Hiring a Personal Care Assistant for Your Loved One

We all want the best possible care for our loved ones. Naturally we want the same kind of care that we would give ourselves. And if we could, we would watch over them to ensure their safety 24 hours a day. Unfortunately, this is not always possible. Jobs, family and life can stretch us thin. Sometimes the reasonable choice is to ask for help.

Families who are contemplating hiring help for the care of their loved ones often consider hiring a personal care assistant (PCA). A PCA is a personal assistant who helps with any activities that the individual with physical limitations may need, which may be determined prior to hiring.

PCAs may or may not have certain certification. However, a certified nurse’s assistant (CNA), does have specific training and certification, an aspect that may be appealing to some families.

Kara Trinkle, a CNA who specializes in working with patients with dementia and Alzheimer’s, believes families may be more comfortable with a person who has certification. "CNAs have to go through a state training course and specialty tests," she says. "A family can hire a PCA, but you’re hiring only off of impressions. A CNA has to go through state certification, a background check, blood tests and a series of shots. CNAs are specifically trained for working with patients."

In addition to skills and training, personality is key when it comes to finding a good personal living assistant for your loved one. The PCA or CNA spends a lot of time with the individual, so a good relationship is important. Trinkle also notes the importance of compassion. "You have to make them feel safe when caring for them by having a heart of compassion," she says.

Families can use a variety of resources to find an assistant. However, the most recommended places to start are with an agency, nursing home or hospital.

Carmen Jones of Virginia is a mother who knows firsthand about the challenges of raising a child who has special needs. Her 5-year-old son, Marcus, has a rare genetic condition called Opitz-GBBB syndrome. Marcus is non-verbal and uses the aid of a tracheotomy tube and g-tube.

"We have worked with a nursing agency in Maryland that has provided us with nurses to interview," Jones says. Many families are like Jones’ and choose to go with a home health agency, a business that specifically finds a personal assistant to meet your needs.

Using an agency may alleviate some of the stressors of the hiring process. For example, one advantage of using such an agency to find an assistant is the agency’s ability to do background checks on potential employees. However, one disadvantage of hiring an agency is that its services may be expensive (though some health insurance policies may be able to pay for the service). Because Marcus requires a tracheotomy tube and g-tube, Jones’ insurance company provides skilled nursing care for 12 hours each day.

Another option to consider is contacting a local independent living center or nursing home. Once you contact the independent living center ask if they have a CNA program or organization. Also, ask if they know of anyone who works independently in homes.

Questions to Ask During an Interview The interview is an important part of the process of finding a personal living assistant for your loved one. Include the following questions in your interview: How do you feel about working with persons with disabilities? What is your prior experience with this? How long were you employed at your previous job? (This is important because you don’t want to train and hire an assistant if they might quit shortly thereafter. If this happens, always be prepared. Have a backup PCA available.) Do you have transportation? What is your driving record? Are there any tasks that you would not feel comfortable with, such as bathroom duties, bathing or heavy lifting?

If funding is an issue in your search for an assistant, there are resources available to alleviate some of the costs of hiring a personal living assistant. You can investigate private resources such as health insurance, which may cover some costs of having in-home care. Or, you can explore available federal and state-funded resources such as Medicaid. A Protected Tomorrows Advocate can help you determine what benefits are available to your loved one.

A family might also consider advertising by placing an ad in the newspaper or posting an ad on a community bulletin board. This is an inexpensive way to reach many potential employees. By placing an ad on a bulletin board at a community college or university career placement center, you have a better chance of reaching students who may be enrolled in nursing or occupational, physical or recreational therapy programs.

Placing an ad on the Internet is another way to find an assistant or other help. "I have linked on a listserv of parents who have special needs children and sent out messages for baby-sitting assistance with my son," Jones says.

Once you have found an assistant to care for your loved one, the next step is to determine which tasks the caregiver will be required to do. The PCA who takes care of Jones’ son needs to be capable of multitasking.

"Marcus needs assistance with almost everything from toileting to g-tube feedings, g-tube suctioning and balance," Jones says. "When he is ill, he has a lot of secretions and sometimes it overwhelms him. The nurse helps him by suctioning his trach and by keeping him comfortable."

To ensure the care process runs smoothly, make sure that a detailed outline of the job description is provided to the assistant. When making the list of duties, make sure to consider frequency, physical requirements and time of day that the tasks need to be done, including assistance with eating and exercise activities.

Sometimes there might be certain tasks that the caregiver is unfamiliar with, however. In addition to an assistant, Jones’ family also employs a nanny. "[The nanny] did not know how to suction Marcus, but she was quite willing to learn," Jones says. "One of the things I look for with a caregiver is the willingness to take the initiative to learn about Marcus and how to best meet his needs."

But how do you know if the assistant is a good match with your loved one? Sometimes first impressions can be deceiving. The interview process may help determine if the individual will be a good fit with your loved one and your family.

"Make sure you interview the attendant extensively and see them interact with your loved one," Jones says. "It’s important to understand why they prefer working with, for example, children versus adults because that will help you gauge how effective they can be in assisting you."

During an interview you should determine what interests the assistant has that will help your loved one developmentally, too. "It’s not acceptable for the caregiver to just pop in videotapes as a form of recreation," Jones says. "Once you have made a selection, provide the caregiver with some structure and a schedule. Then see if they can adhere to it. You will know quickly who is and is not a good fit."

Dedication is vital to the successful caregiver. "It’s a lot of hard work and the pay is not good, so you are there not because you have to be there but because you want to be there," Trinkle says.