What Do You Need? Part 1 of a series on Personal Care Assistants: A Guide to Hiring, Training, and Firing

This is the first of a series of hubs on personal care assistants (PCA). They are also known as caregivers or home health care aides or attendants. Many people with a disability as well as those folks who have charge of caring for a person with a disability will have the need to hire "help." A really good personal care assistant or home health care aide can enable disabled folks to live a freer and happier life.

I acquired my disability over 30 years ago. I am a high-level quadriplegic. In plain English, that means I can't feel anything below my armpits and I need help accomplishing almost every task of daily living (bathing, eating, dressing, toileting, and the list goes on). I have been dealing with PCAs for almost all that time. I am, if I say so myself, an expert in the area.

This first hub will cover some of the basics you'll need to consider before placing your first want-ad or classified.

Many people new to disability or caretaking are lost when first hiring a PCA..  Who should we call?  What qualifications are required?  How much are you supposed to pay?

Generally, most start by asking around.  A friend's sister's cousin has a PCA.  Let's ask them! Another more expensive approach is to go with a home care service.  This is a company that provides PCAs, nursing assistants, and nurses who go into the home.  The actual care needed will determine what type of assistant the agency can provide.  I'll discuss this option later in more detail.

For now, let's assume you're hiring a PCA for yourself or for someone else. It doesn't make much difference.  The procedure is the same. Start by sitting down with a pad of paper and doing some planning.  This is the boring, thinking, research part. 

First, how much do PCA's in your area earn?  Take a look at the ads in the newspaper.  That should give you a beginning range. 

Does your area have an Independent living Center (ILC)? ILCs provide lots of services to people with disabilities (PWDs).  One primary service is information and referral.  They should be able to tell you what the going rate is for a PCA.  Some even maintain lists of PCAs looking for work.  They might also be able to help you with funding.  Many states have programs or waivers to help PWDs pay for a PCA. The folks at an ILC will know if anything is available.

Next, what do you want a PCA to do? This question is more involved than you might think. Start by thinking about when you want a PCA to show up at your house. Now, list every task you want that person to do.

• What kind of personal-care? More than bathing and dressing?
  
• How about housework like cooking, dishes, vacuuming, and dusting?
  
• Will they be leaving the house? Shopping or driving you somewhere? 
• Will you be using your vehicle or will you need theirs?
• What proof will you need about their driving record?
  
• Are you a student? Will you need help in classes? At work?
  
• What about bills and banking?
  
• Do you have pets?
• Do you want someone during the day or at night?
  
• Do you travel? Will you want someone to travel with you?

Occasionally, a PCA will be hired just to be company for someone. That is usually considered to be a "sitter." Sitters are a different type of PCA.. I'll come back to them later.

Once you know what you want a PCA to do and how much you want to pay them, you need to figure out if you can afford them. Chances are you will need to pare down your list of expectations. Have a third-party take a look at your list of duties for a PCA. Are you being reasonable in the amount of time you are considering for an average workday? Have you built in time for breaks and lunches?

Now comes the part that is always hardest for me. Do you want part-time or full-time employees? There are pros and cons for both.

A full-time person can often get more done but you will also have a greater dependence on that one person. It’s easier to train and get used to a smaller number of full-time people. However, who is your backup if that employee is ill, out-of-town, quits, or must be fired?

Bookkeeping, payroll, and other paperwork associated with household employees might also be a consideration. This is a question for your accountant although I'll cover some of the basics at some point in the series.

I have tended to prefer a larger number of part-time people to a fewer full-time ones. I like having a pool of trained assistants. It’s a personal issue and it may take some experimenting to find out what works for you.

If you decide to go with an agency then expect to pay quite a bit more than you would if you hire someone yourself The advantage to an agency is that they have already done the background checks and a fair amount of the training.

Someone from the agency will come out to your house to do a thorough interview and assessment with you. Depending on your needs and the way the agency works, you may or may not get the same person as an assistant each time you need one.

The advantage is that an agency can almost always provide a backup at very short notice. Also, you will generally pay the agency and not the person. This can also vary. Most assistants sent out by this type of organization will have limits on what they can and cannot do for you.

Some agencies will simply locate a potential employee for you at which point you would take over the relationship with the employee. Think temp agency. Again, experience is the best teacher here.

The last idea I want to cover is a “sitter.” I said before that this is a different kind of assistant. Sitters are usually reserved for situations where someone needs to be kept company or just monitored. We had one for my father when he was in the hospital. He kept trying to get up out of bed and he would fall every time. Unfortunately, he would forget that he wasn’t supposed to be getting up. A sitter stayed in the room to remind him to stay down.

Now you’re ready to place a classified ad. I’ll cover how to do that and what information to put in a classified in part two of this series.

Please let me know if this information is helpful or if you do it a different way.  I'd love to learn how other folks manage.