Guide to Using PAS

The following are excerpts from "Working Together: Personal Assistance Training and You" from InfoUse. To see the entire resource, click here.

Introduction to Personal Assistance Services
Rights
Getting Started
Finding an Attendant
Preparing for Interviews with an Attendant
Interviewing an Attendant
Hiring an Attendant after an Interview
Working with an Attendant--Tasks
Supervising an Attendant
Communicating with an Attendant
Abuse by Attendants
Possible Problems with Attendants or Firing Attendants
Your Responsibilities as an Employer of an Attendant
Health and Safety Issues
Emergency Situations
Personal Issues with Attendants

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Introduction to Personal Assistance Services

What is an attendant? What does the term consumer control mean?

A personal assistant provides services to a person with a disability or a chronic condition. Personal assistants are called by many names:

attendant
personal assistant (PA)
personal care attendant or assistant
caregiver
home-care worker or aide

Consumer control means that you, the consumer, are in charge of your own life. You, the consumer, decide what services you need to live independently. You recruit and hire a PA, either directly or through an agency.

Rights

What are the rights of an employer of a PA? What are the rights of a PA?/How can my friends, family, and others help me be on my own?

As an employer, you have the right to:

hire, train, and supervise your PA
decide which tasks you need assistance to complete
direct how work is done in or outside your home
be treated with dignity and respect
receive confidentiality from your PA
feel secure in your home, personal possessions, food, medications, and financial assets
fire and replace PAs who don't respect your rights

A personal assistant has a right to:

receive a clear, well-defined set of expected duties and time schedule
receive requests for any additional duties or schedule changes with as much advance notice as possible
receive clear, step-by-step instructions for doing tasks
receive clear instructions on how to do a job that are logical and efficient
receive instructions and other communications delivered in a clear, direct and assertive manner
be provided with equipment and supplies that are adequate for performing the assigned duties
perform duties in a pleasant and sanitary working environment that has an efficient physical layout
refuse to perform certain proposed duties for sufficient reason and with reasonable advance notice
receive from you, the employer, the confidentiality, respect, and dignity as a human being who has personal thoughts, values, beliefs, relationships, activities and a personal life in addition to providing personal assistance services

Family, friends, PAs, and other caregivers (senior center or rehab staff, doctors, physical therapists, et al) MUST:

treat you as an adult
do duties, errands, or social obligations that they have agreed to do, when they agreed to do them; you have a life and a schedule, too, that must be honored
be dependable and on time and call if they will be late
share kindness, consideration and patience
respect that you are the employer of the PA, and others should not interfere with your directions
develop a good attitude about disability or functional needs. A good attitude includes respecting your right to be independent, make personal choices, and make mistakes and learn from them; you have the right to be treated as an adult with interests, desires, wants and needs as any other adult

Family, friends, PAs and other caregivers (senior center or rehab staff, doctors, and physical therapists, et al) MUST NOT:

be undependable
make unreasonable excuses for being late or not calling to say they will be late
show unwillingness to do duties, errands, social engagements or other commitments, or put them off when it is not necessary
decide they know what is best for you
abuse, neglect, or exploit any frail older person or vulnerable adult physically, mentally, sexually or financially

What are some rules on how to treat my attendant fairly?

What are some rules on how to treat my attendant fairly? What are some things I should know about diversity? What are some things I should know about disability? What are some ok and not ok words about disability?

Etiquette is simply good manners. As an employer you should be respectful in the way that you speak with your PA. You don't have to say "please" or "thank you" for every little thing, but politeness does help. Shouting, yelling at the PA, or barking orders is not respectful.

Some people feel awkward around people with disabilities. They may use terms that you may find offensive. It will make life easier for you, your worker, your family and friends if you help them to understand your preferences and expectations. Be ready to discuss these.

Cultural and ethnic differences can be obstacles, but they can also be opportunities. Understanding the values and traditions of people we work with can improve our work relationships. It can also help us better understand our own values and traditions. Hiring a personal assistant whose background is different from yours may present a unique opportunity to grow.

Getting Started

What are the major sources for getting and paying for an attendant?

Hiring an independent provider
Hiring through an agency
Hiring through an intermediate service organization (ISO)
Hiring (paid or unpaid) family members

Finding an Attendant

How do I find an attendant? What are some ways I can advertise for an attendant? What are some samples of ads I can use to find an attendant?

Before you spend time, effort and money in recruiting new PAs, be sure to ask those you know for leads: current and former PAs and previous applicants, friends, family, neighbors and co-workers.

There are a couple of traditional ways you can advertise the job: flyers, posters, or 3x5 cards, that you put up at public places like employment or career centers, independent living centers, senior centers, etc.; and newspaper ads. If you are at ease with computers, you could place an ad on a jobs website or an electronic bulletin board. You would use the same type of ad as a newspaper or possibly the 3x5 cards.

Preparing for Interviews with an Attendant

What kind of form should I use when I hire my attendant?

Applicants should be asked to fill out a job application form and to provide you with references.

The job application form serves a several purposes:

It gives you more information about the skills of the applicant
It gives you another screening tool. It helps you to decide if the applicant is suitable and worth another interview
It helps you to judge the applicant's literacy if it is important to you that they read and write clearly
It shows you how well they follow directions
It helps the applicant to view this as a serious job
It provides a record for your files

Interviewing an Attendant

What are some places where I can have an interview with an attendant?

Home of a friend or family member
A community service agency
Coffee shops, ice cream parlors or similar places

What are some things I should do during an interview with an attendant?

Greet the applicant. Introduce yourself and spend a few minutes getting acquainted. Compliment them for showing up on time. Offer water, tea or a soft drink.

Ask the applicant to tell you about themselves and why they decided to apply for this job.

If you did not send out application forms and other information in advance, have the applicant fill out the application form including references.

What are some things to look for in an attendant during the interview?/What are some things to look for in an attendant's job form?

Meeting the applicant face-to-face gives you another opportunity for screening. If the applicant will be filling out the application at the first meeting, notice if he came prepared. Did he bring his driver's license and references? Is he on time? If an applicant is late for an interview, can you expect him to be on time for work? Of course, there could be a good reason for being late. But it must be very good. If you think he might make a good PA, schedule another appointment to see if he will be on time.

Ask yourself if the applicant is someone you could work with over time. Do you feel comfortable with her? Does she seem comfortable with you? Does she answer your questions directly and completely? Or is she uncertain, slow to answer, or does she avoid answering your questions? Does she ask you questions either to learn more information or to get clear about something you have said?

Is the applicant's appearance neat and clean?

The job application is more than a list of jobs and job references. Here are some things to look for:

Is it neat? Is it covered with grease spots or coffee stains? This may be a clue about how they will do your work--sloppily
Did they follow directions? Did they answer all the questions? This may tell you how well they follow directions. It also may show how much attention they give to detail. This is important if you have a complicated routine
Does it raise any questions that you should ask? Did the applicant have jobs similar to PA work? Did the applicant do totally different work? Why does he want a change?
Did the applicant provide the references you asked for? If not why not?
If reading and writing are important to your job, is the applicant's writing clear and easy to read? How long does it take the applicant to fill out the form if it is done at the first meeting? Does it take a long time because he doesn't read well?

Hiring an Attendant after an Interview

What should I say to an attendant after an interview if I like them?

When you think you have all the information you need, ask the person if they are still interested in the job. If so, let them know you are still considering them. Be sure to tell them that you will need to check references before you can make a commitment.

If you both are interested, set-up an interview at your home. Be sure to have someone else in the house. During this interview you may have a current PA demonstrate parts of your routine that must be clear for safety and security: lifts, transfers, driving your vehicle.

Let them know the date they are to start working if selected.

Should I ask an attendant for references?

Should I ask an attendant for references? Should I ask an attendant about their past jobs? How do I check on attendant's past jobs? Should I do a police check before I hire an attendant?

If the applicant has not been working for awhile, ask if he or she has done any babysitting, taken any classes, or served on any committees. If a parent was willing to trust this person with a child, that is a good recommendation. Similarly, a teacher or committee chair can tell you whether the person had good attendance and completed tasks properly and on time. You may also want to run a police check.

What are some questions I should ask before I hire someone? How do I offer a job to an attendant?

Were you satisfied with the answers that the references gave you?
Was the applicant on time for interviews?
How easily did the applicant find your home or the interview site?
Were you comfortable with each other in the interviews?
Did the applicant sit with arms and legs crossed the entire time?
Did the applicant give you the number of references you asked for?
Do you think the applicant has the skills and personality to do the job?
Does the applicant seem healthy, strong, pleasant and energetic?
Do you and the applicant have similar lifestyles?
Was the applicant clean, neat and presentable?

Once you have narrowed down your choices, list them in the order you prefer. Offer the position to your number one choice. Sometimes the applicant will have second thoughts or may have taken another job. Then you can go to the next person on your list.

When offering the job:

Let the person you hire know what must be kept confidential when you offer the job. It's a good idea not to discuss personal matters until you know them better
Tell them the start date and time for the first training session

Working with an Attendant -- Tasks

How can I tell my attendant what I need them to do? How do I figure out how much time each task takes for my attendant to do?

At the beginning of each new working relationship be sure that basic expectations are clear. You have expectations of the PA as an employee. The PA has expectations of you as an employer. Review the expectations from time-to-time to be sure they are being met by both of you. When you review the expectations, see if any changes need to be made.

You want a smooth working relationship. To have one, you need to establish clear expectations for the working relationship, working style, and job duties from the very beginning. In addition, the worker has the right to have expectations of you as an employer as well. It's a two-way street.

How you manage your time is important. You may have a variety of tasks, errands, appointments, a job or social activities to attend to. On the other hand, you may not have any specific time constraints. If your daily schedule has no time-specific appointments scheduled, you may feel that you can be freer with how and when you schedule the work to be done. Even so, it is important for you to manage your time and that of your personal assistant in an effective way that allows you to do what you need to do, on time, when you need to do it.

If the worker is unsure of what and how you want certain tasks done, it will be difficult for both of you. Understanding your needs and expectations will make the worker's duties easier to do. Established routines and schedules for daily, weekly, and monthly tasks are important.

Supervising an Attendant

What do I need to do as the employer of an attendant?

When you decide to hire a PA you become an employer. You will gain the benefits of directing your services but you also have the responsibilities of being an employer. You must tell the PA clearly what tasks he needs to do, how to do them, and coach him if he needs to improve his work. It also means you need to treat the worker with respect and help him respect you and want to keep working for you.

Communicating with an Attendant

What are some ways I can talk with my attendant? Why should I check if my attendant likes their job?/How can I ask my attendant if they like their job?

Talk with the PA about what is troubling you. Explain what it is that upsets you. It won't help for the PA to feel defensive: it won't change the situation and is likely to make the PA ignore you. One way to prevent the PA from becoming defensive is to use statements that begin with "I feel" or "I think". The PA can't argue with you, if these are your feelings. Try to get the PA to brainstorm ways that the problem can be handled. Use negative feedback as a last resort, and be firm in dealing with the PA. Make sure she understands what is important to you, why it is important and the possible consequences if the behavior continues.

Don't be surprised if the PA criticizes you. Either the PA feels that you are unfair, unreasonable, or both, or that the work can't be done in the time allowed to do it.

How can I talk better with my attendant? What are some different ways of talking? How can I speak assertively with my attendant?

Keep the focus on the job
Listen closely
Ask questions

A person who exhibits passive behavior does not communicate effectively. He or she has difficulty expressing thoughts, feelings, and ideas. He or she tends to let others make decisions for him or her and feels taken advantage of. Passive people may have low self-esteem.

A person who exhibits aggressive behavior also does not communicate effectively. This person does not treat others with respect. Instead he or she tries to dominate other people. When expressing negative thoughts and feelings, he or she tends to attack the person rather than trying to correct the behavior. Aggressive people may also have low self-esteem. To feel better about themselves, they often cut others down.

An assertive person expresses thoughts, feelings, and ideas honestly and in a clear way. He or she feels good about his- or herself and takes responsibility for meeting his or her own needs. Both negative and positive feelings and thoughts are expressed. When criticism is given, it is not expressed in a way that puts down another person. An assertive person treats others with respect.

Abuse by Attendants

What should I know about abuse?

What are some forms of abuse that I should know about? What if my worker makes me feel bad, but I'm not sure it's abuse? How can family stress lead to abuse? How can I keep abuse from happening in the first place? What are some ways I can stop the abuse?

Abuse can take many forms. Your worker may intentionally hurt you or steal from you. But there are other, more subtle types of abuse that you should learn to recognize. Both obvious and subtle types of abuse can take the forms of:

physical abuse
sexual abuse
mental or emotional abuse
financial abuse
neglect
exploitation

A worker may act in ways that do not physically endanger the employer, but do cause discomfort to the employer. These unacceptable behaviors might include:

Criticizing, teasing or verbally abusing you in a way that hurts your feelings
Giving you the "silent treatment" when he is angry about something
Telling you that you are "just too much trouble."
Talking about sex in a way that makes you feel uncomfortable

The employer should not have to accept any of these behaviors. These behaviors might happen just once or twice when the worker is in a bad mood. The worker might not even be aware that his behavior disturbs the employer. And sometimes, workers, like everyone else, go through rough times in their lives and act moody and angry towards other people. That might explain, but does not excuse, disrespectful behavior.

In any case, the employer can do several things to help himself:

Remind the worker that mutual respect is important to your working together
Tell the worker that his behavior is disrespectful and therefore unacceptable
Tell the worker not to repeat the behavior and
Advise the worker that he needs to stop the behavior if he wants to keep working for you

No matter how well a family adjusts to caring for a person challenged by a chronic condition or a disability, over time everyone feels stress. Family members can be drained by continual demands of caring for a loved one with special needs. When a caregiver feels overwhelmed, physical, mental, emotional or even sexual abuse can occur. Stress factors include:

Increased external pressures such as finances and the needs of other family members
Increased risk of isolation both for the person with assistance needs and the rest of the family
Transition times such as when the child starts preschool, leaves high school and changes jobs
Feelings of embarrassment. Parents or family members may think the person with assistance needs reflects negatively upon them
Feelings of disappointment and frustration. The person with the chronic condition or disability may fall short of the hopes and expectations of loved ones
Constant responsibility. Physical and emotional demands on caregivers may be exhausting
A do nothing attitude. Caregivers don't ask for or use the services and help they need

Possible Problems with Attendants or Firing Attendants

What can I do if my attendant and I have trouble talking?

What can I do if my attendant and I have trouble talking? What are some examples of times I should fire my attendant? How should I respond when an attendant resigns?

One of the hard realities of being an employer is dealing with termination. Whether you like it or not, no one will work for you forever. Sooner or later, you will have to replace a personal assistant (PA). You will need to replace a PA because the PA resigns, because of unsatisfactory performance, or because of serious interpersonal conflict.

It is common to feel a sense of loss and depression when a PA stops working for you. A good strategy that will help to minimize the feelings is to have a reliable replacement trained and ready when the former PA departs. Your former PA may be willing to help train your new PA.

What are some ways I can prevent conflicts with my attendant?

The best approach to solving problems is preventing them in the first place. Using these guidelines can help you keep small difficulties from growing into big problems.

Be sure your PA knows what their job is. Be sure they understand how you want it done. If there is something that seems unclear, deal with it up front. It's better to negotiate early on than have to solve a problem later
Don't look for blame. Were you unclear or did she misunderstand? No matter. Just say "Sorry. Please let me tell you again how I want it cooked."
The PA may ask for supplies she needs to do the job properly. If she doesn't have the right supplies to do the cleaning correctly, she can't do a good job for you
Politely suggest a different way to do something if the PA's way is unsafe, inefficient, or not the way you want it done
Keep an attitude that open communication will help avoid most problems. If you sense that the PA is unhappy with something about the job, bring that up: "John, I have the feeling that you're not satisfied with something. Can you tell me about it? Is there anything you can suggest to correct it?"

Your Responsibilities as an Employer of an Attendant

As an employer, what sort of records do I need to keep track of?

As an employer, you will need to keep some records in order to pay your personal assistants and to pay employment and income taxes. You will need a filing system for the records of your personal assistants, payroll and tax reporting. Keeping good records will make the rest of your administrative tasks easier.

What are some things I should know about taxes?

The IRS provides information that will help you to meet your tax obligations, including:

Hiring Household Workers
Employer Identification Number (EIN)
Form I-9
Other Tax Related Information

Health and Safety Issues

What should I do to keep my attendant healthy and safe?

You will want to train your PA to do what you want, in the way you want it done. Most of the time, they will be working directly from your instructions. Think about hazards in your home and how they can be avoided--try to look with the eyes of a stranger:

use the proper moving techniques or lifting aids. You may wish to stay on top of new technology that could assist you
you must ensure that PAs follow the correct handling techniques at all times. Ensure that they aren't wearing anything unsuitable such as high-heeled shoes for carrying out the maneuver. Always be aware of back problems
check for obstacles and sharp surfaces
make sure nothing is left on the floor that could be tripped over
be aware of caustic substances in your home--bleach, wheelchair battery acid--and provide appropriate clothing or protection for your PA to wear (e.g., gloves)
make sure that electric and mechanical equipment is checked and maintained
look out for loose carpeting or rugs
ensure proper hygiene practices are carried out. Disinfect, wash hands and equipment after use, dispose of waste and so on
take extra care over the preparation and cooking of food. Wash hands before and after, clean utensils and cutting tools thoroughly
If you have pets, you will need to keep them free of parasites. PAs are unlikely to put up with fleabites. Ask your vet for advice on injections and sprays, which you can use

What are some general tips to prevent accidents in the home?

There are some general things you can do to make every room in your home safer:

Keep pathways clear of clutter. This means keeping hallways, stairs, entrances to rooms, and exits from the house clear of items that could block your way, or cause falls or bumps
Remove throw rugs that might trip an elderly or disabled person. Use only non-skid area rugs and hall runners
Store away, remove, or pad all sharp or projecting objects that might cause injury if they fell, were bumped into, or were mishandled. These include large objects such as furniture or appliances, as well as small objects such as knives, scissors, etc
Repair all broken equipment or appliances as soon as possible
Keep machinery with moving parts in a safe location
Get a step stool, preferably one with a handrail for balance. Don't use a chair or other unstable piece of furniture to reach high places
If your home has stairs, they should be well-lit, have at least one handrail, and be free of clutter

What are some tips about how my attendant can move my body? What are some tips I can give my attendant so she won't get hurt?

Never lift more than you can comfortably handle
Create a base of support by standing with your feet 8-12" (shoulder width) apart with one foot a half step ahead of the other
Do not let your back do the heavy work - use your legs. (The back muscles are not your strongest muscles.)
If the bed is low, put one foot on a foot stool. This relieves pressure on your lower back
Consider a back support belt

What are some ways to cut down the risk of infection in my home with my attendant?

Frequent dusting and vacuuming helps stop the build-up of dirt and bacteria. Keep the kitchen and bathroom as clean as possible. Use bleach or disinfectant soaps for cleaning in these areas.

Provide disposable latex (or non-latex if your PA has an allergy) gloves for your PA to use whenever he or she may come into contact with body fluids or wastes or open sores. Advise your PA to do those tasks that require gloves all at one time so he or she does not have to keep taking the gloves on and off.

Emergency Situations

What are some things I can do when there is an emergency with my attendant?

Everyone who uses personal assistance services needs a backup system. It is especially important if you rely on one family member or one live-in PA. If you cannot afford to hire outside salaried PAs, you should establish a voluntary backup system. Your backup system should include at least three friends who live nearby who can help you with basic personal assistant services. These special friends would agree to help you in a crisis or other emergency if there is a reason your live-in family member or PA cannot help. Three friends assure that in a crisis you would be able to reach at least one of them. Put each of their names on a button on your telephone speed dialer.

What are some examples of back-up plans when my attendant can't come?

You have gone through the recruiting process putting in time, energy and money. If you do not have a back-up plan to cover times when your PA is ill or needs time off, now is a good time to build one. If there are other good candidates that you do not select, ask if they would be willing to serve as back-up. If they agree to be part of a back-up plan, keep in touch with them so they know that you are still interested. It might even be worthwhile giving them some training with a current PA on the more complex parts of your routine.

Your city or local municipality may also offer a back-up service for people who need personal assistance. Check with your local independent living center for more information.

What should I do in case I have an emergency? What should I do if I have to go to the emergency room?

Your PAs may or may not have training in emergency First Aid or CPR (cardiopulmonary resuscitation). If they do not, you must provide them with some general information that will help them to assist you in an emergency. You may want your workers to get training in First Aid or CPR. Training can be found by contacting your local American Cross or other agencies.

Train your workers to stay calm, to use their common sense, and provide them with some simple guidelines so they can help you.

What are some things I can do with my attendant to get ready for an emergency?

You and your PAs must be ready to respond to both natural disasters and coomon emergencies--anything from floods to kitchen fires.

You should prepare a disaster supply kit. Use this kit in the event of a prolonged power loss, or take it along if you need to evacuate the building. Include:

Prescription medicines, eyeglasses, other essential medical supplies
Candles, matches, flashlight and extra batteries
Portable radio and extra batteries
A first aid kit (described in Emergencies: First Aid)
Water--enough for each family member and service animals or pets for three days (1 gallon per person per day)
Non-perishable canned foods for meals for a week and a non-electric can opener
Barbecue or camp stove (to be used outside)
Small bottle of chlorine bleach to disinfect water
Blankets, warm clothes, change of clothing
Pet food or supplies for service animal
Heavy duty, waterproof plastic bags for protection or waste disposal
Pipe or crescent wrench to turn off gas and water supplies

How can I teach my attendant to help me manage my drugs? What sort of back-up plans or devices could I have in case of a crisis?

Explain your medications. Whether or not you need help in taking your pills it is a good idea for your PA to understand in general what the medications do for you. "The pills I take help my spasms," "This medication reduces my pain," or "I have a bladder problem that this medicine keeps under control."

Make a list of your prescription medications and when they are to be taken. Post the list where your PAs can find it. This is critical if you need help taking them or if you ever need hospitalization, or need emergency care. The list also should include any supplements, vitamins and over-the-counter medications you take. Include the amount and how often you take them. Put prescription medications at the top of the list.

An emergency response unit is a small alert system worn around your neck on a strap. When needed, press the button and a dispatch center is notified. With a call box in your home, the dispatcher can talk to you and determine the degree of assistance needed. Friends, neighbors or family members you have selected are called to assist unless emergency personnel are needed.

Call local hospitals to see what is available in your area. If none offer the service, national programs exist, but usually at a higher cost. Most require a hook-up fee as well as monthly charges. Some funding sources underwrite the cost for participants. Check with local agencies or your caseworker, if you have one.

Personal Issues with Attendants

Why is it important to have rules with my attendant?

Why is it important to have rules with my attendant? How can I make rules and boundaries with my attendant? What are some signs that a line has been crossed with my attendant? What can I do when a line has been crossed with my attendant? What are some things that might come up if relatives are my attendants? What are some things that might come up if my attendant becomes a friend or lover?

Boundaries fix the limits in the relationship between two people. Relationship boundaries include physical and emotional guidelines and limits. These limits may be stated or unstated.

Boundaries define appropriate behavior in any specific relationship. You can be friendly, develop a warm and trusting relationship, have fun, and be comfortable with each other, without taking advantage of each other.

Your relationships with your PAs are close and complex. Your relationships with friends or family members who also provide services for you (paid or unpaid) can be even more complex. It is important that both kinds of relationships function as smoothly and effectively as possible.

You do not need to be best friends with your PA, but you must be able to work together to ensure that you get the best care possible. The intimate nature of the work makes it important to keep conflict to a minimum. In addition, it may be difficult for one or both of you to deal with physical intimacy without getting emotionally involved.

It is generally not a good idea to become intimate with your PA. But from time to time, it happens. If you do, hire a different person as your PA, not the person with whom you have started an intimate relationship.

What are some ways I can avoid problems when family or friends work for me?

If you and your family have decided that some or all of your personal assistant services are to be provided by family members, you will want to take steps to support those family members. One way is to establish and maintain limits. A few important steps taken in the beginning can prevent problems in the future.

Insist on being as independent as possible, doing as much for yourself as you can. It can be tempting for you to accept the loving care and attention that those who love you want to give you. However, this can make you lazy, cause you to lose skills and not develop new ones
Insist on hiring some outside PAs to help. This will provide support to the family caregiver
Insist on boundaries and a work schedule. This will prevent your care from becoming an all day, time-consuming task
Balance the needs of everyone concerned: the caregiver, the family, your care needs and the needs of your marriage or primary relationship
Schedule regular family review meetings. Use these meetings to check on how tired family members are. See what changes would make things easier such as hiring outside PA help