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IHSS Advocacy Guide

by Paul Greenberg

These are the four functional categories that lead to hours:
1
1
Domestic Services
(cleaning, laundry)
2
2
Related Services
(meal prep, shopping)
3
3
Personal Care Services
(bathing, dressing, feeding, toileting)
4
4
Protective Supervision
(constant oversight for safety)
5
5
Paramedical Services
(giving treatments, tube feeding)

• Protective Supervision is often the largest source of hours for a child—up to 283 hrs/month.
Document Everything Daily
Keep a care log/journal showing:
Every task you do for your child.
The minutes spent each time.
Any safety incidents or near-incidents.
Be specific:
  • Don't say: "Helped with feeding"
  • Do say: "Fed child by hand for 30 mins; prevented choking on food twice."
  • Include nighttime interruptions if you are up for safety-related reasons.
Prepare Evidence Before the Needs Assessment
Collect:
  • Doctor's letters describing:
  • Constant need for supervision.
  • Safety risks (wandering, choking, seizures, self-harm, aggression, etc.).
  • Cognitive/mental impairments that require redirection or protection.
  • School reports showing need for a 1:1 aide or behavioral plan.
  • Therapist/ABA reports describing unsafe behaviors.
Use IHSS Language
Ask medical providers to use language IHSS understands:
  • "Unable to self-direct"
  • "Requires continuous, 24-hour monitoring to prevent injury to self or others."
Maximize Protective Supervision Hours
Key criteria:
Child must have a mental impairment or mental illness AND require 24-hour supervision to prevent injury.
Show that:
  • Dangerous behaviors are frequent and unpredictable.
  • Injury would likely happen without your immediate intervention.
Example advocacy framing:
"My child cannot recognize dangers such as traffic, sharp objects, or strangers, and has run into the street multiple times without warning."
During the Home Assessment Interview
Don't minimize needs
Describe the worst days, not the best.
Be consistent
Your answers, doctor's reports, and care logs must align.
Avoid vague answers
Don't say "sometimes." Instead say: "Four times in the past week, my child climbed furniture and nearly fell."
Key Tips to Maximize Hours
Use specific safety risk examples
(wandering, choking, falls, aggression)
Log every incident
More incidents = stronger case
Use video or photo evidence
If safe and appropriate
Get multiple supporting letters
From different providers (doctor, therapist, school)
Never say your child can be left alone
Even briefly, if you are pursuing protective supervision
Paramedical Services
Any specialized treatments, Requires Doctors order
After the Award Notice
If hours are less than what's needed:
File an appeal within 90 days
Continue documenting needs
Until the hearing
Request aid paid pending
So hours stay the same during appeal