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By Pam K. Hoye 
Editor's note:  Pam is a friend of mine who is confined to a wheelchair with a degenerative medical condition. She has long been an inspiration to me--a talented writer who uses a pen held in her mouth to compose her works, including this impassioned plea below for the public to sign a petition asking the Legislature to let disabled people like Pam keep their in-home caregivers.

February 24, 2012 (San Diego) -- This petition is calling for an IHSS "carve-out", to keep the present IHSS program (which enables me to hire my own caregivers/assistants) as an option apart from total inclusion within  a new managed care mandate.

Want more background?

Heavy Sigh...
Periodically either the State or individual counties have attempted to mandate either "managed care" health services or home care through contracted service providers. The outcome is always the same: High costs and reduction in quality and quantity of services. When do we learn? Add another layer or two of corporate bureaucracy and profit and ya get more admin cost, and direct attention away from direct services. Apparently not yet. Inspired partly (or wholly)  by the recent health care changes, California has gotten the federal go ahead to reinvent some wheels.
What's ironic in this is that California should by a model for other states, especially when it comes to in-home care services. Called in-Home Supportive Services, IHSS is  NOT a low budget item. It will never be. As the baby boomers are becoming seniors and medical science is able to  keep increasing numbers of permanently injured individuals alive -- and as long as we value helping people remain safely in their own homes and communities -- in home care will be in increasing demand. And as long as the economy languishes, the numbers needing IHSS will increase even more, because IHSS is a means-based program serving low-income seniors and disabled persons.
IHSS will never be a low budget item, but it is way less costly that the emergency rooms, hospital beds, and institutions that IHSS has kept us out of. Plus, most of YOU KNOW ME because of IHSS. You may not consider this an asset, but I consider knowing you all, well, gosh, what can I say? Some of you have even worked for me.  :) This is what IHSS was established for: keeping persons with disabilities and seniors active members of our community.
But I've  gotten side tracked. What the State is proposing is that those who are "dual-eligible", ie,. eligible for both Medi-Cal and Medicare, into mandated manage care. That's part 1. Part 2 is to move the whole of IHSS into  the mix.
The original plan is a four county demonstration program of managed care for the target duel-eligible population. While many of us feel "been there, done that", there is a population that need a more management-based approach so finding good "managed solutions" would be of help. The key word is solutionS, plural! One approach will never, can never, fit diverse needs and abilities!
So, first of all, we want to keep the proven, cost-effective IHSS program for those of us who do well with a least invasive approach, and keep these care-giving jobs open to the great persons I've had the privilege of hiring through the years. I am not sick, I am physically limited. I am not (yet) mentally unable to direct my  care and manage my life. I do both well.  Like many, I do not want or need the government to incur the additional expense of replacing my caregivers with certified contract caregivers ... turning my home into an institution.
So, the petition we are seeking signatures for is calling for an IHSS "carve-out", to keep the present IHSS program as an option.
There is another aspect afoot. For some reason Governor Brown has proposed increasing the number of demo counties and fast-tracking a  State-wide duel managed care mandate (including IHSS) within three years. The Legislative Analyst Office released its recommendation against this and calling for the four county demo with careful observation of outcomes, as there is no present evidence that managed care is either outcome or cost-effective.
I have not researched Brown's proposal, nor have I heard its status since the LAO report. I can speculate... The duel-eligible partnership with DC likely promises more  Fed money. Cost-shifting has long been an  issue, inspiring more costly, less effective approaches because "the Feds will pay more of the cost." This disregard for tax-payer money, and readiness to WASTE has to stop.  As we are advocating the  State  level, I'm thinking another thing to do is to lobby DC to eliminate "cost-shifting" incentives.
Another battle...
Anyway, this is where we are at..  Thanks for signing and passing the petition on.

The views expressed in this editorial reflect the views of the author and do not necessarily reflect the views of East County Magazine. To submit an editorial for consideration, contact



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IHSS care

This was a good read with important information that people need to pay attention to even though it does not concern many of us right now it will in the future and our choices are being affected. We need to be allowed to stay in our homes if possible. I am a caregiver and am working both in a persons home and at an elder care home. There is a difference ad all tho there is time that it is better to be in a Care facility and sometime better for the person especially one with dementia and other medical problems that would make i more dangerous to stay in their home. For those with the mental ability the choice should be theirs. Even things regarding when to shower and what we wish to eat when to go outside visit a neighbor, watch a favorite program, listen to music can have a depressing effect on a person not given that choice. I want to have that choice when I am older, I signed.

Friends of Pam Hoye, some sad news to report.

Pam's just informed me that her mother passed away last night.

I hope every reader will sign her petition. It's wrong to force people into nursing homes who are capable of leading productive and happy lives with in-home care. 

Pam, our thoughts and prayers are with you. 

Great Job Pam

Signed, sure hope we can manage to get them to continue your healthcare.