Personal assistance is defined as one person assisting another with tasks an individual would ordinarily do if he or she did not have a disability. Defined more as a human service than a medical service, tasks include dressing, bathing, feeding, trach care, and catheter care; getting in and out of bed or a wheelchair; household responsibilities, including shopping, cooking, and cleaning; and cognitive and communication tasks such as paying bills and reading aloud.
In the United States, the majority of personal assistance is provided by family members and friends, most often the spouse. Personal assistance also can be provided by attendants hired directly by the individual with a disability or through an agency. Some people with disabilities receive services through barter arrangements, by sharing an attendant with others living in a group setting, or by living in residential facilities, such as assisted living apartments.
Every state is required to provide institutional and nursing home placement for people with disabilities under Medicaid. However, many people with disabilities would prefer to stay at home. One major barrier to staying at home is finding and keeping reliable attendants; another even larger barrier is funding. Without a national mandated personal assistance services program, people with disabilities depend on their own personal finances and/or private long-term care insurance policies to provide them with the homecare they need.
Some states have PAS as an entitlement under Medicaid. Indicative of a philosophical shift in favor of people living in a more integrated setting, the federal government has encouraged states to apply for Medicaid waivers to provide PAS to prevent or reverse institutionalization (Litvak, 1998). The system in the United States is fragmented and to learn more about the available programs, contact Social Security, area aging organizations, vocational rehabilitation and independent living centers, and hospital or private social workers.
Consumer-directed PAS, long advocated by the independent living movement, puts control of hiring and firing in the hands of people with disabilities, and provides them, not an agency, more control over their day-to-day activities. Finding and hiring an attendant includes advertising in local newspapers, at independent living or senior centers, libraries, churches, colleges, or by word of mouth. Screening is vital and a few basic initial questions should be asked. A very important part of screening is checking references. During the interview, in a public location, be prepared with a complete description of what is expected. Discuss hours, rate of pay, absenteeism, etc. When hiring, develop a contract that includes responsibilities of both parties, salaries, termination procedures, and a policy about missing and damaged property. Also make it clear that there are federal and state tax laws which will be honored. When employing an attendant, issues of liability also must be considered. Consult an insurance agent about the options through homeowners’ or renters’ policies, or Worker’s Compensation coverage (Aldape, 1994).
Reference
Aldape, V.T. (1994). Home caregivers make the difference. Paraplegia News, 48(12), 40-42.