IHSS Starter Kit for Ages 0-18: Top Tips You Need to Know

Full transcript: Hey, everybody. Welcome to this week's Undivided Live. We are back talking about in-home supportive services for kids up to 18 years old, and as you probably know, IHSS is a vital program and lifeline to many families across California who are caring for disabled loved ones in their homes, but like many programs and systems, it can be completely overwhelming to understand all the variables before you start, and let's be honest, even after you've been in the program for a few years, sometimes you might still have some questions, so we'd like to help with that. We're going to cover the most important things you need to know to get started eligibility, the application process, the in-person evaluation, parent provider requirements, and what to do if you're denied. Lisa is going to give us the lowdown on all of this and more while taking questions from the chat. And speaking of the chat, we'd love to know if you already have IHHS or if you're looking to apply, so throw it in there and let us know who we're talking to you today. I'm Lindsay Crain, and I head the Content and Community teams at Undivided. With me today, we welcome back Undivided public benefits specialist Lisa Concoff Kronbeck. Lisa counsels families about government programs that support our kids and families, like Medi-Cal, Regional Center, CCS, and our focus for today, IHSS. She's also the mom of an eight year old with Down syndrome and self-identifies as an individual with disabilities. Hey, Lisa. Welcome back. Hi, thank you. Also with you today in the chat, we have our Community manager, Donna, and one of our Undivided care Navigators, Iris. They’ll be passing along your questions to us. We're going to get to as many as we can, and we know there's a lot to cover, so if you still have questions after our chat or if you want individualized 1:1 support, our Undivided Navigators would love to help. Your dedicated Navigator will organize all the steps of the IHSS process into a personalized, step-by-step guide made for you, and even better, they'll walk through it with you. You'll have resources, a plan, a guide in how to get there, and a partner to do it with you, so check out the link that Donna shared in the chat about our free 14 day Kickstart, and we can tell you more about how our Navigators can support you exactly where you are, but first, it's time to open our IHSS starter kit. So let's start with the essentials. Lisa, what is IHSS and what is its purpose? So, IHSS is a Medi-Cal program that helps elderly people and people with disabilities, including children, to remain safely in their homes and avoid unnecessary institutionalization. And who is... Excuse me, as I'm sipping water. Who's eligible? Oh, sorry. What are we going to say, Lisa? No, nothing. -- Okay. Who... So who's eligible for IHSS and who isn’t? So people who are eligible for IHSS are Medi-Cal recipients who live in California and who are over the age of 65 or have a disability. They live at home, which is to say, not in a nursing facility, not in a hospital. They live at home in the community, and they are at risk of out-of-home placement without the services, so they need those services to remain safely in their homes. Right. And is it income based? So, it's income based to the extent that Medi-Cal is income based, because you have to be a Medi-Cal recipient in order to receive IHSS, so if you have a share of cost for Medi-Cal, that will carry over to IHSS as well. If your child is receiving Medi-Cal through one of the waiver programs for children or adults with disabilities, then they receive Medi-Cal and therefore they can qualify for IHSS. I mean, they may qualify depending on their needs, but economically, you need to have Medi-Cal. And is there an age range that is allowed? No. They will sometimes tell you that there is and we will get into that, but no, there is no minimum or maximum age. Everything is tied to what a parent would be expected to provide to a typically developing child of the same age, so everything is based on your individual child's needs, but there is no single age after which they say... before which they say we don't accept applications for children of that age, and if they tell you that, then something's wrong. Right. So to be very clear, right, if a social worker tells you that IHSS does not cover kids, just as a blanket statement, that is incorrect because a consistent thing that we hear from parents is that they're told by social workers that you’ll be taking care of your kids anyway, they can't take care of themselves, so they don't qualify for IHSS. So if we hear that, Lisa, how can we respond? So, the most common time when you're going to hear that is when you call to apply. That's the biggest point at which parents get deterred because the person on the phone says, “Oh, we don't really provide services to kids your child's age. Call us back in a few years.” And if you do that, then you haven't been denied, you just haven't applied. So, the answer to that is, “I understand what you're saying. I'd like to go ahead and apply anyway, please.” You don't need to get into a conversation about it. And, “I hear what you're saying. I'd like to go ahead and apply, and if my child doesn't qualify, then they'll get a written denial.” There is no such thing as a phone denial. If they tell you, “Call back in another year,” then they've basically just not given you the opportunity to appeal. Right. And what's also important about that first phone call? That first phone call, you should write down the date because your benefits are retroactive to that date, and so, if you apply and they... Even if you apply and they say, “You know what, your child's too young. Call us back in a few years,” even once you've applied, you still want to appeal if you still believe that your child is eligible rather than just starting over, because, again, you're going back to that date of that first call or the date you submit your application. Very, very important to write down that date, because if things take longer than they should or longer than you expect, then you will get that retroactive pay back to that very first call. Very important. I also... I always point out that you also might direct them to their... the Department of Social Services website, because in the second sentence in that IHSS section, it says disabled children are also potentially eligible for IHSS, so if someone tells you that children aren't allowed and using that as a generalized blanket statement, once again that is 100% incorrect. Yes. I will reiterate, though, that everything... Any time they're determining what child... what hours a child can receive, it's always going to be connected, and you'll hear me repeat this throughout this presentation. It's always going to be connected to what a parent... what care a parent would be expected to provide to a typically developing child of the same age, so just keep that in your... keep that in the back of your head. Absolutely. And... Which also then brings us to the services. So, what kinds of services does IHSS cover? And if you can first give us an overview then we'll get into some of the details. Yeah. So I'm just going to give very basics right now. The first is non-medical personal services. The next is related services. So, non-medical personal services are bathing, helping them dress, personal care services. And then related services might include laundry or shopping or errands. And there's very few related services that parents can get unless it’s considered a paramedical service, and we'll talk about this. Another one is accompaniment to medical appointments, paramedical services, which I just mentioned, which we will talk about more soon, and also protective supervision, which we will also discuss. So, those are the main categories. Right. And do those services and IHSS hours, do they have to be fulfilled in the home? So, generally speaking the answer is going to be yes. There's a little bit of leeway because, for example, accompaniment to a medical appointment can't happen at home, and also, for example, if your child has a diaper, if you've got a nine, eight or nine year old who's still in diapers, they can't just stay at home forever. You're going to have to take them out of the house, and if they need a diaper change, you're gonna have to change their diaper, but the hours are specifically tailored to the amount of times they would expect you to change the diaper, and whether that diaper gets changed at home or at a birthday party or at a family member's house, they're not going to kind of keep track of that, but you're not going to get extra time to take them to other places, so I've heard people ask, “Well, can I get time to take my child to a birthday party?” No, you're not going to get a block of time that says ‘To take child on social outings,’ but if you change... if you do IHSS services while you're there, that's part of remaining safely in your home, is being able to participate in the community, and so you've already been awarded those hours to change the diaper or to do the G-tube feed. Yeah. And Swati just had a related question. She said, “I'm an IHSS provider for my kids, and we're planning to go out of the country for about three months. Can I still claim protective supervision hours for those three months?” You cannot receive IHSS hours while you're out of the country. There are some situations where if you're out of state for a temporary period of time, you can sometimes talk to the caseworker and work it out with them, but not out of the country. Yeah, because it's a federally funded program, federally and state funded program, for California residents. If you're going to be out of the country, they'll... What I would suggest though is if you know kind of the date that you're coming back, I would suggest letting the case coordinator know so that they can reopen the existing case, so put your case on hold and reopen the existing case rather than having to start from scratch. I would reach out to them and discuss kind of how to go about that so that you don't just drop the case and just come back and reapply, because they'll still have your file. It's just you cannot be paid as a provider while you're out of the country. And if you don’t turn in hours for a certain amount, are you automatically dropped? I just wanted to follow that... Well, I mean, they'll reach out to you and find out why you're not providing those hours, but I mean, just in terms of just logistically and also to improve the likelihood that everything runs smoothly, your best bet would be to reach out ahead of time and be like, “Look, we're going to be out of the country. This is the date we're coming back. Can I reach out to you and reopen this file?” They might want to do a reassessment, but the point is, you don't want to just drop the case and forget about it and then come back to it and start over. Right. Always better to be safe than sorry and on top of it. You never know. Well, what about therapy appointments like speech or OT? Okay, so for therapy appointments, you can get transit, so accompaniment and wait time if... number one, if the appointment is related to the child's disability, and number two, if you have to be available to provide an IHSS service on the way there during the appointment or after the appointment. So if it's an... if it's a medical specialist appointment where you have to go in and be there the whole time and you don't know kind of when you're going to leave, you can get accompaniment and wait time for that whole time. If it's a therapy appointment where you have to kind of stand... stay at the clinic because the child might need a diaper changed or the child's G-tube pump, feeding pump might start beeping, you can get wait time for that. If it's the kind of situation where you drop your kid off and you say, “Hey, see you in 50 minutes,” and you can go and get lunch and do your own thing for that time, then you can get accompaniment, but not wait time, because you're able to attend to your own business during that time. Got it. And another question that we hear frequently is, what if your child is admitted to the hospital. If your child is admitted to the hospital, you cannot claim any time during the time that your child is admitted. So, on the day they go in, you can claim the time for the morning before they went in. On the day they come home, you can claim the time for when they were home, but you cannot claim any of the time... And having been with my child in the hospital many, many times, I completely understand that you are there and you are doing a lot of things for your child, because especially if you're on the pediatric... like, the floor and not in the ICU, it can be a couple hours between times when you see the nurse and you're there, but it's a rule of IHSS that while they're in the hospital, you can't get time, even if you're still providing a lot of the same services, so if you're going to... if your child's going to be in the hospital for an extended period of time, you need to let the caseworker know. Got it. And for parents that... who are interested in being a parent provider, who is eligible? Okay, so in order for... So, there's two separate questions here. One is, does the child qualify for IHSS. Do they need these services in order to remain safely in their own home? And the second question is, is somebody able to be paid as the provider. So, a parent can be paid as an IHSS provider if they are unable to work full time or have left full time employment because of their child's extraordinary needs, and there is no other available parent who is available to provide care, and what available means is they're not working full time, they're not doing something else. So, a parent is unavailable if they are working full time, if they're in school full time, or if they are disabled and unable to provide care. If they're unemployed, then they're unavailable during the times that they're actively seeking employment, so when they're looking for jobs, going out on interviews, that's considered unavailable. Full time is generally considered the lesser of 40 hours a week or designated full time by your employer. For some employees, it's going to be 37.5 hours or something close to that, but you're still considered full time, so if you're considered full time, then you're not prevented from full time employment, so if... but if you're working part time, you can be paid as a provider. Okay, so now I'm going to throw out some... Sure. -- some example situations, because we always get lots of specifics and questions because everything feels like, okay, open to interpretation, so what if both parents work full time? Okay. If both parents work full time, then you can hire an outside provider to provide care while you're both at work, and I believe you can get up to eight hours. You can have an outside provider for up to eight hours of what they call respite, which is if you're not at work but you're doing other things like running errands or working with the other kids in your house, if you're not the provider, you can get up to eight hours for that, but mostly they're going to be providing services while you're at work. So, what about if one... if there's two parents and one works full time and one works part time? Then the part... the parent who works part time can be the provider. And what about if both parents work part time? If both parents work part time, then neither one can be paid as the provider, because in either instance, regardless of which parent is providing care, the other parent is still available because they're only working part time, but if both parents are working part time, you can hire an outside provider to provide the IHSS hours while you're both unavailable, so if you're both working part time, somebody can do those hours while you're both at work, but neither parent can provide that, can be paid to provide the hours because the other parent is not employed full time. Got it. And COVID changed a lot of things, but what if one or both parents are working from home? Does that make a difference? I think we all learned during COVID that work is work. It might be a little bit harder sometimes when you're working at home and you have additional demands on you. If you are working full time from home, you are still working. And can a parent be... We hear this a lot. Can a parent be a caregiver to two of their children if both kids qualify for IHSS? Yes. So, you can be the provider for both children. Depending on how many hours they get, you might run up against the the weekly maximum in limited circumstances, -- and I think maybe we can share this link in the chat -- in limited circumstances, you may be able to get an exemption in order to be able to provide more than the usual weekly maximum, up to, I think, 90 hours a week, and after that, you just need to find another provider, but the exemptions now are a little bit harder to get because previously the exemption was basically like if you received these hours before X date and you're the only parent, you can get the exemption, but now there have to be specific reasons, like the lack of an appropriate other outside provider, or the child needs specialized care that has to be provided by someone who lives in the home, so there's more specific exemptions now, but it is still possible under certain circumstances. Okay. And we are getting some specific questions. Zara asked, “What if I'm a single mom and unemployed? Are they going to assume I'm looking for work? I'm not looking for work. I can't handle work and my child, so I'm only looking to be his caregiver.” So, if you're not able to work full time because of your child's needs, then you can be paid as the provider. If you're... It's a little trickier if you're collecting unemployment, and that's something that you'd want to have a separate discussion about, because when you fill out the paperwork for unemployment, you're basically checking a mark that says, I am available and ready to work, and so it gets a little tricky, but so again, that would be another conversation, but if you are not able to pursue full time employment because of your child's needs, then you could be paid as the parent provider. Got it. Now, if you're not working because your job is a seasonal job and you're off during certain seasons, that's another story. If you're usually full time during certain seasons, then the reason you're not employed full time right now is not because of your child's needs, but because this is the nature of your job, but... so it has to be that the reason is because of your child's needs, above and beyond. Right. And I know you touched on before that IHSS is not necessarily a diagnosis, but Sonia had a question and she said, “Can I claim for children who have ADHD, dyslexia, dysgraphia while getting SAI, vision and OT appointments?” Okay, so... A lot... So, we... I think last time this question came up a little bit later is, if the child has a certain diagnosis, can you get hours, and again it's never about the specific diagnosis. It's about what care are you providing to your child that they need to remain safely in their home that goes above and beyond what you would be expected to provide to a typically developing child of the same age. And so when you... so you do have to be... you do have to have a disability as kind of the initial qualifier, but you need to look at kind of the services that you're providing and what goes above and beyond what a typically developing child would need that falls within the categories of... for example, that falls within the categories of allowable IHHS services. So, if they need extra tutoring, for example, that's not going to fall into the category of services that IHSS will provide, so it has to be, number one, a service that falls under IHSS and two, something above and beyond what a typically developing child would need. And so, I mean, there's... If there's executive functioning issues and self-care issues, then you're starting to look at services that you might be providing, but again, it’s not tied to the diagnosis, but to the specific needs, and as we all know, as kids... as parents of kids with disabilities, the diagnosis is one thing, and that only tells you one thing about the child, and there's a massive range of strengths and weaknesses that our kids have, even if they all have the same diagnosis, and so it's really based on your specific child. Because it can present in a lot of different ways, which makes the difference for IHSS. That is the difference, right? Yes. -- And we've talked a little about... We've talked about the parent providers, but for families that are looking for outside providers, can we hire anyone as a provider or do they have to come from an agency? No, they don't have to come from an agency. They can come from an agency. They don't have to. You can choose anybody who's eligible to work in the United States. They have to do the orientation. They have to do a Live Scan. There's no specific first aid or CPR requirement. That's something that you can ask of your worker, but the main requirements are that they have to pass the background check, they have to be eligible to work in the US, and they have to do the orientation. Right. And can a parent work half their child's hours and have an outside provider work the other half? So, if the parent is working part time, or for example, if the parent is in a very intensive medical treatment for themselves and they have to be doing their medical treatment a certain amount, you can only hire an outside provider when there's not an available parent who is able to provide care, so you can't work part time while your child is in school and then come home and be home, but have somebody else providing IHSS hours during that time, because you're considered an available parent during that time, because you're not a full time employee, and you are there and ready and able to provide care for your child. So yes, you could have an outside provider providing some of the hours while you are unavailable. Got it. And can or should potential providers, whether that's a parent or an outside provider, should we go through training before our child or client has been fully accepted into the program? So, I mean, I would suggest starting that process once you have the home visit. You need the paperwork in order to do the Live Scan, and that has to come from IHSS. I mean... and technically anybody can register as an IHSS provider, but yeah, again, you need that paperwork in order to go and do it and to do the orientation. So, I mean, I would usually suggest doing it once you have the home visit, because there's going to be a lag between the time you have the home visit and the time you get the notice of action, and that's kind of a good window to do that process. So, let's talk about the application process. So, what are three things that parents need to know about their initial application? Okay. So, we've actually talked about all of them, so I'm just going to remind you. The first thing is that there is no such thing as a denial by phone. We talked about that. Benefits are retroactive from the date that you apply, and diagnosis does not equal IHSS. You cannot... I mean, sometimes you can get an idea, but you will not be able to tell for certain, child has this diagnosis. What do you think the time is that they're getting for IHSS? You have to know what the child's skills are. You have to know what the child's deficits are. You can't just tell from a diagnosis what they're going to get. Oh, Jana asked, “Can you have more than one provider share the hours that you hire?” Yes. -- Yeah. So, it's not just all in one bucket. Yeah. You just have to make sure and they'll... they prefer if you designate it specifically, like if you tell them, “Okay, this person's working this hours and this person's working this hours.” You just have to make sure that if two different outside providers are entering hours that nobody's going over the maximum. Does that make sense? You don't want to have one person putting hours and then the other, there's not enough hours left for the other person to do... So, make sure that there's very clear communication about who's expected to work which hours and make sure that that happens each month, because the days are different and the work weeks are different, because when you enter it says week one, but that might be the 5th to the 12th or something. You want to make sure that you... everybody knows exactly who's putting in the hours so that nobody's going over the monthly hours or getting penalties or anything like that. Right. Yeah, because you'll get a penalty. Yep. That's a really good point. So, how do we know if our application has been received and processed? So, what I usually suggest is that once you call to make the appeal... to submit the application, you're going to get more paperwork, but I would suggest calling maybe five to seven business days after you make that first call, just to make sure that it was put into the system, just to make sure they got it. I would do the same if you're mailing in an application. Maybe give it five to seven days and call and say, “I mailed in my application. I just want to make sure it was received.” They'll be able to check in the system and make sure it was received, and the next thing you'll get after you make that initial call is more paperwork, so you'll know for sure that it's been processed when you get that next envelope in the mail. And you can also submit an application online, right? Yes, you can submit it online. You can print it. You can fax it. You can make the call. A lot of people call. I think a lot of people find it the easiest, but you can also absolutely submit it online. And how long... You love my ‘how long’ answers, but how long should parents wait to receive an answer, right? If you're trying to be patient... Well now, to receive which answer? You should get that next set of paperwork within a few weeks. The question of how long is it going to be from that first phone call to... No, not that yet. We're not there yet. -- That’s a whole other question. Very first initial... I would say... I would think it'll be a few weeks. It'll probably be a few weeks between the time that you call and the time that you actually get the paperwork in the mail, and then you have to go and have your doctor fill it out and you can find the forms online, but they'll send it to you and they'll assign an intake worker and so that their contact information and where to send it will be on the documents that they send you, but you don't have to wait to have your doctor fill it out. If you already know that you're going to get it, you could have your doctor fill out the health care certification and then just write in the case number when you get it from IHSS, but yeah, you'll know that it's been processed when you get the paperwork and then you go do the paperwork, submit, and I suspect this is your next question is, what do we do next? Right. Exactly. Tell us. Keep copies of every paper that you fill out and submit to IHSS. Keep a copy, make a note of the date that you submitted it. Again, every time you mail something, call them a week later and make sure it was received because they will not call you to say, “Hey, where's this form? We're missing this form.” They'll just send you a denial and say, “Oh, well, we're denying it because we didn't get this form,” even if you sent it. So, there's a lot of paperwork moving around those offices, so your best bet is every time you mail something, keep a copy in case you have to resubmit. Expect that at some point during the entire application process, you will have to resubmit something, so keep the copies and make a note of the date and then call a week later, make sure they received it. That's the next step. Well, and Evy says, “What about if the IHSS intake worker did not provide any paperwork to get fingerprints done, and everything else?” I would ask for it at the meeting. Which I know is a little... some steps forward, but yeah. Yeah, I would ask for it when you do... So, they're not going to provide that documentation when they mail you the health certification form. They're going to provide you that documentation when... Actually I think for the background check, sometimes they actually give it to you at the orientation, but you should be able to ask for it at the in-home visit, and they'll... When you do the in-home visit, they'll have a bunch of other paperwork for you, like the W-4 and all those, like the provider enrollment form. They should provide that to you at the in-home visit, but again, that background form, I think when I did it, they gave it to me at the orientation, to make sure people do the orientation. Right, right, right. Anything that you need, you should ask for at that visit, and they should also be providing you with additional forms if you need protective supervision or paramedical services. They should be giving that to you at that initial home visit too. Although again, you can have that filled out ahead of time. I’m answering... collapsing some of the questions. Yeah. Yeah. Well, it's important to know kind of what happens at each step, so even before we get to that evaluation, right, we've made our initial call, you submit the application via fax, online, call, or whatever it might be, and so now, like you said, we're going to receive more paperwork, the health certification form, so what do we need to know about this stage? Okay, so the health certification form is the form that your doctor is going to fill out. You want it to be a doctor who knows your child well and it's basically just the form that confirms their diagnosis, confirms they’re a person with disabilities, confirms that they're at risk of out of home placement without these services. So it's a pretty straightforward basic form, and the boxes have to be checked in order to move to the next step, so make sure that it's a doctor who understands your child's needs, because if it's someone who... a doctor who’s never met your child before, they're not going to... or has only met them for ten minutes, they're not going to feel comfortable saying they're at risk of out of home placement, so you want someone who is familiar with your child, usually the primary doctor. And understand what that means, right? They’re not scared about like, “What am I signing? What does this mean?” Just make sure they understand what IHSS is. I mean, it helps to talk to the doctor ahead of time and let them know that you're going to be applying for these services and what they are and what they mean. Kind of give them a heads up that you'll have some paperwork. Yeah. All right. So, let's say we've sent in the health certification form, it's been processed, so now we have to prepare for that in-person evaluation. And so earlier you touched on the areas that are covered under IHSS, and in order for us to efficiently prepare for that evaluation with the social worker, we need to understand what's included and what isn't within those categories of service, so can you review the services and give us some examples of each? Yes. So, non-medical personal services, that's going to include the things that people... the self-care things that people usually do for themselves, so that's going to be walking, which they refer to as ambulation. It's going to be a bed bath if they're not ambulatory, if they're not walking, if they're not able to take a bath, bed bath, bathing, brushing teeth, grooming, dressing, bowel and bladder care, feeding, menstrual care if you have an older child, rubbing skin or repositioning if they're at risk of bedsores, help with prostheses or setting up medications, transfer in and out of seats, and respiration. And respiration will include breathing treatments, oxygen, anything like that. And then related services are a bit harder to get for kids, but related services are laundry, and grocery shopping, and errands, and meal preparation, and cleanup. And we'll talk about meal preparation and clean up a little bit later, because that's the one where you're most likely to get it as a paramedical service. So, that's related services. And then accompaniment to medical appointments, we talked a little bit about that. And then paramedical services, which are services that are kind of ordered and supervised by a doctor, so the doctor or other medical clinician has to tell you what to do, how often to do it, what to look out for. So, those are things that the doc... that are guided by the doctor, so you have an order for them and you do them, and then you've got protective supervision, which is for people who require 24/7 supervision, direct supervision, because they have impaired... severely impaired memory orientation or judgment and are therefore at high risk of causing physical harm to themselves or to someone else because of their cognitive deficits. And we're going to get a little deeper into both of those in just a minute, because again, those are some of our most frequent questions, but the parameters within each of these examples are important so we can really properly prepare for this meeting, and so for example, you mentioned meal preparation, so can you give us an example of what is or isn't allowed? Yeah. So, I'm going to give you an example for meal preparation because that's a related service, and then I'll give you an example of a personal care service. So, for a related service, meal preparation is going to be allowed if it's a paramedical service. So, the IHSS has a whole chart of basically everything that... and it's called the functional skills... It's the functional skills assessment for minor children, and it's basically a whole chart of what they expect children to be able to do by themselves independently at a specific age. And I think we can go ahead and share that in the chat so that you can see, the functional index ranking for minor children and if you look at that, you can see that everything... Yeah. It's a... So, take a look at that if you get a chance. And the way that you read this, and this is a really helpful tool if you are kind of trying to decide if you should even bother applying for IHSS. When you look at this chart, IHSS assigns a ranking to each task, based on how much help a recipient needs with that task, so it ranges from they need complete help to they're totally able to do it. It ranges from they're totally able to do it independently to they're totally reliant on someone else to do this task, so it ranges from one to five. A one typically means that the person can do it totally independently, but on the children's chart, a one also means we'd expect a parent to do this for a child of the same age who doesn't have a disability and so they're very lenient with some of these. If you look under housework, it's one throughout childhood. They don't expect children to do any housework. They expect parents to do all the housework, all the shopping and errands, all the laundry until they're 14. They’re very lax with it. I don't know, but if you look at certain categories, for example, meals, preparation of meals and clean up, it's either one or six, so six is it's a paramedical service. So, six is the doctor’s telling you how to do this, and one is independently or a parent does it anyway, so until they're 17, it's either one or six. Either we expect the parent to provide the child with meals regardless of their disability, or this is a paramedical service, and that can be from age zero, so if you have to... and that's going to be, for example, if you've got G-tube feeds, if you have to blend your child's diet, if you have to puree it because your child is a choking risk, if you have to chop it into teeny tiny pieces... With allergies, because I know this always comes up with allergies, it's a little bit more tricky because the question is how much more time are you spending on it compared to how much time you would have spent. If you have to... So, there's all sorts of considerations that go into this, but the basic gist of it for preparation of meals and clean up, which again, is the most likely related service that you're going to get is you're only going to get it if it's a paramedical service, so if there's a medical component to your child's feeding because they're a choking risk, because they have a feeding tube, because they need purees, chopping, that's going to be paramedical service. So that's a good example of a related service where it's either/or, right? But if you look at, for example, bowel and bladder care or any of the other categories on here, you're going to see that it's only one up to a certain age, and those ages differ for each category, so for a child who is four, they're like, okay, well you'll start getting ambulation time if your child's not walking by the time they're five. You'll start getting hygiene and bathing and teeth brushing when they're eight. They'll get dressing when they're five. You'll get bowel and bladder care, so bowel and bladder care is up until they're four years old. They'll only give it to you if it's paramedical, like if your child has an ostomy bag and they're a baby, you can still get it as a paramedical service, but other than that, you can kind of see how the different categories change based on the expectations at a certain age. So, once a child is four, if they're still in diapers, then you're looking at getting bowel and bladder time, even if it's not a paramedical service, because they still need help, and that's even if they're not in diapers, even if they're in pull ups, and they still need help getting dressed or sitting on the toilet or wiping, that's... It's going to be all along the spectrum, and they're never... One of the important things to remember is they're not going to ask you to rank one to five. They're not going to say, “Okay, on a scale of one to five, how much does your child need?” There's a specific way of describing each category, and what they're going to want to know from you is what does it look like. If you're assisting your child with a task, what does it look like? Does it look like verbal prompts? Does it look like hand over hand? Does it look like you're doing everything? So there... So don't think about... I mean, it's useful to understand the ranking, but don't think about, oh, is my child of three or four. Just think about what it actually looks like when you provide assistance with the task. And I see this question from Evy. “For the meal prep related services due to choking risks, do we need the doctor to fill out a form?” Yes. So, if meal prep is going to be a paramedical service, it needs to be on the paramedical services form and the doctor needs to be able to specify exactly what you need to do, exactly how long it should take, how often. Like if... Three meals a day plus two snacks, you need to do X, Y, and Z before each feed, which is estimated to take about this amount of time. If your child needs extra supervision while they're eating because of the choking risk, you may want to have the doctor write that, or you may want to have the OT write that, the feeding OT, and... because they have specific language that they use about how much assistance the child needs with feeding. And so yes, it absolutely has to be on the paramedical services form in order to be considered as a paramedical service. So similar to what you're saying right now about keep track of exactly what you're doing with feeding, should we keep a time sheet of how long that we're spending on any applicable category over the course of a week? Yeah, I think it's really useful to do that, and I think it's especially useful to do that if there's situations where you think that tasks are taking longer than you would expect them to because of your child's... either because of their delays or because of their non-cooperation if it's related to their disability, because they have a set amount of time that they expect each task to take, but we as parents know how long it takes to change a diaper with a cooperative child and how long it takes to change a diaper with a child who's trying to wiggle away because there's something that they want to be doing, and it's not like you can say, “Oh, it's...” You can't always reason with them. You can't, and so if you're contending with a child who's just physically, because of their cognitive deficits or because of their physical issues, it's taking a longer time to do the task, you definitely want to keep track of that, because you want them to include that when they're thinking about... and that may change where it falls on the one to five if it's taking longer to do the task because of their lack of cooperation. Being specific is always better, right? So, I spend a long time and honestly, I'll speak for myself. I have no concept of time, so if I'm doing something, and you might think you do it all the time, right? Maybe it feels like five minutes and then you actually look at how long it’s taking and it’s 17 minutes. -- Start that timer from the minute you stand up to do the task and end it as soon as you're completely done. It... You think, oh, I’m going to get everything ready, and then I'm going to start the timer. No. Include all the time that it takes to prepare, the time it takes to run your... to chase your child around the house to get them to do the task. Include everything because you're doing that task the entire time. It's not just the amount of time that you have your hands physically on the diaper. It's the whole process going through the whole thing. Absolutely. So, just to kind of replay it to myself, but we have to look at that functional index rating, note what applies to our child, keep a log, and then really kind of be ready to present a week in the life of our child. I mean, that would be to really be prepared, right? Yeah. -- To head into it. All right. So, what... I mean, what are the four most important things that parents should prepare ahead of that in-person visit? So, ahead of the in-person visit, if you anticipate that you're going to ask for protective supervision, you definitely want to keep track of all the times that you've had to intervene for... to keep your child from hurting themselves, and that's not... You want to show more than you telling your child, “Don't cross the street,” and then they don't cross the street. They're going to say they can be verbally redirected. You want to show times when you've had to really intervene to stop them from doing something because they didn't understand the consequences of what would happen, and if you're not able to keep a log of specific incidents over the course of a week, make a list of every incident you can remember and these are the types of things that I've had to do to prevent accidental harm because my child didn't understand that if they did X, that Y would happen. Copies of the doctor's... of the Health Certification Form, even if you've already submitted it, it doesn't hurt to have it on hand, and if you already had the paramedical and protective supervision forms filled out, you can bring those to the meeting as well. And then also a list of your child's medications, because a lot of times they ask for that, a list of the medications and a list of their doctors, because I... they want to sit there... They will sit there with a pen and say, “Can you list off your... Tell me your child's doctor and phone number,” and I'm like, “We only have how much time?” so here, I printed you off a list of all 12 doctors and their contact information because we're going to be here all day writing this down otherwise, so if you have that stuff already ready, it's going to be a lot easier for them to just take it and add it to the file and enter it into the computer later. And they will appreciate that as well. They will appreciate having that instead of writing... -- You can only list out so many doctors’ names before, it's just like, let me just give you this information. So, yeah. I have to say, I always remember something one of my old Regional Center service coordinators told us, and she said she had a relative who received IHSS, and she said, “I just put all of their medications on the table.” Yeah. -- So that social worker was like, “Okay, here we go,” and that visual of really, here's what it takes for them to be able to get through a day also is really important. Yeah, but it's... Yeah, definitely. It's good for them to see it and then also just have a list that you can hand them so they don't have to sit there copying everything. That's definitely a good idea because it's not always easy to visualize exactly how much is involved in that medical care. It's impossible to really lay out what a day or a week might be like, so whatever you can do, it will help hopefully. It will help... It will help you at least be able to communicate that. And what is... So, we've talked about some things that you should do, but what's one thing that parents should not do before the in-person evaluation? Don't forget that your child needs to be at that meeting. We're so used to going to meetings about our child without our child. Your child has to be at the meeting because the service coordinator... the caseworker has to meet them, has to observe them, has to do what they need to do to assess. If your child is not there, they won't hold the meeting. If you're... If it's a school day and they tell you that they're showing... because they’re not going to call you and say, “Oh, hey, let's talk about timing. When can I come?” They're going to send you a notice that says, “We will be at your house at that... between this time and this time, on this date. If you can't make it, please notify us. If you absolutely can't do that time, please notify us.” Otherwise they'll expect you to be there, and if you're not there, they'll deny you. They'll send you a denial and say, “Well, you didn't cooperate with the...” So, if you can't do it, call them right away and try to reschedule, and sometimes they'll work with you on rescheduling at a better time in the day, and sometimes they'll just say, “Well, you can pull your child out of school, or we can put your case on hold until you can have your child at home.” They will do that, so just be prepared to have your child at home during that meeting. Right. And so two things that keep coming up, right, that our protective supervision and paramedical... You've kind of explained what each of them are, so for protective supervision, I don't know if you want to kind of recap what you already said about what is it and then who qualifies. So impaired, severely impaired judgment, memory, and/or orientation. It's usually multiples of those, and their behavior needs to be non self-directed, which means that they don't have the capacity to evaluate the potential and to assess the potential danger of their actions before they do it. They just act and they're not capable of thinking about what's going to happen, and you can go back and forth with the caseworkers sometimes because they... sometimes they think that you can't have any kind of sense of awareness and also be non self directing. So, I've heard of situations where parents are like, “Well, they said my child knows their colors so they're self directing and my child can name Sesame Street characters, so they’re self directing.” That is not how it works, okay? We... Your child can know a lot of things intellectually, but not be able to put them into practice. Your child... You can ask your child what they're allergic to and they know that they're allergic to a certain thing, but that doesn't mean that if you put that thing in front of them, that they're going to stop and think, I'm allergic to this thing. There's two... There's a difference between knowing things and being able to put them into practice, so you can drill your child a thousand times about what's the harm of crossing the street without looking both ways, but if they're not capable of remembering to cross the street before they look both ways, when you're not sitting right in front of them going, “What do you do?” that's... They're not self directing if they're not able to stop and think about what's happening and evaluate the potential to... that they might be injured before they act. Or even if they're scripting of, “I'm going to look both ways,” right? “I have to look both ways,” and they don't look and they just start walking. Right. Because there's a lot of stuff that sometimes our kids memorize without really being able to evaluate what the thing actually means, so... just, that's why that log is really important because the person might ask your child, “What are you going to do if there’s a fire?” and the kid says, “Call 911,” because you've drilled with them a thousand times that that's what's going to happen. That doesn't actually mean that they're going to actually do that if there's... They might not even know how to use a phone, but you've practiced with them a million times, so that's why that log is really important, because it shows what actually happens in practice. So, that's protective supervision, so again, it has to be due to impaired judgment, memory, orientation. It cannot be due to intentional aggression or self-harm, so you're not going to get it, for example, for suicide watch if the person is able to contemplate the consequences of what... So, if they're doing it because they want to hurt themselves, then you're not going to get it. If they're doing it because they're trying to get attention and they're... or they're stimming and they're banging their head, you might think of that as self-harm, but if they don't understand that harm is the outcome of what they're doing, then it becomes really important to use the right language, because what you think of as aggression, just casually, aggression or self-harm, without the intent behind it, it's not the same, so just be careful about the language that you use. If somebody is throwing things and lashing out and hitting because they're having a meltdown, that's not the same as, ‘I'm mad at my little brother because he stole my toy, so I'm going to hit him because I want to hurt him and make him cry.’ Those are two very different things. So, if someone is overstimulated or having problems with self-regulation and they are hitting themselves in the head, right, then that is a behavior, because they're not doing it to... Yeah, that's completely different from the kind of thinking that goes into intentional and deliberate self harm with the purpose of harming yourself. And another topic that often comes up is intensive medical issues that could pose a safety risk. Is that considered something... You cannot get protective supervision to watch for spontaneous medical emergencies. So, this is an example that I see come up. Sometimes people will ask about seizures. Can I get protective supervision to monitor for seizures? And the answer is no, you can't get it to monitor for seizures. There may be some paramedical services involved in kind of... If you have to titrate medication for, say, blood sugar or seizures or issues where you have to watch... monitor for certain things. There might be some paramedical services in there, but not protective supervision. However, if a person... Number one, if a person's medical condition makes them likely to engage in behaviors that arise from impaired cognition, that might be another story, and so, it would be a whole conversation. I’m trying to think of examples of that, but there are situations where a person's medical condition makes them more likely to fall into... unpredictably fall into a state where they are... where they do have severely impaired judgment, memory, orientation, and the other piece of that is that if you have a person who is on a lot of medical devices, if they have ostomy bag or a trach or a G-tube or a port, and they don't understand the consequences of pulling at them, they don't understand how to be cognizant of them when they're moving around, or even if they're not ambulatory like my daughter still is... It's still an issue with my daughter, but when she was a baby even, she’d... Oh, this is a chew toy. This very important tube that provides my life sustaining nutrition... Right here for me to play with. This is great. And let me pull it, and I don't understand that pulling it... I don't understand why I feel pain because I'm just pulling on this thing, and she didn't understand, and this happens a lot with kids who have G-tubes or trachs, is that they think they're toys, and they don't understand what's going to happen if they pull them out. They don't understand the medical harm of not having it on them, and the medical harm of it potentially having to be replaced, especially if it's a surgical issue, and so that's a situation where it's a medical emergency that was caused by the person's lack of... the person's cognitive impairment, and so that's the kind of thing that you can get protective supervision for, because what you're watching for is the behavior that... the non-self directing behavior that can lead to harm. And there's two follow up questions to that, and Evy and Jana, these kind of play off each other, but Evy said, “If a child bumps his head on purpose when upset would that be considered protective supervision because they're in danger of hurting themselves? I was told by the IHSS worker that no, because it sounds like the child is just throwing a tantrum.” And let me follow up with then Jana's question, which is a great follow up, which is, “What other language would you use to describe a meltdown that includes physical aggression without intent to harm others?” I would... That's the kind of situation where I would really sit down with maybe the behaviorists, and see if they can... If you have behaviorists, or if not, then maybe OT, because you're talking about self regulation. I would ask one of the providers, whoever is providing a service that is related to that, to kind of write something up about what overstimulation does to a child and what that... what stimming might do. What... Have them use the kind of clinical language to explain that what's happening is not the child is hurting themselves because they want to hurt themselves. It's that they're overstimulated and they can't self-regulate and so they're acting out in whatever way is available to them because they don't have the cognition or the sensory skills to regulate themselves, so that's a situation where I would definitely ask a clinician to kind of help you come up with the right language to describe what's happening to your child. And, again, don't use the word ‘aggression.’ Don't use the word ‘self-harm.’ I would say they're at risk of accidentally hurting themselves in the process of exhibiting this behavior that arises from their disability, and that's happening because they don't... they can't self-regulate. Does that make sense? Do you think that answers the question? Yeah, I think it does. We need to get... We should get the language. It isn't like there's a magic word, right? I know that’s not you were asking. Well, there are magic words that will shut that... that they'll use to shut you down, and those magic words are ‘aggression’ and ‘self harm,’ so you got to figure out a way, and I'm not saying... If your child is aggressive, intentionally aggressive, that's a whole other story, but... So, what I'm saying is tell the truth, but use the language that appropriately describes what you're... what's happening with your child and not just kind of what you casually think of as aggression, because those words really mean something and they have intent behind them. Right. Right. And I think you also, with your answer there, you hit on what my next question was going to be, is that should we be gathering supporting paperwork from doctors, providers, therapists or our child's school to support what we're saying as also being observed by others? Does that help? -- Yeah. I mean, I think that the more documentation you have, the better, and also the more you anticipate pushback, and I've said that before, the more the... Also sometimes, the more less readily apparent your child's disability is, it’s... As you'll know, if you have a child whose disability is not visible, people make a lot of assumptions based on what they see, and if you know that that tends to happen with people who don't know your child and have not really interacted with them, that's another time when a lot of documentation is really helpful because they're going to judge what they see in five or ten minutes at your house In their interaction with your child, and if it's not always as obvious what's happening to your child, then it's even more important to have that documentation. Absolutely. And I mean, to kind of wrap up the protective supervision, I'm looking at the time and I know there's always a lot of questions, but what are the most important things that we should keep in mind when filling out that paperwork? So again, keep track, keep those logs, either of the specific type of activity or what happens in a typical week. Make sure that the doctor who fills out the form is aware of these things, because they need to fill out the form, and you don't want it to be filled out by somebody who doesn't know the kid, and it's like, yeah, they seem fine. So, talk to your doctor as these things are happening and explain what you're asking for and explain, “Remember that time we talked about blah, blah, blah?” This is exactly the kind of thing that is watching out for, so make sure they're familiar with your child. And then again, the whole discussion about using the language that describes your child appropriately. Just think about what those words mean and whether or not there is actually that intent behind them, and if there's not, then use different words. And lastly, is... About protective supervision, is there an age range where protective supervision kicks in? No. So, again it's always going to be based on the supervision or whatever. Anything with IHHS is always going to be based on a typically developing child of the same age, and what a parent would be expected to provide, so for supervision, it's going to be based on what a typically developing child the same age, how closely they would need to be supervised, so there are certain ages where it's a lot harder to get that supervision, which is very young ages, because they're going to say, “Well, a two-year-old always needs supervision. A three-year- old always needs supervision,” but again, that's another area where the more documentation you have, the better to show that they need more supervision than a child of the same age who doesn't have the same disabilities. You cannot deny protective supervision just on the basis of age. You can deny it because they don't need more supervision than another child, but they can't just say, “Oh, we don't provide it for children of that age.” There has to be an assessment. They have to actually look at the child and see what their needs are. Right. Just like that initial call. Same thing, right? And what about paramedical? I know you touched on paramedical, but again, what is it and who qualifies? Okay. Ordered and directed by a physician or other licensed clinician, It'll affect... Oh, so we didn't come up on this, but protective supervision will add 195 hours to your monthly hours, and so for kids who don't have a lot of... for kids who are in that age where they don't... where they're not going to get a lot of time for dressing and bathing and stuff, a lot of times, most of the hours are going to come from protective supervision. And then for paramedical services, it's just going to be based on how long it takes to do those tasks. There is no age limit, protective... for paramedical services. It's just going to be based on the services that are ordered by the doctor relating to the disability. And is there anything that we... This came up... This question was actually inspired by when we did this before. Our parent asks, “Is there anything we should not do in the evaluation meeting?” So, don't understate your child's needs. It is very tempting for all of us to want to just brag about everything that we're so excited that our child is able to do, but they'll take that at face value. If your child can read their name, they're gonna be like, “Child can read.” If your child... Be willing to talk about your child's deficits. I know that it's really hard to talk about those and put them into words, but this is one area where you really have to do it. Like I always say, don't exaggerate, but be willing to tell the truth. Tell the truth, and be open about the level of help that your child needs and the level of care that you need to provide, and again, drawing... hitting that point home, use the right language to describe what's happening with your child. If it's aggression, call it aggression, but if it's not, then don't call it aggression. I mean, and what you were saying, Lisa, about, that it can be hard, but you have to be honest about what's going on, and I think this is... I think IHSS is one of the hardest appointments because you really do... I mean, it's not an exciting thing to be talking about. When somebody's like, “All right, well, this program is because your child is so disabled that they would be living outside the home,” it's... it can be really emotional, but it is important that they understand the reality of what your life is so you can get the support that you need and that your child needs, but it's no fun, that's for sure. And so what happens if we are denied after that evaluation visit? So, if you're denied after the evaluation visit, you'll get a written denial. It's called a notice of action. A notice of action is what you get in the mail that says whether you've been approved or denied, tells you how many hours you're going to get, says that you need to appeal. It's called the notice of action. If you receive that and it's a denial, it will include information about how to appeal. You have 90 days to appeal a decision. You need to appeal that in writing and what will probably happen after you submit your appeal is that somebody from the county will reach out to you and offer what's called a conditional withdrawal where you agree to kind of put your appeal on hold and they'll send someone out to do another assessment. It might be the same person, it might be someone else, but they'll redo the assessment, and then once you get that proposed new assessment, you can decide, okay, I'm gonna accept this or no, I want to reinstate the hearing, and it will... It still goes back to the original. Yeah. Don't say, “Oh, well, I disagree with this, so I’m just gonna...” If they tell you try again in six months, never go for that. You always want it to go back to the original date. Absolutely. And I also want to shout out, Sonia, what Sonia said, totally hear that. She said, “It's hard to talk honestly with my child listening in.” Yes, -- It is terrible. Definitely that... And that is a huge part of the challenge of having to have your child there and trying to balance, because you're the one providing. There's not another available parent, and so you're providing care for your child at the same time that you're talking. Yeah, I totally hear that. It's really frustrating. If that's a serious... If that's a major thing where your child is going to understand everything and you really don't want them to hear it, you can write something up. You can say, “Look...” I mean, you can say, “Look, I don't really feel comfortable talking about this with my child right here because it's going to really hurt them to hear it articulated, but here, I've written.... I've written this and this is... this will tell you a lot about what we're dealing with,” and maybe they want to call you back, and what's happening right now, actually, with COVID is a lot of times they're doing a lot of the interview on the phone, and then they're coming for a home visit to observe the child, so to the extent that that's possible, you can also request that, because that might be easier on them than writing something up and giving it to them. You can request to do part of it on the phone and then do the home visit separately, and again, they're doing that because of COVID, but I think that that is something that could really be beneficial going forward for situations like that. Jenna gave another great suggestion too. She said, “Can you put headphones on the kids so they don't listen as much?” I've tried that, of which the headphones were thrown across the room. Whatever's going to work. But yes, if you could do it, do it, right? Whatever's going to work. I mean, if your kid is unlikely to be cooperative with just... with keeping headphones on or... Just think about what's going to work best for your child in that situation. I mean, I like the phone interview format because you get that part of the discussion over with, and then they do the home visit. Right now, some of them aren't even coming into the home. They want to meet your child and see them, but during COVID, some of them are staying outside and you come to the door and... which is really fun because if you don't want your child running out into the street, you're just like, okay, I've got my child on this side of the door and the caseworker on this side of the door and what do you do? But you just figure out logistically what works best so that the caseworker sees what you're dealing with. And, I always say, I know you hate this question, but it is important for us to have some sort of a range, but what is the range of hours that a client under 18 can receive? It's the same for clients who are over 18, which is literally zero to 283. Whether your max is 195 plus weekly... sorry, 195 plus monthly or 283 is going to depend on how many personal care services your child needs because they have different classifications that are based on whether you're severely impaired or non severely impaired, but if the child is severely impaired, which means they have 20 or more hours a week of personal care services, then... and paramedical, then they're considered severely impaired, and then the max is 283, and that is true even if their need is higher than 283. 283 is the hard cap for an individual for... unless there's other waivers involved and that’s a whole other conversation, but for IHSS, for most kids who are just on Medi-Cal, or through the Regional Center, it's usually going to be... it's usually gonna be 283 is the max. And once you get hours assigned, can they ever change? Yes. So, you'll have an annual reevaluation if circumstances... So, if you receive your notice and you got hours, but you are shocked because you thought that your child would qualify for many more hours based on... based on looking at everything, like that chart, based on everything, you thought there would be more hours or you really feel that your child should be eligible for protective supervision, you can still appeal that, and if you've been doing the hours and later down the line, you realize and it's outside the 90 day time to appeal and you're like, wait a minute, this isn't enough hours, you can ask for an additional reassessment. When I... They may be able to do a certain number of hours talking over the phone and going over the hours, but usually they'll want to do a whole other home visit. Just be prepared that if you ask for a reassessment, the hours could go up or down, so they might reassess and be like, “We don't actually think you need these hours,” so just... but if you feel pretty confident that your child would... or if your child has additional needs that they didn't have when they did the original evaluation, say, for example, your child is hospitalized and when they come out, they have additional needs that weren't the case before and they're going to be long term, you can ask for a reassessment, and submit additional paperwork, and ask for the additional hours. And to follow that up with another one of your least favorite questions. How long can this entire process take from that initial call to receiving your child's hours? Months. That could be like two or three months, or it could be eight or nine months, depending on whether you have to appeal, depending on whether they have all your paperwork, and again, the best way to keep on top of that paperwork is every time you send them something, call and make sure they received it, because the longer it takes for them to get everything that they need, the longer it will take for them to give you a decision. This is not going to be something where you call and file and 30 days later, you have a paycheck. It's just not... That's just not this process, but to the extent that you can control the length of it, it's going to have a lot to do with making sure that they have everything that they need, they have all the forms, that nothing gets lost, so you can contribute to it being a shorter amount of time, but especially with the pandemic, it's a process and it's a long... It’s a... There are processes that are longer, but it's not going to be... It's not overnight. Right. Yeah. Don't start now expecting that maybe it'll be all ready by the time your kid's out of school even, right? But just get it started not knowing. Right. Yeah. And what's the most important thing that you want parents to walk away with today? Empowerment. I mean, this is a super intimidating process. Even if you've been doing it for years, it's still stressful to have the annual meeting, but I feel like it becomes a tiny bit less, or maybe even a lot less intimidating when you understand the language that they're speaking, when they're not throwing all these terms out at you, and you have no idea what they're talking about, it just gets even that much more overwhelming, so by understanding the concepts and terminology behind the service, I feel like it makes it ... I feel like it can make you more empowered to be able to effectively advocate for your child and not get intimidated and overwhelmed as much by the process and by how incredibly complex it is. Absolutely. I actually just want to throw in one last question from Paula. She said, “I'm my daughter's IHSS provider. My daughter is going to be turning 18 in November. Can my husband apply to be a personal assistant provider? In short, can both parents be providers? One parent is the IHSS provider and the other parent is the provider for personal care services program?” So, personal care services program... I would have to go back and check the regulations, but I'm not sure. If it's waivered personal care services, I'm not sure that parents can be the provider on... for those services. I'd have to go back and double check. It depends on what kind of... which waiver you're on and who can provide services. I have to check. I'd have to check. And that, although actually for adults it... the rule may be different. It might be that it's okay for adults. And again, a lot of these rules apply differently for... I specialize in kids under 18, which is why I'm like, let me... I was just wondering if it's that transition question. But one of the things that's important to know is that the rules about... all the rules about working full time, working part time, all that stuff, and who can be the provider, all of that falls away when your child turns 18. These rules about parent... It's because it's involved a minor child, that's when the rules apply about a parent working full time versus part time. So, I know that on some waivers, a parent can't be paid to be for... paid as IHSS or personal care for minor children, but I'm not sure what the rule is for an adult on that. Got it. All right. And I also do see Evy saying, “It took me almost a year due to all the miscommunication.” I think that's a common occurrence. Yeah. Even without having to go through the appeal process, it can still take a long time if people are losing forms, and that's why just keep a copy of everything and anticipate that at least once you will have to resubmit something. Thank you, Lisa. Thank you so much. I mean, I know we covered a lot. Every time I talk to you, honestly, I learn something new. There's so much to cover and when it starts to feel overwhelming, just think of the starter kit framework that we laid out today and then set your priorities for each of these six steps, learn the essentials, call and apply. Remember, you can't be denied on the phone. Fill out and return a completed health care certification for your child, prepare for that in-home visit, choose, hire, and train a provider, and appeal if denied. And as we've just covered, be prepared to possibly wait months, but the silver lining is, if approved, you will receive a retroactive check from the first day that you made that call. And we know it's a lot to absorb, but once you jump in, hopefully it starts making a bit more sense maybe. So, we would love to know the number one thing that you're walking away with today. I mean, did something in particular resonate that you hadn't thought of before, something that you still have questions about? We'd love for you to throw it in the chat so we can learn what's connecting and what we need to spend more time on, because we know it's... Every, every, every situation, there might be something that you're very... that matters to your family, and is very important that we would love to get further into next time, because we're going to be doing these IHSS events regularly, and both Lisa and I know how stressful this process can be, and so if you want a partner to talk through the application process, to review your paperwork for protective supervision or even to role play for that in-person evaluation, which I usually do alone, in a room by myself, but our Undivided Navigators would love to be that partner for you. And in addition, various specialists hold biweekly office hours for Undivided members. Lisa is a frequent guest, and she would love to answer your questions personally. All of our members, including those in their Kickstart, are invited to stop by for five minutes or the entire hour. So, to find out more information about how you can receive this personalized support, check out our free 14 day Kickstart. Donna is going to put the link in the chat window. Our mission is to support you so your children can thrive, and we want you to thrive too, so please reach out and let us know how we can help. If you're not already a member of our Facebook group, join us. This week we're talking about senseis, traveling phlebotomists, and new guidance for parents raising kids with Down syndrome. Plus, we are wrapping up our Goldbelly gift certificate giveaways and we're talking about our upcoming happy hour in person here in LA so you can find out more information in the group, so we hope to see you there. And we have another Undivided Live tomorrow. We're doing a Friday edition. We're going to be talking to education advocate Kelly Rain Collin. She's going to be telling us what to focus on for your first IEP, your child's first IEP, so if you're in the early years of IEPs or you know someone who is, please share the RSVP info that Donna is sharing in the chat. And next Thursday we're back for our regular Undivided Live and we are bringing Lisa back next week. We can't get enough of her. She's going to get us ready for summer with Regional Center, resources like social rec funding, specialized supervision, aides for camps, additional ABA hours when needed, and more. So, have you called your service coordinator yet? If not, don't miss next week. Donna's going to put that RSVP in the chat window as well. You can submit your questions ahead of time with your RSVP, so even if you can't attend live, Lisa can hopefully get to those questions. That's next Thursday at 12:30 where you can find us every week. We are predictable. Same time, same place. So, thanks again to Lisa for decoding IHSS for us, to Donna and Iris in the chat, and especially to all of you for stopping by Undivided Live. Have a beautiful weekend. Bye.