IHSS Paramedical Services: What Medical Tasks Providers Do

By the Unified Savers Editorial Team

This information is based on official California DSS guidelines and is reviewed for accuracy. For case-specific legal advice, consult a qualified attorney or your local legal aid organization.

IHSS paramedical services allow an authorized home care provider to perform specific health-related tasks — including wound care, catheter care, medication administration, and respiratory therapy support — that would otherwise require a licensed medical professional. These services are not automatically available. They require a physician’s written order, county social worker authorization, and in most cases specific training for the provider. As of 2026, paramedical services remain one of the least understood and least utilized categories in the IHSS program.

What Paramedical Services IHSS Covers

Under California Welfare and Institutions Code § 12300(b)(6) and CDSS regulations, IHSS paramedical services are health-related tasks that a physician has determined are necessary for the recipient’s medical treatment and that a non-licensed person can safely perform with training and supervision.

Commonly authorized IHSS paramedical services include:

Medication Administration

Oral medications: administering pills, liquids, or supplements at prescribed times
Topical medications: applying prescription creams, ointments, eye drops, or ear drops
Injections: subcutaneous insulin injections and similar subcutaneous medications (not intravenous)
Nebulizer treatments: setting up and administering breathing treatments under physician direction

Wound Care

Cleaning and dressing wounds as directed by the treating physician or home health nurse
Monitoring wounds for signs of infection
Applying prescribed topical treatments

Catheter Care

Routine care and maintenance of urinary catheters (Foley catheters)
Emptying catheter bags
Catheter irrigations as specified in physician orders (if within scope for non-licensed providers per county policy)

Bowel Programs

Digital stimulation and manual evacuation of the bowel for recipients with spinal cord injuries or other conditions requiring this care
This requires specific physician orders and is subject to county-by-county approval

Ostomy Care

Cleaning and maintaining colostomy, ileostomy, or urostomy appliances
Bag changes and skin care around the stoma

Respiratory Services

Suctioning of tracheostomy tubes (in counties and cases where this is specifically authorized)
Assistance with ventilator-dependent care under physician and county approval

Range of Motion Exercises

Passive range of motion exercises to maintain mobility, as prescribed by a physical or occupational therapist
These are sometimes authorized under Personal Care services but may also fall under paramedical

What Paramedical Services IHSS Does NOT Cover

Not every medical task can be performed by an IHSS provider:

Intravenous (IV) medications or fluids: Administration of IV drugs or IV hydration requires a licensed nurse and is not an authorized IHSS paramedical service
Advanced wound care: Wound debridement, wound vac therapy, or care of deep tissue wounds beyond simple dressing changes require licensed medical personnel
Complex tracheostomy management: Many counties restrict trach suctioning; always confirm with your county
Skilled nursing assessments: IHSS providers can perform specific ordered tasks, but they cannot make clinical judgments or assessments — those require a licensed home health nurse
Tasks not ordered by a physician: No paramedical service can be authorized without a written physician order specifying the task, frequency, and any special instructions

How to Get Paramedical Services Authorized

The authorization process for IHSS paramedical services is more involved than for domestic or personal care services because it requires medical documentation:

Step 1: Obtain a Physician’s Written Order Your treating physician must provide a written order specifying:

The exact task to be performed
Frequency and duration (e.g., “wound dressing change daily” or “insulin injection twice daily”)
Any special instructions or contraindications
Confirmation that a trained non-licensed caregiver can safely perform the task

Step 2: Inform Your IHSS Social Worker Contact your county IHSS social worker and request that paramedical services be added to your assessment. Provide the physician order. The social worker will determine whether the requested service falls within IHSS paramedical coverage.

Step 3: Provider Training Most paramedical services require the provider to be trained before performing them. Training may be arranged through:

The treating physician or specialist’s office
A home health nurse (often through Medi-Cal or Medicare home health)
Some counties provide training resources through the IHSS Public Authority

Training requirements and documentation vary by county. In most counties, the training must be documented and may need to be renewed periodically.

Step 4: Authorization and Timekeeping Once authorized, paramedical service hours are added to the recipient’s monthly IHSS service plan. Providers claim these hours through the standard ESP timesheet or TTS telephonic system, typically as a separate service category from domestic and personal care hours.

Paramedical Services vs. Home Health: What’s the Difference?

Paramedical services are often confused with home health services provided through Medi-Cal or Medicare. Here are the key differences:

	IHSS Paramedical	Home Health (Medi-Cal/Medicare)
Who provides care	IHSS provider (non-licensed)	Licensed nurse or therapist
Duration	Ongoing, part of IHSS hours	Time-limited (skilled care episode)
Payment source	IHSS program	Medi-Cal/Medicare
Authorization	County social worker + physician	Physician order + plan authorization
Tasks covered	Defined, simpler medical tasks	Full skilled nursing care

Many recipients use both programs: home health for initial wound care training and skilled nursing checks, and IHSS paramedical services for the daily ongoing care between skilled visits.

Hours Calculation for Paramedical Services

Like all IHSS services, paramedical service hours are based on time-study formulas applied to the frequency and complexity of the authorized tasks. Unlike domestic services, paramedical hours are heavily driven by physician orders:

A daily insulin injection might be authorized at 0.25 hours per day (7.5 hours per month)
Daily wound dressing changes might be authorized at 0.5–1 hour per day
Catheter care might be authorized at 0.25–0.5 hours per day plus additional time for bag changes

Total paramedical hours are added on top of personal care and domestic service hours in calculating the recipient’s overall monthly authorization. They do not reduce other service categories.

What to Do If Paramedical Services Are Denied

If your county social worker denies a paramedical service request, you have options:

Ask for the denial in writing. Request a formal Notice of Action (SOC 157) explaining the reason for denial. You cannot appeal without it.
Review the denial reason. Common reasons for denial: the task is not within IHSS paramedical scope, the physician order is insufficient, or no county-approved training is available. Each has a different remedy.
Obtain stronger documentation. A more detailed physician letter explaining the medical necessity and safety of having a non-licensed provider perform the task sometimes reverses a denial.
File a State Fair Hearing. You have the right to appeal any denial through a fair hearing (WIC § 10950). File within 90 days of the Notice of Action. Legal Aid organizations in California assist IHSS recipients with fair hearings at no cost.

Frequently Asked Questions

Q: My IHSS provider currently gives me my insulin injections without being authorized for paramedical services. Is this a problem? Yes, this is a compliance risk for both the recipient and provider. If the provider is not authorized for and claiming insulin administration as an IHSS paramedical service, neither the provider nor the program has a record of this care. If something goes wrong, there is no protection for either party. Additionally, unauthorized paramedical tasks can expose the provider to liability. Request authorization through the proper process.

Q: Does the provider need a nursing license to perform paramedical services? No. IHSS paramedical services are specifically designed to allow non-licensed providers to perform tasks that would otherwise require a nurse, with physician authorization and training. California Health & Safety Code § 123110 and related statutes permit this arrangement within the IHSS program context.

Q: Can a family member who is my IHSS provider perform paramedical services? Yes. The IHSS program allows eligible family members (including spouses under specific conditions, and parent providers for adult children) to serve as providers. A family member authorized as your IHSS provider can perform paramedical services if all the standard requirements are met: physician order, social worker authorization, and appropriate training documentation.

For more information on IHSS services, authorized hours, and provider rights in California, visit Unified Savers — a trusted resource for IHSS recipients, caregivers, and home care workers across California.