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

The consumer is primarily responsible for recruitment, but nurse case monitors say they spend a lot of time and resources helping with recruitment. Local unemployment offices often refer potential applicants. Applicants go through a standard screening at the state level. The DHMH enrolls 30-60 new providers per week.

2. Attendant Screening

The state maintains a record of attendants with a history of abuse and incompetence; this includes individuals who have been fired from nursing home jobs. The applicant's social security number is checked against this list before hiring occurs. The attendant must also provide two letters of reference and a photo ID, be over 18, and have a physical examination to verify that they are capable of physically performing their duties. Nurse case monitors have some "veto power" if they believe the applicant is unsuitable.

3. Attendant Interviewing

The consumer is responsible for interviewing the attendant. S/he ultimately decides whether or not to hire the attendant, but in practice the pool of applicants is so small that consumers are often stuck with whoever they can get.

4. Attendant Certification

No certification of attendants is required.

5. Attendant Hiring

The client is ultimately responsible for hiring. A standard contract is signed by the consumer, attendant, and case monitor, which explicitly states that the attendant is self-employed. The contract is then reviewed by the DHMH.

6. Attendant Training

The case monitor does some attendant instruction. Formal one day trainings are available in some counties.

7. Attendant Supervision

Case monitors are responsible for attendant supervision during the 60 day reevaluations, but consumers are encouraged to call if there are any problems. Case monitors say they spend a lot of time responding to such calls.

8. Attendant Payment

The provider completes an invoice which s/he submits to the DHMH. Case monitors must sign these invoices, but they often pre-date invoices, which opens a potential for fraud (i.e. the attendant bills for days service was not provided, or continues to bill the state after being fired). It is difficult to assess the frequency of this, according to advocates and the DHMH, because the consumers are hesitant to report abuse for fear of being left without an attendant at all. One case monitor interviewed now refuses to pre-date invoices because of several experiences with fraud.

9. Attendant Termination

The consumer is responsible for attendant termination, but.may be hesitant to fire an incompetent or abusive attendant because of the difficulties associated with hiring and retaining attendants. Terminated attendants will only go on the state "blacklist" if the case monitor reports them.

10. Conflict Resolution

Case monitors are the main resource in resolving conflicts between consumers and attendants.

B. Consumer Support

1. Consumer Advocacy

The nurse case-monitor may function as an advocate, but there is no source of consumer advocacy outside the service delivery system, although some groups such as ARC may intervene in some cases.

2. Consumer Training

No consumer training is offered by this program.

3. Consumer Outreach

No formal mechanisms exist for consumer outreach, although there appears to be widespread knowledge of and use of the program among the state social and medical service systems through the nurse case monitors.

4. Quality Monitoring

Case monitors conduct a formal provider evaluation during the 60 day assessment. There is little systematic overview of quality other than this procedure. Advocates suggest that there is tremendous variability among services between counties.

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