In-Home Supportive Services under age 18

We sat down with Undivided's Public Benefits Specialist, Lisa Concoff Kronbeck, to hear the answers to commonly asked questions about In-Home Supportive Services. Check out the highlights in our event recap here, or catch the full replay above.

*Note that IHSS made updates to who qualifies to be a parent provider as of February 2024. You can find the details in our article about IHSS providers.

Lindsay
Hey everybody, welcome to Undivided Live. I'm Lindsay Crain and I head the content and community teams here at Undivided. And today we are talking about In-Home Supportive Services, or IHSS, for individuals under 18 years old. And as you may know, IHSS can be a crucial program for families raising kids with disabilities, providing the specialized childcare our kids need right at home. It's a lifeline for many families across California as it can support individuals throughout their lifespan. But it can also be overwhelming and confusing for parents to navigate, like so many of these systems in which we operate. And on a daily basis, we receive questions about eligibility, how hours are calculated, if young kids can qualify, how to demonstrate the need for more services. And lately, we've had tons of questions about the paid Career Pathway trainings, but more on that in a minute. We want every eligible family to understand what IHSS can offer, how they can access these vital supports, and what to do when they disagree. So with us today to help us answer all of these questions and more, we welcome back and 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 a kiddo with Down syndrome and is herself an individual with disabilities. She also actually loves talking about IHSS, which makes her even more beautifully unique, because for many of us (me) just makes us see red. So hello, Lisa, welcome back. Always good to have you here.

Lisa CK
Thank you.

Lindsay
And also with you today in the chat, we have our community manager, Donna and our lead navigator, Kelly. Donna will be passing along your questions to us, so please throw them into the chat. She will also be sharing article links throughout our talk, so you can read more about what we're discussing. And for our member families, we break down information even further. They have access to step by step guides on everything related to IHSS from the application process to prepping for your annual visit to applying for protective supervision and everything in between. And even better, you have your own Navigator to walk through every step with you. Plus, as I just mentioned, one of the biggest demands we're seeing right now are questions around the IHSS Career Pathways classes. So we're building a specialized support program to help guide our families through what can sometimes feel like a bit of a maze. So in case you're not familiar, the Pathways classes will continue to be offered through 2024. As paid training opportunities over the next year, they're open to any IHSS provider. And yes, that includes parent providers. You can get paid for attending classes that grow your knowledge about caring for your child or other individuals who may need support or home care. So we work with families who've made several thousand dollars, in addition to all the knowledge they've accumulated, so we don't want you to miss out on this opportunity. But as many of us have learned, it's unfortunately not always as easy as, you know, just finding a list of classes, clicking, and signing up whenever you want. Lisa's smiling because she knows this very well. We're going to address the trainings near the end of our chat with Lisa. Plus, we'll let you know how Undivided can support you with what can be a somewhat tricky process. So let's jump right in about all things IHSS. So Lisa, for those who are not yet in the program, what is IHSS?

Lisa CK
So IHSS is In-Home Supportive Services. It's a Medi-Cal service designed to help elderly people and people with disabilities to stay safely in their homes by providing funding for home care for tasks that the consumer would usually be able to do on their own. And their inability to do that is potentially jeopardizing their risk of remaining at home instead of being institutionalized. IHSS specifically is not, sometimes we hear 'oh, you're just being paid to stay home and take care of your kids.' That is not what IHSS is. What's happening is some of our children with disabilities are eligible under the IHSS regulations to qualify for home caregiving. And IHSS allows parents to be paid as that care provider in certain circumstances, which we'll talk about a little bit later.

Lindsay
Got it, and who is eligible for IHSS and who isn't?

Lisa CK
Okay, so you have to be a California resident receiving Medi-Cal. You have to be elderly or have a disability. You need to live at home. So not in a nursing facility, not in a hospital, not in a group community care facility. You need to be at risk of out of home placement without the services. So I was talking about before, like, you can't dress, you can't bathe yourself, you're at risk of being put in an institution, because that that lack of self care skill ability. And yeah, those, those are the main criteria.

Lindsay
And I know that's scary language. So I'm sure we have some parents on here who haven't yet entered into IHSS. We know that's scary language, but Lisa is talking about legal language that surrounds IHSS. But one common myth. And to clear up, Lisa, and I actually, you know, just heard this yesterday, but is IHSS income based?

Lisa CK
So IHSS is a Medi-Cal program. So to the extent that Medi-Cal is income based, IHSS is income-based because of that, but there are several Medi-Cal programs that allow people with disabilities to access Medi-Cal, regardless of income that might be deemed to them from other people. So in that regard, it is not specifically income based separately from Medi-Cal.

Lindsay
And like I said, we're constantly hearing the wrong information about this coming from, you know, some even well-meaning providers who are who are maybe telling some of their clients that this is income based. So it is important to know, like Lisa said, only when you're taking account into Medi-Cal, but correct me if I'm wrong, Lisa, right, just just to restate it right, that your child's benefits are not affected by your income?

Lisa CK
If you are on the Medi-Cal institutional deeming waiver. The question is, is IHSS income based? No. Medi-Cal can be income based, but Medi-Cal can also be given based on any one of any one of their home and community based services waivers. And so those those are not calculated in the same way.

Lindsay
And we just had a question from Crystal, she said they don't qualify if we don't have Medi-Cal? We have Kaiser.

Lisa CK
No. So you, well, if you have Kaiser, it depends on whether that's private or Medi-Cal Kaiser. They have to have Medi-Cal. It doesn't have to be their primary insurance, it can be a secondary, a lot of our kids have private insurance through our work. And then their secondary insurance is Medi-Cal, then that still counts as them having Medi-Cal.

Lindsay
Right. And is there an eligible age range?

Lisa CK
No. No, they will frequently tell you, 'Oh, like look call back when your child is a certain age.' There is not an eligible age range. Everything is tied to what kind of care a parent would be expected to provide to a typically developing child of the same age. So to the extent that your child has extraordinary care needs that exceed that, that fall into the IHSS categories, they can't deny based just on age.

Lindsay
And so to be very clear, if a social worker tells you that IHSS does not cover kids, that's incorrect. So as Lisa knows, you know, again, like she said, a consistent thing that we hear from parents, especially parents with young kids, is that they're told, they could be told by a social worker, you have to take care of your child anyway, they can't take care of themselves, so they don't qualify for IHSS. So Lisa, if we hear that, how can we respond?

Lisa CK
The response is, 'I understand, I would like to apply anyway. If my child is denied, they can send me a written notice of action.' Because a lot of times what will happen is they'll try to deny you on the phone. And there is no such thing as a phone denial, what happens is if they deny you on the phone, they've prevented you from denying, and they've prevented you from establishing a date and application date. They've prevented you from developing any appeal rights because you've never filed anything. So if they, because your benefits, if your child does qualify, the benefits are retroactive to the date that you apply. But if you never apply, and you just call, and they say, 'Sorry, we don't provide it to kids,' and you say, 'Okay, I'll call back in a few years' and hang up, that's it. So they may well tell you, 'Oh, we don't we don't accept children under five. We don't accept children under 10.' I've heard all sorts of different ages as like what we don't accept. 'I understand that my child may be denied, I would like to apply anyway. Thank you so much.'

Lindsay
Got it. And another frequent question we hear, you know, as IHSS stands for In-Home Supportive Services, do all IHSS hours have to be-- fulfilled in the home?

Lisa CK
So that's a tricky question. Basically, they're going to assign the hours, they're going to assess the need for hours and calculate hours based on the hours that would be needed at home. They are not going to come back and walk around with you and say, 'Well, you changed the child's diaper at the grocery store, or you changed the diaper at Grandma's house. So we're not going to count that.' What they are going to count against you is any of those diaper changes, or G Tube feeds, anything that somebody else does. So your hours are based on what's happening at home, but your child is not under house arrest. They have to be allowed to leave the house and enter the community. So if you're providing, you know, if you take child to Grandma's house that day, and you change their diaper there, that's not going to change your diapering hours. What you are not going to get is additional hours to take the child to Grandma's house for a social visit. So when they say IHSS is not for social visits, and not for like protective supervision, they're not going to give you additional time to go on excursions. But if you're changing your diaper, if you're changing your child's diaper here or there, they can't force you to stay at home forever. But if your child gets their diaper changed X number of times a day, but three of them happen at school, they will take that out, because the school is providing that service on weekdays, and the school is providing, say, one G tube feed a day, so they will deduct from that.

Lindsay
Got it. And what about therapeutic appointments like speech or OT?

Lisa CK
So those are calculated separately. Parents, there's a category of services called accompaniment and wait time. Sometimes they'll tell you, 'Oh, you have to take your child to appointments anyway.' But there is an all county letter that talks about this. Parents can get accompaniment and wait time for appointments if, number one, the appointment is directly related to the child's disability, and two, the parent has to perform an IHSS approved task on the way, during the appointment, or on the way home. So whether that's transfer, whether that's diaper changing, G tube feeding, if you have to be available during the visit, then you can also get wait time. And so what they're going to tell you is if you can drop your child off, and say, 'Okay, see you in an hour, I'll pick them up,' they're not going to give you wait time for that because you have a designated out, you have a designated drop-off point and address, a designated pickup point, and you're allowed to attend to your own tasks in between. So if you get to drop them off and leave, then you'll get accompaniment like transit time, but you won't get wait time. But if you have to be on call and available in case your child needs one of those IHSS services, like a diaper change, like a G tube feed, something like that, then you'll get wait time as well. And there is an all county letter that I believe is going to be shared in the chat that I've had to share in the past. Because I was told 'You're a parent, you have to take your child to doctor's appointments.' Okay, but this is what the state says about this issue for parents and children with disabilities.

Lindsay
Got it. And what about, you know, unfortunately, this can be frequent for our families, what if your child is admitted to the hospital?

Lisa CK
If your child is admitted to the hospital, you can bill for the hours up until the time that your child was admitted. You can bill from out when on the day they come home you can build from the time they were discharged for the rest of the day, because they were at home, you absolutely cannot bill any time for a day that they were in the hospital for 24 hours. And I know that this can be really frustrating for parents of kids with disabilities. Because we all know that we are next to our children's side the entire time. We're the ones often doing the diaper changes and the G tube feeds even if they're in the hospital. But that's the rule. And you cannot, while the hospital has responsibility for your child, you cannot bill IHSS time.

Lindsay
Okay, and what about on the opposite end? The fun things? What about vacations?

Lisa CK
So this is another area where things are kind of murky. There are eligibility issues that come up if you're out, you absolutely cannot bill for being out of the country. If you're out of the country, you cannot bill IHSS time. If you're within the country but out of state, you are supposed to clear with with the caseworker first.

Lindsay
And that's even if it's like you're gone for two days.

Lisa CK
So this is where it gets murky, like they don't really have a specific guidance on. You're not supposed to be out of the state for more than 30 days or else that can mess with your eligibility. With residency, there's issues, but what I can tell you is you're supposed to let your caseworker know if you're going to be out of state for any like meaningful period of time. And you're supposed to get pre approved to get the hours. I can tell you that there are parents who have done that and not been approved. I can tell you that there are parents who have done that and been approved. I can tell you there are parents who have not notified them and had not had a problem. And I can tell you that there are parents who have not notified them and have had problem. So that's about what I can say on that is that you're supposed to let them know. And they are supposed to authorize it if you're traveling with the child and providing those services in a home setting. But you see how it gets messy.

Lindsay
Right. And I know, we've known multiple parents who have had, you know, gotten that letter saying, 'Hey, we're gonna be there in, you know, two days,' and they didn't get the letter because they were out of town. And then that can be a problem. Right? Well, and for parents who are interested in being the parent provider, which we've kind of been touching on, but who is eligible for this?

Lisa CK
Okay, so in a two parent household, one parent has to be working full time, disabled, in school full time, or otherwise completely unavailable to provide hours. And the non working parent has to be unable to get full time employment because of their child's extraordinary needs. In a one parent household, it means that the parent is unable to get full time employment because of the parents extraordinary needs. For the parent to be paid as the provider. Full time is the lower of an average of 40 hours a week or designated full time by your employer. So if your employer says 36 hours is full time, then that's full time. You know, I've heard a lot of like nurses, that'll come up where like, they'll work a certain number of days per week, and that's considered full time. That's if you're considered full time by your work, then you're considered full time. And then you would not be able to be paid as your your child's provider.

Lindsay
And I think you wanted Donna to share a letter in the chat as well. At least I didn't know.

Lisa CK
Yeah, that kind of goes over when parents are eligible to be the parent provider.

Lindsay
Yeah. So if you have any other questions about that, that letter will go into more depth if there's specifics that you want.

Lisa CK
Yeah, yeah, all county letters are actually really helpful. They give guidance to all the counties about specific questions that have come up over and over again. When that happens, they submit an all county letter, they write a letter to the directors of every county department of social services, and explain exactly what the rule or regulation is. And those are documented on the California, the CDSS website, the Department of Social Services, you can look at like the a list of all the all county letters and get guidance. And those are some of the ones that we're posting in the chat here.

Lindsay
And what about, and we had a couple of questions that came in with RSVPs before the event about this, can a parent be a caregiver to two children if they both qualify for IHSS?

Lisa CK
So the the answer is yes. But if the children have combined hours of more than 66 hours a week, because that's if you have one client, your maximum hours are your maximum weekly hours, or the total monthly hours divided by four. But if you have two clients or more, your max hours are 66 hours a week. So the only way to go over that is by applying for an exemption. Now exemption one, their child had to have been receiving IHSS before 2016. e a So the main exemption is exemption two, where basically you have extraordinary circumstances. And either the child has a complex medical or behavioral need and the service the IHSS has to be provided by someone who lives with them. Or you live in a part of the state where you just can't find there are just no providers available. Or you can't find a provider that is able to to communicate to the recipient in the same language. So those are the those are the criteria for getting Exemption two. And if you get Exemption two, then you can you can work up to 360 hours a month. So I think that comes out t bo like 90 hours a week. And that will allow you to work additional hours. But if it goes beyond that, you have to hire an outside provider, and that can get tricky because if the argument is you can't hire an outside provider then how do you hire an outside provider?

Lindsay
Exactly. And I think Donna was going to share a link about the exemptions again that you know go into more detail as well. So you can check that out. And so Lisa can a parent work half of their child's hours and have an outside provider work the other half?

Lisa CK
If a parent is eligible to be paid as the provider, then they can hire an outside provider only when there is no available parent. So if the parent works part time, or if the parent is in school part time, or if the parent has an illness and is unable to provide services, or if the parent is hospitalized, and is unable to provide services or has COVID. And all of those, I mean, during during the pandemic, that was a whole other thing with the COVID hours. But if the parent is unable to provide hours for any of those reasons, they can hire an outside provider only during those times. But they can't hire an outside provider for respite. Like if they're at home and able to provide services, then they're the one that's on call.

Lindsay
Okay, and for those I mean, there's, I know parents on this call, again, who haven't yet applied, or maybe they're in the process. But for those applying for the first time, what are three things that parents need to know about their initial application?

Lisa CK
Okay, so the first one I already said, which is there is no such thing as denial by phone. If it's not in writing, it didn't happen. If you didn't get a form, if it's not in writing that you applied, they may not have put in the application. So if you apply, you don't hear anything for a few weeks, you should call and make sure that they got your application. Because with all these benefits, it's like if it's not in writing, it didn't happen, basically. So that's one. Two, benefits are retroactive from the date of application. So make sure that you write down what day you called and requested that they take your information. And number three, a diagnosis does not automatically mean approval for IHSS. Let's see a lot of people post in some of the Facebook like social media groups, like 'Oh, my child just got diagnosed with XYZ, how many hours can I get for IHSS?' That is really not how it works. Every child is assessed based on their individual needs. And the hours will be awarded based on that particular child and not based on their diagnosis. So that's really important to know.

Lindsay
And I did want to really reiterate the second thing that you said that benefits are retroactive from the date of application, and Lisa keeps really stressing that, you know, can't be denied on the phone because you need to be able to log, right, follow up has to be in writing that you applied because as things can take a while, which, you know, is going to be my next question, but sometimes things can take a while so, you know, if it takes months, which you know, it has been known, like, even up to 10 months sometimes for things to really get going, guess what, though, you're gonna get paid from that first phone call you made, if your child's accepted into IHSS, you're gonna get retroactive pay for whatever hours were awarded from the date of application. Right, Lisa? So that's like 10 months of getting paid that, you know, so if you're kind of putting off calling or thinking, you know, am I ready to do this? It is important, like, once you start, you can get that retroactive pay.

Lisa CK
Yeah. And there's another thing that sometimes comes up is that if you if you've been a longtime Medi-Cal recipient, there are some circumstances where if you've already been providing all these services, and you can show that the child qualified, you can sometimes go even 90 days retroactive to the date of application. And sometimes that will get a little bit confused, like the the caseworker will get confused, and tell you 'Oh, you can only get 90 days of retroactive benefits.' And this will be like after 10 months, and they'll be trying to tell you, you're only going to get 90 days. And they're confusing the 90 days prior to the date of application with the 90 days of retro benefits from the date that you apply. So if that comes up, like reach out to us, but just I've seen it happen.

Lindsay
And like I said, I know this is your favorite question. But how long does the process or can the process take from initial application to formal decision?

Lisa CK
It varies. It varies. There's no set amount. They have statutory requirements like after which they're supposed to respond to your request for application, like you should have heard from them within 30 days and gotten the medical like the health certification in, and they should have scheduled somebody to come out to your home. But as with many things, there are frequent delays. They're notorious for misplacing papers or they never got it and they're not going to let you know they didn't get it. They're just going to deny. So it is not supposed to take that long, but it will take months. And also it also depends on whether or not you have to appeal because if you have to appeal, then you potentially have a conditional withdrawal and then you potentially have a hearing. And it's really difficult to say, because there are so many variables involved.

Lindsay
And we will touch on appeals later if, unfortunately, if you find yourself in that boat, and Yesenia did have a follow up question about the exemptions. She said can both parents be providers when Exemption two was denied, so that all hours are used?

Lisa CK
If both parents meet the criteria, so if the parent is initially unavailable, and then the first parent is doing all of the hours, and then another, that's already been qualified to do all the hours, and then the other child has a need, and then the other parent has to quit their full time job in order to take care of the other child's needs, because the first parent, once they're doing the maximum number of hours per week is now considered unavailable, then yes, there are situations where that has happened. But you have to show that both parents meet the criteria in order to be parent providers. There are situations where that is happening when a household has multiple children who have extraordinary needs that both parents are providing.

Lindsay
And Ana also had a question: can my child get IHSS if they go to a special needs daycare during the day, how do the hours work for something like that, especially for a parent that works or goes to school part time?

Lisa CK
Okay, so typically what will happen, and it really depends on what your child's specific needs are. We can get into this a little bit when we talk about protective supervision. But anytime you have services that are being provided by somebody else, that is going to get deducted from from your total weekly hours. But the way that it works, if you have protective supervision, is that they don't actually pay for 24 hours a day, they pay for 195 hours per month max for protective supervision. So what they're going to do when they calculate your hours is they're going to say the need for protective supervision is 168 hours a week because that's how many hours there are in a week. And then if your child is in school 30 hours a week, that's going to get deducted out of the 168. But it's not really going to get deducted out of your time because you can only get like 40 hours, 45 hours a week of protective supervision, because of the way that the math breaks down, you know what I mean? So, but if your child has diapering at school, or if your child has G Tube feeds at school, they will deduct a small amount out of that, if the child gets fed a certain amount of times at school or gets diapered a certain amount of times of school, they will take out of that. It doesn't, so it may be like a small deduction. But for protective supervision, it sounds like a lot because it sounds like a big chunk of time, but it's not actually making that much of a difference on your Notice of Action, if any at all.

Lindsay
So this is probably a good time, like let's review the available services. You've been touching on some of them, Lisa, and if you could give some examples of each.

Lisa CK
Okay, so we have non medical personal care services. That is basically the activities of daily living, ADLs, that's dressing, bathing, ambulation, feeding, toileting, those general self care things that people that the ADL say activities of daily living. Then there's related services and for children, you generally need to show extraordinary need for these. Those include laundry and grocery shopping and errands and meal prep. You're generally not going to get grocery shopping and errands for a child. Laundry, you can make a case for extraordinary need if your child for example has an ostomy or a toileting issue or G Tube feeds where like there might be more laundry than usual because of their medical needs. And meal prep and cleanup is also an area where there might be paramedical needs involved. But otherwise, you know, for younger children, parents usually cook their meals anyway, so you don't get a lot of time for that. And we're gonna look at the chart in a minute that shows the ages for each of these things. Then there's as we discussed accompaniment and wait time for medical appointments, paramedical services, which we will discuss, and protective supervision, which we will also discuss.

Lindsay
Right. And so the parameters within each of these examples are really important because we have to be able to have, you know, set expectations and so we can properly prepare for our visit, which you know, for taking log and hours, which we'll talk about, but for example, bowel and bladder care. Can you give us an example of what is or isn't on there?

Lisa CK
Oh, can we actually bring up the functional index scale early so that it can be up while I'm talking about this? Okay. So basically, when they ask you about what your child's needs are, you're not going to be asked to rank your child's needs. But when you describe what your child needs, they will rank your child's needs. And typically, right where you see on this chart everywhere where it says one, usually a one means that the client can do that for themselves. For a child, a one means that the either the client can do it for themselves, or the parent would usually be expected to provide this service anyway. So you can see that like, you're not going to get you're not going to get shopping and errands until maybe the child is 17. They're very generous with laundry, they don't expect them to do their laundry until they're 14 and housework until they're adults. Don't tell your kids this, right?

Lisa CK
My mom did not live by these rules.

Lisa CK
But this is how they gauge what counts as a service that the parent is a school would be expected to provide to a typically developing child of the same age. So if you look, for example, at bowel and bladder care, a one means parents are going to be doing that anyway, a six means that it's a paramedical service. And we're going to talk about paramedical services in a minute. But you see that once one for which for toileting, once the child has four, then they're going to rank it on a scale of one to six, which is one to five means, you know, anywhere from total independence to a little bit of assistance verbally, to hand over hand to total reliance on someone else to do with the task. And then six means it's paramedical service. For a baby, a six is going to mean something like they have an ostomy bag or they have catheterization. That where where that the toileting itself becomes a paramedical service and not just changing diapers. And it's the same for feeding where it's a one or a six, meaning one, one is the parent, I don't know why they expect a seven year old child for their parent to feed them. But a six is going to be a child with a G tube. So if your baby, if you're, you know, if your six month old has a feeding tube has a G tube or a G J or J tube or anything, that's going to count as a paramedical service. They can't tell you, 'Oh, parents usually have to do that for their child' because no, they don't. That's a paramedical service. And if you look at dressing, it's a one up until they're four or five years old, and then it's a one to a five so that once they're five, then they're going to start basing it on how much help the child actually needs. And so this chart is really helpful in terms of if you've got a small child, and you're trying to decide when to apply. Looking at this chart can really help you get a sense. And this is setting aside paramedical services and protective supervision. But looking at this chart can help you kind of decide like when you think would be the appropriate time to apply and how you think your child is going to qualify based on these criteria. And these numbers are based on a variety of, you know, adaptive skills as assessments and some other tests that that kind of gauge where kids are supposed to be developmentally at certain ages.

Lindsay
And so once we have this chart, we're looking, we're figuring out okay, yep, I do this, right. This is the level where we are, this is what you know, I'm doing anyway, I mean, Lisa, there's so much we do for our kids. So it's really hard to break down and understand. Right, and that chart is very helpful, but to really understand like, what counts and what doesn't, should we once we really figure out, you know, what is eligible under IHSS, should we keep a log of how long we're spending on any applicable category over the course of say, a week?

Lisa CK
I would especially keep logs of paramedical service, paramedical services, and a behavior log and an intervention log for protective supervision. For other things, they have set ranges based on whether the child needs more assistance or less assistance, they have a set amount of time that they give for each individual service. But if you think that your child probably takes longer than average, for example, if you have a five year old who's in diapers, and you know you're gonna get diapering time because because the child is not supposed to still be in diapers at five, according to models of what a typically developing child is where they are developmentally, but your particular child has behavioral issues, or physical issues that make diaper changing take longer than you would expect a diaper changing to take for a five year old who needs a diaper change, then you should log it. Because then you're saying, like, I understand that you have this set amount of time, but it actually takes more than this, because of my child's behavioral needs or because they, you know, because of some physical needs that that we have, it takes longer, or we have to change diapers more often.

Lindsay
I think also a log can help parents because you're, you're know, you're on autopilot, you're used to doing these things. And so if someone's sitting in front of you saying, Yeah, well, I mean, this is the amount, you know, you know, this is, it's a small amount of time, or maybe you'd be doing this, you know, for a child, you know, the same age, then, you know, if you have those logs, I mean, it can be eye opening to a parent to really see how long time is spent. And so it can really help when you're sitting down talking about all of the many things that you're doing for your child to really put into perspective. I think it can be surprising to some parents to

Lisa CK
Yeah, and the thing to remember is, like for paramedical services, especially, is to count the time from the minute you start to the minute you stop, like don't gather all the things together, like if you're preparing meds, right? Like don't get everything up in a line and get it all ready to go and then start the timer. Because the amount of setup time like that, that's part of it. Like it takes time to get gather all the meds, to get all the syringes, to measure it out. Like there's more to it than just giving the meds, right. So, yeah, so include everything, you know, it takes time to set up the G Tube, like the pump and the formula and stuff. It doesn't just start when you put on the extension and hit the start on the pump. Like there's more to it than that.

Lindsay
Right, which actually is, you know, a great point of like, what are the five most important things that parents should prepare ahead of in person evaluations or reassessments?

Lisa CK
Okay, a log of behavioral interventions for protective supervision. And that is not only a log of all the times that your child has been injured, but all of the times that you have prevented your child from being injured. Because we all know that those are two very different numbers. And we know that they would look very different if you were not intervening. So make sure that you keep that log every time you've had to stop your child from accidentally hurting themselves. Number two, copies adopt doctor's forms, even if you've already submitted them, bring them again. And make sure you keep copies for yourself. Paramedical and protective supervision forms, if you've already been able to get them completed, you should be given those forms at the meeting. But it helps if you've already been able to have them done. A list of all the child all the medications that your child is taking if they're taking any medications. And don't understate your child's needs. Don't exaggerate. But don't understate. I know it gets very complicated talking about our child's needs. Because when we talk about their deficits, we also want to talk about their strengths. And it's so hard to talk, for some of us, about what our children can't do. But it's really important that you be upfront about what your children can't do, and be willing to talk about their weaknesses and their deficits, because this is a particular time when it really matters. And to the extent that you talk about their skills, understand that they will take that at face value. Like if you mentioned I'm so proud because my child wrote their name, after working with them for six months, my child is finally able to recognize their name, caseworker might write, 'child can read.' And understand that what you're saying is being taken at face value. And just be very, very straightforward about what your child is not able to do.

Lindsay
And one thing I know, I've heard over the years is to as much as you don't want to, you don't want to go there, sometimes like think of your child on their worst day, right? Or, you know, where that is, you know, could be a typical day for you. And really bring that to life and make sure that they understand like what that looks like, what what that time is and what that reality is.

Lindsay
Yes, sorry. Yes, I'm muting because my dog is barking in the background. Exactly. Amazon, arch nemesis. Yes, that completely makes sense. And, you know, a lot of that, that could be everyday for a lot of us whose children have problems, you know, you know, or who have challenges regulating.

Lisa CK
Yeah, I mean, like on a day when they're particularly bad, but not bad, but like misbehaving or like, difficult or challenging. That's a terrible word, bad. On a challenging day, where things are particularly difficult for you, not necessarily like a day where they like, a day that you know would be likely to happen again at any time. So it's like, you know, there's some days where like something very specific and traumatic happened and things were very challenging. That's not the kind of day I would describe, but like just you we've all had that day we're just like, Oh, what is going on? Like, why is like, why is my child not listening to me? Why is my child is not just doing all of the things and that's the day you describe because it's not like something just clicked. That day could come at any time. And that's the day that you never know when you're going to have it or not. And that's that's a good day to describe. Does that make sense?

Lisa CK
And it's not even just about, yeah, it's not even just about behaviors, if your child has medical issues, or your child has G Tube issues, like there's you know, there's a day when the pump just will not stop beeping at you. And it's why is this happening? Why is why does this pump hate me? And that's part of living and taking care of a child with a feeding pump and a G tube is things go wrong with it, and you can't predict it. And things like that happen all the time. And so describe the way things happen.

Lindsay
Exactly. And what, on the other end of the spectrum then, what is one thing parents should not do before the in person evaluation or reassessment?

Lisa CK
I would say, have your child there for the meeting, make sure that they're there, they will expect you to keep them home from school. They, some of them, some caseworkers are really flexible, and they'll send you a time but it's like, oh, the child's in school at that time, oh, we can make it this day. Or they'll say okay, well, we can just put your case on pause and stop your benefits until your child is available to meet with us. I've heard that too. So you know, be prepared for your child to have to stay home from school if they have to be there. And do not give them your only copy of anything. Keep copies of everything. Because things get lost all the time. These offices have thousands and thousands of consumers whose files are going in and out. And it is very common for things to get misplaced, or for things to never make it into the file. So do not give them your only copy of anything. Unless it's like they handed you a form and you fill it out and you hand it right back to them on the spot. Fine. But if you if you went into had your doctor sign a form. No, you they don't get the only copy, you have to make sure that you keep backups.

Lindsay
Absolutely. And something that you've been mentioning throughout our whole talk: protective supervision, paramedical. So let's get into that. First: protective supervision. What is it and who qualifies?

Lisa CK
Okay, protective supervision is for people with severely impaired memory, judgment, and/or orientation, who require 24/7 supervision because they're likely to injure themselves or others due to their non self directing behavior. And non self directing means that they are unable to assess the danger and risk of harm before doing something. Self directing can mean something different to different people, it can mean something different to doctors, it can mean something different to behaviourists. But for IHSS self direction means if someone is self directing, it means that they are able to identify the risk of harm before acting. And assess and determine is this going to potentially hurt me and then do it anyway. Right.

Lindsay
And oh, sorry.

Lindsay
I was gonna say, well, one of the biggest questions that can come around this are about aggressive behaviors. So what about aggressive behaviors, either to oneself or to others, does that qualify for protective supervision?

Lisa CK
Go ahead.

Lisa CK
So that's another word that has a very specific meaning with IHSS. Where aggression means intentional self directing, lashing out at somebody else, or intentional self directing harm. And that is another word that can be used differently by doctors or behaviorist, behaviorists especially, will say aggressive behavior if the child just lashes out. But if they don't understand that they can hurt somebody by doing that, is it really aggression? And so those are words aggression and self harm that you have to really think about when you use those. Think about what they mean and think about what they mean to IHSS. And if that's not what's happening, if like somebody will say, 'Oh, my child has aggressive behaviors. Can I apply for protective supervision?' My first question is, does the child know that he can hurt somebody by those behaviors? Is he trying to hurt somebody? Or is he just like having sensory input issues? Is he just, is he just like, frustrated and lashing out and not understanding that he can hurt somebody? And if they say he doesn't understand that you can hurt someone, then I say then don't use the word aggression. Because IHSS will take that as self direction.

Lindsay
Right. I mean, I you know, I know parents whose children have certain genetic conditions where they need like, really sort of extreme sensory input. And that might be biting. That might be like grabbing, and the intent is not aggression. It's like sensory wise to them. And so it's important, like you said, even though somebody might see that as aggression, yeah, describe it as that.

Lisa CK
Well self harm, they don't usually classify self harm. They differentiate between aggression and intentional self harm or suicidal ideation or suicidal attempts. And so they'll say like, you can't get protective supervision in order to keep somebody under supervision who's suicidal. Right? So intentional self harm, they separate from aggression. But absolutely, if your child is not meaning to hurt themselves.

Lindsay
Or others.

Lisa CK
Just say this is intentional self harm, because if not, that's now what it is.

Lindsay
Or others, right? Exactly.

Lisa CK
So just understand that words have meanings, especially with IHSS and use them in that way. Right. Right. Use your language intentionally.

Lindsay
Right, yeah. And intensive medical issues, right, that might pose a safety risk. For example, seizures, are those also not protective supervision?

Lisa CK
Nope, you cannot get protective supervision to watch for spontaneous medical emergencies. Seizures are one of those things. There have been some cases where a person would have seizures, and then they would become cognitively impaired and potentially wander off. And there have been some cases like that, where there was a basis for protective supervision. But you cannot, that's a really specific case, like you generally cannot get protective supervision to monitor for spontaneous medical emergencies. The one exception to that is if the medical emergency is being caused by the person's cognitive impact. So for example, if a child has a port, or if they have a trach, if they have a G tube, and they're constantly yanking at it, or tripping over it, or pulling it out because they don't understand what it is, they don't understand it's not a toy, they don't understand what will happen if they pull it out. And this is a life sustaining device, that can be a basis for protective supervision because the child doesn't understand the consequences of disrupting this life sustaining equipment that needs to stay connected to them. And the reason for them disconnecting it and potentially harming themselves is because they don't understand the consequences of their actions.

Lindsay
And, you know, speaking about intentional language, also, like, thinking about how that translates into the paperwork, right. So what are the most important things to keep in mind when filling out the protective supervision paperwork?

Lisa CK
So like I said before, keep track of dangerous behavior, whether there's actual injury or not. Because if you have a child who needs protective supervision, you know that you are intervening to keep them safe multiple times per day, sometimes multiple times per hour. And they need to be aware of how much supervision they require in order to not get injured. Make sure that your child's doctor is aware of these behaviors and the energy that you put into keeping your child safe, because the doctor is the one who needs to fill out the forms. And you want it filled out by somebody who knows your child and knows their history and knows their their limitations and cognitive impairments. And the other part is kind of what we talked about before is using using language that describes your child's behavior, your child's behavior appropriately and intentionally and not using words that have kind of colloquial meanings, that have different meanings to IHSS and could potentially jeopardize your child's ability to get the support that they need. Right.

Lindsay
And similarly to how we talked about the logs. So you have that information, right that you're putting together yourself. Do we need to gather supporting paperwork from doctors or providers, therapists that are working with our kids, maybe our child's school? Do we need to gather that to submit with the paperwork?

Lisa CK
It's not a bad idea. The most important forms are the ones from the doctors. Because IHSS is very much focused on what happens in the home. And so you know, if they're talking about how the child elopes at school, sometimes they'll take that into consideration. And sometimes they'll say we don't really care what happens at school because that's not about them being able to live at home. So the most important documentation is what's documenting what happens at home, and the documentation from the doctors about their their diagnoses and their their clinical limitations. Where this becomes especially important, I, you know, I kind of say sort of the more like, the less readily apparent your child's disability is to the caseworker, the more you're going to have to provide documentation to substantiate your child's disability, because when they come into your house, you know, and I don't want to talk badly about caseworkers, because some of them are absolutely lovely. And some of them are very, very jaded. And there's no way of telling who the caseworker is going to be. And like I said, some of them are absolutely lovely, and they care about our kids, and they want to keep them safe. And some of them are just like, why are you being paid to be to take care of your child? And so if they come into your house, I've heard horror stories about like, the caseworker looks at the child and says, the child doesn't look disabled. Hey child, what's your name? They say their name, this child's not disabled, he knows his name. Like it's so arbitrary, and based on the caseworker's observation of your child in that moment, and it depends on how long they stay. It depends on how meaningful their interaction is with the child. And so if you know 100%, that the caseworker is going to come in and see your child and be able to understand, like how clearly this child needs interventions and support, that's one thing. But if you suspect that the caseworker is not going to really understand your child by interacting with them for a short period of time, that's when having more documentation can be really helpful. So it makes sense.

Lindsay
Yeah. Yeah. And I'm sure it makes sense to a lot of these families, probably you know, parents run into all kinds of things, especially when trying to get benefits, IEP. I mean, and you know, the kids might present in a different way that isn't obvious, or isn't what that caseworkers thinking means, I guess, then that can be really difficult. So I'm sure, and I'm sure for families listening are like, Yep, that's me.

Lisa CK
Yeah. And you know, some kids have a have a social script memorized, where you can ask them, what's your name? My name is x. How old are you? My name is Y. And they're like, well, this child knows. But you could ask them any question, and their answer is going to be their name. And the next question is gonna be their age, because they have a script memorized, because that's what people always ask them. So it's just, these are not clinical social workers. Like they're not trained, they're not all like always trained to really be able to identify a child's disabilities from a short interaction.

Lindsay
And something else just to keep in mind, your initial visit, or they're assessing if you're going to get any hours, that probably will be a different caseworker than if you're approved for IHSS hours, that then becomes your regular caseworker. So if it's a bad experience, you know, don't get discouraged, you know, you know, it should be a different person that would be assigned to you. And what about age range? Because, you know, again, there's a lot of misconceptions, Lisa. So is there an age range where protective supervision kicks in?

Lisa CK
No, a child cannot be denied protective supervision on the basis of their age. And Donna will share an all county letter that says as much; however, you have to be able to demonstrate why your child needs more supervision than a typically developing child of the same age. And when a child is six or seven, that's a little bit easier to establish. If a child is two, you need to be able to demonstrate why your child needs more close supervision than a typically developing two year old. And so it's not impossible. There are children who need that close supervision, but you you better be prepared to document it and and substantiate that claim. Because otherwise, they're going to say, well, all two year olds need supervision. And this is where, you know, this is not limited to situations where you've got kids with medical devices, but this is certainly an area where kids who have medical devices that they're playing with and removing because they don't understand, that will separate a child who needs protective supervision from a typically developing two year old or even a one year old, like if they can't, if they're not mobile, for example, you have to be able to demonstrate how they can hurt themselves if they're not ambulatory. But if they have IV port, if they have a G tube, if they have oxygen, a trach, and they can really seriously hurt themselves by removing those things. Even if they're not ambulatory. Then there's your answer for how they can hurt themselves without without walking. Right. And that that can come up with young children too.

Lindsay
And once your child is granted protective supervision, do they automatically qualify every year thereafter?

Lisa CK
No. They may not ask you to renew it every single year. But they usually will every couple of years. And they'll let you know, when they send you the notification that you have your annual visit, they will include a copy a new copy of the paramedical services form, and it will be checked on the form that you need to have an updated one.

Lindsay
Protective supervision.

Lisa CK 55:30 Supervision sorry.

Lindsay
All the Ps.

Lisa CK
Yes, they're both PS. Yeah. And that is true of protective supervision and paramedical services that if you need them updated, they will notify you ahead of time that you need those updated.

Lindsay
But it is important to know if you're thinking like why are they asking like, you know, I mean, it's hard. It's like, well, my child is still disabled, right, but just know that that is an expectation. Every couple of years, they might ask for updated paperwork. So don't be surprised. Yeah. And paramedical also, so just for those that don't know, can you tell us what what is paramedical and who qualifies?

Lisa CK
Paramedical services are services that the person would ordinarily be able to do for themselves, but that are ordered by and directed by a physician or other medical provider. So checking blood sugar, doing, you know, and anything, so it's not administering over the counter medic medication. But like, if the doctor has to tell you how often to give this, if it requires additional judgment, like if the doctor says, you know, do this and if this then give this dose, if this then give this dose, then you're talking about paramedical services. So there's all sorts of, I'm trying to see if I can, there's so many different services that it can be. You've got catheterization, dealing with ostomy bags, G tubes, injections, anything where something is like puncturing the skin, or going in through through a stoma in the body. If you have to do enemas, if you have to monitor vital signs, if you have to check blood sugar, and this is where kind of the the issue of monitoring for medical emergencies, which you can't get, can sometimes bleed into paramedical services, which you can get, which is that if a person is not able to communicate their symptoms, you might have to monitor them for certain things more frequently. For example, blood sugar, if they can't tell you I feel a little lightheaded, they can't tell you how they're feeling. The doctor might tell you that you need to monitor them more times per day than somebody who could actually communicate their feeling. And it would be based on that too. You know what I mean? So if you have to monitor something, or take a certain vital sign more often in the day because of the child's inability to communicate symptoms, then that would go into the paramedical services. Right.

Lindsay
And so all these things are taken into consideration whether you have protective supervision, paramedical, or you have the other available services, what is the range of hours that a client under 18 can receive?

Lisa CK
This is my favorite question.

Lisa CK
It is literally zero to 283. There is absolutely no way to predict, you know, this is what I see a lot online, are people asking me like, My child has x, how many hours can I get? I don't know, let's talk about your child. Let's go over the chart, like what is your child able to do? Because it's so particularly tailored to the child, that there's no way to predict how many hours they're going to get. If you know 100% they guarantee qualify for protective supervision. I mean, they could even be denied and you might still have to appeal. Even if it's like so obvious, like you may still have to go to hearing. If a child needs protective supervision, that will add 195 hours to their monthly hours. So their hours will be 195 plus whatever personal care hours and related services and accompaniment they need. The maximum hours is 283. So if you have a child who has extensive needs, that's 283 is the max for IHSS. There may be other services, but that's a whole other webinar. But it's zero to 283. The 283 is the maximum and the only people who are gonna get 283 hours are people who are considered severely impaired. If you're non severely impaired, it means you need less than 20 hours a week of personal care services. If you're severely impaired, it means that you need 20 hours or more of personal care services, and then the max hours becomes to 283.

Lindsay
This is it.

Lindsay
Right. And I'm looking, I think Tosha asked a question about protective supervision. Do we have to specifically request for protective supervision, in addition to IHSS hours already in place, when they schedule renewal? Do they typically attempt to decrease already previously approved hours when you're requesting an additional service?

Lisa CK
Typical is such a hard word with them. Because, you know, it's again, like, it totally depends on the caseworker. It depends on your child, it depends on how the meeting goes. If your child has a certain number of hours, and then, at the next meeting, you ask for protective supervision, that should not have any impact on the other hours, you're just asking for an additional service. I'm not sure if I'm answering the question, but like, if you, if you already have protective supervision, you should not have to ask for it again at the next meeting. It's considered part of your child's hours, and they're still IHSS hours.

Lindsay
But I don't think she has it yet, Lisa, just to say because I think there's already hours in place. Okay. So I think she said do we specifically have to request for protective supervision, in addition to the hours already in place, do you wait until they show up?

Lisa CK
You don't have to wait for the annual renewal. You can request it ahead of time. You can ask for a reassessment. If your child's circumstances have changed, sometimes they'll say that they're only allowed to increase hours up to a certain point in between annual visits. But if your child's circumstances have changed, and they now need protective supervision, you can request that. If you don't request it, you are not going to get it. In theory, they are supposed to give you information about protective supervision if your child has any cognitive delays. They're supposed to automatically give you that information if your child has developmental disabilities. That does not always happen. So if you don't ask for protective supervision, and they don't give you the form, and you never submit the form, it's never going to happen.

Lindsay
Yeah, but I think that's, as a follow up question to that, we should reiterate also, that hours can change from year to year, just because you have protective supervision doesn't automatically mean that you have it forever, right. Same with hours.

Lisa CK
Yeah. And I mean, you should know that anytime you ask for reassessment, like they can, they can move your hours up or down. Like if they reassess, and they're like, Oh, the child can do this now, they could put your hours down as well. But as your child gets older, if the gap between your child's skills and those of a typically developing child of the same age are growing, then the hours should be going up, not down.

Lindsay
Right. Well, and as hours can change, so can pay rates. So you know, some good news, right? IHSS as workers, we're supposed to be receiving a raise in January, correct? Yes.

Lindsay
Yep. So keep checking that link, like Lisa said, even if it's just a couple days before, so you can see.

Lisa CK
So when I started providing, back in the day, when I started providing IHSS hours, that the rate was like nine something per hour. There have been tremendous efforts at getting toward a living wage for in home care providers, for getting overtime. And there are additional pay rates coming up, increases, so the pay rate is different from county to county. And so a lot of the negotiation has been about making sure that it is tied to a certain amount, either tied to the state minimum wage, or tied to being a certain amount above the minimum wage. So as the minimum wage goes up, then the IHSS providers rates go up, too. So Donna's gonna share a link in the chat to the county, the county rate that like the hourly rate per county. This is usually updated a few months before, sorry, a few days before the new month. And so this is always kept up to date, but it's only up to date, like as of like right now. So I think what's up right now is like hours as of December 1, but like mid to late December, it should come up hours as of January 1, and you'll see those changes. Some counties are going up 20 like to 50 cents or 75 cents. Some counties have an incremental rate increase where there'll be a small increase in January and then another small increase in July. But you can expect that across the board most of the counties will increase over the next two years. And a lot of them will go into effect this January 1, and there will just be continual increases.

Lisa CK
I mean, the thing is like, you may be able to find out now based on your county, your county's website, or your county's union, or your county's public authority might have that information already available. But there's just like, there's so many different counties in California, and everyone has a different rate.

Lindsay
Right, right. Okay, so you know, earlier had some questions about appeal. So what happens if we're denied, either after the initial evaluation, or they try and terminate or reduce hours after a reassessment? What can we do?

Lisa CK
So appeal. Appeal within 10 days in writing and request aid paid pending appeal, which means that your hours stay where they are until you are finished with the appeal process. You can still appeal after 10 days, but then you won't have aid pending appeal, and you want to keep those hours in place while you are in the appeal process. The most likely thing to happen is that they will offer a reassessment in exchange for a conditional withdrawal of your appeal. And what that means is that you conditionally withdraw your appeal, and they'll come and do a reassessment. And if you agree with the reassessment, then you completely drop the appeal. And if you disagree with the reassessment, then you reopen that appeal. So before you sign anything about a conditional withdrawal, make sure that you see in writing that it says that if you disagree that your appeal goes back to the original date that you that you appealed and not like starting a new appeal. But that's generally what happens is that someone from the county will reach out to you and offer to do a reassessment. And a lot of the disputes are resolved at that phase. Because if you're, I mean, if the county can clearly see that if you're able to document your child's need, you know, they save resources by not going to appeal in situations where they're likely to lose. So hopefully you can get that resolved and reassessment. That's not to say you definitely can, sometimes they put their foot down, and they just don't want to argue about it. But there is there is a chance of getting that resolved with a reassessment.

Lindsay
And Donna did share a link, because, you know, it definitely gets complicated. But check out the article, which is all about appeals, you know, that you hope you never have to know the information and hopefully won't, but unfortunately, a lot of parents do. So it's good to know what your options are. And like Lisa said, that aid paid pending is really important, it's kind of like a stay put. And you want to make sure you keep getting paid while you're figuring it out. So that that 10 days is really important. And sometimes you get the letter, and by the time you're getting it saying you have 10 days, you might have two days. So I mean, I know families have had to like turnaround and like overnight, FedEx something or if fax is an option like something.

Lisa CK
You can do it online too.

Lindsay
In every county?

Lisa CK
There's a state website for appeals.

Lindsay
Great. Yeah. Okay.

Lisa CK
That information should be in the appeal packet.

Lindsay
Yeah, it's not a letter you want to sit on. Because we all have those piles. I'll get to it. Not. Yeah. So that's the most important thing to remember. Right. And, you know, I know we're over time, but we really wanted to, you know, we need to cover and want to cover what we talked about at the beginning of our chat, which is the IHSS Career Pathways Program, right. So this is an opportunity for all providers, again, including parent providers, to get paid for completing training modules. And this is an opportunity that's been extended through September 2024. And if you can take advantage of it, it's a great way to grow your knowledge and get paid for it. So as I said earlier, there are families that we work with who've made thousands of dollars participating in their own professional development, which is pretty incredible. So some trainings are asynchronous, others are virtual with an instructor, and yet others are in person. And they also fill up very quickly. So, Lisa, what are the most important tips that parents need to know about finding and registering for IHSS Career Pathways classes?

Lisa CK
Okay, so the first thing is word travels quickly. So I mean, there are whole Facebook groups dedicated to like alerting people, to when different providers have opened up classes. So basically what happens is, there are a bunch of different counties who have a designated provider for these career pathway classes, and you do not have to reside in that county to take their classes. You can take classes from any county and most of the classes are virtual, they're on Zoom. And so you just have to kind of keep a list of all the different county providers that they contract with, and when when they open their classes, word travels very, very quickly. And like sometimes like the the website won't work in the first 10 minutes because everybody's trying to register. There are a few providers that are bigger and have more classes, like Homebridge has a ton of classes. And they also have a ton of asynchronous classes that you can do on your own pace. Center for Advanced caregiving also has classes that are like three, four hours long. They're all really good classes. And there's kind of quirks of each provider, each vendor. But they all fill up very quickly. So keep an eye on our Undivided facebook group page, or join one of the variety of IHSS Facebook groups, especially the ones that are dedicated to the Career Pathways program, because people will post when something is open so that everybody can kind of you know, a feeding frenzy.

Lindsay
It's like a Taylor Swift concert, these classes are like a Taylor Swift concert.

Lisa CK
It's like the old days you with Ticketmaster, where like, yeah, I guess I guess it's still like that too. But I remember when you had to like line up and like or call and yeah, it's very much like tickets, except it's IHSS classes. So sign up as soon as you hear about the class opening, don't say I'll do this in a couple days. Because the classes will fill up. Keep your IHSS provider number handy. I have it in an iPhone. So I put it as like a keyboard shortcut. Because you will need it for certain vendors, you'll need it for every class you sign up for. And others like you just put it in your account and it's there. But it helps if you don't have to go looking for it. So I just put like hashtag IHSS Pn. And so every time I write that, which I'm unlikely to write, on any other occasion, it puts out, it spits out my provider number so that I don't have to go looking for it or memorize it. And that really helps. So keep that handy because you will need it and keep track of the classes that you take and hold on, they're gonna send you a certificate after every class, I take screenshots and keep those in a folder on my phone, because every once in a while after you submit your hours, and there's in our article, there's a there's like a little tutorial on how to submit your hours so that you get paid for these trainings. And every once in a while, you'll get one declined. And they'll say, Oh, we don't have a record of your attendance, you write back to them. And you include your IHSS provider number and a copy of the certificate from that. And that resolves the issue because you have the certificate that proves that you attended that class. And, yeah, the other thing that I want to let people know about is the incentive program because you get paid for training time. So the time that you're in your classes, and that includes overtime. So if you're over 40 hours a week, you will get paid the overtime rate for those classes. There's also several incentives for participating in this program. So do we have time if I just kind of explained what the incentives are? Okay, so there's incentives number one, two, and three, incentive number one is taking, so okay, so the IHSS, like the Career Pathways Program is divided into different pathways. So one of them is the generalized pathway, which is general health and safety, and then adult education. And the other one is specialized pathway. So there's a few different ones, the two main ones that people are taking are cognitive and behavioral deficits and complex health needs. So incentive number one, is you take 15 hours of any one single pathway. So all the classes in the same paths, kind of like a little mini major, right, take 15 hours in the same pathway. And then you submit for your training time incentive, that's $500, you get $500, just for, in addition to the to the payment for the time you spent, you get $500 incentive to complete 15 hours, you can do incentive number one twice. So that's $1,000, just for taking 30 hours of classes that are going to help you in caring for your child. Incentive number two is you take classes, you take 15 hours of classes in one of the specialized pathways, and then provide work over a period of 30 days at least 40 hours for a recipient who needs those services in that pathway. So they haven't really articulated how they differentiate, but my understanding and my speculation that is just speculation is that if your recipient has protective supervision, that's going to qualify them for the cognitive and behavioral impairments pathway. Right. So if your child has protective supervision, you want to take classes in that pathway. And then if your child has complex health needs, I would think that if there's physical assistance, like ambulation, if there's like transfer, if there's assistance with bathing, if there's paramedical services, then you're looking at complex health needs, and you want to take classes in that category. Once you take the 15 hours in that specialized pathway, and you've submitted all those hours, you have 30 days of working at least 40 hours a month. And then that's another $500. Incentive number three starts as soon as the 30 days are over from incentive number two, and you can use the same 15 hours that you did for the previous specialized pathways, you take those 15 hours of specialized pathways, you work 30 days, that's incentive number two, you work six months, averaging 40 hours, or for at least 40 hours that average, but at least 40 hours minimum, each of those six months, that's $2,000. That's the incentive bonus for working for six months for a recipient who needs those specialized pathway skills for six months, and you get $2,000. So it's really and these classes are really, really helpful. Like I, there are classes that they offer on autism, there's classes that they offer on on physical assistance, and there's a lot of classes on caregiver burnout, which is so important.

Lisa CK
What are you talking about? Who would go to that?

Lisa CK
There's classes on, you know, kind of like emotional regulation and like caring for a family member. And there's classes on Alzheimer's, which I personally found helpful because my mother in law was dealing with Alzheimer's. At the same time, you know, I'm providing care for my child, but also, my mother in law lives with us who has Alzheimer's, and these classes were really helpful for me, and understanding, you know, being part of the team of family members and caregivers who were caring for her. So there's, there's really valuable classes, and it's totally worth, like, intellectually and emotionally and also financially worth looking into this program, because it's, it's really helpful. So I really encourage you to participate if you can.

Lindsay
Yeah, and as a point of clarification, do the training hours count against your maximum allowed hours caring for your recipient?

Lisa CK
No, they don't, they don't come out of your recipient's hours, so they don't get deducted from the recipient's hours, and you will not get a violation if you've worked all your hours for your recipient, and then you go over time with the training classes. You will get a violation if your total training time and IHSS worked hours exceed 24 hours in a day. So there's some tricky areas where some of some of the self paced classes, you get three hours of credit for them, but like a lot of people don't take the full three hours. I mean, they're like, you go at your own pace, but you get the three hours credit, if you know, if it takes you an hour and a half or two hours, you're still gonna get three hours. But if you claim 12 hours that you work for your child, and then you claim like, like 15 hours of training time, they're gonna know something's up like they know you didn't do that. So you know, pace yourself and leave yourself time to actually do those classes. Don't schedule, don't sign up for classes at a time when you know that your child is likely to need a lot of support. Because you do need to pay attention and participate. If you do not live with your recipient, if you're caring for somebody that you don't live with, you cannot be on the clock for IHSS and also be taking classes at the same time. This doesn't come up as much for parents, because when are we not providing care to our children? But you know, if you're at home during the day, while your child is at school, that's a really good time to sign up for classes. Or, you know, while they're taking a nap or something, like do asynchronous classes while they're napping or something like that. Just kind of schedule them at times where you know, you'll be able to participate. Absolutely.

Lindsay
And I mean, I see there's there's a couple of questions that unfortunately, we're not going to have time to get to but I want you to know that Lisa, after we talk, you know, she'll go in and the next couple days and look at the chat. So if there's questions that have come up that we haven't answered, then you know, she's she's really active in that chat, and she'll definitely let you know if we can answer that.

Lisa CK
I'll try to answer some of those questions.

Lindsay
Exactly. What what did you say, Lisa?

Lisa CK
I said I'll hop in and try to answer some of those.

Lindsay
Absolutely. And I know we could ask questions for days, right, like we could we could spend her all day and I know we covered a lot today. So the most important thing we want you to know is that no matter where you are in the process, whether you're thinking about applying or your years in struggling to register for a Pathways class, we can support you with every stage of need, and Donna shared lots of articles today that can get you started. But if you want or need more than articles, our Undivided Navigators are ready to create a plan just for you. And you can receive that plan during a free kickstart where your navigator will learn about your family's priorities and create a roadmap with you and for you. So Donna will show the kickstart link again so you can learn how our navigators can support you exactly where you are. And regarding the Career Pathways program, specifically, we want to ensure that our families know when new classes are released and how they can register. You know, Lisa mentioned all these Facebook groups and it's a lot, right. So if you're not somebody who you know, has the bandwidth or the time to be on all these different things, right, getting ready for that Taylor Swift concert, then you have one year right to take advantage of this program. And we want you to make the most of this opportunity. So we're kicking off the new year with a private event for our members in mid January with Lisa, she's going to be recording a training with step by step instructions on how to enroll in various classes as well as what to expect, so which again, is not always as easy as you think it will be. So this will be accompanied by our step by step guide and what I'm calling unofficially, but our big amazing career pathways FAQ, which is going to feature dozens and dozens of the most common and uncommon questions that we receive from families about these classes every day. So our navigators and benefit specialists have been answering hundreds of questions from parents, you don't need to spend hours searching for the answers. We've done the work for you. And we're assembling those into an easy reference sheet. And it's all stored right in your Undivided account, accessible with the click of a button. And Lisa is going to hold an office hours in mid January where parents can ask her any and all questions about the Pathways Program. So we want you to optimize every opportunity to support your child and yourself. So whether that be with IHSS, IEPs, Regional Center, Medi-Cal or even filing out of network insurance claims, just please reach out. Our navigators would love to meet you and hear about how we can support your family. We have lots of exciting things brewing for 2024 and we're going to share details as soon as they finalize, and until then please stay connected with us during our parents only Facebook group. Follow us on Instagram, Twitter, YouTube, LinkedIn, all the fun places. So thank you again to Lisa, to all of you. We know how busy you are. Our mission is to support you so your children can thrive. And we want you to thrive too. So from everyone at Undivided, we wish you an amazing holiday season. We'll see you soon.