In-home supportive services for individuals with cerebral palsy in California

Individuals with cerebral palsy (CP) may require personal assistance services for optimal functioning. The primary goal of this project is to determine if differences in health services exist between individuals with CP with family versus non-family member paid personal assistance providers. The secondary goal is to describe the population of children and non-elderly adults with CP receiving in-home supportive services (IHSS) and determine their health care costs compared to other IHSS recipients.

Administrative data from the California Departments of Health and Human Services, Social Services and Developmental Services were linked and de-identified to provide information about individuals receiving IHSS in California in 2005. Recipients with CP were characterized and compared by age. Then to determine the factors associated with hospital use and emergency room (ER) use for IHSS recipients with CP adjusted odds were calculated. Monthly expenditures were calculated from claims data.

2.3% of all IHSS recipients in 2005 had CP of which 46% were children. 59% of recipients with CP have a parent as their paid provider. The presence of other medical diagnoses was the only factor associated with increased adjusted odds of hospital and ER use for both child-aged and non-elderly adult recipients with CP. Functional limitations and provider type were not associated with increased odds of health care utilization. Monthly health care expenditures for recipients with CP were ∼$1000 higher than for other IHSS recipients.

Having a parent as the IHSS provider was not associated with difference in health service utilization. This finding supports the policy of allowing parents to be paid providers.