New America Media, Commentary, Katharine Hsiao and Anna Rich, Posted: Apr 11, 2011

California’s budget crisis is threatening to decimate crucial health and social services for everyone, but the people who would be most harmed by the proposed cuts are likely to be seniors and people with disabilities, mostly ethnic elders and immigrants.

Data obtained by the National Senior Citizens Law Center (NSCLC) show that among recipients of the state’s In-Home Supportive Services (IHSS), a major target for Sacramento budget cutters, about half (49 percent) speak a language other than English at home.

IHSS provides in-home assistance to frail, lower-income seniors and people with disabilities so they can live safely at home instead of being sent to a nursing home. The program is critically important to ethnic elders, whom research shows are more likely to get long-term care at home than in a nursing facility.
Over 60 Percent From Ethnic Communities.

More than 60 percent of IHSS recipients’ ages 65 and older receiving care at home are from ethnic communities. In contrast, the majority of nursing home residents are white. This means cuts to IHSS would have a disproportionately larger impact on California’s racial and ethnic minority families and communities.

Older adults with limited English proficiency already face significant barriers to getting the home care they need.

One Burmese-speaking refugee, Ms. S, needed IHSS but had trouble getting care due to language barriers. An English-speaking social worker called to set up an appointment, but Ms. S., whose full name we cannot use here, did not understand the arrangement.

Ms. S’s IHSS application was denied because she missed the appointment. It was only after she got help from both a legal aid lawyer and a bilingual community worker that she got approved for IHSS home visits. For ethnic elders, such as Ms. S, the situation is likely to get much worse.

The budget bills Gov. Jerry Brown, a Democrat, recently signed contain very harmful cuts to IHSS. More cuts are anticipated if the governor’s proposed ballot measure to raise state revenue by continuing certain taxes set to expire isn’t passed.

Besides direct cuts to services, new proposed requirements will make getting access to those services even harder. One of these is a new rule that people must get a special medical certification before accessing IHSS. The state anticipates saving upwards of $120 million as a result of this tightened regulation. [For more on this issue, see “California Budget Cuts at Odds With State’s New Alzheimer’s Plan.”]

It is worrisome, though, that some of these potential “savings” would be at the expense (and suffering) of people who don’t speak or read English well enough to understand the complicated regulations.
Whenever the government sets up new bureaucratic hoops, those who have the most trouble jumping through them tend to be vulnerable individuals, often those with limited ability to communicate in English, who are already marginalized.

Overcoming Language Barriers

As the National Senior Citizens Law Center found in its recent report, “Improving Language Access to Keep California’s Older Adults at Home: An Examination of the In-Home Supportive Services Program,” limited English-proficient older adults have a much harder time navigating this complex program, because they often receive important notices in English only. Also, they have trouble getting understandable information over the phone.

NSCLC’s report proposes numerous sensible, cost-effective measures for improving language access to the IHSS program. One measure, for instance, would be to centralize document translation at the state level. Right now, each county has the responsibility of translating many documents. This is a wasteful and duplicative approach, often resulting in translations being unavailable at all.

The NSCLC report also calls for better training for those administering the language interpretation program about how individuals with low English proficiency can fall through the cracks. And it recommends better enforcement of existing language-access laws.

The governor and California Legislature need to stop trying to squeeze savings out of the most vulnerable members of society. Cutting the IHSS program and making it less accessible to seniors with limited proficiency in English is cruel, bad policy and ultimately more expensive for the state.

Without home support programs that serve them in their own language, it will be very difficult for ethnic elders to avoid the expense and isolation of a nursing home, as well as unnecessary and costly emergency room visits.

Shortsighted budget cuts risk causing a health crisis and undermine the stability of thousands of families, who currently care for their frail and elderly parents and grandparents.

For questions, or for additional information about how current and proposed cuts to In-Home Supportive Services and other programs will impact particular immigrant groups and communities of color, contact Katharine Hsiao, khsiao@nsclc.org, 510-663-1055, ext, 306, or Anna Rich, arich@nsclc.org, 510-663-1055, ext. 305.