IHSS Starter Kit: Top Tips You Need to Know

Event transcript: Hello, everybody. Welcome to Undivided Live. Today we are 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 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 or many years, but we want you to be one step ahead so you can get the help your family needs. So, we're talking today about the must haves in your IHSS starter kit, from eligibility to your initial application, to prepping for your child's in-person evaluation, the details around who can be a parent provider, and what you can do if you're denied or in disagreement. Lisa is going to give us the lowdown on all of this and more, and take questions from you. There's a load of information to cover, so let's jump in. I'm Lindsay Crain, and I head the Content and Community teams at Undivided. With me today we welcome back Undivided Public Benefit Specialist Lisa Concoff Kronbeck. Lisa is our Yoda for all of the fun government systems that are crucial for our families: Medi-Cal, Regional Center, CCS, and our focus for today, IHSS. Beyond her professional commitment to help families navigate the world of government benefits, Lisa is in the trenches with us. She's also the mom of an incredible kiddo with disabilities. Hello, Lisa. Welcome back. Hi. Thank you. You're not going to show your Yoda? Well, it’s not Yoda, it's the baby. It's like the Grogu And by the way, I was calling her Yoda before I knew that she had a life size Yoda, so it's kismet. So to start, let's cover the essentials. So, Lisa, what is IHSS and what is its purpose? Okay, so IHSS is in-home supportive services. It's a Medi-Cal program that is designed to help elderly people and people with disabilities remain safely in their homes, by receiving services in their homes. What is it not? It is not paying parents to stay home and do what they're supposed to do. That's one of the very common misconceptions about what IHSS is. IHSS only pays for services that are above and beyond what a parent would be expected to provide to a typically developing child of the same age. And the parent can only be paid as a provider when the child's extraordinary needs prevent them from keeping... from obtaining or keeping full time employment. So this idea that people are being just paid to stay home, it's just... it's nonsense, but that's what we hear a lot. And so that's what IHSS is not. Who is eligible for IHSS and who isn't? Okay. So, you need to have Medi-Cal in order to have IHSS. If you have a share of cost then the share of cost applies to IHSS as well. You need to require the services in order to remain safely at home, so you need to be at risk of out of home placement if you don't receive those services in your home. And another question about eligibility. We received a lot of questions ahead of time with the RSVPs asking, is it income based? Because it seems like parents keep hearing that over and over, possibly even from social workers. Or maybe there's a misconception. Well, so Medi-Cal is often income based, but there are many different programs with Medi-Cal. Some of them are income based, and some of them are specifically designed to help people with disabilities remain in their homes, and so there are waiver programs where a person... a child with disabilities can get on the waiver without regard to household income if their own personal income and resources are within the thresholds. So, in theory, it is an income based program because it's tied to Medi-Cal, but if you have Medi-Cal, then that should suffice as the measure of whether you qualify in terms of economics. We've also done an article on the Medi-Cal institutional deeming waiver, so if you do want more information, if your child is a Regional Center client and you are not on that waiver, we can give you more information about that waiver. So, if someone is saying it's income based, you don't have Medi-Cal, you can look and see if that's a possibility for your child. Also age range. So, is there an age range that is allowed. Like what... Another big question. In principle, there is no age range. Zero to however... Zero to end of life. The issue is that there are certain services that are only available to children of a certain age because again, the services that can be awarded are designed around care needs that exceed those of a typically developing child of the same age, so remember that phrase when you're thinking about what your child might qualify. Needs that exceed those of a typically developing child of the same age, needs that go beyond what a parent would be expected to provide to that child. There's a whole index that shows kind of at what age, and these are based on developmental scales, that show kind of what age children are expected to do x, y, z task with... independently. And so you can look at the chart and see kind of... and it's very generous. I mean it's got kids not doing laundry till they're like 17 or something, but it gives you an idea of where they expect that children should be able to perform certain tasks independently. Then there are also certain services under IHSS that are only available to adults, because parents are generally expected to require to provide that service regardless of age.. And so I think it also bears repeating that if a social worker tells a parent that IHSS does not cover kids, that is incorrect, right? Because a common thing that we hear from parents is that they're told by social workers or whoever's answering the phone when they call that you should be taking care of your kids anyways so they don't qualify for IHSS. So, Lisa, how can we respond if that's what we're hearing? So as I said before, this is a really frustrating misconception, and what we have to understand in terms of the IHSS program is that in the past, kids with disabilities and adults with disabilities were very frequently institutionalized as a default. You have a child with Down syndrome, they tell you, here's a place where you can put this child, and California, a lot of countries or a lot of states around the country, but specifically California in the beginning started developing programs for home and community based services that were designed to keep people in their homes and not force them into institutions, and IHSS is one of those programs. It's one of the home and community based services programs, and so when you have the caseworker saying, “Well, you're supposed to do this anyway,” there's two separate questions here. One is, does the child need in-home supportive services in order to remain safely in their home based on what they're able to do in terms of self-care relative to a child of the same age who is typically developing? And two, is there someone who can be paid as the provider? And there's all sorts of rules around available parents to provide services, whether the parent is working or not, but it's a separate question from whether the child needs those services to remain safely in the home. So if they tell you, “Well, we don't provide services to kids who are this age. Call us back in three years,” right, what I would suggest saying is, “I understand. I hear you, but I would like to go ahead and apply anyway, and if my child is denied, they can send me a written notice of action,” because what has happened many times is that someone will call and they never even get to the point where they submit an application because the worker says, “Oh, call back when your child is ten,” and they're like, “Oh, bummer,” and they hang up, and then they've never applied, they have not established any appeal rights, and it's wrong. Depending on your child's specific needs, there may be services that they're eligible for, so be nice about it, but say, “I totally hear you, but I'd like to go ahead and apply anyway, and you guys can send me a written denial if we don't qualify, if you feel we don't qualify.” And, something that you have said to me in the past, right, that they cannot deny you on the phone. No, they... -- Without an application, without... with just calling, right? You cannot be denied. Is that correct? It's not... Yeah. It's not a denial. If you call and say, “I'd like to apply for IHSS services for my six year old who has disabilities,” and they say, “Sorry, we don't do that. Call back in three years,” that's not even a denial. That’s their gatekeeping the ability to apply in the first place. So no, that is not a denial. Yeah. So go ahead and apply. Yeah. By the way, I did... I went to the IHSS site yesterday and right there on the Department of Social Services website, in the second sentence, right, on the IHSS tab, it says, “Disabled children are also potentially eligible for IHSS,” so if someone says that children aren't allowed and using that as a blanket statement, that's a hard not correct, but I love exactly what you said, Lisa, right? It's like thanks I'd like to apply anyway. If my child is denied then they can send me a written notice of action. Yeah, and it's important to remember that as you apply, your retroactive benefits are retroactive to the day that you called. And so, if they say, “Call us back in three years,” that's three years when you could have been getting benefits, and so it goes from that first call. Yeah. Very, very important to make that call. Which is also why you don't want it... If they say, “We're going to deny you now, but call us back in in six months,” no, keep applying, and if they deny you, you can appeal. Right. Which we'll definitely cover that as well. First let's talk about what kinds of services that IHSS covers. So, if you can first give us an overview and then we'll get into some of the details in just a little bit. --All right. So, there's non-medical personal services, and we'll talk about this later. There's related services, but related services are usually awarded to adults. There's very, very few instances where if you can show extraordinary need, you might be able to get them for younger children. And then there's accompaniment to medical appointments, which also has specific requirements. And paramedical services, and protective supervision. So, those... and each of those has their own rules and criteria, and we can talk about that, but those are the basic services that you're going to see. Right. And do... Obviously with the name alone, in-home supportive services, right, but it doesn't seem quite as straightforward as always in-home, but do IHSS hours have to be fulfilled in the home? So, this is a tricky question, and I'm still trying to find an All County Letter or something on point to this. When it comes down to it, it's in-home supportive services, so they're going to base your hours on services that are meant to be provided in-home, but at the same time, there's an argument to be made that people with disabilities are not meant to be basically stuck in their homes forever because they need diaper changes or G-tube feeds, and so if you have to take your child to the grocery store and you have to change their diaper there, or you go to a family member's house or a birthday party, and you have to change their diaper or do a G-tube feed there, that service, that allowed service should still be included. The issue is that you're not going to get extra time to go out on social outings, so you might get extra time to accompany to medical appointments, things that are medically necessary if you have to provide services, but you're not going to get the time on your notice of action that says this is the time block when you can go to a birthday party or a soccer game or whatever, and be with that person, but again, there are different situations where certain services do have to be provided outside of the home, and so there is an argument to be made there that if the service is authorized to be in the home, and if the person providing the service is the provider and is authorized to provide the service, that it shouldn't matter whether... where the diaper is changed, if that makes sense. Yeah. And when you kind of talked about medical appointments, what about... I mean, obviously a lot of our kids have therapies, so taking them to speech therapy or PT, is that... Can we... for the same kind of thing, right, if we still have to carry those services out during those appointments, can we...? Yeah, so there's a whole set of specific rules about that. The last time... maybe last year when I had my redetermination, they tried to say, “Oh, well, you're a parent. Parents usually have to take their child to appointments,” and I went and found the All County Letter, which is All County Letter number 1742, and there are specific rules about when a parent can get accompaniment to appointments, and also wait time. So, for accompaniment, you... Their argument is Medi-Cal provides medical transit, and so in theory they should be able to get to and from their appointment and have that covered, but if an IHSS service is required on the way or during the appointment or on the way home from the appointment, then parents can get accompaniment, so if you have to change your child's diaper, as soon as you get to the appointment or start the G-tube feed right when the appointment starts or something like that, and that's an allowable service, then you can get accompaniment time. Wait time is based on whether or not you're able to attend to personal business while the child's in the appointment, so if you go into a therapy appointment, you're sitting there, or you're on call to change diapers, or be there in case the G-tube feed starts having issues or starts... a pump starts beeping, you're on call so you can get wait time. If you're able to drop your child off and be like, “All right, I'll see you in 50 minutes,” then you're not going to get wait time. And I just... I don't think I said this before, but for these medical appointments, it has to be a medical appointment that's related to the child's disability, because parents of typically developing children take them to checkups, right? They take them to their annual well-child visit, but if it's a cardiologist, pulmonologist, therapies, anything like that that's related to the disability, then that's included in the appointments that you can get time for. Okay. And this might be covered under what you just said, but a slight variation. If you're going to therapy with your child, you're staying in the waiting room, but they're in the therapy room with the therapist, is that okay? I mean, but then if something needs... if they need a diaper change or something else, you're there and then... Yeah, if you're there, if you can't leave because you have to be there in case one of these on call services is needed... Again, my child has a G-tube. If she goes into physical therapy and it somehow gets dislodged, what are they going to do? I have to be there. And so, yeah, if you have to be there to attend to your child's IHSS service needs, then that's wait time. And one more question that I think is really common, and we did have some questions about this. What about hospitals? So, if your child is admitted to the hospital... No. If your child is admitted to the hospital and spends several days in the hospital, you can get time for the hours before they were admitted, at home prepping... preparing them to get ready or go, and you can get time on the day that they came home in the evening once they're already home, but you cannot claim any IHSS hours during the time when the child is in the hospital for the entire day, because somebody else is legally responsible for your child during that time: The hospital. And so another big area that parents want to hear about, parents are interested... If they are interested in being a parent provider, who is eligible for that? What I'm about to say, in case there’s anybody watching who has an adult child, what I'm about to say specifically applies to parents of children under 18. So, if a parent wants to be a provider for a child under the age of 18, there are a few conditions that have to be met. Again, the child has to be at risk of out of home placement if the services are not provided, that specifically in a one parent household, the parent has to be unable to work full time or obtain a full time employment because of the child's extraordinary needs. In a two parent household, one parent has to be unavailable because they're working full time, in school full time, disabled, and the other parent who's going to be the provider has to be unable to find full time employment because of the child's extraordinary needs, so you're not going to be able to be the parent... If you have two parents who are both working full time... both working part time, for example, they're going to say, “Well, you have two parents who are available to take care of the child,” so they're not going to allow the parent to be a provider, and they're not going to allow you to hire an outside provider for any time when the parents are home. Okay. So, I have a couple kind of scenarios because it's always, like, well, what about this? What about this? And I hear what you're saying, but then it gets a little confusing, but first, can you define what is full time? Okay. Full time is an average of 40 hours a week or more, or if... It's defined by statute as an average of 40 hours per week or more, but they may also say that you're employed full time if your job classifies you as full time, like if you're working four ten hour shifts in your... Or, sorry, if you're working three 12 hour shifts and your job classifies that as full time, they may still argue that that's full time employment, because that's what you would be working if your child didn't have those needs. But yeah, it's... Generally speaking, it's going to be the lesser of an average of 40 hours a week or whatever your job classifies as full time. And so, this seems pretty obvious, but I'm still going to ask. So again, we're just talking about parent providers right now, so can you be a parent provider if both parents work full time? Okay. First of all, none of these questions are obvious. Like, nothing is obvious. I say that. I’m thinking... but for me, I'm like, okay, let me dissect every thing. So, if both parents are working full time, then you can... the child can qualify for IHSS, but you would hire an outside provider during the times when the parents are not at home. Okay. And what about one parent works full time and the other works part time? Can the part time parent be a provider? Yes. The part time parent can be a provider and you can hire an outside provider during the times that the part time working parent is at work. You can hire an outside provider whenever there is no available parent, so if both parents are at work, then you can hire an outside provider. What you cannot do is one parent is working full time, one parent is working part time, but then when they get home, they want to have an outside provider come in while they're at home, that you can't do, but if you need an outside provider while the parent is working, then that's when you can do that, and the parent can also be provide... be the parent provider when they're home. So, you can be a parent provider with some of the hours. It isn't like you're going to be parent provider, you have to provide all of the hours. You can do half the hours, and while you're at work, an outside provider can do the other, if you're working part time. You can, or you can also do all the hours because our kids still go to school. Right. Depending on your job, of course. Yeah. Depending on your job, if you're working part time while... only while your child is at school, you still can do all of the hours. Yes. Right. But if you need to split them up, you can, so somebody can't say it's all or nothing, right? It depends on the situation. Okay. And we talked about this back when there were all the mandates and the kids were home, but just to clarify too, what if one or both parents are working from... if there's two parents working from home with the assumption that if both are working, one, it would be part time, but let's actually just say one person is not working. They want to be the parent provider and the other parent is working from home. Does that affect anything? Well, as we all learned during COVID, working from home is still working. If the parent is working full time, regardless of location, they are considered unavailable. What about the parent provider who might be working part time and then their spouse, if they have a spouse or a partner, and they're at home working full time... Right. They're still unavailable during the time that they're working. Working from home is still work. Yes, as many of us know. Yes. And oh... and this this question came in quite a few times before too. Can a parent be a caregiver to two of their children if both kids qualify for IHSS? Yes. So there are... Yeah. So, the short answer is yes. The long answer is depending on how many hours they have, there is an exemption that allows you to... So, we'll get into the maximum hours, so I'm not going to start throwing out numbers right now, but there is an exemption that you have to be approved for ahead of time that allows you to go above the maximum hours that's usually allowed if there are two children living in the same household who have those hours. If you go past that number of hours, you've got to get an outside provider. Okay. And so for families that are looking for outside providers, can we hire anyone as a provider? Do we have to look at agencies? Can we bring in a family friend? Who can be an outside provider? Any of the above, as long as they're eligible to work in the United States and can pass the background check. Okay, great. And they can live in the home just like a parent, even if it's not a parent, if it's a family member that lives in the home, they can be a provider as well. Okay, great. And what kind of trainings do providers need to undergo? What kind of expectations can parents have? So, I think that's going to depend on the individual provider, because there's an orientation that they're required to do, and you have to do that within an allotted time of signing up, but it's mostly about administration and the rules and how you submit timesheets and what's allowed and what's not. I don't believe they have a CPR First Aid requirement, although individual families could ask their provider to do that. A lot of it's going to be about training your provider for what your child needs. If they need G-tube feeds, if they... if you're doing medication administration, it's that stuff that's supervised, and we'll talk about that again later, but it's going to be about training the provider for your child's specific needs. And that's... so that's one training that providers have to go through with IHSS? It's the orientation. They call it the orientation, and it's largely administrative. Got it. And it doesn't matter if that's outside provider or parent provider, everyone's going to the same...? Yeah, everyone has to do that. Even if you're a parent provider, you have to do the background check and fingerprinting and you have to do the orientation. So, what about... because I know everyone on this call, you're just... you're on top of everything, right? But if you're looking ahead and you're thinking, okay, the process is going to take a little bit of time, can someone go to that orientation before their child or their client has been accepted into the program, or do you have to... you can only go to the orientation if you're like, yep, this is who I'm going to be a caretaker for, and then you're allowed in? In theory, anybody can become an IHSS provider, but they're going to give you the paperwork at the... when you... When they come to your house for the meeting, they'll give you all the information. I mean, the Live Scan fee is not cheap, so you might want to wait on that, but I mean, in theory, anybody can register to become an IHSS provider. It's... I mean, I guess the thing to know is that your start date is going to be... is not necessarily only tied to... for a parent provider, it's... the start of IHSS is tied to when you called, so... You know what I mean? Yeah. But you... The bigger thing is that you have a certain amount of time once they initiate that process., I believe it's 90 days, once they give you the paperwork, you have to do that within that amount of time. Including the Live scan results, all of it. -- Including the Live Scan. Live Scan’s pretty quick, though. Yeah. So, let's talk about application process. So, someone wants to apply. What do they do first? Well, hold on. I just want to clarify one thing. Once you get that paperwork you don't want to wait. Once the caseworker has handed you the paperwork and said, “This is how you go become a provider,” do it, but I'm talking about if you haven't even filed yet, you probably don't want to run out and go and become a provider. Okay, anyway, sorry, continue. Okay. Yeah. No. All right. Application process. Let's do it. No, it’s good, and those are the tips that we have to know, right? It's like yeah, this isn't something where... I can speak for myself. There's a big corner or a pile in the corner where it's like, I'm going to get to that. It's like, no, no, you gotta... You need to do it, right? You need to get on it. So, all right, application process. So, let us know, okay, if someone wants to apply what do you do first, and what are three things that parents need to know about that initial application? Okay. So, the first two I've already said. Number one: There's no such thing as a denial by phone when you call to apply. That is not what's supposed to happen. So again, “Thank you, but I'd like to apply anyway.” Number two: Benefits are retroactive from the date of application, so if they tell you, “We're going to deny you now, but you can try again in a couple months,” or, “We lost your paperwork, so try again.” No. You want to stick to that that protected date of application. And number three is a diagnosis alone does not equal eligibility for IHSS. A lot of times people will think, oh, my child was diagnosed with x, y, z. Does that mean I qualify for IHSS? And the answer is a disability is required for a child to qualify for IHSS, but everything is based on your child's specific care needs. It's not oh, the child has this diagnosis, so that translates to these services and this number of hours. It's all based on your particular child, and so that's really important to keep in mind. And again it's only for services above and beyond what a typical developing child would be expected to receive from their parents. Got it. And how do you know that your application has been received and approved? I personally like to make sure that IHSS has received everything that I've sent, because they will not tell you if they didn't get it. They just deny you. So, when you call to submit the... when you call to apply, maybe a few days later you can call again and say, “Hi, I just want to make sure that my application was initiated and processed,” and they'll see it in the system if it's there, and if it's not there, they'll be like, “Oh, let’s do this again.” If you have sent in paperwork, I would give it maybe a couple weeks or a week or two, and then call them, and again, you're calling the IHSS helpline. That's who I would suggest calling. And you say, “Hey, I sent this paperwork in. Can I just confirm that it was put in the file,” and they should be able to see on the computer what's been in the file. If you're denied, you're going to get a notice of action. If you're approved, you're going to get a notice of action. If you're not hearing anything, that's when you can call and be like, “Hey, it's been x number of weeks and I haven't heard anything. What should I expect?” With the pandemic, everything's taking a little bit longer, but the key thing, number one is... I guess one of the key things that we'll talk about later with the health certification is they give you a certain amount of time to submit paperwork once they give it to you, and if that time elapses and they don't have the paperwork in their hands, they're just going to deny you. They're not going to call and say, “Hey, just a reminder that we don't have this paperwork,” they’re just going to deny you, so get on that and make sure they receive it and keep copies of everything, because the odds are there will be... there will come a point where you have to send something again. So, with... Is it safe to say within a month, if you haven't received a notice of action, then for sure call, right? I mean even before, but if a month’s gone by... With the health certification, I would call after a week or two and make sure they received it, because you have 45 days from the time that you apply. You have to submit that health certification within 45 days, and that's the signed form by the doctor, so you need to make sure they got it. After that, I mean, it... In theory, they're supposed to send things within a certain amount of time, but especially with the pandemic and even outside the pandemic, they have really high caseloads, and it's not uncommon for them to take longer. And Maggie just asked a clarification. Can you apply online? Does it have to be phone? Yes. I believe that you can apply online. You can also print out the application and mail it. It's just a lot of people tend to apply by phone because it’s the easiest. Right. Okay. But you can. But again, even if you mail it, I would still make sure that they received it. Right. Right. With a phone call too. I also like the idea of the phone call, because then it's officially logged somewhere when you've called because that retroactive pay could have to really come in depending on how your process goes. All right. So, we make that initial call, we submit our online application, and so now we're going to receive more paperwork and a health certification form. Is that right? What's next? Yeah. Yeah. So again, they're going to send you the health certification, and from the time they get... I think I misstated before, from the date of application. No. It’s from the time that they send it to you, you have 45 days to complete it. After they receive it, so it's not 45 days from that call...? Right, right, right, I misstated that before. Yeah, it's 45 days from the time that you receive it. You have to have your doctor fill it out and send it back to IHSS. What exactly is the paperwork, just so parents can...? So, it's paperwork that the doctor fills out and the doctor confirms that the child needs at least one IHSS service, and that the child is at risk of out of home placement if they don't get the services that they need, and then there's an area where they can list what are the child's limitations, and that's where they would put the diagnosis and what their functional limitations are. So, that's the health certification. That's not the form that addresses paramedical services and protective supervision. So, that's the foot in the door form. That's the form that establishes that there is a need for IHSS and after that there's more paperwork to say what kind of services, but they will not approve IHSS without this form. Right. And I know... --They will deny it if they don't receive it. Well, and with all paperwork sometimes there's... I mean, obviously you're filling out honest information about your child, but sometimes there's just things that... there's tips that parents need to know, so are there... What are the three most important tips that parents should consider when filling out that health care certification? I would talk to the doctor. I would go to the doctor that knows your child and their limitations the best. Don't go to a doctor that really doesn't know your child because they're... A lot of times doctors might assume, oh, this child's fine, just looking on paper. Go to a doctor that knows your child, the physician that best knows your child, knows what their limitations are, and have them fill it out. You might want to talk to them ahead of time. If they're not familiar with IHSS, kind of talk to them ahead of time. Let them know what it is that you're asking for. And yeah, I mean, those are the main tips that I would recommend. Okay. So, let's... we're going to be really optimistic and say great, application is approved. We'll also talk about if it isn't, but the application is approved. The next step would be getting ready for that in-person visit, and I know earlier you touched on some of the areas that are covered under IHSS, and in order for us to officially prepare for that first in-person evaluation with the social worker, we need to understand what's included and what isn't within those categories of service. So, can you give us some examples and really run through? Yeah, I'm going to give some examples, and then as I'm giving examples, you can think about when you think a child would usually typically be expected to do a task on their own because they're kind of all over the place. So, non-medical personal services, you have ambulation, which is walking, you have routine bed/bath for people who are not mobile, who are not ambulatory. There's bathing, oral hygiene and grooming. There's dressing, bowel and bladder care, feeding, menstrual care, rubbing skin and repositioning, and again, that's going to be for people who are not mobile, help with prosthetics, and setting up medication, transfer in and out of seats, and respiration, and then related services. These are the services that parents are generally going to be expected to provide, but there may be some exceptions, and that's laundry, grocery shopping and errands, and meal preparation and cleanup. And then... and we'll talk about meal preparation in a minute. There's also accompaniment to medical appointments, and we talked a lot about that, and then there's paramedical services, which are... which basically means that a person requires 24/7 supervision because of severely impaired judgment, orientation, or memory in order to prevent them from accidentally hurting themselves or someone else, and not that there's a... we can talk about that as well. That's... It's... There's very specific criteria for that. I'm sorry, that's for protective supervision. Protective supervision is that. Paramedical services are services that are ordered and supervised by a licensed clinician. Home exercises for PT, G-tube... Well, not G-tube. Yeah, G-tube is under feeding, but it's for medical services still. And giving medical... I’m trying to think of what other paramedical services... Oxygen is under respiration, testing blood sugar, anything that involves wound care, anything you basically need training for is going to be under paramedical services. And I know we just threw out a really long list with first ever people listening, there's a lot and within... I mean, the parameters within each of these examples are really important. So, yeah, you had mentioned meal prep, so if we take meal prep, can you give us an example of what is or isn't allowed for meal prep? Okay, so meal prep is a really specific example, because it falls under related services, but it's... if you look at that functional skills index that came up earlier, you're going to see that it basically says that they should classify children as able to do it independently, or the parent is expected to provide the service, or it's a paramedical service. If you have a child who is a choking risk, has aspiration issues, needs their liquids thickened, needs their food chopped up into tiny bits or pureed because of their medical condition, that falls under paramedical services, even though it's preparing food, and so in that sense, meal preparation can be a paramedical service if it's because the doctor says food needs to be prepared this way so that the child can eat safely, as opposed to, my child doesn't know how to cook and they're whatever age. It's a different service if it's it's a different service if it's for medical reasons. Does that include special diets, Lisa? I mean, to the extent it goes above and beyond what... the time that it would take to prepare a diet that's different, but do you know what I mean? Again, it's always going to be about what's above and beyond what's expected for a child of the same age. Let's see... -- Can I ask... Can we take a really... maybe a real common example: dressing. So, dressing. What is... How does a parent think about what is... right, because dressing a child, like if you take even... Go ahead, you do it. Yeah. Okay, so the way that IHSS calculates how much time they give for a specific service is they have ranking numbers, and those are one through five. I can pull up the exact specifics of it, but it's basically ranked on a category of one is either the child can do it independently, or a parent would be expected to provide that service to a typically developing child within the same age. So, if it's a ranking of one on that chart, it’s... it means you're not going to get time for it. From two through five, it's going to be based on how much help the child needs with the task, whether they need complete assistance with it, whether they need a little bit of physical help with it, whether they just need some verbal prompting, or that they just need a little bit of reminding, and those numbers are... the numbers are going to correlate to how much time is allotted to it, if that makes sense. So, rank one is total independance, rank five is total reliance on someone else's help, and they'll give you an amount of time based on how much help the child needs with the task. So, that's something during that meeting that you're going to be working through that chart. Yeah, yeah. I mean, they're not going to show you... They're not going to hand you the chart and say... What they're going to say is, “Okay, can... based on how old your child is, can your child dress themselves? Do they need help? How much help do they need? What do you have to do in order to help them get dressed? Are they getting stuck in their clothes?” It's... Think about that ahead of time is, how much help does your child need? And that's one place where you can talk to your occupational therapist about those ADLs and things, because they have language that they use in terms of how... what percent assistance the child needs. Right. Max assist, mod assist. Exactly, exactly, exactly. And so, yeah, if they're pushing back on you... They're usually not going to push back on the ranking, but if they do, that's... if you go to a hearing, that's where you'd want have the OT kind of talk about max... So, to get ready for those conversations, obviously looking at all of the services to kind of get in your head, because a lot of times it's hard to suddenly be like, yeah, this is what it's... I will speak for myself. I like to kind of talk things through in my head to make sure that I kind of lay things out, but should we be keeping a time sheet of how much time that we're spending on any of those applicable categories, before we're meeting with the social worker, maybe over the course of a week? It's useful to know. It's useful to keep track of that information. The really important log to keep is if you're requesting protective supervision, because that's where you're going to keep a log of your child’s non-self- directing behaviors that could cause physical harm to themselves or someone else, but it's worth keeping track of how long these tasks take you from start to finish so that you have an idea of how to talk to the caseworker about it. It's also worth keeping track of how your child's abilities or disabilities can extend the amount of time that it takes. For example, it takes a certain amount of time to dress a child or change a diaper. It takes a different certain amount of time to dress a child or change a diaper when the child is not cooperating, and so if you have the situation... or if the child has low muscle tone and they can't assist with putting an arm in, or you have to do all of the movement for them, these things take extra time, and so those are things that are useful to kind of keep track of when you're talking to the caseworker about how long these tasks take. Right. And you might have... An average eight year old can get into the car, put their seatbelt on, do everything themselves, and if you have an eight year old child who is not independently doing those things, and that requires getting them safe, getting them situated, and making sure that they're seated in a way that's comfortable, there's a lot of things that can go into it, and so that's really... Does it always come back to what would a child of this age... What is the typical...? It does. Yeah. I mean, that's what it's always based on, and... but again, they have designated amounts of time that they give for diapers, they have designated amount of time that they give for bathing, and if you have a child who's on Lasix, for example, you're going to have more diapers to change, so you want to let them know about that. If you have a child who has multiple laxatives and you’re having to change them throughout the day more frequently even than a child of the same age who is also in diapers, you want them to know about that. It's just... It's... They may or may not be able to provide the extra time, but you need to make sure it's documented. To summarize what you just said, what are the four or five most important things that parents should prepare ahead of that meeting? Okay, so you want to have a list of all your child's medications if you're going to be asking for medication prep. Keep... I mean, again, keep track of kind of roughly how long it takes you to do things especially... but especially for protective supervision, if you have examples of times where you've had to physically intervene to stop your child from accidentally causing physical harm. If you have... I would bring copies of any forms that you've submitted. I would still bring them to the meeting just in case they're like, “Well, we don't have a record that you sent it,” like, “Oh great, I happen to have another copy right here.” If you've already been able to get the protective supervision and paramedical services form, then bring them with you. Usually they'll provide you... provide them to you at the meeting, but if you happened to already get those prepared, bring those with you as well, and your child. Do not forget that your child needs to be at that meeting. If they schedule it on a school day, they will expect you to pull your child out of school. So, I mean, you can... If you're working with a reasonable caseworker, you can usually say, “Well, do you have a time period when you can come, and this is the time my child gets home from school. Are you able to come during this time?” But if this is what time they're able to come, they're going to expect your child to be there. So, don't forget that. -- This is not... Yeah. This is not about you, right? It is about the child. So, that's the most important thing, not to forget to bring to the meeting: your child. Definitely. All right. So, two things that keep coming up that, again, are some of the biggest... the most frequent questions that we receive from parents. Protective supervision and paramedical services. So first, protective supervision. You've already kind of touched on it, but again, what is it and mostly who qualifies? Okay. So, protective supervision, again it's about severely impaired judgment, orientation, and memory, and one of the difficult things about having that form signed by the doctor is that judgment and orientation and memory can look different in kids than they look in adults, and it's harder to define a child's orientation. Do they know that it's Monday? Do they know that it's January? Do they know they're at home? Do they know... It's really hard to define, but this is something to talk to your doctor about. So, that... So, number one is the severely impaired of those categories. The second one is that they're non-self- directing, which means they act without being able to contemplate the effects of their actions and assess for danger. And so sometimes they'll say, “Oh, well, you're not... you're self-directing because you wanted to cross the street.” Your ten year old child must be self-directing because they saw an animal across the street and wanted to run to it, and it's like, okay, well, a child can have goals, can have wants, and still not be self-directing, because if they run out into the street and aren't able to assess the damage of running out to the street without noticing cars, that's not self-directing. It's like my kid can decide that she wants to give her baby a bath, but that doesn't mean that she can assess the danger of turning on the hot water and being around water when she's not water safe. It’s not just that the... that a person has absolutely no concept of what's happening, it’s that they're not able to assess the danger of what they're doing and the ramifications of their actions. Or even a child that's scripting or knows they run out and they cross the street and afterwards they're like, yeah, I should look both ways, but not realizing that they've already crossed the street to do it. So, they hear it and people have been working on it, but they still are not generalizing that, and they don't understand. They hear the words, but they're not using it. They don't know how to apply it. Right. -- Yeah. And that’s... I mean, that's the tricky thing with memory, because my child knows the entire movie of Encanto, but I can tell her a million times not to do something that's not safe and she's going to be doing it again five minutes later. I have to physically stop her from doing it. So, you got to think about how judgment and orientation and memory impact their ability to assess for danger, so... yeah. And so one of the things that is not included in protected supervision is damage to property and intentionally aggressive or self-harming behavior, and so those are specifically excluded, so if your child is just breaking things, but they're not actually hurting someone, that's a separate story from... I mean, there's a lot of overlap. If your child is throwing glasses and there's a risk that they're going to cut themselves on the glass, that's not just property damage, that's potential risk to themselves, but if they're intentionally hurting themselves or you... You also cannot get it for suicide watch. You cannot get it to monitor for suicide. You also cannot get it to monitor for potential medical emergencies unless the medical emergencies are caused by the person's cognitive deficits. So, for example, you cannot get protective supervision to monitor for seizures, but if your child has a port or a G-tube and they're constantly playing with it because they don't understand what's going to happen if they pull it out, that's a medical emergency that's caused by their lack of self-direction, and so that is something you could get protective supervision for. And one piece of clarification about the aggressive behavior, if a child is aggressive against others, still that doesn't fall into protective supervision? It’s still always going to be about whether they are able to contemplate the consequences of their actions. If they hit someone knowing that if they hit them, it's going to hurt them, then that's different from if they're just kind of lashing out because they're frustrated and they don't... And it's kind of... because they don't understand that they could hit somebody. Do you know what I mean? It's a matter of intent and self-direction, and what they understand about the consequences of their actions. Which could also be said something similar to if a child is stimming and has self-injurious behavior, but they're doing it almost just automatically without the consequence, without... Right, because they're not doing it with the intent to hurt themselves. Right, exactly. But it's not a suicide watch. It's different. So, that does... So, that would qualify. That would be a qualifying condition for... Yeah. Yeah. --Got it. So, with protective supervision, I think you mentioned there was some other paperwork possibly. I want to ask about that, and do we need to gather paperwork from directors, providers, therapists, our child's school? Do we need sort of supporting evidence from... reports from their team to also contribute to that paperwork for protective supervision? So, usually it's going to be based on the doctor's form, and what you talk about with the caseworker at your meeting, the log that you've created of either a day by day log or a list of all the different things that can happen on any day. If they're starting to push back on it, then you might... I mean, they might ask for a copy of the IEP. You might want to get the behaviorists involved, but typically it's initially going to be about the doctor's form and what the doctor writes on the form and what you discuss with them. It's worth having in preparation so that if they mention at the meeting, “Well, we don't... I'm not sure about that,” you could say, “Well, here's an assessment. Here's a behavior assessment that shows that they don't understand what they're doing.” It's worth having. Yeah, I know parents who have had... because they have it anyway, right, with their reports, the fact that their child has a 1:1 aide at school and they need that, and then, their... like you said, their behavior report, other things, so, but do they... Does that have to be taken into account, or is it really just about the doctor's form? Is that all that IHSS needs to look at? You can give it to them and they can look at it, but they're not obligated to go and seek those records from the school or anything, but you can provide it and they should take that into consideration. Okay. And how does protective supervision affect the alloted hours that can be given to... Okay, so there's a lot of different stuff that goes on behind the scenes in terms of where the money for your IHSS is coming from based on what program you're enrolled in, but for our purposes for this discussion, it's usually going to be that protective supervision will add 195 hours monthly to whatever weekly services you’re getting. So, there are some situations where the max is 195 and that's it, but if you're under a certain program, then it's going to be 195 plus whatever weekly hours you’re getting. And for protective supervision, you don't have to keep track of time like you do for other services, right? For your time sheet, it's like, this is how long things are taking. For protective supervision, you're not itemizing things within those allotted hours? Yeah. No, because you're always watching them, and again, you need to be able to demonstrate that your child needs more close supervision than a child... a typically developing child of the same age. When you're a live in provider, when you're a parent who has a child who lives with you, you don't... When you log your time sheets, you don't actually put the time slots that you worked. You put the number of hours a day that you worked, and protective supervision, it's going to show up as a number on your notice of action, but it's not going to be 24/7. They don't cover 24/7, so it's like this is how much we're going to pay you for protective supervision each month, even though the actual 24 hours, times a month, days is way more than that. Does that make sense? Does that answer your question? Yes. Completely. Yeah. I just... I know that when, especially before parents start, it's like, okay, well, so am I going to have to be writing down every little thing that my kid does throughout a day to try to do a timesheet, and I think that's really stressful, and I've actually met parents who it’s like, “There's no way I can do that,” so I think it's important to set the expectations of whether it's protective supervision or a timesheet, are parents going to have to be writing down every little thing and timing things? Not at all. Not at all. They're going to say, this is how much time you get per day or per week for this task, and just know that you're going to change... you're going to use that time and more, but you don't have to keep track of every single task that you do and how long it took. The idea behind doing that is just for the application process, so that you really know how long it takes you, and if it takes an inordinately long amount of time because of your child's disabilities, you can mention that, but on a regular basis, once you're approved, no. It's... They know how many hours you're expected to work per day based on the hours that you were awarded. And is there an age range for protective supervision where it kicks in, or again, you can't get it before here? So again, this is super tricky. They are not allowed to deny protective supervision based on the child's age alone, but again, as I've said many times, because you got to remember this, it's going to be based on what a parent... what the level of supervision a parent would be expected to provide to a typically developing child of the same age, and so an infant needs constant supervision, a one year old needs constant supervision. By the time... And these are not hard lines. If your child has medical devices and they don't understand them and they're liable to pull them out because they don't understand that if they pull it out, it's going to hurt, let alone cause damage, you might be able to get a younger, but a lot of times a lot of advocates will say three is kind of the area where you really start seeing that divergence between what you would expect and what you actually need for the child's supervision, but it's all dependent on your child's needs, so they have to be non-self-directing. They also have to be able to cause themselves harm, so if your child is not mobile and there's nothing that they can do to really hurt themselves if they're just sitting there, they're not going to give you protective supervision. They have to be capable of causing themselves harm. Now, that's going to look different if the child has medical devices attached to them, because even if they can't walk, they're still going to be able to to cause harm by their lack of understanding. So, the bottom line to that too then is obviously with all of the really specific caveats that you've given of eligibility, but protective supervision cannot be denied on the basis of age alone. Age alone, but it's always tied to what you would expect without the disability. Perfect. And Alyssa sent and... Alyssa just wanted to make sure. She said, “What happens if you have two kids who need protective supervision? Is there anything to know in that situation?” Then you have two kids who need protective supervision. Again, you're going to run into some of those limits. Even if you get the exemption, if you have two kids who are awarded max hours for protective supervision, you're going to go over that, and so you may need to have another provider. They used to do proration. I believe that that has been ceased now. They used to say, well, if you can provide protective supervision to two kids at once, so you're going to get fewer hours because you're providing two at once, and I believe they don't do that anymore, and so you're going to... you need to make sure that you have the exemption to provide the max hours for two children, but you may still have to get another provider. There are limited situations where the other parent, if they... if you have two children who need protective supervision, the one parent provides and then the other parent has to leave full time employment because the first person is... the first parent is already providing all the services and they’re no longer available because they're at their maximum hours, so the other parent has to leave full time employment. There are certain limited exceptions where that might happen, where both parents could be the providers, but it's really technical, so... Yeah. That's the thing, just like you said, no easy answers, no bad questions, no easy answers. There's no such thing as obvious. It can be a really complicated answer. Paramedical. Again, what is that, and who qualifies? I know you've kind of already touched on it, but who qualifies and how does that affect hours? So, paramedical services, that's going to include anything that’s really prescribed and supervised by the doctor, especially where things are going into the body, the G-tube feeds, injections, catheterization, checking blood sugar, if you have to do enemas or stoma care, if you have to monitor in such a way... If you're just check... If the issue is check blood sugar every hour, there may be a different amount of time than if you have to check blood sugar and modify... titrate medications based on that. Or anything... basically anything where you need training by the person who's prescribing the services in order to be there and provide them. That's paramedical services, again, catheterizations, anything that requires judgment that you've... training that you've received from the healthcare provider. Is that a block of hours like protective supervision or is it...? No, it's going to be based on the specific tasks, and again, this is where you need... you really want to work with your doctor to... I mean, I personally do a spreadsheet because for my child, the amount of room on the paramedical services form is not enough, and so I have the doctor write, “See attached spreadsheet.” I do... We do a spreadsheet. We look at each of the tasks that we do, how long it takes, how many times per day or how many times per week, and how long this prescription is good for, so this is going to be the case for the next two years. This is going to be one year. This is going to be indefinite. Have them write that on there. And I have the doctors... I ask the doctor to sign each page that we've gone over so that they see that the doctor... the doctor knows what's on those forms, the doctor’s the one who's... that's coming from them, but it... Yeah, everything has to be very specific. And age? Is there... Are there any age requirements again for medical? No, no, because infants... you could have an infant... And this is another area where the rules are a little bit different for, for example, diapering versus if your child has a catheter or an ostomy, that even if you have an infant who would usually be expected to be in diapers, you could still get toileting time under paramedical services because your child needs to be catheterized and has a stoma that you need to care for, or colostomy, and that's above and beyond what a typically developing child would require, so that would be one case where that would fall under paramedical services.. And Telene just asked... I don't know if you're going to know this, Lisa, she just said, “How delayed are the offices in processing intake or renewals?” Do you have any information? I don't know offhand. They're... They... The biggest gap is usually from the time that... I'm thinking about this... They usually send out the paperwork pretty quickly. They get someone... They have a timeline where they have to do a visit, and so the actual initial visit is usually pretty on point. The big gap is kind of in between that first visit and getting the approval, and again, that's going to have to do with how long it takes them to go through the assessment, how long it takes them to receive the paperwork, the additional paperwork you send, whether they lose it, whether it never gets to them. That's where I think the biggest gap is, and that's where it can really come in handy to make sure that you're keeping copies of everything, and following up with that IHSS help line to make sure that those papers were received. And is there any mandated timeline from the time they come to your home to when you can be approved or denied after the... after that evaluation meeting? I don't know offhand, but if there was, I could tell you that they're not always following it. The bigger timeline is when they're required to do a visit, to actually come and do their assessment. One thing that you mentioned, just to go back to the meeting too, I was... I had been talking to you and I said, is there anything we should not do in an evaluation meeting? Don't forget to bring your child. I mean, it's easy to forget that because a lot of times we're used to our kids, unless they're older, a lot of times they don't attend their IEP. Especially with the pandemic, they often don't attend their IPP. You might have that call on the phone. With the IHSS in-home visit, they have to be there. I feel like we have to touch on the fact that we really have to honestly portray our child's needs, and I know there's a common saying that you really need to obviously be honest, but you really need to describe your child on their worst day because your child could be sitting there having the best day ever. I can attest to that, right? And so how do parents need to talk about their child's needs during that meeting? Yeah, that's a really good point. You can't understate your child's needs. You have to not be afraid to express your child's limitations. And it's really... It... I know we're so proud of our kids, and we want to say, “Oh my gosh, my kid wrote...,” and this is not a good example because writing has nothing to do with IHSS, but it's like if you said, “I'm so proud, my child was able to write their name today,” they would write down, “Is able to read and write” It's... They'll take the tiny thing that you say your child can do and extrapolate that into your child is able to do... And so I think it's really important to articulate what your child's limitations are, and think about, okay, maybe they have a good day, maybe they have a really bad day, on average, they might be somewhere in between, but we don't know when that's going to happen. Just be clear about what your child is and is not able to do, and don't understate it. You... it can feel really painful to say out loud what our child is not able to do, but this is one time when you really have to. Yeah. And it is an emotional meeting, and I know a lot of parents say that it doesn't... We're not used to just sitting there saying, well, this is... but it's... it is important to get the support that you need to be honest. You can still talk about their strengths, right, but you really need to talk about... you need to think out all of those... all of the things that we're discussing and be really honest about what those needs are. Yeah, I mean, because there are times when it's totally appropriate to be like, “Look how far my child has come. They're able to do this and this and this and this,” and there are other times where it's appropriate to say, “My child is still not able to do this assignment,” and it's all true. These things can be true all at the same time. Right. Yeah. And I know we're already over time, but there are a couple things that I really... We need to touch on denials, right? So, what happens if we're denied after that evaluation visit? What can parents do? Okay, so if you’re denied, you’re going to get a written denial in the mail. It’s a notice of action, and it's going to include information about how to appeal. If you really believe that your child qualifies for these services, then I would encourage you to appeal. What's most likely to happen... Not mostly. Very frequently, they will contact you and say, “We'll give you a... We'll do a conditional withdrawal. You agree to withdraw your appeal and we will agree to a new assessment. If you don't agree with the new assessment then you can reinstate the original appeal.” And just make sure that it's clear somewhere in that paperwork that if you reinstate the appeal, it goes back to the original date of application, and that is a way that they try to avoid going through the hearing process in situations where another evaluation could happen. So, just... When they do a reevaluation, just be prepared that it's always possible that they can take hours away and not just give more hours, so just be aware of that. If you are receiving hours already and you get a notice that your hours are being cut, that you have your hours and they come back after the next meeting and say, “Oh, we're going to take away these services,” right? When you get that notice of action, you have ten days from the time you receive it to appeal in writing to keep what's called aid paid pending appeal, and that means that the benefits will continue as is while you go through the appeal process, and that has to happen within ten days in writing. So, that's if you've already been approved and then they're trying to change your services or terminate them. That's a separate thing, but if you are denied the first time around, yeah, appeal. They might say, “Oh, why don't you withdraw it, apply again in six months,” again, we've talked about this, your protected date of eligibility is the day that you apply, and so to the extent that you can hold on to that, that's going to protect the services that you've already provided. And like so many services, a lot of times they... Sometimes, I'm not saying this specifically to IHSS, but across the systems in general, they just... they're going to see who's going to appeal. I mean, if there's... I mean, so you... If you're denied, if you have it within you to do it, do it, if your child needs it. I also wanted to share this comment from Telene. She said, “Not sure if you're all aware, but they're canceling IHSS for non-renewal after they do not contact the families for renewal. I have about seven to eight cases in LA County that families have lost IHSS. We're asking families to appeal and inform their Regional Centers. Please share. IHSS made an appointment for my client during the day. They did not tell the mom about the appointment. The kid was at school, Mom was at work, they showed up and marked them as a no show. She did not know until Tuesday when she went in to put her in her hours and the portal was closed to her.” Yeah, that would be a situation where you would want to appeal immediately, because that... You do have to show up to your meeting, but they have to notify you that it's going to happen, so you always want to make sure that your address is up to date in the system, but yeah, if it's been 11 months or 12 months and you haven't heard from them, because they're going to do a recertification every year, if you have not heard from them, you may just want to call and say, “Hey, I haven't heard anything about my annual assessment. Can you let me know?” But yeah, they will cancel your services if you're not there for the meeting, but again, they need to notify you that it's happening, because you can't be there for a meeting that they didn't tell you about. Yeah, so I guess it's a good point. If you haven't heard from them, you might not want to just count on the fact, I'm going to slip under the radar, maybe we don't have to have the meeting this year. Something like this can... There will be a meeting every year. And the other thing that you that it... is that if you're on the waiver, if you're on the Medi-Cal waiver, you do need to make sure that that gets renewed every year because your IHSS will be impacted by whether or not you're enrolled in Medi-Cal, so you want to make sure that you get your recertification packets filled in for the waiver as well. Yeah. Because, yeah, everything is a snowball, and it all affects... Alyssa just asked, she said, “Are there any phrases to not say during an evaluation meeting?” Specific phrases to say or avoid? My biggest answer to this would be be to really, if you're asking for protective supervision, to really articulate the reality and not... You might say just colloquially, every day you might say, “Oh yeah, he's just hurting himself,” but... based on their behavior, like, “Oh, he's constantly hurting himself,” or, “He's constantly being aggressive,” when what you really mean is he doesn't understand what's going to happen if he throws things or lashes out. You got to be careful about your language. Tell the truth, be honest, but understand what those words mean to them, and understand what non-self- directing behavior is, and understand that something that looks like aggression, they're going to interpret that as intentional, when what you might mean is just that somebody else is getting hurt in the process, so just I would think about your language in the context of protective supervision. Again, be honest, tell the truth, but use words that fit the reality of how they measure these things. Okay. We have to wrap up, so these really, really quick answers, which I know you're like, “Lindsay, I can't do a quick...,” but I know you're going to hate this question, but just so parents know, what is the range of hours that a client under 18 could receive? Literally zero to 283. Again, we talked about this. There is not a set amount based on the diagnosis. There's not a set amount based on the child's age. It's so specific to your child's specific care needs and their level of assistance that they need on any given task. There are rules about what the maximum is if you are severely impaired versus non severely impaired. I mean, that's based on how many hours you require a week, but the maximum might be 195. It might be 195 plus your regular hours if you have protective supervision, or it might... if you're severely impaired, it's 283. If you have two children who are receiving protective supervision, it might be more than that because you have an exemption. Again, these are not simple questions, but it's... the range is so wide. It's just based on your child's needs. You're going to love this question too. But, so, I guess I should say ‘should.’ How long should or can this entire process take from that initial application to getting something saying, “Great, you're approved, here's your hours, let's get going.” I mean, how long should it take and how long can it take? Several months, with the word several being extremely generous. I mean, you're not going to be set up in a few weeks. This is a process, and that's why it... you have that protected date of eligibility from the time that you applied, because it takes time. It takes time for them to process everything, it takes time for them to do the visits, it takes time to make sure that everybody submits the paperwork they're supposed to submit. It's going to be a couple months, and again, a couple to several months, with those being widely open to interpretation. I like the way that you put that. It's true because yes, exactly. Okay. And what is the most important thing that you want parents to walk away with today? I feel like a foundational understanding of what IHSS is and what all these... all this terminology is, because it can be a really intimidating process. I still get anxiety the day of... the day before, the day of my IHSS... It's just it's stressful and it's intimidating, even if in theory, there's no questions at all, it's just stressful and having the understanding of the concepts and the terminology and kind of what everything means can go a long way toward making it seem less intimidating. I mean, giving you the confidence to really advocate for your child and get what they need. Yeah. I mean, so much is on the line with these visits. It is. I mean, it's just... it is really is like a lifeline for so many families and for the clients, for our children, and it is... Yeah, you just think one little paperwork mistake or one word said, am I going to put everything on the line? it's just, it is... It is really nerve racking. And I mean, I think... Thank you, Lisa, because I mean, really we can take each of these sections and talk all day about it, so thank you so much for coming and really unraveling, giving us this overview, but still hopefully there's a lot of meat there for parents to take away and really use with their own experiences, and if it starts to feel overwhelming, I guess I would say think of sort of the rough guide that we laid out today and then set your priorities. I kind of wrote down, sort of as we were talking, kind of the six steps, right? Learn the essentials, call and apply, remember that you can't be denied on the phone, fill out and return the completed health care certification for your kiddo, prepare for that in-home visit. You choose hire and train a provider, even if that's yourself, and appeal if denied. And be prepared to possibly wait for months, but again, the silver lining is if you're accepted, you will receive a retroactive check from that first day you made the call, and believe me, I know many people who received checks for ten months. I'm not trying to scare anyone, but I mean, for some people it might take a while, things might happen, but that is a silver lining. And both, as Lisa said, we both know how stressful this process can be, and so if you want or need deeper support and a one-on-one guide to talk through the application process, to review your paperwork for protective supervision, or even to role play for that in-person evaluation, our Undivided Navigators would love to help you through it. They can help build your own personalized step-by-step guide and priority list to tackle all of the aspects of IHSS that you need to handle, and in addition, we have specialists hold biweekly office hours for our members. So, to find out more information about how you can get this personalized support, check out our free 30 day Kickstart. Donna’s going to put the link in the chat window. Our mission is to support you so your children can thrive, so please reach out and let us know how we can help. Thanks again to Lisa again for decoding the very complicated, but very essential IHSS process for us today. Good luck. We hope to see you soon. Have a beautiful weekend. Bye everybody.