There is a shortage of aides and barriers that seem illegal with cd services. Many times, attendants have worked and never been paid or paid out of pocket, because the fiscal agents are irresponsible, untrained and make the hiring process difficult. There is a sense of ageism, as the people receiving services are elderly and disabled and yet asked to do things online with little or no knowledge or experience.
Sf services come once a month but should not have to do all the paperwork for fiscal agencies. This is making it hard to get attendants:

there is a 4-6 week gap between starting and payment,

wages are low for necessary medical care that if not provided, creates negligence. 

There is no one seeing why people aren’t using services or helping to find them services. After 3,7,9,16 months there should be someone who moves this person to agency directed or helps them find an aide. Sf just comes and is only set of eyes on person all month. There are no resources for aides. There is a huge shortage. 

Access, this year refused to pay out respite hours near the end of the year. I was told a supervisor would call me but they never did. 3 aides have quit this year as they 1. Got locked out of portal and called and reported this and it was never resolved. 2. They couldn’t complete the application because of errors  and couldn’t access the email for verification, repeatedly. 3. They worked respite hours and approved hours and were not paid. Any other job, this would be illegal. This is why they set it is as the eor, to make the elderly sick and disabled person responsible for the mistakes of the fiscal agent. There is nothing regulating this and there is no choice of provider for fiscal agent. I must change insurance companies to get a new fiscal agent. 

There needs to be a response team not related to the fiscal agent that can help. I understand this is supposed to be sf services but they are paid monthly so I wait 3 months and still things aren’t fixed. I’m not sure how much longer I can stay in home with these “supports” 

agencies in my area have no staff and I have been on a waitlist for over a year. The only ones with aides is home instead and they don’t bill Medicaid. 

There needs to be livable wages, and a system that works to receive pay. These fiscal agents are unintentionally destroying the system of cd services.