SPINALCORD: Personal Care Assistants: Special People for Your Special Care

This article is from the Pushin' On Newsletter, Vol 12[1], Winter, 1994.

Personal Care Assistants: Special People for Your Special Care

Individuals with a higher level spinal cord injury, that results in tetraplegia (quadriplegia), often need a personal care assistant (PCA). The help provided by the PCA allows an individual with SCI to live more independently. The help with tasks such as getting in or out of bed, bathing, dressing, driving, shopping, or cleaning, allows many individuals with SCI to live active, productive lives.

Family members are often the first to provide the help needed after the injury. A spouse or parent will often insist on being the caregiver. They may feel it is their "duty". Some family members do not want an outsider caring for their loved one. However, the individual with SCI needs to decide what help he needs and who will provide it.

Some individuals chose a PCA from outside the family. They feel this keeps the roles of family member and caregiver separate. A PCA allows the individual with SCI to be independent of his family and the family member does not become resentful because of the added duties.

The hiring, training, and supervision of a personal care assistant can sometimes be a frustrating and time consuming process. The following are suggestions for locating PCAs and keeping them as their employee.

Advertising for a Personal Care Assistant

Place ads in local or neighborhood newspapers. Give a clear description of the type of work involved, your geographic location, the hours needed, and the pay. This will keep you from getting calls from people who do not fit your needs.
Post job announcements in church bulletins, in dorms on college campuses, and in hospitals or clinics.
Contact the local Independent Living Center to see if they keep a register of PCAs.
Contact employment agencies that provide private health care nursing. The local state employment office may also take orders for job positions.
Word of Mouth. Letting people you know or work with is often an excellent way to get the word out that you are looking for an assistant.

Who Makes a Good PCA??

College students are often available in the early morning hours and in the evening hours when you need PCA services. The college student will often accept a lower wage. They may be willing to trade services for room and board if you need a live-in assistant.

Students in training programs such as physical therapy or occupational therapy have a special interest in rehabilitation. They may be looking for some practical experience that relates to their school work. The negative side with students is there is more turnover since they are only available while they are in school.

Individuals with medical training or who work in a medical facility, such as LPNs, lab technicians, or nursing assistants, have the interest to provide good medical care. Their work schedules are often flexible enough to fit your schedule.

Interviewing the Applicant for the PCA Position

Have a list of questions ready to ask the applicant. Be specific.

Do they have dependable transportation?

What other responsibilities do they have? family? classes?

Do they have other skills that you require: drivers license, cooking, housework.

Describe all the duties involved, such as lifting, bathing, bowel and bladder programs or grocery shopping.

Have a brief written application for the applicant to fill out. Ask for information such as previous work experience and references. LI>Explain any special rules you want them to follow, such as no smoking or letting you know if they will be late.

Ask for and check references. Teachers are excellent references. They can tell you if the applicant is on time for class and responsible in getting assignments done?

Making the Job Offer

You might hire an individual for a few days on a trial basis. This gives them a chance to see if the job is really what they want. It also gives you time to see how you get along.

Have a written contract that specifies the job duties, hours of work, days off, wages, and reasons for termination. Both parties need to agree to the terms of the contract.

Qualities Wanted in a PC

Individuals who use personal care assistants were asked what qualities they wanted in their PCA. They said they wanted them to be. . . .

Punctual - You depend on the PCA to get you ready on time, so they must be there on time. They must have reliable transportation.
Trustworthy and Honest - The PCA will be in your home and have access to your belongings. You want someone you feel comfortable with and can trust.
Able to Follow Instructions - They must be willing to accept directions and follow them exactly as you say. Your daily routines are important to your good health.
Comfortable with Following a Routine - You will need certain daily routines done at regular times every day. The PCA must follow your schedule.
Good Natured and Patient - Unexpected frustrations can occur in your daily routine. A sense of humor and patience are important.

Working with your PCA

It can be difficult finding that balance between employer and friend. Some suggestions to avoid confusion or problems:

Be sure that the PCA understands that you are not sick. You only need help doing daily routines that you can no longer do for yourself. You are an independent individual and only want help in areas outlined as part of the PCAs duties.
You may need to be assertive. You are the one who decides what to do and how to do it. Give the PCA clear directions on what needs to be done and the proper techniques involved. Be direct and firm when a problem occurs.
Have a back-up system in place. Have substitute PCAs who can fill in when your regular PCA can not be at work. They too have unscheduled emergencies in their lives. The PCA also needs days off.
Know your obligations as an employer such as social security and taxes

Resources on Personal Care Assistants

Books:

Independent Living Research Utilization (ILRU) The Research and Training Center on Independent Living serves as a national center for information, training, research and technical assistance. They have books and manuals available on attendant care. For a listing of their materials write to: ILRU at TIRR, 2323 S. Shepherd, Suite 1000, Houston, TX 77019. 713-520-0232.
Preventing Secondary Medical Complications: A Guide for Personal Assistants to People with Spinal Cord Injury. 1992. Developed by the Training Office of the RRTC in SCI at Spain Rehab Center.
Easy to read information for the PCA on giving proper care in assisting someone with SCI. Send orders to: UAB-Spain Rehabilitation Center, RRTC Training Office, Rm. 506, 1717 Sixth Ave. South, Birmingham, AL. 35233-7330.Cost $3.50 plus $2.50 postage/handling.

Videos:

Partners in Independence: The Personal Care Attendant's Role in Pressure Sore Prevention. (12 min) $30 for consumers; $85 for professionals. The video addresses ways a personal care attendant (PCA) may provide assistance in the routine of proper skin care. It can be used by SCI employers in training new PCAs in the home setting. Order from: Linda Herson, TIRR, 1333 Moursund, Houston, TX 77030 713-797-5945.
The Consumer: Issues and Answers (19 min) Deals with Locating a PCA; Interviewing; Training and Conflict Resolution. For individuals and families who will need a PCA. The Provider; On Being a Personal Assistant (19 min). How to become a PCA and skills involved .
The Community: A Vision (11 min) Looks at the independence that a PCA offers vs. nursing home care and inter-dependent relationship with a PCA.
This series of 3 video tapes on PCAs is available free of charge on a firstcome, first serve basis. Contact: Mark Johnson, Shepherd Spinal Center, 2020 Peachtree Rd. NW, Atlanta, GA 30309. 404-352-0772.

c 1994. Board of Trustees of the University of Alabama
For permission to reprint for further distribution contact the SCI Web Information Manager.
This publication is supported in part by a grant (#H133B80012) from the National Institute on Disability and Rehabilitation Research, Dept of Education, Washington, D.C. 20202. Opinions expressed in this document are not necessarily those of the granting agency.