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San Diego ranked last on state funding for cerebral palsy, epilepsy, and autism care

San Francisco tops of California's "respite care" money pile, audit finds

Families at San Diego used a median of 27 percent of authorized funding for respite services.
Families at San Diego used a median of 27 percent of authorized funding for respite services.

San Diego has come up significantly short against the San Francisco Bay Area regarding state funding for so-called respite family services, an August 30 report by acting California State auditor Michael Tilden says.

"In fiscal year 2020–21, families at San Diego used a median of 27 percent of authorized funding for respite services while families at Golden Gate used a median of 90 percent," according to the audit.

Magnifying the disparity, San Diego serves 35,000 consumers, compared to 10,000 for Golden Gate, according to the report, and average San Diego payments per case were lowest among those surveyed.

"The average respite authorization per consumer for fiscal year 2020–21 varied among the four regional centers we reviewed from roughly $8,000 per consumer at San Diego to more than $15,000 per consumer at San Andreas."

Families at San Diego used a median of 27 percent of authorized funding for respite services.

California's in‐home respite services program "provides temporary care and supervision to individuals with intellectual and developmental disabilities who reside with family members," notes the document.

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"Twenty-one contracted regional centers coordinate respite services for consumers in their respective areas."

"Developmental disabilities include intellectual disabilities, cerebral palsy, epilepsy, autism, and other disabling conditions closely related to an intellectual disability," the report says.

"In‐home respite services are designed to protect the consumer’s safety and to address basic self‐help needs and other activities that would ordinarily be performed by the family members."

"In‐home respite services are critical to families that care for loved ones who are consumers because these services can help improve family relationships by providing primary caregivers relief from their duties."

But "roughly 21 percent of caregivers authorized each year to receive in‐home respite services do not use any of these services," says the audit.

"The most common barrier that users reported in our survey was a lack of available respite workers for the times needed. In fact, of the nearly 950 survey respondents who reported experiencing barriers, nearly 70 percent, or 650, identified the lack of available respite workers for the times needed as a barrier or challenge to using in‐home respite services.

Though it gets significantly more monetary support than San Diego, Golden Gate, which covers Marin, San Francisco and San Mateo counties, comes in for criticism along with San Diego for failing to furnish adequate access to services.

"Our audit of four of these regional centers— Golden Gate, Inland, San Andreas, and San Diego—found that [the Department of Developmental Services] has not adequately taken action to reduce barriers to some families’ access to respite services."

"Some families were not able to access respite services because of barriers such as a lack of available respite workers and difficulty finding respite workers who speak the family’s language," says the report.

Without specifics, the document adds that, though a 2018 law repealed a previous limit on respite services, the state's Developmental Services Department "has not adequately ensured that regional centers are no longer limiting the number of respite hours a family may receive. In particular, we found that some regional centers still have policies that impose a limit.

"For example, one regional center’s policy states that the regional center may not authorize more than 90 in‐home respite hours in a quarter for a consumer.

"Because [Developmental Services] does not ensure that regional centers have clear processes or documentation, it cannot determine that they are not inappropriately restricting the number of in‐home respite hours made available to families."

The audit encouraged more use of the so-called Financial Management Services method of providing services, also known as Participant‐Directed Services, which the report says provides clients with benefits "such as hiring their own respite worker with whom they are comfortable and who speaks their language."

"Even though the [Financial Management Services] option may be the best choice for some families, the regional centers we reviewed have neither adequately informed all families about its existence nor ensured that this option was available to families."

"Only 11, or less than 1 percent, of the more than 11,000 families using in‐home respite services offered by San Diego used the FMS option in fiscal year 2020–21," per the audit. "San Diego explained that it does not have a vendor that provides FMS services, which may account for its low level of family caregivers using that option."

"San Diego conducted very little outreach to inform families of the FMS option."

In an August 5 response to a draft of the audit, Developmental Services director Nancy Bargmann "partially agreed to the recommendation," adding, "In lieu of modifying regional center contracts, [Developmental Services] will include the development of FMS providers as a priority for the upcoming Community Resource Development Plans which are prepared by regional centers each fiscal year."

Regarding limits on the centers’ services called out by the audit, the response says, "By October 2022, [Developmental Services] will review the policies of all 21 regional centers to ensure that they do not contain provisions that impose overall limits and will require revisions as necessary.

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Families at San Diego used a median of 27 percent of authorized funding for respite services.
Families at San Diego used a median of 27 percent of authorized funding for respite services.

San Diego has come up significantly short against the San Francisco Bay Area regarding state funding for so-called respite family services, an August 30 report by acting California State auditor Michael Tilden says.

"In fiscal year 2020–21, families at San Diego used a median of 27 percent of authorized funding for respite services while families at Golden Gate used a median of 90 percent," according to the audit.

Magnifying the disparity, San Diego serves 35,000 consumers, compared to 10,000 for Golden Gate, according to the report, and average San Diego payments per case were lowest among those surveyed.

"The average respite authorization per consumer for fiscal year 2020–21 varied among the four regional centers we reviewed from roughly $8,000 per consumer at San Diego to more than $15,000 per consumer at San Andreas."

Families at San Diego used a median of 27 percent of authorized funding for respite services.

California's in‐home respite services program "provides temporary care and supervision to individuals with intellectual and developmental disabilities who reside with family members," notes the document.

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"Twenty-one contracted regional centers coordinate respite services for consumers in their respective areas."

"Developmental disabilities include intellectual disabilities, cerebral palsy, epilepsy, autism, and other disabling conditions closely related to an intellectual disability," the report says.

"In‐home respite services are designed to protect the consumer’s safety and to address basic self‐help needs and other activities that would ordinarily be performed by the family members."

"In‐home respite services are critical to families that care for loved ones who are consumers because these services can help improve family relationships by providing primary caregivers relief from their duties."

But "roughly 21 percent of caregivers authorized each year to receive in‐home respite services do not use any of these services," says the audit.

"The most common barrier that users reported in our survey was a lack of available respite workers for the times needed. In fact, of the nearly 950 survey respondents who reported experiencing barriers, nearly 70 percent, or 650, identified the lack of available respite workers for the times needed as a barrier or challenge to using in‐home respite services.

Though it gets significantly more monetary support than San Diego, Golden Gate, which covers Marin, San Francisco and San Mateo counties, comes in for criticism along with San Diego for failing to furnish adequate access to services.

"Our audit of four of these regional centers— Golden Gate, Inland, San Andreas, and San Diego—found that [the Department of Developmental Services] has not adequately taken action to reduce barriers to some families’ access to respite services."

"Some families were not able to access respite services because of barriers such as a lack of available respite workers and difficulty finding respite workers who speak the family’s language," says the report.

Without specifics, the document adds that, though a 2018 law repealed a previous limit on respite services, the state's Developmental Services Department "has not adequately ensured that regional centers are no longer limiting the number of respite hours a family may receive. In particular, we found that some regional centers still have policies that impose a limit.

"For example, one regional center’s policy states that the regional center may not authorize more than 90 in‐home respite hours in a quarter for a consumer.

"Because [Developmental Services] does not ensure that regional centers have clear processes or documentation, it cannot determine that they are not inappropriately restricting the number of in‐home respite hours made available to families."

The audit encouraged more use of the so-called Financial Management Services method of providing services, also known as Participant‐Directed Services, which the report says provides clients with benefits "such as hiring their own respite worker with whom they are comfortable and who speaks their language."

"Even though the [Financial Management Services] option may be the best choice for some families, the regional centers we reviewed have neither adequately informed all families about its existence nor ensured that this option was available to families."

"Only 11, or less than 1 percent, of the more than 11,000 families using in‐home respite services offered by San Diego used the FMS option in fiscal year 2020–21," per the audit. "San Diego explained that it does not have a vendor that provides FMS services, which may account for its low level of family caregivers using that option."

"San Diego conducted very little outreach to inform families of the FMS option."

In an August 5 response to a draft of the audit, Developmental Services director Nancy Bargmann "partially agreed to the recommendation," adding, "In lieu of modifying regional center contracts, [Developmental Services] will include the development of FMS providers as a priority for the upcoming Community Resource Development Plans which are prepared by regional centers each fiscal year."

Regarding limits on the centers’ services called out by the audit, the response says, "By October 2022, [Developmental Services] will review the policies of all 21 regional centers to ensure that they do not contain provisions that impose overall limits and will require revisions as necessary.

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