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attendant care- how have you found it?

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    attendant care- how have you found it?

    just curious how some of you who are dependant on others to help w/ care have gone about finding attendants.

    -what has been an effective method of finding someone?
    -where have you looked (i.e. classifieds, schools, etc)?

    I'm just curious because it's a struggle & hassle to find "quality" people to help w/ my care & I need to figure out some more options than I have now.


    Hiring PCAs

    This has been posted here before, but is worth repeating:

    This is an excellent site with a free manual on how to recruit, hire and manage your PCAs:

    This book (Avoiding Attendants From Hell) must be purchased, but is also excellent:

    Unfortunately this site appears to have disappeared from the web. Too bad as it had some potential:

    Our SCI center runs a PCA program that combines a training program for people who want to be PCAs, a training program for our clients in how to be good PCA managers, and a program that links the two groups together for interviews and potential hiring. We also have many clients who hire outside this program. Some places to check or post ads:

    -free papers like the "Penny Saver" (much more effective and usually cheaper than the newspaper)
    -college employement centers
    -schools of nursing, PT, speech pathology, and OT
    -word of mouth (let both your AB and disabled friends know you are looking)
    -posting at churches, community centers, unemployment offices, rehab centers and hospitals (if they will allow this).
    -ask around at nursing homes for the aides who work there and are looking for some additional hours or income or to get out of that environment.
    -retired military. We have found a lot of success running ads in the newsletter on base, but focus on those who are retired. Some of the best have been mechanics, etc. without any healthcare background.

    Be prepared to "grow your own' by training people yourself. Sometimes previous "experience" is all wrong, and puts the person in a position of thinking they know more than you. Taking the time to train may help you maintain the position of "the boss" easier.

    [This message was edited by KLD on January 06, 2002 at 09:20 PM.]


      KLD, Maybe you can shed some light here. For the record, the CNA situation for a SCI, in NJ is '''POOR'''--[[SEE my post; '' cna shortage in nj''--care forum]] . I notice that you frequently use the term ''PCA''[i know what you are refering to], but here in NJ there are only CNA'S. ,,,,,,,,,,,,,,,Is a PCA, a CNA who is trained to work with SCI patients ??

      Here in NJ, it is just about '''IMPOSSIBLE'''to get an aide from an agency who has any knowledge of bowel/bladder care. Yes, I'm open to teaching someone who ''wants'' to learn and will probably be with me for some time. I consider bow/blad care at the ''TOP''of the personal in care . It is very difficult to be comfortable/confident with an aide, when; as I stated, the CNA field In NJ is poor and the track record for an aide to stay with you for any significant time is minimul to nil.

      KLD, you stated; ,,,,,,,,,,''Our SCI center runs a PCA program that combines a training program for people who want to be PCAs, a training program for our clients in how to be good PCA managers, and a program that links the two groups together for interviews and potential hiring. We also have many clients who hire outside this program.'' == Is this program that you speak of; Does it train aides to deal/manage specifically with the needs of SCI's ??

      Is the CNA/SCI deficincy/problem that i describe exclusive to NJ ??

      Obviously you can sense a degree of frustration in my post, Thanx for listening,,,Thanx for your answer.


        I posted

        care / attendant requests in four local hospitals.
        Got about a half dozen responses. I rotate three assistants over a two week, one hour per day visit / time period.

        Be as detailed as you can about what type of care / assistance you need and willing to pay for.

        As with any business relationship, money talks. In my opinion be willing to give up something else in order to possibly offer more $$.

        I recommend somewhere between $20-$30 per visit.

        Good luck.

        Oh, one more thing, referrals are critical and the best resource.


          CNA vs. HHA vs. PCA

          Much of this will differ according to the state you are in. In California, CNAs (certified nursing assistants) have a required training program and exam and are certified (like a license) by the state. This is also true for HHAs (home health aides). Neither of these training programs includes any specific information about SCI. In this state most of these people work in nursing homes or hospitals (CNAs) or for home health agengies (HHAs). In California, most hospitals, nursing homes or home health agencies follow strict state rules which do not allow these people to do caths, bowel care, injections or assist in administration of medications. Basically they can help with ADLs, bathing, feeding and transfers, but that is about it. In addition, since HHAs generally work for an agency, they are much more expensive. The agency generally does provide them with benefits if they work full time. ON the other hand, the agency and their supervising RN is their boss, not you, and you may have problems in directing your care the way you want it done or setting work hours that work for you. As an RN, I know how "bossy" RNs can be, and how rarely they want to listen to what the patient (who usually knows much more about SCI) knows needs to be done. Often agencies set minimum numbers of hours that you must hire someone for (for example at least a block of 4 hours is common around here). On the other hand, it may be easier to get an emergency replacement with an agency.

          A PCA is not a legal term, but is used a lot in the disability community. In California, you can hire anyone you want and call them a PCA. The state IHSS (in home supportive services) program will allow you to select anyone to be paid as your PCA if you qualify for this program. This includes family members, friends, etc. You can pick a HHA or CNA also if they are willing to accept the wage that IHSS pays (not much), but they get no benefits (in most counties). You can hire for as few hours as you want, at the times you want (if under IHSS, they tell you the number of hours/month they will pay, and that is it). You are the boss. Under California law, a PCA is seen as an extension of the person who employes them, so legally they can do any care that you direct them to do (as long as they are not practicing nursing or medicine) and that you would be able to do yourself if you were physically able. This gives a lot more latitude and flexibility. Unfortunately many insurance companies will not allow you to use a PCA as they want to have reports on you from a home health agency in order to pay. This is more the medical model than the self-help model, which is what ADAPT is trying to promote.

          You need to find out what is required in your state, and what your funding source will cover.

          Our PCA training program does not give our PCAs any legal status, although we give them a certificate indicating their training. It is very much specific to SCI or MS, although we have had our PCAs successfully work for people with CVA, ALS, or TBI as well.



            From what it looks like there is not a consumer directed program for personal assistance although they have had some "model projects" in NJ?


            Here in Virginia we have consumer directed Personal Assistance service programs ( Medicaid Waiver and a State Program) and while they are not without some problems they offer eligible consumers the option of taking a direct role in managing their own attendant care.

            Sounds as though you are at the mercy of an "agency model" which can be very limiting ( sounds like I don't need to tell you).

            Because NJ has already done a "study" and sunk money in to consumer directed care it is an Advocacy issue worth pursuing with legislators.

            There is a lot of good info out there on the cost effectiveness of consumer directed PAS and because of the situation you describe it will have to become a fact of life in all states ultimately.

            Good luck.



              In 1989 a social worker hooked me up with an individual who was willing to work as a PCA. After one week he said, "I can tell you and I aren't going to last more than a week". It is now 13 years later and we have been married for 11 yrs. I no longer "pay" him but his maintance costs are higher.
              Every day I wake up is a good one