Estimated Monthly Hours — Summary
Total Estimated Monthly Hours
Based on functional index ranks and documented need level across all service categories
Personal Care~82 hrs
Related~18 hrs
Domestic6 hrs
PS~varies
Category 01 — Personal Care Services
Bathing, Oral Hygiene & Grooming
Rank 4
~14 hrs/mo
Recipient requires substantial human assistance with bathing, oral hygiene, and grooming. Recipient can perform some minimal participation in the task but is largely dependent on the provider for safe completion. Failure to provide assistance poses a risk to the recipient's health and safety. Based on the level of need documented, time has been assessed at the higher end of the applicable range.
📝 Preparer Notes
"Maria can no longer safely enter the shower without physical assistance. On two occasions she has lost her balance and grabbed the towel bar. She requires a shower chair and full hands-on support for washing her hair, body, and performing oral hygiene. She cannot manipulate the toothbrush effectively due to hand tremors."
Dressing
Rank 4
~8 hrs/mo
Recipient requires substantial human assistance with dressing. Physical limitations significantly impair the recipient's ability to manage clothing independently. Provider must assist with most aspects of dressing to ensure safety and completion. Based on the level of need documented, time has been assessed at the middle of the applicable range.
📝 Preparer Notes
"Maria cannot button clothing or manage zippers due to hand tremors and cognitive confusion. She often attempts to dress out of order or puts garments on incorrectly. Full assistance is needed every morning and evening."
Ambulation
Rank 3
~7 hrs/mo
Recipient requires some physical human assistance with ambulation. Recipient can participate in walking but cannot move safely throughout the home without hands-on provider support. Based on the level of need documented, time has been assessed at the middle of the applicable range.
📝 Preparer Notes
"Maria uses a walker but requires standby assistance due to frequent balance issues. She has fallen twice in the past three months — once in the hallway and once in the bathroom. She is unaware of her fall risk."
Bowel & Bladder Care
Rank 5
~26 hrs/mo
Recipient is unable to manage bowel and bladder care with or without human assistance. The provider must complete all aspects of this service including toileting assistance and incontinence management. Based on the level of need documented, time has been assessed at the higher end of the applicable range.
📝 Preparer Notes
"Maria is fully incontinent and requires adult briefs changed multiple times daily. She does not recognize the need to use the restroom and requires full assistance with all aspects of toileting hygiene. This requires provider assistance approximately 6–8 times per day."
Transfer
Rank 3
~4 hrs/mo
Recipient requires some physical assistance with transfers. Recipient can participate in the movement but cannot safely transfer between surfaces without hands-on provider support. Based on the level of need documented, time has been assessed at the middle of the applicable range.
📝 Preparer Notes
"Maria requires physical guidance for all transfers — bed to standing, chair to standing, and entering/exiting the vehicle. She cannot judge distances safely and often misjudges the surface behind her."
Feeding
Rank 1
Independent — 0 hrs
Recipient is independent in feeding. No provider assistance is needed for this task.
Category 02 — Related Services
Preparation of Meals
Rank 5
~30 hrs/mo
Recipient is unable to prepare meals with or without human assistance. The provider must complete all aspects of meal preparation on behalf of the recipient. Based on total dependence in this category, time has been assessed at the higher end of the applicable range.
📝 Preparer Notes
"Maria has left the stove on multiple times. On one occasion a pot boiled dry and nearly caused a fire. She can no longer safely use any kitchen appliances. Full meal preparation assistance is required three times daily."
Meal Clean-up
Rank 4
~11 hrs/mo
Recipient requires substantial human assistance with meal clean-up. Physical limitations prevent safe and independent management of kitchen hygiene tasks following meals.
Shopping for Food (1:00/wk)~4 hrs/mo
Other Errands (0:30/wk)~2 hrs/mo
Laundry — In-home (1:00/wk)~4 hrs/mo
Category 03 — Domestic Services
Housecleaning 4 rooms · 1 exclusive · 2 shared occupants · Max 6 hrs/month
~4:30 hrs/mo
Proration applied: The home has 4 total rooms. The recipient exclusively occupies 1 room (bedroom). The remaining 3 rooms are shared between 2 occupants. Recipient's prorated share = 1 + (3÷2) = 2.5 of 4 rooms = 62.5% × 6 hrs = 3:45 hrs/month. Rounded to 4.5 hrs with rounding adjustment.
Category 04 — Non-Medical Personal Services
Repositioning & Rubbing Skin High frequency — physician ordered~12 hrs/mo
Medication Management Full administration — cannot manage independently~4 hrs/mo
Care of Prosthetic Devices Hearing aids — daily assistance required~2 hrs/mo
Category 05 — Paramedical Services
No physician-prescribed paramedical services identified at this time. If ordered by a physician in the future, this category may be added during reassessment.
Category 06 — Accompaniment & Wait Time
Medical appointments per month ~2.5 hrs per appointment (cognitive assistance)~10 hrs/mo
Accompaniment reasonCognitive — cannot communicate independently
Wait time authorizedYes — unpredictable duration
Add-On — Protective Supervision Analysis
Protective Supervision Assessment Add-On Included
Based on the information provided, the recipient demonstrates significant cognitive impairment that supports a request for Protective Supervision under IHSS criteria. The following findings were documented across all six assessment blocks:
Danger Awareness: Recipient is unable to recognize or respond to dangerous situations. This represents a significant safety risk and supports the need for continuous protective supervision.
Short-Term Memory: Recipient demonstrates severe short-term memory impairment and is unable to retain basic safety information. This level of impairment supports the need for continuous supervision.
Orientation: Recipient is not reliably oriented to time, place, or familiar persons. This level of disorientation poses significant safety risk and supports the need for continuous protective supervision.
Wandering: Recipient has a documented history of wandering, representing a significant safety risk when left unsupervised. Preparer documented: "Maria was found walking down the street at 2am in January 2026. A neighbor called 911. She had no recollection of leaving the home."
Unsafe Home Behaviors: Recipient engages in unsafe behaviors within the home environment that pose a risk to health and safety without continuous supervision. Preparer documented: "Maria has left the stove on, left the front door open in winter, and attempted to take multiple doses of medication within the same hour."
Emergency Events: Recipient has required emergency services as a result of being left unsupervised. This documented history strongly supports the authorization of Protective Supervision.
Diagnosis causing supervision needAlzheimer's Disease (Stage 3, progressive)
Physician documentationYes — documented by neurologist
Can be safely left aloneNo — 24 hours/day supervision needed
History of wanderingYes — police contact January 2026
Unsafe home behaviorsYes — stove, medication, door incidents
Overnight supervision requiredYes — sundowning and nighttime wandering
Physician recommends 24-hr supervisionYes
Neuropsychological evaluation completedYes — 2025
Age group routingElderly (78) — dementia-specific assessment applied
Total Estimated Monthly Hours
IHSSHours.com · Sample only — not a guarantee of eligibility or authorized hours
106 – 124
hours per month
What To Do Next
1
Contact your county IHSS office to request an in-home assessment. Bring a printed or digital copy of this report with you to the visit.
2
Gather supporting medical documentation — physician letters, specialist evaluations, hospital records, and neuropsychological reports. These strengthen your case significantly.
3
Be specific with the social worker about daily needs. Describe each task difficulty in detail — walk them through a typical day. Do not minimize the recipient's limitations.
4
For Protective Supervision: ask your physician to document the diagnosis and safety risks in writing before the visit. Bring records of any wandering, falls, or emergency events.
5
If you disagree with the county's authorized hours, you have the right to request a State Hearing within 90 days. Keep a copy of this report as supporting documentation.
6
IHSSHours.com can be used again before each annual reassessment to help you document any changes in the recipient's condition and prepare for the updated evaluation.