The only thing more disturbing than allegations of fraud in the state's in-home care system is the tendency to use that fraud as an excuse for gutting the program.
While fraud is intolerable and must be rooted out, scapegoating is its twin evil. Those who cheat and those who blame the victims pose an equal threat to the hundreds of thousands of elderly and disabled Californians who rely on a little government help with their daily lives.
California's In-Home Supportive Services program is one of the state's fastest-growing expenses. More than 440,000 people – older, poorer, more frail than their neighbors – receive help from the program.
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.
It costs about $5 billion to cover the meager wages of a veritable army of caregivers – often members of the recipient's family – who do the drudge work that keeps the bedridden, the frail, the mobility impaired out of institutions. The federal government picks up the lion's share of the tab. The rest is covered by the state and the counties.
The cost grows larger each year. Because the need gets larger. Because California's population is getting older. Because the baby boom is now the aging boom. And yet, despite the growing cost, it is still dramatically cheaper to care for someone at home (about $13,000 a year) than to place them in an already overburdened nursing home ($55,000 or more).
Reports of rampant fraud in IHSS are nothing new. It's the same story with all government programs. We've recently seen reports of corruption beyond credulity, even suggesting that one of every four dollars is lost to cheaters. Such a rate is highly unlikely.
Still, no one disputes that there are cheaters, nor that those cheaters should be held accountable. We have enough information to know that fraud exists. But we don't have any kind of reliable data to tell us the extent, nor how best to stop it. It's time to gather that data.
Assembly Bill 682, by Bonnie Lowenthal, which passed its first committee recently, calls for a study of fraud to get a dependable baseline number from which we can make informed decisions on 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 don't respond by gutting the program, any more than we respond to insurance fraud by canceling our insurance policies. We know there are crime rings that specialize in rigged accidents, but we don't spend less on auto coverage because of that.
It's the same with fraud on Wall Street or in the banking system. Not only did we not jettison 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. Yes, there is fraud. We need to find it and stop it. But 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, it is necessary. 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.
Lowenthal represents the 54th Assembly District, which includes Long Beach, Signal Hill, San Pedro, Avalon and the cities of the Palos Verdes Peninsula.
Saldaña is the speaker pro tem of the Assembly and represents the 76th District, which includes San Diego and surrounding communities.
Yamada represents the 8th Assembly District, which includes Vacaville, Davis, West Sacramento, Fairfield and Benicia.