Report 2021-120 Recommendations

To ensure that it has sufficient data to better identify usage barriers and disparities, DDS should update its in-home respite data by February 2023 to periodically track the amount of respite hours authorized and used by each regional center, and the usage of each service delivery option (Agency, EOR, or FMS). DDS should use this information and the data it already collects from the regional centers to identify potential limits, trends, and disparities related to in-home respite services. DDS should, at a minimum, analyze the usage of and authorization for in-home respite services across the categories we list in the report. That analysis should identify any disparities statewide, at individual regional centers, or among regional centers. If DDS identifies problematic disparities that suggest barriers to the use of in-home respite services, then it should take action to address them. For example, DDS should direct regional centers with low FMS usage to conduct additional outreach to ensure that families are aware of the benefits of this option.

DDS should review the policies of all 21 regional centers by October 2022 to ensure that they do not contain provisions imposing overall limits on the amount of in-home respite service hours authorized for families to receive each quarter and require revisions as necessary.

DDS should develop standard outreach materials by February 2023 that present key information about each respite service delivery option, including a description of each option and its benefits and drawbacks. It should provide these outreach materials in multiple languages on its website and to all regional centers to include on their websites and disseminate to all of the families that use centers' services so that they have the knowledge and opportunity to select the option that best fits their needs.

DDS should amend its contracts with the 21 regional centers by February 2023 to require all regional centers to have a plan for ensuring that they have an adequate number of service providers for all in-home respite service delivery options, including the FMS option.

DDS should amend its contracts with the 21 regional centers by February 2023 to direct them to train their service coordinators to explain the benefits of each of the in-home respite service delivery options so that families can determine which option will work best for them.

The Legislature should amend state law to require regional centers to include in their annual disparity reports to DDS—which show demographic data about the users of in-home respite services—specific, measurable actions to reduce barriers and disparities in the use of these services. At a minimum, these reports should identify the following:

- Concrete, measurable actions the regional center will take to improve access to in-home respite services.

- Timelines for completing those actions, including specific intervals for periodic updates on progress.

- Specific outcomes the regional center plans to achieve through these actions.

The Legislature should amend state law to require DDS to submit a plan to the Legislature during the annual budget process that outlines the specific and measurable actions it will take to reduce barriers and disparities in the use of in-home respite services.

To ensure that DDS takes adequate actions to verify that regional centers address barriers, the Legislature should amend state law to do the following:

- Require DDS to annually follow up with regional centers by instructing the centers to produce a status report each year on steps they have taken to reduce barriers to using in-home respite services.

- Require corrective actions from regional centers that DDS determines have failed to take sufficient action.

To promote transparency and accountability, the Legislature should require DDS to promulgate regulations establishing a standard method—similar to the assessment tool used by some regional centers—for regional centers to document their rationale for determining the amount of in-home respite hours they authorize.

The Legislature should require DDS to, every two years, determine whether the current reimbursement rates for in-home respite services are sufficient to attract an adequate number of respite workers statewide and to adjust the rates accordingly.

The Legislature should require DDS to, every two years, evaluate, develop, and implement incentives, as necessary, to attract in-home respite workers with skills and abilities that can reduce barriers, including the shortage of respite workers who are bilingual or who are trained in dealing with specific behaviors.