Q: What exactly is a paramedical service?
A: An IHSS paramedical service is a care service that requires authorization and training by a medical professional before the caregiver can provide that service. Some examples include wound care, suctioning, g-tube feeding, and anything that requires sterile treatment, puncturing the skin, or inserting something into the body (e.g. enema, catheter, etc.)
Q: Does medication administration count as paramedical services?
A: Medication administration falls into two categories. One is preparing routine medications that are provided in regular doses and intervals, and the other is medications that have to be administered based on your judgment and assessment of your child's symptoms and needs. You can put both on the paramedical services form, and IHSS can sort out which ones go into assistance with medication prep, and which ones go into paramedical services. The ones that are going to fall under paramedical services are situations where you've been trained by your child’s provider on how to give the medication, or you have to assess your child's symptoms to determine when to give it or how much to give.
Q: What if the service is not directly related to the child’s developmental disability? For example, if a child with Down syndrome has asthma and needs breathing treatments.
A: Unlike the Regional Center, IHSS is not limited to people with developmental disabilities. Children who have no cognitive impairment can receive IHSS hours based on their physical care needs, if those needs place them at risk of institutionalization without home care above and beyond what would be expected for a child without a disability. Asthma is in itself a medical condition that may necessitate extraordinary care in some cases.
Q: Can I get paramedical service hours for administering medication to a child under age 5?
A: Paramedical services are not age-based. However, certain personal care services that are usually not authorized for younger children may be authorized if the service is paramedical, e.g. catheterization or tube-feeding for babies, who usually don’t qualify for toileting or feeding.
Q: My child has a cognitive disability, but IHSS says I don’t qualify for protective supervision because the need for supervision is based on their medical needs and not their behavior. Can I get paramedical service hours instead?
Protective supervision is an IHSS service that is authorized when a person requires 24/7 supervision due to the likelihood that they will accidentally harm themselves due to impaired judgment, memory, or orientation. Protective supervision will not be awarded if the only reason the child needs supervision is to monitor for spontaneous medical emergencies.
However, a child with both medical and cognitive disabilities may require extra care for the medical condition compared to a child with the same disability but no cognitive impairment. This can be true regardless of whether or not protective supervision hours are awarded. For example, a child with diabetes or asthma may be able to tell their parents when they are having symptoms and require as-needed medications to be administered, but a child with diabetes or asthma who is also non-verbal may require more frequent assessment because they can’t tell their parents when there is a problem. You might start by asking your child’s doctor, “My child can't communicate their symptoms, so what do I need to be doing in order to make sure that I'm giving the medication when it's needed and that I'm recognizing flareups or attacks?” To help quantify these additional care needs, you can talk to the doctor and get a sense of what you need to be doing, and then document the time you spend on these tasks. If any specific medical task takes longer than would be expected for a typically developing child, then document the actual amount of time you’re spending on your child’s care. Talk about that with the doctor as well, and make sure they understand and document that it takes longer to administer the medications because of your child's sensory needs or behavioral needs, for example, depending on your circumstance.
Q: When would travel time and attending a diagnosis-related therapy count as paramedical?
A: Travel time is not included in paramedical services because it has its own separate category: accompaniment and wait time. If the appointment is directly related to the disability — not an annual wellness checkup or regular dental cleaning, for example — and if an IHSS-authorized service is required either on the way there, during the appointment, or on the way home, then parents may get accompaniment and wait time.
As far as wait time goes, if this is the kind of appointment where you can drop your child off and come back in an hour, then you're not going to get wait time. You can get accompaniment, but not wait time. If it's the kind of appointment where you have to be physically present and you're on call to provide IHSS-authorized tasks during that time, then you can potentially get wait time. If you're required in the session because the provider needs to train you, or because you need to change diapers, or something like that, then you can get wait time for the whole appointment because you had to be on call to provide IHSS-authorized services.
When you have your initial or annual home visit, it helps to have a list of your child's weekly disability-related appointments, including:
Q: Do I have to reapply for paramedical services every year?
A: You will always need to have the annual visit, but it varies as to how often IHSS will want you to update the paramedical services log. They probably will have you fill out a new log every couple of years at least because they want you to keep that relatively updated.
Use the Undivided platform to get a step-by-step walkthrough that helps you apply for IHSS paramedical services, including expert tips for the home visit, all the forms you’ll need, sample paramedical service logs, and more.
Q: What are non-medical personal care, domestic, and related services?
A: Non-medical personal care services assist the individual with activities of daily living, such as walking, eating, toileting, grooming, bathing, etc. Domestic and related services help the person remain safely in their home environment, e.g. domestic work (house cleaning), meal preparation and cleanup, grocery shopping, and laundry. Children generally do not qualify for domestic services, but may qualify for some related services depending on age and circumstances.
Q: How do I review at what age a child is expected to complete activities of daily living independently?
A: IHSS’s age-appropriate guidelines for activities of daily living (ADLs) are based on the widely accepted models of when typically developing kids are expected to reach certain milestones. For example, it would not be uncommon or unexpected that a typically developing five-year-old might still need some help with bathing, and that's their parent’s responsibility. But by age eight, a parent of a typically developing child would not expect to still have to assist. IHSS considers the range of expectations for typically developing children, and the age-appropriate guidelines trend toward the later end of that range. For example, some kids toilet train at one and a half or two years old, and some kids are still having issues at three. Therefore, IHSS will not start authorizing toileting hours until age four (unless the child’s toileting needs are addressed by paramedical services like catheterization or ostomy).
Q: Could I get hours for laundry if my child is changing clothes multiple times per day?
A: Typically, laundry is not awarded for children until age 14. However, in some cases, you may be able to demonstrate extraordinary need for this service. You would need to have medical documentation from your child’s doctor establishing the reason your child generates more laundry than a typically developing child. However, laundry is usually limited to one hour per week. You may be able to articulate a need for additional time in a related category in addition or instead. For example, if your child has a lot of extra laundry due to toileting accidents, you may be able to get additional time in the toileting category to account for the additional cleanup, whereas if your child is changing clothing frequently due to sensory or behavioral needs, you may be able to argue for additional time in the dressing category. In any event, make sure that you have the doctor document the reasoning for this need.
Q: How do I get more hours for my child’s unmet needs?
A: Unmet need hours are hours for which there is an assessed need for IHSS-specific services beyond the maximum hours allowed. For a child meeting IHSS’s definition of “severely impaired,” the statutory maximum is 283 hours. Anything beyond that should be documented as unmet need. Look at your Notice of Action on page three to see if any hours of unmet need are documented already. If you are at your home visit and the case worker says, “We don’t need to assess in these additional categories because you’re already at the maximum so it won’t change anything,” you can request that the need be assessed anyway and documented as unmet need.
IHSS will not pay for hours of unmet need — that’s what they mean by “unmet.” However, it can be important to document them anyway, for several reasons. First, it can potentially provide a buffer in the event of funding cuts; this is not a guaranteed protection, but during past budget cuts, reductions in hours were applied to unmet need first. Second, you can refer to documented unmet need when requesting additional service hours from other agencies — for example, respite or personal care hours from the Regional Center or Waiver Personal Care Services (WPCS) for individuals on the Home and Community-Based Alternatives (HCBA) waiver.
Remember that unmet need only accounts for services that could have been authorized by IHSS in the first place; your child may require services that IHSS simply does not provide (e.g. a 1:1 aide for social and recreational activities in the community), and you can also address these needs in requests to different agencies.
Q: What do I do if there's a change in my child’s care needs during the year? Do I have to wait until the next annual home visit, or should I try to change IHSS hours mid-year?
A: If there’s been a significant change, you can request a reassessment. If it's a very small change, you might not request one because any time they come out and do a reassessment, you never know how it can go in either direction. However, if there’s a significant change, you can request a reassessment at any time during the year.
Q: Will my child get more hours as they get older?
A: Generally speaking, for younger kids who have a lot of care needs, ages four and eight are very often the ages where you see additional non-medical care tasks come in. At four years old, you can get hours for diapering. At eight, you can get hours for dressing and personal hygiene, bathing, tooth brushing, and other hygiene issues. At these milestones, IHSS is gauging whether or not that's parent responsibility in terms of personal care needs. The things that come up for teenagers are laundry, basic household chores, and some meal prep, but IHSS is generous with how old kids are expected to be before they do any housework, generally above age fourteen. At age eighteen, there are additional hours that minors can’t qualify for, like domestic services.
There is no age requirement for paramedical services and for protective supervision; it depends on your child’s care needs and whether they need more medical care or supervision compared to a typically developing child of the same age.
Q: What is a home program by an OT or PT, and what should I write on the IHSS application?
A: IHSS provides funding for home care that is required for a person to remain safely in their home, and it can be really difficult to quantify the extent to which you are doing tasks that go above and beyond what a typically developing child requires. Often, physical or occupational therapists will give specific recommendations for what a parent should do at home to reinforce what the child is working on in therapy. You can talk to your child’s therapist(s) about all those things they recommended that you do every day in order to reinforce and encourage the child so that they can keep up these skills in between sessions. You might ask the therapist, “Is there any way that you could write that down as a home plan so that we have it clearly delineated, we can follow it effectively, and we can provide it to IHSS so that they can quantify it?”
Q: If there are cuts to Medicaid, will IHSS case workers cut services during annual visits?
A: We can’t make any predictions about what's likely to happen. If you ask your caseworker now what's going to happen, they're going to say, “We don't know.” We don't know what's coming either, but what we do know is that if we sit back and do nothing, they're likely to make deep cuts to our programs. So do what you can now before that happens, to advocate for your child. Reach out to your state and federal representatives. Tell your stories, tell your child's story, and make sure that they understand the impact. At the state level, make sure that they understand the impact and that it's not right for people with disabilities to be the ones to to bear the burden of these cuts. Our article here has examples of actions you can take, including resources for phone scripts and letter templates to send to your representatives.
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