COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Department

DATE:

December 20, 2004

BOARD MEETING DATE:

January 11, 2005

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Four-fifths

TO:

Honorable Board of Supervisors

FROM:

Charlene A. Silva, Director, Health Services Agency

Lisa Mancini, Director, Aging and Adult Services Division

SUBJECT:

Aging and Adult Services Reorganization

Recommendation

1.

Approve an Appropriation Transfer Request to recognize additional federal and state welfare administration revenues and associated expenses in the amount of $324,000

2.

Adopt a Salary Ordinance Amendment deleting two positions and adding five positions to implement the recommendations

Vision Alignment

Commitment: Ensure basic health and safety for all

Goal 8: Help vulnerable people – the aged, disabled, mentally ill, at-risk youth and others – achieve a better quality of life.

The reorganization plan contributes to this commitment and goal by assuring quality programming, detecting and preventing program fraud and abuse, and improving efficient service delivery.

Background and Discussion

Aging and Adult Services (AAS) and the Public Authority for In-Home Supportive Services provide a variety of services for seniors and disabled adults including Adult Protective Services, the Public Guardian, In-Home Supportive Services (IHSS), case management, and an array of services provided through many community-based organizations.

Commissions and Provider Services Unit (CPSU)

As part of Aging and Adult Services (AAS) 2004-05 budget a Health Services Manager I position was eliminated. The position has been responsible for overseeing the work of the Commissions on Aging and on Disabilities, meeting requirements of the Older Americans Act and Older Californians Act, and managing the division’s array of community-based services. In addition it had responsibility for the county’s response to the public access components of the Americans with Disabilities Act (Title II) (ADA). Changes proposed for CPSU include replacing the HSM I position with a Program Services Manager I position, shifting ADA responsibilities from AAS to Health Administration staff, and consolidating contract monitoring and liaison responsibilities from five Community Program Specialists (CPSs) to four. The fifth CPS position will be transferred to AAS Administration to work with the Director in place of the Management Analyst position, which will be deleted.

In-Home Supportive Services (IHSS)

As a part of the state’s efforts to balance its budget for 2004-05, two actions were taken that impact IHSS locally: 1) initiation of the Federal Waiver which increased the federal share of the cost of IHSS, and 2) the passage of the Quality Assurance and Program Integrity Act (SB1104), which includes a number of enhanced activities to be performed by the counties and by the state Departments of Social Services and Health Services. Goals of these activities are to improve IHSS assessments, standardize service authorizations, and detect and prevent fraud and abuse. Therefore, we are proposing the following changes:

a.

Transfer a long vacant CPS position from the Public Authority to IHSS to develop, implement, and supervise the Quality Assurance and Program Integrity effort in San Mateo County.

b.

Fill a vacant Social Work Supervisor position to improve supervision in IHSS to enhance quality assurance efforts.

c.

Convert a vacant Deputy Public Guardian III position to a Social Worker II and transfer the position into IHSS, and add one new Social Worker II position to IHSS. One worker will be assigned fulltime as Intake Specialist, to standardize intake assessments. The other will carry a full caseload, slightly reducing overall caseloads, allowing all staff to take on additional quality assurance tasks

d.

Add a new Office Specialist to IHSS to support the increased staff and quality assurance activities in the unit

The County Manager’s Office and Employee Public Service staff have reviewed and approved this plan.

Fiscal Impact

There is no additional net county cost associated with this reorganization plan. The cost of adding the Program Services Manager position will be met through savings achieved in deleting the Management Analyst. The cost of the additional positions in IHSS will be met with new state and federal welfare administration revenues made available through an increased allocation from the Department of Social Services and as described in the ATR. Estimated salary and benefits costs for IHSS are $121,000 for the remainder of 2004-05. The balance of the revenues added through this ATR ($202,900) will provide funds for a variety of expenses, most of which are one-time expenses to provide infrastructure improvements and supplies and equipment for new employees. The ATR adds $124,000 in state welfare administration revenues and $200,000 in federal welfare administration revenues.