Case Studies of Six State Personal Assistance Service Programs Funded by the Medicaid Personal Care Option. V. Support Services Available


A. Attendant Management

1. Attendant Recruitment

There are no systematic recruitment efforts, in part because the state does not want to appear to be the employer. Counties maintain lists of independent providers, but these are often out of date and aren't a viable resource for consumers or adult service workers.

Because of flexible family regulations, almost half of the providers are relatives. According to case workers, most consumers have people they want to become attendants, so recruitment is not usually an issue. People who need the most help with recruitment are those who are new to the area and have few community connections, those who are difficult to work for, and those who need several attendants because they have high levels of need. People who live in congregate housing have an easier time retaining attendants because attendants can work for more than one person.

Recipients say that the low wages, lack of benefits, and low hours generally make work as an attendant undesirable. Some consumers recruit family members only because they can't find anyone else. In Kent county, the Independent Living Center has written a grant to access DSS county discretionary funds to launch a provider recruiting project. Program regulations allow people to use agency providers, but $333 per month doesn't buy much PAS from agencies.

2. Attendant Screening

Recipients are responsible for screening.

3. Attendant Interviewing

The recipient and service worker jointly interview the attendant.

4. Attendant Certification

The caseworker must certify that the attendant is capable of doing the tasks outlined in the service plan.

5. Attendant Hiring

Recipients are responsible for hiring attendants.

6. Attendant Training

Recipients are responsible for training attendants.

7. Attendant Supervision

Recipients are responsible for supervision.

8. Attendant Payment

The recipients are responsible for attendant payment and FICA withholding. This is one of the most controversial aspects of the program (see "attendant withholding", section VID, below).

9. Attendant Termination

Recipients are responsible for firing attendants, but lack of available replacements or back up makes this difficult. People who have live-in attendants may experience even more difficulty in firing attendants, because of landlord tenant law.

10. Conflict Resolution

Service workers are responsible for mediating disputes between attendants and consumers.

B. Consumer Support

1. Consumer Advocacy

There is no formal source of advocacy within the DSS other than the service workers. The Department of Rehabilitation has a client assistance program, and independent living centers and other groups may provide advocacy.

2. Consumer Training

Consumer training is not a regular Medicaid service. Consumers who are also involved with Physical Disability Services (PDS) may receive management training from Centers for Independent Living in some regions.

3. Consumer Outreach

There is no formal program of consumer outreach, although workers are asked to present information on program services to disability or service provider groups.

4. Quality Monitoring

Recipients are responsible for monitoring their own services and calling workers if there is a problem. DSS conducts occasional field reviews, and monitors documentation.

View full report


"casestud.pdf" (pdf, 683.55Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®