Cardboard boxes filled to the brim with paperwork litter the floor of the South of Market apartment that Kathryn Galves shares with her husband.
“This is my on-the-floor filing cabinet,” the 68-year-old said jokingly before explaining that she had planned to hide away the boxes at a nearby storage space
But without outside help, that plan seems daunting. Both Galves and her husband are disabled.
“I have arthritis in both ankles, both knees, both hips and both shoulders, and I don’t know when it’s going to flare up,” said Galves, who in addition to gout also suffers from emphysema. “I take medicine for everything.”
Per her doctor’s orders, Galves is not allowed to lift more than 25 pounds or climb excessive stairs, restrictions that prevent her from accomplishing tasks she once did with ease, like tidying up the apartment or washing the couple’s laundry.
In recent months, a new experimental program has provided Galves with some support in that area. For 15 hours each week, she can count on the assistance of a home care worker, a service that was previously unaffordable to her.
Support at Home, a city-funded pilot program that has been enrolling clients since last August, aims to make in-home care affordable to middle-income San Franciscans who need it. It fills the gap that Galves and an estimated 14,000 other seniors and adults who live with physical and cognitive disabilities fall into.
Classified as “upper-poor,” they have jobs or sources of income that disqualify them from subsidized benefits through Medi-Cal, like free access to In Home Support Supportive Services (IHSS) offered under the state’s low-income health plan, despite a verified need for the service.
The catch is that many senior or disabled San Franciscans who don’t meet the state’s low-income threshold don’t necessarily make enough to pay an average of $28 per hour cost to employ a home care worker out of pocket.
“The income requirements [for Medical] are really low, and asset limits are ridiculous,” said Jessica Lehman, executive director of Senior and Disability Action, one of several advocacy groups that urged The City to fund and test the pilot.
That has been the case for Galves. The retired legal secretary said her Social Security Income was just $2 above the medical income threshold for IHSS.
Support at Home requires a simple one-page application, and clients get signed up within the comfort of their own homes following a referral.
In order to qualify for the program, clients must be 18 years old, San Francisco residents, require assistance with two activities of daily living such as cooking or shopping and be willing to pay a sliding-scale portion of the home care cost, which is determined by income level.
“They can wind up paying as little as $70 per month,” said Laura Liesem, regional director of Community Living Services of the Institute on Aging (IOA), the nonprofit that administers the program. She added that clients “get significantly more care than they can purchase on the market with those dollars.”
Unlike IHSS, clients can have up to $40,000 in assets, not counting a home or a car, and a monthly income of up to 100 percent area median income, which in San Francisco is set at about $80,700 for a single adult, according to Liesem.
In 2016, The City agreed to fund the pilot for Support at Home based on a framework created by its advocates, with some 1.6 million in add-back funding for a period of two years. In that time, the program aims to serve a total of 175 to 250 people.
Shireen McSpadden, director of The City’s Department on Aging and Adult Services, said The City is funding the pilot program “to see if providing  hours of home care a week will help them stay safely at home.”
Another goal of the pilot is to ensure that caregivers are paid decent and fair wages. Home care workers who are hired through three contracting companies under the program are paid $15 per hour — a wage that is “higher than the market rate and higher than [San Francisco] minimum wage,” Liesem said.
Throughout its duration, the pilot is actively assessed by a group of health policy experts at UC San Francisco — and its permanent implementation is dependent on positive results.
A challenge that has emerged so far is capturing adults with disabilities who are not seniors.
To date, 96 people are enrolled in the program, and 48 are waiting to be assessed, according to McSpadden. Of the 96, 10 percent are under 60.
”We are seeking a population that hasn’t been served,” said Liesem, adding that services for seniors are often more accessible than for people with disabilities in San Francisco.
Liesem said the point of the program is to make an impact on individual lives with “a small amount of care” that could potentially keep them in their homes and communities.
Galves said Support at Home has not only improved her quality of life, but that she has also found a friend in her hired home care worker.
“She makes it fun,” said Galves, with a grin. “She helped me pick out clothes for my vacation with my husband for my birthday. She also shaved my head for me.”
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