By the Unified Savers Editorial Team
This information is based on California CDSS program guidelines. IHSS service availability and hour limits can change. Contact your county IHSS office for current information specific to your situation.
IHSS covers four main service categories: domestic services (housekeeping, meal preparation), personal care services (bathing, dressing, grooming), paramedical services (assistance with medical tasks ordered by a physician), and protective supervision (for recipients who cannot be safely left alone). The exact services and number of authorized hours depend on a county social worker’s in-home assessment of the recipient’s functional needs and living situation. Most IHSS recipients receive between 40 and 120 hours of authorized service per month.
The Four Main Categories of IHSS Services
California’s IHSS program divides covered services into four broad categories. Understanding these categories helps recipients know what to request during their social worker assessment and helps providers understand the tasks they are authorized — and not authorized — to perform.
Category 1: Domestic Services
Domestic services cover tasks related to maintaining the recipient’s home environment. These are the most commonly authorized IHSS services.
Covered domestic services include:
- Housecleaning: Vacuuming, mopping, dusting, cleaning the kitchen and bathroom, taking out trash
- Laundry: Washing, drying, and folding the recipient’s clothes and linens
- Meal preparation: Planning and cooking nutritious meals appropriate to the recipient’s dietary needs and restrictions
- Grocery shopping and errands: Shopping for food and household items necessary for the recipient’s care
- Dishwashing: Cleaning dishes and kitchen utensils after meals
Important limitations: Domestic services are authorized only for tasks the recipient cannot perform themselves due to their disability or medical condition. IHSS does not cover cleaning for other household members who are not the IHSS recipient. If a recipient lives with family, only the recipient’s share of cleaning may be covered.
Category 2: Personal Care Services
Personal care services are the most varied IHSS category and cover the direct physical assistance that recipients need because of functional limitations.
Covered personal care services include:
- Bathing and grooming: Assisting with bathing, showering, oral hygiene, hair washing and styling, shaving, and nail care
- Dressing: Helping the recipient put on and remove clothing and adaptive equipment
- Bowel and bladder care: Assistance with toileting, incontinence care, and catheter management
- Ambulation and transfers: Helping the recipient move safely — getting in and out of bed, wheelchairs, chairs, and vehicles
- Feeding: Assisting with eating for recipients who cannot feed themselves independently
- Respiration: Assistance with respiratory devices (not including skilled nursing tasks)
- Rubbing and range of motion: Providing massage for circulation or prescribed range of motion exercises
Personal care services require the most documented medical need and are typically tied directly to the recipient’s diagnosis and functional limitations documented in their care plan.
Category 3: Paramedical Services
Paramedical services assist recipients with medical tasks that would otherwise require a nurse or trained caregiver. In IHSS, a provider can be authorized and trained to perform certain medical assistance tasks under a physician’s written order.
Covered paramedical services include:
- Bowel programs: Following a prescribed bowel care protocol
- Gastrostomy tube feeding: Assisting with tube feeding under physician and nursing instruction
- Tracheostomy care: Suctioning and basic trach care as instructed
- Wound care: Basic wound dressing changes as prescribed
- Medication management: Organizing medications (not administering injections — that requires a licensed nurse)
- Catheter care: Emptying and cleaning urinary catheters
Paramedical services almost always require a physician order, and the IHSS recipient’s social worker may require nursing approval for these tasks to be included in the authorized hours.
Category 4: Protective Supervision
Protective supervision is a specialized IHSS service category for recipients whose cognitive or mental health condition means they cannot be safely left alone — even if they are physically capable of performing some tasks independently.
Qualifying conditions typically include:
- Alzheimer’s disease and other dementias
- Traumatic brain injury with behavioral symptoms
- Severe intellectual disability
- Certain serious mental illnesses where the person is at risk of harm without ongoing oversight
Protective supervision is one of the most misunderstood IHSS categories. It does not require the provider to be doing a specific task at every moment — it authorizes the provider to be present and available to prevent accidents, intervene in unsafe behaviors, and monitor the recipient’s safety continuously.
Protective supervision hours are typically among the highest-authorized in IHSS, sometimes reaching the maximum monthly hours, because the need is continuous rather than task-specific. Approval requires strong documentation from physicians and sometimes a mental health professional.
What IHSS Does NOT Cover
Understanding IHSS exclusions is as important as understanding what’s covered.
Services IHSS does not cover:
- Medical services requiring licensure: IHSS providers cannot give injections, administer IV medications, or perform wound debridement — these require licensed nurses
- Skilled nursing visits: IHSS does not cover registered nurse visits; these are handled through Medi-Cal home health benefits separately
- Yard work and home maintenance: IHSS does not cover lawn mowing, gardening, or home repairs
- Pet care: IHSS covers only care tasks related to the recipient, not caring for pets or other household members
- Transportation to non-medical destinations: IHSS covers accompaniment to medical appointments, but not general transportation services
- Childcare: IHSS does not cover childcare for the recipient’s children
Services for live-in providers only: Certain tasks, such as laundry and cooking, are sometimes authorized at lower hours when the provider lives in the same home as the recipient, because the provider naturally performs some domestic tasks for themselves. The social worker accounts for this overlap during the assessment.
How IHSS Authorized Hours Are Determined
IHSS hours are set by your county social worker based on an in-home assessment called the IHSS Assessment. During this visit, the social worker evaluates:
- Which functional tasks the recipient cannot perform safely or independently
- How much time each task reasonably takes given the recipient’s condition
- The recipient’s living situation (live-alone, with family, or in a shared home)
- Medical documentation supporting the level of care needed
Typical monthly hour ranges by care level:
- Low-need recipients: 20–80 hours/month (primarily domestic services)
- Moderate-need recipients: 80–180 hours/month (domestic + personal care)
- High-need recipients: 180–283 hours/month (personal care + protective supervision or paramedical)
- Maximum monthly hours (2026): 283 hours per month for most recipients; exemptions allow more in specific circumstances
If a recipient or provider believes the authorized hours are insufficient for the recipient’s actual care needs, they have the right to request a reassessment at any time and to appeal any hour reduction.
How to Ensure All Eligible Services Are Authorized
Many IHSS recipients receive fewer services than they are entitled to because the social worker is not aware of the full scope of their needs. Here’s how to prepare for your IHSS assessment to ensure all covered services are considered:
- Document every task you need help with — write down every daily and weekly care task, how long it takes, and why you cannot do it independently
- Gather medical documentation — request letters from your physician, specialist, or therapist describing your functional limitations and the care tasks you need
- Review your Notice of Action — after your assessment, review the service list carefully. If a task you need was not authorized, ask the social worker to explain why
- Request paramedical authorization if applicable — if you need help with physician-ordered medical tasks, ask specifically for paramedical services to be added with supporting medical documentation
- Appeal if hours seem insufficient — you have 90 days from the Notice of Action to request a state hearing if you believe your assessment was incorrect
FAQ
Can my IHSS provider help me with tasks not listed on my care plan? No — IHSS providers are authorized only to perform the specific tasks listed in the recipient’s approved care plan and are paid only for those authorized tasks. Performing tasks outside the authorized scope is a program violation. If you need an additional task added, contact your county IHSS social worker to request a reassessment. The reassessment process can add new services if the recipient’s needs have changed.
Does IHSS cover transportation to medical appointments? IHSS does cover “accompaniment” — a provider accompanying a recipient to and from medical appointments, pharmacies, and health-related errands. The provider’s travel time is covered while accompanying the recipient, but IHSS does not pay for driving or vehicle costs. Transportation vehicle costs are a separate Medi-Cal benefit. Verify with your county office how transportation accompaniment is authorized in your care plan.
What happens if my recipient’s condition changes and they need more services? If a recipient’s condition changes — new diagnosis, surgery recovery, progression of existing condition — they can request a reassessment at any time by contacting their county IHSS office. The social worker will conduct a new in-home assessment and may increase authorized hours and services based on the updated needs. Do not wait for the annual reassessment if care needs have significantly increased. Bring updated medical documentation to support the request.
Additional Resources on Unified Savers:
- IHSS Hours Calculation California — How the state calculates your authorized monthly hours
- IHSS Reassessment Process — How to request a new assessment
- How to Appeal IHSS Hours Reduction — Your rights when hours are cut
- IHSS Protective Supervision Guide — Detailed guide to protective supervision authorization