Health Disparities


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The HOME Project

The HOME Project (Helping Older-adults Maintain independencE) is an ongoing qualitative study that is documenting the experiences of older Californians with disabilities who depend on fragile arrangements of paid public programs and unpaid help to live safely and independently at home.

In-depth interv
iews are being conducted with older adult consumers of In-Home Supportive Services (IHSS) and their caregivers; most receive other public supports and/or informal help as well. All are insured through both Medicare and Medi-Cal (dual eligible) and the second phase of the Home Project specifically looks at elders eligible for the state's new Cal MediConnect managed care program. 

The following publications and case studies document the experiences of older adults with disabilities who receive state services, and highlight the effects of budgetary reductions and delivery system changes.

Related publications:​


Related case studies: HOME Project - Year 2 (2012-2014)

These case studies document the experiences of some of the 37 seniors participating in the second phase of the HOME Project as they transition to managed care under the Cal MediConnect Program.

Angie is an immigrant who worked until she was diagnosed with a number of health conditions, including Parkinson's disease, diabetes, heart disease, and non-Hodgkin's lymphoma, which is in remission. She struggles with social isolation and has experienced significant gaps in her medical care network, in particular, the availability of providers that speak her native language.

Despite her tendency to be very engaged in her community and with the coordination of her own care, Wilma has increasingly had to rely on family members to help manage her medical care and long-term services and supports. After struggling with numerous hospitalizations and a new diabetes diagnosis, Wilma had relocated to an assisted living facility by the end of the year​.


Related case studies: HOME Project - Year 1 (2010-2011)

These case studies document the experiences of some of the 33 seniors participating in the first phase of the HOME Project as they faced reductions in public supports and services due to state budget cuts.

Ana provides intensive levels of home care – both paid and unpaid - to her elderly parents; both have dementia and have experienced significant health declines over the past year. ;The burden of caring for her parents with limited public support has led to a decline in Ana's own health and well-being.



Bertha lives alone and struggles with diabetes, chronic pain and depression. She has difficulty finding and keeping a caregiver who can help her with household tasks and with personal care needs such as bathing and dressing.​

Given her limited informal support and several chronic physical and mental health conditions, Carmen's IHSS provider is central to her domestic and personal care needs. Any minor change to the limited support services she receives makes a visible impact on Carmen's mental health and day-to-day activities.



Despite multiple health conditions that limit her mobility, Eileen continues to maintain an active lifestyle through her work as a tutor and participation in community and cultural events. Eileen highlights the importance of having consistency and stability in her support services as she experiences ups and downs in her health over the course of a year.

 After experiencing a 40% cut in IHSS hours, Ella's family has done their best to help meet her personal and medical care needs. Ella's fragmented informal and formal support network – and extremely limited financial resources -- have led to a continual struggle to manage her diabetes and depression.

As an IHSS recipient for over 10 years, Fran has been able to live independently in spite of multiple health conditions including fibromyalgia and diabetes, and limited formal and informal support. When Fran loses her home, she struggles to maintain stability in her medical and long-term services and support network, while also searching for an affordable place to live.

 ​A combination of informal and formal supports has enabled Jill to continue to live independently with a neurological illness that has greatly affected her energy level and mobility. With this support network, she manages the challenges that arise as a result of cuts to her IHSS hours, SSI, and social security benefits

After transitioning from his home to a skilled nursing facility, Michael continues to adjust to his life with the help of his IHSS provider and a limited network of support.  This change marked a significant loss of independence, and he struggles with limited opportunities to direct his care.

Roy’s ability to oversee his health and social care needs with the help of his IHSS provider and his service dog has allowed him to continue to live in the comfort of his own home. Although his health begins to deteriorate slowly over the year and he loses his SSI benefit entirely, he continues to advocate for his needs.

 The range of support Vickie receives from her two IHSS providers, a social worker from MSSP, a home health nurse, and her two children enables her to continue to live independently at home with multiple complex and chronic conditions. This network of care allows her to navigate through unexpected problems that arise with housing and finances.

With the help of her daughter and son-in-law who, as family and IHSS providers, manage both her medical and personal care needs with around-the-clock care, Yvette is able to continue to live safely at home. The closure of the Adult Day Health Care center she attended combined with cuts to her IHSS hours  introduce new challenges and a greater burden for her and her family members.


This project funded by: