a lot of the ADL start coming into play. You can see that that ambulation and dressing both come in at five, diapers come in at four, feeding, feeding and or and basically hygiene come at eight. So just think about your child's age and sort of what they would typically be expected to need help with at their particular age.

So you can, so we're going to talk a little bit about paramedical services now. And paramedical services, it's, I'll explain what it is, but you can click on, you can click on the link to the article in your roadmap, and you can add these goals straight to your to your account.

So paramedical services are services that are ordered and directed by the child's physician or another licensed medical provider. So this is not your standard range of motion. This is not like you're giving Tylenol. This is you have to be trained or use judgment in order to provide these type of services. So again, not even with medication, like it's not, you know, a medication that you're that where the the prescription says, you know, give once a day in the morning, it's it's the kind of service where you have to look at the child and assess and use judgment, or when it's a service that you had to be trained by a provider to do so. Some of these examples, we have G Tube feeds, any injections or testing, blood sugar, monitoring, preparation, and administration of those medications, home therapy programs, and we'll talk a little bit about that. Anything where you're putting a device into a stoma or an orifice in the body, so enemas, stomas and wound care, catheterizations, maintenance of G tubes and ostomies, any anything relating to to openings in the body is generally going to be a paramedical service monitoring of vital signs. And we talked to monitoring for as needed medical interventions. And we talked a little bit about this in the Protective Service webinar, because start protective supervision, because you cannot get protective supervision in order to monitor for a medical emergency, but if your child is unable to communicate their symptoms, you may be able to get some additional paramedical services, time for monitoring if you need to do checks of vitals or checks of blood sugar or assessing their situation more often because they're not able To communicate their symptoms. And then again, we have related tasks requiring judgment based on training that you've gotten from your provider. There's some other services that are included in separate categories, but they should still go on your paramedical services form, and that includes things like nebulizer treatment, suctioning, oxygen administration, inhalers, anything that is relating to respiration, you should still put it on the paramedical services form, but they might carve that out, depending on what it is, and put it under respiration, but still have it, have the doctor write it down.

So the SOC 321, is the form that you'll have your doctor sign and they'll fill out they should be writing the type of service, how often the service needs to happen, like the number of times per day, and also how long it should last each time, and also, sort of how long this should be anticipated to last. So some of these things, some of these services and interventions, might be indefinite. Some of them might be one year or until next reevaluation. So your doctor should just indicate that.

Now, for a lot of our children, this is not enough room this. This is there's only a little bit of space for the doctors to write. And some of our kids need a lot more interventions than that. So one of the things that you can do is have work with your doctor to create a separate list or a spreadsheet for the doctor to complete and sign make sure that it continues to include all of the information, including the type of service, the time, the duration, frequency, how long it's supposed to last. And I usually try to make sure that they sign every page so that it's clear that the doctor signed off on each of those things.

If your child's needs sort of make the task take longer than it would expect be expected to take, you may also want to include that in the paramedical services form if it takes longer to feed, if it takes longer to change diapers. It helps to include that for for example, you know, the example I just gave is like a breathing treatment or venting a G Tube. They'll even have allotted amounts of time that they expect something to take for that.

But you know, if your child wants to chew on the nebulizer mask or is squirming around while you're trying to vent the air out of their out of their belly, that makes the task take longer. So you should be documenting the actual amount of time that it takes you, and you might need to explain that it takes a little bit longer because of your child's additional needs. And again, we talked about how the child's inability to communicate, those symptoms might mean that you need to monitor more often.

So if your child's PT, OT, or speech, and generally for speech, they're more often looking at swallowing as opposed to language. But generally, if your provider has given you a written home plan to follow, and this is not like, Oh, here's some things you can do at home to reinforce but a structured home plan that they want you to be doing throughout the week to reinforce what they're working on in session, you can have them write that home report, and then on the paramedical services form, have your doctor write as one of the line items, home therapy plan As directed by and then the provider, and then attach a copy of that plan. And again, that also needs to include, you know what you're doing, the frequency and duration and how long it's anticipated to last.