Chapter 19
Attendant Management

As an employer of an aide or attendant, you will be running a small business and will be using the skills of a personnel manager. The purpose of this chapter is to help you succeed as an employer.

 
DETERMINING ATTENDANT CARE NEED

The first step in looking for an attendant is deciding what activities you will need help with. This is called a "needs assessment". The checklist in table 19.A. provides a general outline of duties an attendant might perform. Go through the list and mark each activity you will need assistance with. It is also helpful for you to note when and how often you need particular types of care. This will help you assess how many hours a day and how many days a week you need an attendant. If you need assistance in areas not listed, write them in the "other" spaces.

You may find you need more than one employee; for example, one in the morning and another at night if you do not need assistance during the day. Or you may need one for weekdays, then another for weekends so that each has time off. You may also want to ask someone you know to work for you when one of your regular employees is on vacation or needs time off or is sick. Sometimes previous attendants who are no longer working for you will do this, as they know your care.

 
CHECKLIST FOR PERSONAL CARE

Now that you have outlined your attendant needs, your next step is to clearly outline what is expected for each task listed. This may help you avoid conflicts about duties your attendant is to perform and ensure that you get the care you need. An example of a personalized care checklist is given in table 19.B.. The checklist gives step-by-step instructions for one element of your personal care.

It would be impossible for you to include every detail of every step in your individualized checklist. But, on the other hand, if important information is left out, the step might not be performed properly. Here are some general guidelines for developing specific steps in an individualized checklist.

1. Be brief. Try to make the steps as short as possible.
2. Put steps in correct order. Make sure the steps are arranged in the order in which they will be performed.
3. Include what, when, where. Make sure the attendant knows what materials are needed and when and where the job will be performed.
4. Avoid how. Much of the "how to" of many steps is too detailed to include in the checklist, and you should teach them while the task is being performed. However, make sure to specify those steps that are essential or often neglected.

Items on the checklists should come from your needs assessment. It is often best to arrange the checklists in a workable order. For example, if bathing is the first task to be done each morning, the bathing checklist should be first. Some people find it helpful to arrange the checklists in daily (e.g., dressing, eating), weekly (e.g., shopping), or monthly (e.g., wheelchair maintenance) order. Having the checklists arranged in an orderly manner would simplify both your and your attendant’s responsibilities. The checklists then become the basis for a vary clear and complete job description for your attendant.

 
PREPARING A JOB DESCRIPTION

A job description needs to be very clear so that you can describe the job to a possible employee. This allows an applicant to see if the job is acceptable. Do not try to make the job sound easier or less time-consuming than it actually is in order to persuade an applicant to take the job.

The job description must be based on your specific needs and should include the following information:

• Duties and responsibilities (as described in the checklists)
• Number of hours of work per week
• Scheduled days and times
• Holiday policy
• Salary and benefits
• Qualifications, such as ability to lift a certain weight, first aid and CPR training, drivers license

If your attendant is going to live with you, your job description should include specifics about the living arrangement:

• Work hours versus leisure hours
• Days off
• Sharing of common space, including kitchen and laundry
• Roles and rights of other members of the household
• Policy on visitors
• Housekeeping
• Attendant’s share of utility bills
• Acceptable behaviors (for example, smoking, drinking alcohol, partying, noise)

 
IDEAS FOR RECRUITING

Here are a few suggestions for finding an attendant:

• Advertise in the local newspaper
• Place flyers on bulletin boards
• Use word of mouth through family, friends, churches, and clubs
• Use an agency, either for-profit or non-profit, that will screen and refer applicants to you. This can include local Employment Security Office (unemployment benefits office)

 
Newspaper Ads

 
Posters & Bulletin Boards

Various college campus locations, personnel bulletin boards, hospital staff lounges, and even public notice places such as those found in some supermarkets, libraries, motor vehicle offices, and community centers all offer you free recruiting places.

The strategy of content and layout for a poster or index card is much the same as for newspaper ads. Use your splashy headline to attract curiosity wherever possible, then include the newspaper ad content (see section above). With more space on a flyer, you can include more of the optional information discussed above. Reproduction costs can be minimal, and the greater freedom for attractive art forms lets you be more creative. Tear-tabs at the bottom of your flyer can be a very important feature. (See figures 19.2. and 19.3.)

Here are some considerations in posting your flyers:

• If you can do your posting independently, fine; if not, bring a friend with you.
• To make your message seen, pick a good place! Choose posting areas with high-pedestrian traffic of the type of people who might be interested in your offer. For instance, if you post an advertisement on a college campus, you will probably find students who are goal oriented, intelligent, and willing to learn; however, you should expect a high turnover rate due to school vacations, graduations, and transfers.
• Within these high-traffic areas, favorite places are either where people check out notice by habit (job notice board or a favorite bulletin board), or where people must wait for something and may read from boredom (outside of elevators or cafeterias). Now that you have a good place, find a good spot within it, where your message can be seen.
• Observe any rules imposed for the posting area, and check your postings regularly to ensure no one has covered them with others.

 
Word of Mouth

Don’t overlook the obvious; the people around you every day. Friends (e.g., from class activities or apartment living) might well include today’s reserves and tomorrow’s attendants. The big advantage of recruiting in this manner is your knowledge of the interested individual. Advertise during informal conversation. Family and friends may be able to identify reliable and dependable individuals who have the ability to provide care for you - including themselves. Some people you might think least interested in working for you may pleasantly surprise you.

 
Using an Organization or Agency

A number of not-for-profit organizations can be sources of attendants. Centers for Independent Living assist people with disabilities to live independently and many maintain an information and referral service. So, too, do many senior centers.

Refugee employment through refugee agencies is an excellent source of help. You offer an individual exposure to advanced English, and you may have external support from the agency.

Nursing schools may be able to help you locate nursing students who want to gain experience in the skills of their future profession.

Clients of the Department of Developmental Disabilities and Vocational Rehabilitation are another good resource. Sometimes a mentally retarded person can make a good attendant. Other people with disabilities may work out also.

You can also use a home health-care agency as a source for attendants. While they may have more training than attendants from other sources, you may not have the option of choosing your own attendant. Agencies provide insurance and other benefits to their employees, contributing to a more stable work force, but they are often more expensive to use than finding an attendant on your own.

 
PEOPLE WHO MAKE GOOD ATTENDANTS

There is no specific profile of the perfect attendant, but there are a few tips that may make the task of finding one a little easier:

• Consider a wide variety of options. Don’t restrict yourself to someone with a specific ethnic background, culture, educational level, age, or social group.
• When selecting attendants, do not expect a long-term relationship, but do expect dependable care. Select people based on whether you feel they can be trusted. You are trying to select an employee who you believe will care for you on a regular basis.
• Family can be useful, but remember the employer/employee role. Hiring a family member may have drawbacks!
• Use friends, the SCI team, or family to help check someone out when you are really stuck or having trouble. Be careful, though, not to over-use your privilege of friendship or family ties.
• Know your own likes and dislikes. Besides basic care needs, know what you like and dislike in people. Trust and dependable care depend on your knowing yourself and letting others know what you like. Who do you like to be around and why?
• It may be helpful to learn to assess personality (general style and behavior patterns) and emotions (how people express feelings). Pay attention to how people look, talk, and act. Notice if they are well groomed and confident. Does conversation flow smoothly?

Also, trust your gut reaction: Does it feel right to be around this person? If you feel sad, angry, confused, etc., when with this person, do you want to spend a great deal of time with them?

Another part of how you feel towards a potential attendant may be your attraction to them. Remember that you’re not hiring a friend or a lover.

 
HOW TO HANDLE CALLS ABOUT THE JOB

Give a brief description of what the job entails: personal care, housekeeping, meal preparation, shopping, or driving. If the person is still interested, you may want to set up an appointment to meet in person or ask further questions. Here are some topics you should cover before meeting applicants:

• Do they mind doing personal care? (You may have to be specific about what this entails, such as bathing and bowel or bladder care). Can they handle nudity that goes along with personal care? If they cannot, there is no sense wasting their time and yours. If they do not mind it, then discuss basically what is involved.
• Do not hire someone you have not seen who sounds nice on the phone.
• Describe basic household duties and other chores.
• Describe your living environment. Emphasize the positive.
• If you need a driver, find out whether they mind driving the type of vehicle you own and whether they have a good driving record.
• Discuss your social lifestyle and what you consider appropriate and allowable.
• Ask what kind of work they have done and whether they have work references.
• Ask if there are any physical or emotional limitations that would make it difficult or prevent them from doing this job.
• Ask if they are available to work the hours you need assistance and what flexibility they have for additional hours or filling in on short notice.
• If people call and you do not want to hire them, just tell them the position has been filled or that you are considering other people for the job.

If you get satisfactory answers and want to meet an applicant for an interview, pick a convenient time and place to meet. You may want to meet somewhere other than your home, for your own safety and independence.

 
INTERVIEWING

It has been the experience of many people with disabilities that half the people who made appointments for in-person interviews do not show up. Ask people to please call you if they change their minds.

Have a schedule and a job description ready for them to read. Have a notebook, to take down information like name, address, phone number, Social Security number, date of birth, ability to lift or transfer, drivers license number, social interests, and at least two work references. Other acceptable references are counselors, teachers, or ministers.

Have someone else there to write this down if you are severely disabled. This person may also prove to be a good support person during the interview.

Discuss the job in greater detail. Let the applicant know what social behavior you allow, what unexpected events may arise, the things you like doing for recreation, and what areas of your life you want to be kept confidential.

Here is a short checklist you may want to use to help discuss background:

• How many years of education have they completed?
• What kinds of work have they done and liked the best?
• Have they had any experience of being around a person with a disability?
• How long have they lived in the area?
• What are their attitudes toward disability?
• How do they deal with boredom and stress?
• Will the work hours fit into their schedule? How much flexibility do they have?
• Will they feel comfortable driving a large vehicle like a van?
• Would they mind getting up in the night to turn you or help you go to the bathroom?
• Do they understand that some physical lifting may be required?

Allow them to ask questions about your disability and lifestyle. They need to know in order to be able to do their job well. When you complete the interview, let the applicant know you will call them back with your decision. It is never a good idea to hire someone "on the spot".

 
CHECKING REFERENCES

As any employer would, you should not hire anyone without checking references, even if it means writing or calling out of state. A foreigner must already have a work permit and Social Security number. Unless they do, you won’t be able to hire them because of FICA, federal, and state unemployment tax requirements.

When calling on references, identify yourself, explain that you are disabled and are interested in hiring one of their past employees. Describe the nature of the work they will be doing and the need for having someone dependable and honest. Tell them you would like them to tell you some things about the person. Consider asking the following questions:

• How long was the person employed?
• Was the applicant dependable?
• What about absenteeism?
• Did this person deal with money on the job?
• Do you consider this person to be honest?
• How well did the person take supervision and criticism?
• Can the person work independent?
• How was this person’s rapport with other employees and supervisors?
• What was this person’s reaction to stress?
• Why did this person leave the job?
• Would you rehire this person?

 
MAKING A CHOICE

After you have checked the references, you want to pay particular attention to the answers on dependability, honesty, working and getting along with others, why they were terminated, and their rehire status.

Are your social lifestyles compatible? Do not hire someone thinking that person will change for you or that you have the right to control that person’s life. What the attendant does on off-hours should not concern you as long as it does not affect the quality of work. If you need a lot of driving done, be sure he or she has a good driving record, because it will affect both your safety and insurance.

If for any reason you do not feel comfortable with the person, do not hire that person. (See the section in this chapter on People Who Make Good Attendants).

Find out how long the person will be able to stay. The longer, the better - but that should not keep you from hiring the person. Some employers will hire a qualified person for a short time if they are sure they will get good service. This can be helpful when you are waiting to be discharged from a hospital. You can look for a replacement once you are home. It also helps when you need to start school or go to work.

What sort of physical and emotional health does the person have? Emotional problems can be very difficult to deal with. If you suspect but are not sure the person has emotional problems or will not be able to handle the job, hire them on a two-week trial basis.

Let the applicant know your decision within a week or less.

Finally, do not hire out of desperation. Try to remain calm and clear-headed. If you publicize as much as you can and have your schedule and job description in good order, it will increase your chances for success.

 
USING A LETTER OF EMPLOYMENT

To avoid any misunderstandings, it is helpful to have a written letter of employment from you to your personal assistants. That letter should cover such matters as hours of work, salary, vacation and sick leave, unacceptable social behaviors (smoking, alcohol use, profanity) and what can lead to termination, who pays when the attendant accompanies you on social outings, and the time needed for notice when the person decides to leave the job. There should also be a clear description of the arrangement made regarding taxes, Social Security, and any noncash reimbursements. The job description should be attached to the letter and referred to within it.

For live-in attendants, you should also include information about utilities (phone, newspaper, shared costs, long-distance bills) and use of your personal items such as shampoo, detergent, car, wheelchair, food, etc.

Keep a copy of the letter in your employment files.

 
HAVE A BACKUP PLAN

At some time or other, you will not have an attendant when you really need one. This could be due to an attendant’s illness or being fired or quitting without notice. Or you may just need more than one attendant. Especially if you need care seven days a week, no one person will always be available. Personnel assistants must have some days off and you need to find someone else to care for you then.

When you first get into the business of employing attendants, figure out your backup plan. You may cut down what you require, such as the housecleaning, or you can eat with a friend, or have a potluck. Do a second needs assessment and be realistic about what care you can eliminate without sacrificing your health and safety.

Arrange with a family member or friend to know your personnel care, so that you can call on them to help you in an emergency. You may want to make arrangements with a neighbor (who would like to earn a little extra money occasionally) to know your care so that you can use that person when you have a need. You may make an agreement with another individual who has an attendant to share an attendant in an emergency.

Some communities have organizations that can supply attendants on an emergency basis. These may be a local visiting nurse service or an organization for individuals with disabilities. Since these resources often require advance application, assessment of needs and eligibility, and scheduling, you need to make arrangements before you are left without assistance.

Realize that the same individual doesn’t have to supply all your needs. A visiting nurse will assist with bowel and bladder care, for instance, but will not perform housecleaning or run errands. You (or your family, friends, and neighbors) may know a responsible teenager who would like to earn some money performing those non-skilled tasks.

The most important part of handling the sudden loss of your attendant is planning for that situation and having several contingency plans. Remember that relatives and friends are just that... relatives and friends. If you have not overused them in the past for attendant functions, they may come through for you when you have no attendant.

 
WORKING WITH AND SUPERVISING AN ATTENDANT

Being a supervisor may be a new role for you. To be an effective supervisor, you need to understand the skills involved. Supervising does not mean being a boss. Supervising means working with your attendant and guiding him or her to make sure the job gets done.

This section reviews the basic skills of effective supervision. It stresses the need to work with your attendant to solve problems and to be firm when necessary. Because of the close contact between attendant and attendee, the employer/employee roles can get confused. It is important for you to use supervisory skills to stay in control, to solve problems, and to maintain a good relationship with your attendant.

REMEMBER:
Your Attendant Is Only Human

Your attendant has formally agreed to be responsible for the needs you have discussed. In return, he or she can expect your respect. He or she is a fellow human with a separate life, of which helping you is only one part. Your attendant is not bound to you for more than the hours stated in the letter of employment. You have a perfect right to expect that services will be satisfactorily performed. At the same time, you do not have an open charge account on your attendant’s time.

Do not be demanding. Use the same tact and warmth with your attendant as you would a friend. If you find you are repeatedly short-tempered toward your attendant, objectivity step out of yourself for a few minutes and retrace the heated events as a third person in the room. Try to see who was really at fault or what proportions of fault were involved. Ask yourself before you confront, snap at, or argue with your attendant, "Is this a real fault of my attendant that hampers my needs, or is this a personal habit that just gets on my nerves?" If you really find your attendant is at fault, or considerably at fault, ask, when you are clearly in a receptive and unhurried mood, to "discuss something with you". Get your attendant’s point of view.

If, on the other hand, you find you are mostly at fault, stop yourself. You will find that thinking before you speak helps you to maintain control. See the chapter on Psychosocial Adjustment for other suggestions on communication.

Expect that even an experienced attendant will forget items of your daily routine at times. Try to be tactful with your reminders.

Finally, if you need help on a special project, try to give your attendant some advance notice if possible. If it is time to change the bald tires on your wheelchair, or to do a non-routine spring cleaning of your dorm or apartment, try to let your attendant know this well in advance. This allows your attendant the courtesy of scheduling the project at a convenient time. This will help prevent the friction of a rush demand and increase the likelihood of a thorough job.

In general, show the same gratitude and respect toward your attendant as you would any other friend. Everyone appreciates a few "please" and "thank you" comments.

 
Confidentiality

Before you hire a person, make clear what things you want kept confidential. Respect each other’s needs for privacy when using the phone, having company, or handling financial, family, and social information. Have respect for each other’s bedrooms and personal property.

Remember that when you discuss personal problems with your attendant and ask for an opinion, he or she may not be able to give the best feedback or advice. You are not hiring a counselor. Many people find it uncomfortable to even listen to the problems of others, much less give advice. Do not assume that your attendant will do this. If your attendant is willing to listen to you, you should be willing to do the same when he or she needs someone to talk to.

 
Performance Checks

As an employer and supervisor of your attendant, it is important to provide good, clear feedback about job performance directly to your employee. For many people, "performance checks" create negative feelings such as fear, tension, or distrust. It is up to you, as an employer and supervisor, to make performance checks a positive, motivating experience. Good performance that is recognized and praised will probably make both your job (as supervisor) and your employee’s job (as an attendant) much easier.

Attendants should understand that using performance checks benefits and protects them as well as you. In this model, we provide attendants with ongoing performance feedback by scheduling performance checks. Performance checks consist of the same checklist that you developed in sorting out your specific attendant care needs.

How often they should be done depends on you and your attendant. There is no rigid rule. You are responsible for giving feedback any time a job is not performed to your satisfaction. Simply remember that with a new attendant, the more often performance is checked, the sooner small problems can be solved.

As a general rule, daily duties should be checked twice monthly; weekly duties once monthly; and monthly duties every two or three months. This does not mean that you should give feedback only while doing performance checks. In addition, performance checks should not be the only time you give positive feedback when duties are performed well. When your attendant is working hard and doing a good job, a little praise goes a long way.

 
Deal with Conflict

Many problems arise out of making assumptions. Although a job description and letter of employment should help to clarify basic issues, rules and agreements can be broken nevertheless. Then what do you do? If there is a conflict over duties, pay, time off, social conduct, or use of property, remind the person of the agreement. If he or she refuses to comply with your wishes, act promptly and firmly to find a replacement. When you are dependent on someone for survival, it is not easy to fire that person on the spot and find another person. Allowing the situation to continue, however, will mean you will have to go without service and your health may be jeopardized.

Do not let things pile up. Deal with each issue as it arises. You may want to have an advocate help you and the attendant to settle the disagreement.

 
Communication

When communicating, it is not so much what you say as how you say it. Do not try to hide your feelings by saying something nice in a negative tone of voice. When talking to a person face to face, look at him or her. Evasive eye contact may convey a message that you do not want to listen to the person or deal with the issue or do not mean what you are saying. Also, communicating your appreciation on a regular basis is important so that your attendant does not feel taken for granted.

If you think your attendant is not going to listen well, consider writing letters about your concerns or put them on tape if you cannot write. Have an advocate - a friend to help settle problems or check to see if you are okay. The advocate can also follow up on your progress. Do not let something wait, especially if it relates to your care. Being assertive is very important. See the chapter on Psychosocial Adjustment. Assertiveness is a skill that can be practiced, and several good books have been written about how to ask for what you need without being rude, nasty, or obnoxious. (See assertiveness examples below).

 
ASSERTIVENESS EXAMPLES

1. A man with a disability had planned in advance to attend a concert he had long wanted to see. The day before the concert, his attendant asked him to find another driver, because the attendant had just gotten a dinner invitation from a buddy. The disabled man let the attendant know that he appreciated and understood the attendant’s desire to go to dinner with the friend. Then he reminded the attendant of the previous agreement to drive him to the concert. The man also pointed out that it was too late for him to make other arrangements, so the attendant would have to fulfill the commitment to drive him to the concert.
2. A woman with a disability had hired a man to be her attendant. At the time of the interview, she explicitly stated that she had no interest in combining work with romantic involvement. After a month of employment, the man started making passes and suggestive remarks to her. She reminded him of their conversation at the time of hiring. She said she was sorry about his feelings for her, but she did not feel the same way. She stated that she would appreciate his not bringing up the issue again. If he brought it up again, she would have to let him go. The man said that he was sorry, too, and would respect her wishes. He said that he would like to give a two-week notice of termination and then leave, because he could not promise that his feelings would change.

 
SALARIES AND FRINGE BENEFITS

As an employer, you will be paying a salary to your employee. This money may come from different sources. Your financial resources and the community’s going rate of pay will determine the amount of the salary. You may also be providing room and board and benefits in addition to salary. (See Your Responsibilities as an Employer sections).

 
Paying your Attendant

Many programs exist that may pay for attendant care. Each program has different eligibility criteria, application processes, and employer expectations. It is important to consider using one or more of these programs for cash wages for the attendant. It is also possible to provide noncash wages, room and board, and other benefits as the sole payment or in combination with a cash wage.

Your social worker and other health-care team members are available to explore the various options. Review the material below and then discuss your attendant plans with your social worker or others. Remember that you are the employer and (unless you use an agency) will be responsible for recruiting, hiring, firing, paying wages, and reporting cash and noncash wages for tax purposes.

 
Possible Payment Sources for Attendant Care

All of these programs generally require paper work such as medical documentation of need and/or financial statements. Check with each funding source about IRS and Social Security reporting requirements.

State Medicaid Programs

Contact your local program about in-home attendant care programs. Some states have special income waived programs, including funding for employed people who need ongoing attendant care after they return to work.

Workers Compensation

Each state and federal program has different requirements for funding attendant care. Ask your agency contact person for more information.

Private Issuance

Check your policy. Some policies may provide for attendant care.

Department of Veterans Affairs

VA does not directly pay for attendant care, but does supply extra pension and service-connected income to help with these expenses. Many VA medical centers provide some limited skilled nursing, and a few may also provide some unskilled help in your home. There may be funds available specifically for bowel and bladder care. Ask your nearest hospital benefits counselor or SCI center social worker for more information.

State Vocational Rehabilitation Agencies

In rare instances, a vocational program may include coverage for attendant care.

Home Health Services

Home health care is typically based on having a skilled care need, as defined by state and federal regulations. Depending on the funding source, a person may also be able to get some additional unskilled type of assistance. A physician order for skilled care is required. Home health care may be skilled nursing or therapy related, such as occupational or physical therapy. The Joint Commission on Accreditation of Health Care Organization certifies home health agencies that meet their standards; ask about certification when screening a potential agency.

 
Your Responsibilities as an Employer When Providing Cash Wages

If you are receiving funds with which to pay your attendant, follow the instructions from that funding source regarding:

1. What payment records you must keep
2. In what way and how often you will be receiving this aid
3. What procedure they suggest you use in paying your attendant(s)?

The source may insist on obtaining the names and Social Security numbers of each attendant to enable their direct payment. Try to persuade your funding source away from this plan. You may find that the process of a check coming "automatically" to an attendant takes away some of your natural, employer’s right to bargain with an attendant. Also, whenever you change attendants, the paperwork and delay in the payroll process can result in an unearned paycheck being sent to your former attendant or a considerable delay in the first paycheck being sent to the new attendant.

Ask your funding source and local tax people whether your particular plan of funding requires any attendant you employ to declare the income on federal, state, and/or city taxes. As a matter of courtesy, inform your attendants of any taxes they must pay at the time you employ them.

 
Your Responsibilities as an Employer When Providing Noncash Wages

There is another way that allows you to deduct the "salary paid" from your income taxes. Quite simply, you reimburse the attendant by noncash means. As one quickly sees from the "Summary Chart of Federal Tax Forms" that follows (table 19.C), both the paperwork and tax costs to employee and employer are considerably less for noncash than cash wages. However, more background homework is necessary. The IRS has specific criteria regarding when and how meals and lodging can be medically deducted.

One of the simplest ways to accomplish this is to offer your attendant(s) room at your home in return for their services.

EXAMPLE: You have decided that it is best for your particular needs to hire two attendants. You rent a two-bedroom apartment, take one bedroom for yourself, give the other to your two attendants and have the attendants split the duties. In return, you offer your attendants noncash wages in any of various combinations of room, board, electric power, and so forth.

Before deciding what item(s) to offer, you may want to explore how much of each item is currently considered medically deductible for your particular living situation. A current Revenue Ruling implies that the cost of any commodity that is offered to the attendant, beyond that which you and/or your nonattendant family would need ordinarily, might be medically deductible. For example, if you would normally need a one-bedroom apartment, but you have to rent a two-bedroom apartment for the attendant(s), then the cost difference between the one-bedroom and two-bedroom apartments might be deductible. Similarly, the cost of additional food, electric power, etc., incurred only because of the existence of the attendant(s) is possibly deductible. You may well want to limit your noncash wages to deductible items.

Choose, in priority, those noncash items that you can most easily prove you paid for by means of receipts or other records. Clearly divide these expenses objectively by the number of people in the living situation. For example, lodging and power are easier to substantiate and divide objectively than food costs.

To determine how large to make this noncash package, figure the amount of cash salary normally to be paid and equal that in noncash benefits. Whatever is NOT being offered in the noncash wage package must be understood from the beginning to be the financial responsibility of each occupant, such as food, clothing, utilities, and shaving articles. This goes for anyone who routinely shares a dwelling.

See the "Summary Chart of Tax Forms" to determine which reporting forms are still necessary. This means that you are telling the IRS who has received what amount of "income" from you. No FICA payments are required. Again, call your nearest IRS office for these forms, which will be self-explanatory.

To safeguard your own interests in case or IRS audit, see the notes at the end of the table 19.C for suggestions on your personal record keeping.

Certain filing requirements may be different from information supplied here due to such factors as personal situation of taxpayer or changing IRS policies and rulings. Use the data in table 19.C as a guideline and check your particular situation and wage method with latest policy of your nearest IRS office.

 
KEEPING TRACK OF ALL THIS

It is really helpful to have a file on attendants you have interviewed (acceptable and unacceptable) and also the ones you hire. You will need to keep information for tax reporting and W-2 forms. You may also want to refer to it in an emergency.

A file box is good for keeping verification forms, your copies of tax reports, and copies of cancelled checks for future reference.

You could use a card file or a notebook for information on attendant applicants. The data should include:

1. Name
2. Address
3. Phone number (message number also)
4. Date of birth
5. Social Security number
6. Driver’s license number
7. Date you hired them
8. Date they were terminated
9. Reason for termination

TABLE 19.C. A Summary Chart of Federal Tax Forms
for Employers of Personal Assistance Services

 
GRACEFULLY PARTING WAYS WITH AN ATTENDANT

Even though you have taken much care in screening and choosing an attendant, the one you hire may prove to be unsatisfactory. In that case, you will have to make your dissatisfaction plain and be firm in your right to expect better service. If improvement does not occur, you should move quickly to find a satisfactory replacement. An unreliable attendant is not healthy for either mind or body. You must keep control over how your own basic needs are to be met in order to meet your goal of independent living.

Try to have your attendants leave on the best possible terms, because you may want to call on them in an emergency. Also, consider developing a checklist for what needs to be completed before attendants leave. Some things to consider are:

• Make sure they have filled out a verification form (if you are receiving Chore services) before paying them.
• Make sure all basic duties are completed so the new attendant can enter a clean and orderly household.
• Get their key to the apartment/house.
• Get a forwarding address or permanent phone number. (Keep this information for your files).

 
PREPARING FOR THE RECURRING CYCLE

The termination of an attendant will mean either a smooth transition into the employment of someone else or a frantic scramble for a replacement. It depends on whether you have done your homework.

With the best planning and preparation of the new attendant, even the most experienced employer may feel insecure in the transition from old to new. Anxiety is a natural feeling for anyone moving from an established, familiar situation into one that is new or uncertain. For certain people with disabilities, this twinge of insecurity will be a little more intense due to a little more architectural--or personal care--dependency.

Studying and analyzing as many aspects of the situation as possible and then preparing for them has proven the best way to minimize that transition twinge. We hope that helpful hints of this text will best enable you to do so for yourself.

 
RESOURCES

 
Publications

Managing Personal Assistants: A Consumer Guide.

Purchase:

PVA Distribution Center
PO Box 753
Waldorf, MD 20604-0753
(888) 860-7244

Download: www.pva.org

 
Web Sites

www.eldercare.com
CareGuide.com provides general information and housing, legal planning, assisted living, and home care resources by geographic area based on a client profile of needs that you provide. There are free quality care tools such as checklists to evaluate assisted living and nursing home facilities. This is a relatively easy site to use.

www.nfcacares.org
National Family Caregivers Association (NFCA) helps to raise awareness and support for all who provide direct care to people who are ill or have a disability.

www.senioralternatives.com
Senior Alternatives for Living Online offers a nationwide directory of state agencies that can help answer questions about home health care.

 

SCI Self-Care Guide Main Page Chapter 1     SCI Anatomy & Physiology Chapter 2     Skin Care Chapter 3     Circulatory System Chapter 4     Respiratory Care Chapter 5     Range of Motion Chapter 6     Bladder Management Chapter 7     Bowel Management Chapter 8     Nutrition Chapter 9     Medications Chapter 10   Nerves, Muscles, and Bones Chapter 11   Autonomic Dysreflexia Chapter 12   Pressure Sores Chapter 13   Psychosocial Adjustment Chapter 14   Sexual Health & Rehabilitation

Chapter 15   Community Resources Chapter 16   Vocational Rehabilitation Chapter 17   Recreation Chapter 18   Driver’s Training Chapter 19   Attendant Management Chapter 20   Home Modifications Chapter 21   Approaching Discharge Chapter 22   Pain after Spinal Cord Injury Chapter 23   Substance Abuse and SCI Chapter 24   Exercise Chapter 25   Alternative Medicine Chapter 26   Equipment Chapter 27   Staying Healthy Glossary