Care Partners, an Alameda County collaboration, Social Services and Health Care Services agencies share responsibility with hospice providers for shaping what will be a transformative change requiring extensive collaboration between health-based and community-based care teams.


In America each day 8,000 -10,000 people are turning 65 years old. Life expectancy has increased from 50 years in 1900 to 78.5 years in 2000.  In Alameda County we anticipate over one hundred percent increase in persons over 60 years old by 2030. The Elderly will age in place: 38% will live with disabilities; 27% will live in low-income households; 15% will live in households with no car; and, only 14% are actively engaged in the labor force.  According to the Center for Disease Control, most people (80%) are diagnosed with a chronic degenerative illness in their 50s and spend the next 20 years managing the illness.  They eventually die of the illness or a complication of that illness.

Many critically ill people are living in low income households with disabilities. The California, In-Home Support Services Program (IHSS) is administered by the Alameda County Department of Adult Aging and Medical Services supports over 19,000 people in their effort to stay at home while managing disabilities. The Public Authority (PA) is  funded to provide in-home help to qualified In-Home Support Services consumers. Each qualified consumer will hire a PA Chore Worker to provide assistance with daily living chores.  IHSS 2016 data show countywide that 16% of IHSS consumers are 85 years old and 2% of IHSS consumers are 95 years old. We estimate 3,000 consumers can be categorized as old to old-old.

Care Partners Pilot was developed to achieve two goals:

    1. Identify and train IHSS Chore Providers and IHSS Social Workers to become allies in an advance care planning conversation that will increase advance health care planning and hospice utilization among terminally ill consumers.
    2. Integrate advance health care planning into the delivery of In-Home-Support Services and investigate the impact on the lives of the terminally ill.


There is clear evidence that people want to have more control and less medical intervention when facing a life-threatening illness.  In spite of that, doctors rarely bring up end-of-life choices with their patients and patients often don’t start those conversations with their families.  Timing of the conversation, differences between doctors and patients in race and class and religion are all barriers to initiating end-of-life discussions in the hospital or office.

The Care Partners pilot program brought innovative ideas for empowering trained IHSS chore workers to become end-of-life conversation starters and planning allies for their clients.  The IHSS workers are in the home with their clients, are trusted and familiar, and have an up-close view of the clients’ overall condition and their decision making style.


Alameda County Health Care Services Agency, Getting the Most Out of Life program and the Social Services Agency, Department of Adult, Aging, and Medical Services together with the Alameda County Hospice Providers Coalition developed the Care Partners Pilot designed to integrate advance health care planning into the IHSS service delivery system. Also to investigate the impact of hospice, an underutilized Medicare and Medi-Cal benefit on the lives of the terminally ill IHSS consumer.

The Pilot Phase I August 2015 results show, 156 IHSS social workers and Public Authority chore providers were trained and requested to support CARE PARTNERS outreach to eligible IHSS consumers. Evaluation surveys show 67% of trained IHSS social workers indicated training resulted in a positive response to advance health care planning and a willingness to make referrals to Care Partners program. Further, 100% of Care Partner referrals received from IHSS social workers for in-home advance care planning and hospice educational visits resulted in hospice admissions. First quarter 2016, Care Partners has received more calls and referrals for advance care planning assistance and hospice than the entire previous year. Evidence Care Partners can become an integral part of the support structure providing advance care planning and end-of-life services at a time when consumers face the highest health care costs coupled with high stress and fear.

Phase II July 2016 – will address the question of core competencies and infrastructure requirements to train, manage, set and ensure quality standards for the consistent delivery of an advanced care services within the IHSS and the Adult Protective Services programs. Our analysis supports that the pilot proved feasibility of this approach and we look forward to CARE PARTNERS becoming a regular part of the IHSS program.



Marilyn Ababio, Pilot Director

or 510-667-7415


“Getting the Most Out of Life” program is directing the IHSS Pilot.

For more information contact:

CARE PARTNERS: or call 510-577-3517



To Make a Care Partners Referral:

Secure Fax: 510-577-1965