Sample IHSS Hours Estimate
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This is a realistic example of the detailed, multi-page PDF report you'll receive. Every section shown here is generated from your actual questionnaire answers — personalized to the recipient's specific situation.
What makes the IHSS Hours Estimate different
CDSS-Style Narrative LanguageEach task includes an automatically generated assessment narrative using official California CDSS language — the same language your county social worker uses.
Smart Hour EstimatesHours are determined by your specific answers and preparer notes — not a generic range. The system reads your responses and selects the appropriate tier automatically.
Your Notes, In the ReportEverything you write in the Preparer Notes fields appears directly in the report — giving the social worker specific, documented examples of the recipient's needs.
IHSSHours.com
The IHSS Hours Estimate — IHSS Preliminary Assessment
Report Date
June 7, 2026
Maria G., Age 78
Date of Birth
March 14, 1948
County
Sacramento County, CA
Primary Diagnosis
Alzheimer's Disease (Stage 3)
Living Situation
Lives with Adult Daughter
Assessment Type
The IHSS Hours Estimate
Prepared By
Elena G. (Adult Daughter)
Relationship
Adult Child
Current Care
Informal family caregiver (unpaid)
Sample only. All data shown is for illustration. Results are preliminary estimates and do not guarantee IHSS eligibility or hours you may qualify for.
Estimated Monthly Hours — Summary
Personal Care
~82
hrs / month
Related & Domestic
~24
hrs / month
Estimated Total
106–124
hrs / month, plus Protective Supervision
| Task | Rank | Estimated | Basis |
|---|---|---|---|
Bathing, oral hygiene & grooming | 4 | ~14 hrs | Within HTG range |
Dressing | 4 | ~8 hrs | Within HTG range |
Ambulation | 3 | ~7 hrs | Within HTG range |
Bowel & bladder care | 5 | ~26 hrs | Within HTG range |
Transfer | 3 | ~4 hrs | Within HTG range |
Preparation of meals | 5 | ~30 hrs | Within HTG range |
Meal clean-up | 4 | ~11 hrs | Within HTG range |
| — | assessed | Separate analysis |
A monthly ceiling applies to the total. No matter what the task-by-task figures add up to,
a county can authorize at most 283 hours a month if the recipient is severely impaired, or
195 if not (WIC 12303.4, MPP 30-765.111 and .121). “Severely impaired” means a
total assessed need of 20 or more hours a week across non-medical personal services, meal preparation, meal
clean-up where prep and feeding are both required, and paramedical services (MPP 30-701(s)(1)) — the
starred box in the lower middle of a Notice of Action shows the figure. Protective Supervision counts
inside that ceiling, not on top of it. Any assessed need above the ceiling should be recorded on the
Notice of Action as unmet need; it does not add hours, but it is the documented basis for a
WPCS request or a CalAIM Personal Care and Homemaker Services referral.
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.
Category 03 — Domestic Services
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 4:30 hrs with rounding adjustment.
Category 04 — Non-Medical Personal Services
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
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.
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
Sources for this sample
- CDSS Hourly Task Guidelines — weekly time ranges by Functional Index rank, converted to monthly at 4.33 (MPP 30-763.2). Every task figure in this sample falls inside its published range
- MPP 30-757.14 — personal care task definitions; 30-757.131 and .132 meal preparation and clean-up; 30-757.11(k)(1) domestic services
- MPP 30-701(s)(1), WIC 12303.4, MPP 30-765.111 and 30-765.121 — “severely impaired” and the 283 / 195 hour monthly maximums
- MPP 30-757.17, 30-757.171 and 30-757.172 — Protective Supervision, and the five situations in which it cannot be authorized
- ACL 15-25 — nonself-direction, physical capability, and episodic behavior; ACL 09-30 — hours authorized on assessed need, never solely on diagnosis
- WIC 12301.2, MPP 30-758 — time-per-task and frequency
Every Hourly Task Guideline figure on this site comes from one set of numbers, checked against the CDSS IHSS Training Academy HTG Documentation Worksheet. This sample is for illustration only and is not a guarantee of eligibility or authorized hours. How we calculate estimates
