Date of Graduation

Fall 12-14-2018

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Behavioral Health (MSBH)


School of Nursing and Health Professions

First Advisor

Kathleen Raffel


Introduction: In Home Supportive Services is a Medi-Cal program serving low-income seniors and adults with disabilities. IHSS clients, or “consumers” are responsible for finding, hiring and supervising their IHSS home care worker. IHSS workers provide services such as feeding, bathing, bowel and bladder care, meal preparation and clean-up, laundry, and paramedical care. This project was created to identify why a high number of IHSS clients have not been able to hire and retain an IHSS care worker. The aim of the study was to understand the consumers interactions with IHSS and identify points at which consumers experience challenges in navigating this system.

Methods: In Partnership with San Francisco’s IHSS program and San Francisco’s IHSS Public Authority (PA), data was collected through 1) a focus group with IHSS staff; 2) semi-structured interviews with IHSS consumers; 3) observations of home visits to IHSS consumers; and 4) survey calls to IHSS consumers on the verge of losing their IHSS services.

Results: Common characteristics of IHSS consumers that created challenges in hiring a provider included: no previous experience in hiring personnel; the fear of having a stranger in their house; an absence of motivation to hire someone; and not understanding their role as the employer of the care worker they hire. IHSS consumers also faced challenges utilizing the Registry list of available care maintained by the Pubic Authority.

Conclusions: Findings suggest that information and tips on hiring a provider created by the Public Authority should be given to IHSS recipients when they are approved for IHSS services. Additionally, conflict resolution trainings should be offered to IHSS consumers to resolve disputes with care workers before firing them and having to find a new care worker, and the PA should provide a mediator to help manage conflicts between case workers and consumers.