Posted: September 11, 2021

In-Home Support Services for Older Adults

There are various situations when older adults may not yet be ready for long-term care and instead, prefer to live at home before making the transition to a Residential Care Facility for the Elderly (RCFE). Having help with tasks around the house not only makes the lives of seniors and the disabled easier, but may also allow the person to remain at home.


In June 2019, Governor Gavin Newsom issued an Executive Order for the creation of a Master Plan for Aging. The Executive Order is a statewide effort to serve the needs of older adults, their families, and caregivers1. Specifically, the order aims to address the following issues1:

  1. Growth and sustainability of the In-Home Supportive Services (IHSS) program.

  2. Access to long-term care, financing for long-term care services, and improved quality of long-term care services.

  3. Labor supply and retention of the long-term services and supports workforce.

  4. Programs to enable older adults to remain safely in their own homes and communities.


A large part of the Master Plan for Aging focuses on the In-Home Supportive Services (IHSS) program. IHSS provides in-home assistance to eligible aged and/or disabled individuals to enable recipients to remain safely in their own homes. The administration of IHSS is a complex partnership that includes the following entities: program recipients, the California Department of Social Services (CDSS), Department of Health Care Services (DHCS), counties, public authorities, program advocates, providers, and employee unions2.


In the IHSS program, the recipient of the services directs the care and chooses who will provide the care. Additionally, a friend or relative may serve as a care provider, or a referral may be obtained through the IHSS Public Authority Caregiver Registry. Care providers must complete an enrollment process and pass a background check. Many lower income adults living in California qualify for these services, which will be discussed in this article. 


What types of services does IHSS provide for older adults?

Services available through the IHSS program include3:

  • Personal care services (assistance with activities of daily living (ADLs), such as bathing, grooming, dressing, and feeding)

  • Domestic and related services (routine house cleaning services, laundry, shopping, meal preparation and cleanup, and errands)

  • Paramedical services (health care-related services, such as administering medication, and wound care)

  • Protective supervision4 (necessary for older adults who are *non-self directing, mentally impaired/ill, and/or require 24-hour supervision at home. This service consists of observing an older adult’s behavior and intervening in order to protect them from risks of injury, hazards, or accidents.)

  • Accompaniment to medical appointments (accompanying older adults to appointments and wait time during appointments)

  • Heavy cleaning (typically only authorized when there is a need when IHSS is first granted and includes thorough home cleaning of hazardous waste and debris)

  • Hazard abatement (light yard work needed to allow older adults to live safely at home)


Based on the needs of an older adult, a County of San Diego (County) social worker will make a decision about which tasks and the number of hours per task that can be allotted to the individual.


Who is eligible for IHSS5?

  1. Be enrolled in free or share of cost Medi-Cal 

  2. Possess a qualifying immigration status

  3. Be a California resident

  4. Live in their own home and not in an institution

  5. Be aged, blind or disabled


What is the process for applying for IHSS?

The application process must be completed within 30 days of when an individual starts the application. Individuals can submit an application by phone, mail, email, fax or in-person at Aging & Independence Services. Moreover, an applicant needs a completed Health Care Certification Form (SOC 873) from their health care provider and must allow County social workers to conduct an in-home assessment. Afterward, the County will send a notice of action to determine the eligibility of the applicant, with details of approved tasks and hours for each task, which cannot surpass 283 hours per month3


For more information on how to apply for IHSS, visit the California Department of Social Service IHSS page by clicking here. Additional information regarding how IHSS authorized services are determined for older adults can be found on the fact sheet here. You can also learn more about the IHSS program by visiting the IHSS website here


IHSS can be an important option for families not yet ready for a higher level of care offered by RCFEs or other housing options for older adults. Providing this information to prospective families can help RCFE Administrators and staff build trust with families to show that you have their best interests at heart.


*Non-self directing: An inability, due to a mental impairment/mental illness, for individuals to assess danger and the risk of harm.