Introduction to In-Home Support Services (IHSS)

I’m about to give you the good news about In-Home Support Services (IHSS) in Colorado. The good news is IHSS is available in Colorado if you’re on certain Medicaid Home and Community Based Services (HCBS) Waivers.

If you’re not sure what IHSS is, read on. All the basics are covered in this article, including definitions, qualifying information, and helpful links to other articles.

In my last article we looked at trends in Long Term Services and Supports (LTSS) and how Participant Directed Programs have become available in Colorado. ‘Participant Directed’ refers to how typical LTSS services are accessed and managed. This is in contrast to what is known as Traditional Directed, or Physician Directed care. You, as participant, can now select your own caregivers and direct your own care.

One of these progressive models that allows you to direct your own home care is In-Home Support Services (IHSS).

What is In-Home Support Services (IHSS)?

IHSS is a participant directed service delivery model for people with disabilities who qualify for Home and Community Based Services (HCBS) Waivers. It is not a specific public health program. IHSS refers to the way you as a participant already on an HCBS Waiver can manage your own home health care.

IHSS has to do with the way home health care services are accessed, delivered, and managed. Instead of a physician being the director of your care, you become the ‘boss’. IHSS has been approved by Centers for Medicare & Medicaid and allows you to direct your own in-home care under the authority of a participating home health agency.

Even if your health is unstable, if you are able to direct and manage your own care (or have an Authorized Representative of your choosing do it), IHSS may be a good option for you.

Which services qualify as In-Home Support Services (IHSS)?

Colorado statute defines IHSS as “services that are provided by an attendant and include health maintenance activities, support for activities of daily living, personal care services… and homemaker services.”

Personal care services are those services like assistance with brushing teeth, bathing, using the restroom, meal preparation and medication reminders.

Homemaker services include household chores and light housework, like grocery shopping and meal preparation.

Health maintenance services are those medically skilled care services such as IVs, feeding tubes, catheter irrigation, enemas, suppositories, and wound care.

Older woman with a disability in electric wheelchair smiles and talks with a woman sitting near her on the bed.

“Minister Hoffman Homecare Budget02.JPG” by Ian Jackson for Government of Alberta is licensed under CC BY 2.0 https://creativecommons.org/licenses/by-nd/2.0/legalcode

Who Hires the Caregiver and Who Employs the Caregiver?

Under IHSS, as participant, you can select who you want to be your caregiver (including your spouse!), and the home health agency you are working with becomes the employer and does the actual hiring, not you.

If you don’t have a home health worker in mind, the agency can help you find someone. With the traditional agency model, the agency hires who THEY want. With IHSS, you select who the agency hires or can choose to utilize an agency caregiver. The agency along with the participant will help train the caregiver to personalize the care.

IHSS is available to qualified participants on the following three HCBS Waivers:

Are spouses allowed to be hired under IHSS in Colorado?

Since 2016, Colorado now allows spouses to be hired as caregivers by a home health agency. Prior to 2016, spouses were not allowed to be reimbursed for care under IHSS. The Independence Center is a home health agency that is actively hiring and training spouses for home care.

One of the biggest perks of being hired as a spouse to care for a spouse with a disability is the benefits that come as a paid employee. Paid employees of a home health agency could be eligible to receive any benefits available, such as health and dental insurance, 401(k), and paid time off.

How Does the Agency fit into IHSS?

IHSS is participant directed care. However, the agency still is the employer (not you) and is responsible for oversight, hiring, training, providing backup services, and nursing supervision. The agency also oversees your care budget and manages payroll for your caregiver(s).

You, as participant, work closely with the agency and your case manager to determine which services and supports you need.

Nurse Practice Act Waived Under IHSS

IHSS contains a valuable provision related to the Nurse Practice Act in Colorado. Tasks that are reserved for skilled nurses (RN or CNA) but that don’t require the clinical judgment of a nurse are allowed to be performed by a home health care worker that is not a nurse. In essence, under IHSS the Nurse Practice Act is waived.

The home health agency through which the IHSS services are being delivered will assess the caregiver’s ability to perform such tasks. This results in considerable cost savings as well as convenience to the participant. By having the the Nurse Practice Act waived, you can receive care from your loved ones, and those family members or friends can be paid for giving care.

For instance, a mother who is employed by the IHSS agency as caregiver for her daughter can perform such tasks without having an additional outside worker come in for the tasks.

Getting Involved with IHSS Policy

Are you an IHSS participant and want to give input into the state administration of IHSS? Consider attending the Participant-Directed Programs Policy Collaborative (PDPPC), which is a joint collaboration between participants and the Colorado Department of Health Care Policy and Financing. Attendance at these monthly meetings is also possible via conference call. For more information including meeting dates and conference call dial-in, click here.

The Independence Center Can Help

Do you have questions about whether IHSS may be right for you? The Independence Center is not only a home health agency with expertise in IHSS, but it is a Center for Independent Living. As such, it advocates at the local and state level for continued increase in quality of life for people with disabilities. If you are considering IHSS, talk to us. We can help you navigate the ins and outs and support you in your decision. Contact our Home Health Office Administrator at 719-471-8181, ext. 130 with questions about IHSS or other participant directed programs.