Suppose you were running a bread line and someone ran off with a loaf. You might yell for the cops, but you wouldn’t shut down your operation and tell hungry people to go home.
However, that’s what some people want to do with the state’s in-home care system, known as In-Home Supportive Services, or IHSS.
And they want to do it for the very same reason. They are convinced that some people are stealing.
We don’t know how many people are stealing. We’ve heard anecdotes and random estimates. We don’t know exactly what’s being lost.
But we’re talking about a big program here. About $5 billion – nearly half of which is federal money. About 440,000 recipients. Hundreds of thousands of providers.
It’s also one of the state’s fastest-growing programs. Our population is getting older. Baby Boomers aren’t kids anymore. People need help.
IHSS services go to low-income people who need help getting out of bed, or into the bath; Alzheimer’s patients, stroke victims, children with severe disabilities; people who can’t cook for themselves or clean their home.
Recipients hire a caregiver, either through personal connection or through a county-run registry. These caregivers do hard jobs at low pay. They reposition people in their beds, clean bathrooms, change diapers. Although they bargain collectively to set their wages county by county, no one is getting rich.
The state rightly views this program as a cost saver. The alternative for a large portion of this population would be institutional care – a nursing home or other facility. But a nursing home costs $55,000 a year, or more, and assistance in the home costs about $13,000 a year. From a fiscal standpoint, it’s an easy choice.
But what about the fraud? How much of those savings are lost to cheaters and scammers who bilk the system.
Assembly Bill 682 (Lowenthal), which passed its first committee last week, could solve at least that part of the problem. The information part. It calls for a study of fraud to get a dependable baseline number from which we can make informed decisions about enforcement and investigative policy. We need to be targeted and surgical in our response, because the fact is, every dollar we spend hunting down cheaters is a dollar we can’t spend on folks in need.
We believe the response to fraud is to measure it, and then to stop it.
We believe strongly that you don’t respond by blindly gutting this valuable program. You don’t punish the innocent along with the guilty.
That’s not how we handle other targets of fraud. We don’t, for example, respond to insurance fraud by canceling the policies of honest consumers. Take Wall Street or in the banking system. Not only did we not junk the system, we spend trillions to shore it up. That’s because the risk of losing the financial sector is greater than the burden of fixing it.
The very same is true of IHSS. It is a good system that helps a lot of needy people, and it saves countless billions while doing so. And just like banks, brokers and insurers, we have to have it. Some people literally can’t get through a day without it.
The bottom line about fraud in our in-home care system is that we don’t have a bottom line. We lack a tally, even a good estimate based on something more than anecdote and innuendo. But we owe it to every taxpayer, recipient and caregiver to get to that bottom line, because without a detailed accounting, we put vulnerable people at the mercy of cheaters and those who would throw the baby out with the bathwater.