Modes of Service

The type of home care worker you hire will depend on your needs, preferences and finances.

This page covers the four major sources for getting a personal assistant.

• Independent Provider (IP)
• Intermediate Service Organization (ISO)
• Home Care Agency (HCA) or Home Health Agency (HHA)
• Family Members, Friends, Volunteers

Independent Provider (IP)

Independent providers are PAs who work for you directly. They are not part of any other organization.

If you choose to hire an independent provider you will need to

• recruit
• screen
• interview
• check backgrounds and references
• do payroll and figure and pay payroll taxes.

You will need to follow all required state and federal labor, health, and safety laws. You will need to have insurance to cover any injury or accident to your PA on the job. Check to see if this is covered by your renter or homeowner's insurance policy.

The IP may or may not have any training or experience. Some people with disabilities consider that an advantage. It gives them an opportunity to train someone in how they want the tasks to be done.

You also will need to be sure that you have a back-up system in place. The back-up system is for times when the PA is ill, does not show-up, or takes some time off.

People with disabilities usually cannot provide benefits for their PAs. Benefits are health care insurance, paid vacation, or retirement plans. Low pay and lack of benefits lead to the need to replace the worker often. The low pay and lack of benefits might be overcome by other trade-offs. You will need to figure out what trade-offs make up for the low pay and no benefits. Some trade-offs could be flexible hours or room and board. Some independent providers belong to labor unions. The unions provide them with some health care benefits and training.

You can find out the pay range in your area by calling agencies that serve people with disabilities or senior citizens.

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Intermediate Service Organization (ISO)

There are organizations that do recruiting, possibly some screening and a little training of workers. They provide you with a list of PA names to choose from. Some of them will handle paying your PA and reporting taxes for you. Some may provide some benefits for the PA. These organizations are called Intermediate Service Organizations or ISOs. ISOs frequently are nonprofit or government sponsored organizations.

ISOs take many forms. They can be any of these:

• freestanding organizations designed for this purpose
• local Area Agencies on Aging
• local mental health programs
• other government social services or health programs
• local or state government public authorities for this purpose
• local social services agencies.

An ISO will help you to put together regular and back-up workers to meet your needs. An ISO may provide a list of workers who may have been screened and may have minimal training.

The worker works for you like an independent provider. The ISO refers the worker to you. The ISO may have some rules that the worker must follow. It also may provide you with a place to go if you have problems, or need back-up services.

The advantage to using an ISO is that it handles payroll and taxes. It does the recruiting, screening and some reference checking. Sometimes ISOs provide some benefits to the worker. However, some ISOs only provide you a list of names and don't provide any other services. So it is important to ask what they will do for you. They also may provide a "case manager" who can help with supervising your situation.

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Home Care Agencies (HCA)

A home care agency can provide you with a personal assistant who can carry out a range of services. Services can be personal care and homemaker or chore services. Home care agencies can be for profit or non-profit businesses. These agencies can provide workers who have minimal training. The agency also may provide a "case manager". The case manager oversees your situation and the worker.

Be sure to ask whether or not the agency

• allows you to be the day-to-day supervisor
• allows you a choice in "hiring" and firing the worker.

Agency charges are higher than hiring an independent provider or one from an ISO. The agency adds on its overhead (office maintenance, supervision costs, training, etc.). Some states cap the hours or dollar cost of service according to the state's assessment of your need. If the service costs more, you will receive fewer hours of service.

Home Health Agencies (HHA) often are Medicare certified. This means they can provide home health services that Medicare and Medicaid will pay for. Licensed professionals (nurses, physical therapists, doctors, and social workers) provide these services. These agencies also may provide homemaker/chore services. These agencies provide more supervision and control of the services they provide.

If you decide that an agency is the best way to go there is an Agency Checklist with questions to ask the staff.

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Family members, friends, or volunteers as PAs

Having family members, friends, or volunteers as your PA may save you a lot of time and energy at the beginning. However, great care is needed that they do not become overworked, tired, stressed, or depressed. Each has other issues that could affect your decision to choose them.

Family members may serve as personal assistants. They may be paid or unpaid. This may be the easiest process for you if a family member is willing and available. He or she would be someone you know and trust, is familiar with your condition, and your likes and dislikes. However, it may be harder for them to see you as their employer. Such a relationship comes with the "baggage" of family history. A parent, brother, sister, son or daughter may want to do things their way. They may be more protective of you. It may feel good to be protected. Be careful. You may be trading your independence for that protection. A husband or wife may think they can do it all - tend to your needs, the house, and work. It is important to get additional help to preserve the marriage relationship.

It will take more skill on your part to get them to understand why you need a written job description, work agreement on services to be performed, and how you want them done.

Friends, paid or unpaid, provide another alternative. However, many of the same issues that apply to family members also apply to friends. It is possible to overuse either of them. Often they want to help. Sometimes they even think they can do it all themselves. However, if you over use or abuse the help provided by friends, they may begin to avoid you. Then you will lose the friend, the companionship and the help they provided you.

Organized groups or individuals may provide volunteer help on a short-term basis. These could be people from churches or social clubs. Other "volunteers" are the many people that you encounter daily who help by opening doors, picking up things that you drop or reach for something in a store for you.

Consider the pros and cons of each source of PA services. Talk with friends who use PA services, the Independent Living Center and other local service providers. Assess your needs and determine which is best for you.

What if your sister became your personal assistant?

PA: You always ate my spaghetti at home.

Consumer: The whole family ate it. I actually prefer the one in the jar with the Italian sausage and garlic.

PA: Well aren't we uppity. You prefer something out of a jar to my homemade sauce.

Consumer: Aw, come on, you made it with tomato soup. Besides, I'm the boss now, and I get to have what I want.

PA: Oh, yeah, you always got what you wanted when we were kids.

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Go to Personal Goals and Preferences

Getting Started > Modes of Service