Knowledge Center
TATRA Navigation Menu
What are Personal Assistance Services?
excerpt from Point of Departure, Vol. 4, No. 2...PACER Center...Winter 1999
Personal assistance services assist people who have mental or physical disabilities with activities of daily living. These services compensate for an individual's functional limitation and can include assistance with personal hygiene, dressing, transferring, mobility assistance, cooking and cleaning. Health related tasks that can be delegated to an unlicensed person by a health professional such as dispensing medications, catheterization and tube feeding are also considered attendant services. Personal assistants, or personal care attendants (PCAs), are individuals who are hired to perform services that enable persons with disabilities to participate more fully in community settings and activities, including employment.
Financing for Supports
Sources of funding include:
Private funds. The most common payment source for attendant care is the individual or family who is receiving the service. Many individuals in middle income brackets who do not financially qualify for programs below must pay for the care themselves. Individuals who litigate or obtain a settlement should include attendant care as part of the planned trust or settlement. Private funding may also include money contributed by local civic groups.
Medicaid. Depending on the state, Medicaid might pay for personal care attendants, case management, therapeutic services, medical care, technological and physical aids, and other services.
The State's Medicaid Home and Community-Based Services Waiver. Most states have such a waiver, administered either through their Department of Social Services or their Developmental Disabilities office. This waiver could pay for a whole range of support services, including service coordination/case management. In eight states (California, Colorado, Florida, Illinois, Maryland, Michigan, Rhode Island, and Wisconsin), Medicaid has approved a Community and Supported Living Arrangements waiver, which can fund an even broader range of support services.
This program allows states the flexibility to develop creative alternatives to institutionalizing Medicaid-eligible individuals. The program recognizes that with assistance, many individuals at risk of institutionalization can remain in their homes and communities, at a fraction of the cost of institutional care. These services are in addition to traditional home health services covered by Medicaid for many years.
State Funds for Residental Services. Currently these funds may be used to finance group homes and apartment programs. They could also pay for supports that allow a person to live in his or her own home.
Independent Living Funds Through Vocational Rehabilitation.
Funds administered by the state's Developmental Disabilities or Social Services offices.
Personal Assistance Services funded by Medicaid must be:
Authorized by a physician in accordance with a plan of treatment, or
Authorized by a state approved individual service plan;
Provided by a qualified individual who is not a member of the individual's family;
Provided at a recipient's place of residence or work, and ordered by a physician as part of a care plan;
Include nursing or home health aide services provided on a part-time or intermittent basis by a home health agency;
Medical supplies, equipment, and appliances suitable for use in the home are also covered. Physical or occupational therapy, speech pathology, and audiology services are optional services states may choose to provide.
Finding a PCA
Finding the right PCA to fit a person's needs can be challenging. Even in states that provide reimbursement for PCAs, pay rates are low, making it difficult to attract and keep competent workers. In addition low unemployment exacerbates the difficulty of finding attendants. One solution is to hire several part-time attendants instead of a full-time person. Part-time attendants can serve as back-ups for one another.
Honesty, reliability, intelligence, a good sense of humor and the ability to work hard are all qualities to look for in a PCA. While compatibility is important, hiring friends or family members may present problems. Separating private relationships from working relationships can be difficult.
If you know someone interested in becoming your PCA, encourage him or her to apply at your home health agency. By referring your own candidates instead of relying on the agency, you have more control and may avoid possible staff shortages. The individual PCA, not the agency, makes all the difference in the degree of satisfaction one experiences.
Families must often be creative in their quest to find a PCA. Ask for recommendations from friends, churches, recreation programs, paraprofessionals & teachers. Advertise at postsecondary programs for special education, physical therapy, speech pathology, and at medical schools and nursing schools. College students are often available in morning and evening hours when PCA services are needed. Students may also accept lower wages or be willing to trade services for room and board for individuals who need a live-in assistant.
The Employer's Role
Hiring a PCA puts you in the position of employer. Avoid letting your PCA make decisions for you. You are the one in charge, even though you are physically dependent on your PCA. You will be expected to train your own PCA. This can be time consuming if there are frequent turnovers. Patience and respect for others are essential qualities of a good PCA employer. People will not work well unless they are treated with respect.
Legislation
The current system provides entitlement to institutional services but not to community-based attendant services. Billions of tax dollars are spent on nursing homes and other institutions with only a fraction of that for community-based alternatives.
On January 29, 1999 Vice President Gore announced a new proposal to promote more flexibility in the Medicaid program to choose home and community-based care. This proposal would enable states to expand their programs to cover community-based care as well as nursing home residence for individuals with income up to 300% of the Social Security Income (SSI) limits.
Two bills introduced in the 105th Congress were not acted upon: the Medicaid Community Attendant Services Act also known as MiCASA and the Long Term Care Reform & Deficit Reduction Act also referred to as the Feingold bill. MiCASA was drafted by ADAPT (American Disabled for Attendant Programs Today). MiCASA. will be reintroduced in both houses of the 106th Congress. Minor changes have been made to the bill, but it remains true to MiCASA's original principles.
Resources
The January, 1999 issue of Disability Resources Monthly (DRM) contained a supplement on personal assistance services. Cost: $3.50. To order, request back issue Volume 6, Number 6 (January, 1999) from DRM, Disability Resources, Inc., Department IN, 4 Glatter Lane, Centereach, NY 11720-1032; 516-585-0290 (voice and fax); e-mail: info@disabilityresources.org Disability Resource's web page also provides online links to a number of web sites focusing on this topic: www.disabilityresources.org/PCA.html
Vocational Rehabilitation Initiative
KY-SPIN (Kentucky Special Parent Involvement Network)
2210 Goldsmith Lane, Suite #118
Louisville, KY 40218
800/525-7746 Voice; 502/456-0893 FAX; e-mail: spinvri@aol.com
PACER's site offers many PDF files for download, which require 
