In the 1950s, the State of California provided for in-home care through the Attendant Care program, which gave a grant to eligible consumers who hired and paid their providers. Funding was from State, Federal and County sources. In the early 1970s, the Homemaker program was added to the Attendant Care program (AKA “Chore” program), allowing those consumers who could not supervise their own workers to receive services from a County-employed homemaker.
In 1973, the State mandated local County control of the Homemaker and Chore programs and provided funding and in 1974, the Social Security Act was amended to transfer local cash assistance programs for the aged, blind and disabled to the federal government (the SSI/SSP program), which, without the State funding mandate, would have ended funding for Attendant Care and the Homemaker program. In 1979, State legislation was passed to end the distinction between the two modes and to identify the consumer as employer and the State as responsible for payments and related fiscal issues. This was the origin of our current In-Home Supportive Services Program.
Initially, IHSS was primarily a program to pay relatives for providing a few hours of care a week to their family members. In the late 70s and early 80s, the program quickly grew and its focus changed to preventing premature institutionalization. In the early 80s, the State set a cap on spending and Counties had to pay for 10% of cost over the cap. Providers received minimum wage and no health benefits. Consumers received little assistance finding workers, workers had difficulty getting jobs, and turnover was high. Efforts to improve wages and benefits and organize workers were frustrated by the absence of an employer of record, with which unions could bargain. Some Counties provided IHSS, under contract, through homecare agencies; a few provided consumers with homemakers employed by the County. SIP was a “supported individual provider” option in some counties, providing additional support to consumers who hired their own workers.
In the late 80s and early 90s, advocates for seniors and the disabled joined with labor and local government and were successful in securing the passage of legislation in 1993 that allowed Counties to set up a public authority or non-profit consortium that would establish a registry to help consumers find workers, investigate the background and qualifications of the workers, provide for training, and serve as the employer of record for collective bargaining. To ensure a strong consumer voice, consumer-majority governing or advisory boards were mandated. The legislation became W&I code 12301.6.
San Mateo, Alameda and San Francisco Counties set up the first three public authorities in the mid 90s and negotiated the first agreements with the unions representing the IHSS providers. Public authorities, County government and labor began working together to improve wages and provide health benefits, offer training and other support services to consumers and workers, and to provide opportunities for consumers to influence what and how IHSS services are provided. In the early 1990s, the federal government began funding over 50% of the cost of the IHSS program (and public authorities) under the Personal Care Services Program, a Medicaid Waiver program.
In 1999, AB 1682 became law, requiring each County to establish a public authority or similar entity by January 2003. The original public authorities began meeting as the Public Authority Council in the mid 1990s as an informal workgroup that shared information and their experience. CAPA is a direct descendent of that Council.