4.2.3 Personal Care Attendants (PCAs): Working Together Effectively
Louisiana Statewide Transition Project and Louisiana: Healthy and Ready to Work Fact Sheet Series
	7/28/99

I. WHY IS THIS IMPORTANT?

Personal Care Attendants (PCAs) can provide support and/or assistance to young adults with disabilities by supporting or assisting with personal care that is related to activities of daily living. PCAs may provide this support/assistance at home, on the job, and/or in the community. By providing such a service, a PCA can help foster a more independent lifestyle.

After a PCA is hired, the work is not over. In order to maintain a positive and effective working relationship, it is necessary to have good interpersonal skills. Young adults must know how to assert themselves appropriately in order to get things done. Clearly defined responsibilities are also crucial to the working relationship; the PCA must know exactly what is expected. Young adults must be able to give feedback, and even possibly know when and how to fire their PCA.

II. KEY POINTS

After hiring PCAs, young adults must train them. This will be much easier if the young adult has conducted a personal needs assessment in order to identify and define the tasks with which assistance or support is required. It is also helpful to train a new PCA when time constraints are not an issue. Tasks take significantly longer during the first week or so of employment, and both the young adult and PCA may be nervous. It is also important to let the PCA know what personal information must be kept confidential.

In order to get what is needed from their PCA, young adults must know how to be assertive. Assertive behavior communicates both personal responsibility and mutual respect. Taking personal responsibility involves accepting responsibility for feelings, needs, and decisions. It also means knowing how to communicate these things to others. In close working relationships such as those between young adults and their PCAs, taking personal responsibility can foster mutual respect. Mutual respect means that both young adults and PCAs recognize the right of the other to have feelings, opinions, or points of view that differ from their own.

An open line of communication can also set the stage for a successful working relationship. By listening carefully to what the other person is saying, young adults and their PCAs can avoid possible misunderstandings and confusion. When listening to what the other person is saying, it is important to face them and maintain eye contact. It can also be helpful to paraphrase what was said by the other person in order to be sure the message was clear. It should be noted, however, that sometimes conflicts do arise, and therefore must be dealt with by the young adult and PCA.

When a conflict occurs, it is vital to handle it promptly and in a professional manner. Because of the close relationship between the young adult and his/her PCA, there are many opportunities to handle conflict early, or even to avoid it altogether. It is important to address conflicts or problems as soon as possible, otherwise they may linger, causing unease and possibly resentment. It is important to remember to tackle one issue at a time; few people can handle more than this.

When discussing problem areas with PCAs, young adults should ensure that their conversation is private. They should also allow their PCA physical and emotional space, as well as adequate time to think about the conversation. Young adults should be concise and specific when expressing concerns as well as solutions; the PCA needs to leave the meeting knowing what will be expected. Young adults should end the meeting with appreciation. At the very least, they should thank the PCA for being willing to listen and talk openly. Young adults must take the responsibility to follow-up with the PCA on the issue. It is important to recognize any improvement, while continuing to give feedback about areas that still need work. Finally, young adults should also keep records of any conflict that has arisen, as well as any feedback given to the PCA.

If the problem is not resolved after discussing it with the PCA, it may be time to consider other options. Before taking drastic measures such as firing the PCA, young adults should first ask themselves the following two questions: "Is what I am requesting reasonable or readily achievable?" and "Did I make an assertive request that respected the feelings of my PCA, while communicating clearly what changes were needed?" If the answer to each question is "yes", the young adult should once again meet with the PCA to discuss the issue. During this meeting, the young adult must stress that the changes must be made. If changes are not made, young adults should make one more attempt to resolve the issues, pointing out that failure to make the changes will result in the PCA being dismissed. Young adults should always keep backup supports in place in the event the PCA suddenly quits or it becomes necessary to fire them. It should be noted, however, that if a PCA works through a service provider, all feedback must be shared with both the PCA and the provider. It will be the responsibility of the provider to dismiss the PCA.

III. ROLES/NEXT STEPS

Students/Young Adults:

Self-advocacy and self-determination skills can be very helpful when utilizing the services of a PCA. Young adults must learn how to articulate what they want and/or need, and also how to advocate for themselves to get it. By learning and practicing self-advocacy and self-determination skills while still in high school, young adults can gain the experience needed to be successful employers of PCAs.

Young adults should make efforts to improve their communication skills. The more effective they are at communicating their needs to others, the better their relationship with their PCA will be. Communication is key when working with a PCA. Young adults must be able to accurately express their needs in a way that is clear and also respects the feelings of the PCA. They must also be skilled at providing feedback about the performance of the PCA in a timely and effective manner.

Young adults must practice various conflict management strategies, and be willing to utilize them when needed. By providing prompt, clear feedback to PCAs, young adults can help foster an atmosphere of mutual respect.

Young adults must keep records of their interactions with their PCAs. These records will help give an objective view of the performance of the PCA, which will be helpful when evaluating them.

Young adults must keep backup supports in place in the event the PCA suddenly quits, or if it becomes necessary to fire them.

Families:

Families should encourage self-advocacy. Families must recognize that young adults need to develop skills that will enable them to make things happen. By encouraging young adults to speak for themselves and to make decisions for themselves, families can help foster greater independence.

Families should be willing to provide backup supports in the event the young adult's PCA suddenly quits, or if it becomes necessary to fire him/her. By being available to fill in on an as-needed basis, families can help assure that the young adult's needs will continue to be met.

Family members can play a key role in helping the young adult train his/her PCA. This is especially important if the task the PCA is learning is complicated, or if the young adult cannot explain it fully.

Agencies:

Agencies that provide PCA services should strive to make their policies and guidelines empowering to young adults utilizing these services. Agency personnel should work with both young adults and PCAs in order to foster communication and conflict management skills in order to facilitate better relationships.

All agency personnel involved in transition planning should support young adults in their quest to be self-determined. By listening to young adults and respecting their thoughts, opinions, and dreams, agency personnel can help young adults advocate for themselves and reach their goals. Local education agencies (LEAs) and adult agencies can offer self-advocacy/self-determination training to young adults. These skills are very useful when working with PCAs.

When requested, all adult agency personnel should attend Individualized Education Program (IEP) meetings at which transition to adulthood is discussed. LRS counselors, OCDD personnel, and others have valuable information that must be shared with teachers, families, and young adults wishing to utilize PCA services. If the young adult is already using the services of a PCA, then he/she should also be invited to be a part of the transition planning process.

IV. RESOURCES/CONTACTS

Department of Health and Hospitals

Division of Home and Community-Based Waiver Services

PO Box 91030

Baton Rouge, LA 70821

225-219-4280

Centers for Independent Living:

New Horizons, Inc. (Shreveport area)

318-865-1000

Resources for Independent Living, Inc. (New Orleans area)

504-522-1955

Southwest LA Independence Center, Inc.

318-477-7194

(Each center has satellite offices in surrounding communities)

Louisiana Rehabilitation Services (LRS)

925-4131 (in Baton Rouge) or 800-737-2958*

Office for Citizens with Developmental Disabilities (OCDD)

225-342-0095*

(*Contact these state offices in order to get the number of the regional office nearest you.)

V. REFERENCES

Ludlow, Catherine D. (1995). Getting From Here to There: A Manual on Personal Assistance, The Training Partnership Project: A. J. Pappakikou Center.

Ulicny, Gary, R., Jones, Michael, L. (1987). Step by Step Guide for Training and Managing Personal Care Attendants, Research Training Center on Independent Living: University of Kansas.