Congratulations on your new position as a Personal Care Assistant (PCA)! This handbook will provide you with basic information to use when working as a PCA.  


Self-Direct Program  

The Self-Direct Program is designed especially for people who live with disabilities and wish to manage their own personal care services by developing a long-term supportive care program in a home setting. 


The program at Ability Montana is called Self-Direct because the Consumer is in charge of making the decisions about their care needs with the assistance of a Personal Care Attendant. The Consumer is the Employer and Ability Montana will act as the Employer of record. 


The Self-Direct Program is designed for people who choose to stay at home instead of using traditional institutional care. People can direct their own care by hiring, training, and managing their Personal Care Attendant (PCA).  


For many people who are aging or live with disabilities, the key to living independently is having a Personal Care Attendant who can assist with activities of daily living (ADL). Activities of daily living are tasks such as bathing, dressing, hygiene, meal preparation, mobility, transportation, housekeeping, etc.  

Additional services may include instrumental activities of daily living (IADL), which include household maintenance, correspondence assistance, laundry, shopping, community integration and skill acquisition. Assistance with health maintenance activities (HMA) are medication administration, bowel treatment, urinary systems management, and wound care. Health Maintenance Activities must have prior authorization from a health care professional. 


In certain situations, a Consumer can arrange to have a Personal Representative (PR) direct services on their behalf. The Personal Representative has the same duties and responsibilities as the Consumer/Employer. In this manual, all references to Consumer also apply to the personal representative.   


The purpose of this handbook is to provide basic awareness about working with people with disabilities and the types of assistance people may need. This handbook also helps promote health and safety within the work environment.  


One of the things you will learn in this handbook is that people with disabilities are as unique as other people. Therefore, your Employer will be responsible for hiring and training you in specific tasks. Your training really begins the day you go to work.  


You have accepted a very important position as a personal care assistant to a person who has limitations in performing tasks of daily living. 

If you are a person who finds a sense of purpose and meaning in serving others, then doing the job of a Personal Care Attendant may be the right job for you. You will be playing an important role in assisting your Employer to live an independent, full life. You will be providing a valuable service to your Employer, and will be contributing to your Employer’s family and society.

Mission of a Personal Care Attendant

To empower individuals with the necessary resources and skills to live as 

independently as possible through mutual interdependence between 

the Employer and Personal Care Attendant. 

Pay and Benefits

Personal Care Attendants are paid $12.41 per hour. A reimbursement of $.33/.34 cents a mile will be paid to employees who use their own vehicle to transport the Consumer to medical appointments, shopping trips, and trips to engage in the community. A current copy of your Montana driver’s license and vehicle insurance must be on file with the Ability Montana office to receive mileage reimbursement.

Health insurance is available to Personal Care Attendants who work 30+ hours per week for three consecutive months. Holiday pay is also available for specific holidays worked as outlined in the Self-Direct Policy and Procedure Manual and on the pay period calendar. A non-Employer match 403B account is also available to Personal Care Attendants who work 20+ hours a week and contribute at least $200 per calendar year. Ask the Ability Montana team for any additional information about these benefits.  

Other services—authorized by Waiver—such as Homemaker and Specially Trained Attendant, are paid alternative rates and can be discussed with the Self-Direct Specialist at Ability Montana.  

Rights and Responsibilities

Both Personal Care Attendants and Employers have rights and responsibilities.  

Personal Care Attendants have the right to:  

  • Be treated with respect and dignity.  
  • Express reasonable concerns regarding working conditions. 
  • Express feelings about work expectations.  
  • Be paid for services rendered. 

Personal Care Attendants have the responsibility to:  

  • Perform all agreed-upon duties in a thorough and caring manner.  
  • Communicate clearly and honestly to the Employer in a confidential manner.  
  • Be dependable in the work relationship.  

Consumers have the right to:   

  • Have time by themselves.  
  • Make their own decisions.  
  • Experience success and failures.  
  • Have their basic needs met.  
  • Pursue their own interests.  
  • Determine their own lifestyle and house rules.  

Consumers have the responsibility to:  

  • Respect their Personal Care Attendant’s privacy.  
  • Communicate clearly and honestly about feelings, needs, expectations, routines, and schedules.  

Being a Personal Care Attendant requires a great deal of integrity.  

What is integrity?  

  • Being honest with yourself and others.  
  • Doing the right thing even when no one is looking. 

What are some ways to show integrity?  

  • Safeguarding your Employer’s property.  
  • Admitting your mistakes.  
  • Treating others with respect. 
  • Telling the truth.  

Why is integrity an important quality for Personal Care Attendants to have?  

  • Many Employers believe integrity is one of the most important characteristics Personal Care Attendants can have.  
  • Working in someone’s home may mean that you have access to your Employer’s money, personal possessions, and private information, making integrity an essential quality. 

On the Job

Your Employer will be the one who trains you on the job. Be sure to ask questions along the way. Ask your Employer for a timesheet when you start working in order to record time worked and job tasks performed. Questions about the timesheet can be directed to your Employer or the Oversight Specialist at Ability Montana.

Job Tasks

Every Employer is unique and will require assistance in a variety of job tasks. Some job tasks may include:  

  • Meal preparation  
  • Feeding assistance   
  • Dressing/undressing  
  • Grooming/hygiene  
  • Mobility  
  • Transportation 
  • Bowel care  
  • Urinary management  
  • Bathing  
  • Housekeeping   
  • Transferring  
  • Shopping 

Your Employer is only authorized to receive a certain number of hours of personal care assistance. Although they do not have to disclose this personal information to their employees, it is important to work out a schedule and discuss job tasks and the time needed to complete the work.

Timesheet and Mileage Record

Work times and tasks performed are recorded on a timesheet. Timesheets can be given to you by your Employer or picked up at the Ability Montana office. A calendar that outlines the pay period schedule was included in your application. Additional copies can also be picked up at the Ability Montana office. Your timesheet is due by 5:00pm every other Monday. Specific timesheet due dates are noted on the pay period calendar. 

Timesheet Policies
  • Use only blue or black ink.  
  • Neatness is a must. Messy timesheets will be returned and may not be processed in time for payment that pay period.  
  • Do not use Wite-Out or correction fluid.  
  • Signatures from both the Consumer and PCA are required.  
  • Timesheets that are not turned in on time will be counted as late and processed the next pay period. Personal Care Attendants living in rural areas may FAX or send a secure email of timesheets to meet the 5 o’clock deadline on Monday.  
  • Only one PCA can work for a Consumer at a time. Overlapping hours will not be accepted. There can be exceptions – see a Ability Montana Program Specialist. 
  • Times in/out must coincide with times in/out on the mileage record for shopping, community, and waiver. 
  • Medical escorts must have every box filled in. Times in/out do not coincide with the timesheet. The time spent transporting Consumers to appointments is additional time arranged for this task. Trips that are seven miles or less can be written on the timesheet accordingly. Trips that are eight miles or more must be approved by Medicaid transportation prior to the appointment by calling 1-800-292-7114. Write the reference number in the odometer section and fill out all other boxes accordingly.  
  • Misrepresented timesheets constitute fraud. 
Communication and Listening Techniques

As a personal care assistant, communication and listening skills are very important. These skills enable you to understand your Employer’s needs and preferences. You will also have to communicate your needs and preferences effectively.

Communication Techniques

Be respectful  

Do not use a parental tone or act as if you know what is best for your Employer. Use an “I” expression when communicating and remember that you are speaking to your Employer. 


Be open and honest in your communication  

Basic honesty is very important to your relationship with your Employer. Sometimes you will have to discuss negative feelings in order to solve problems. Remember to use “I” statements.  

For example: “I feel unappreciated when you speak angrily at me or do not talk to me at all. What can I do to improve the situation?”  


Be able to give and receive compliments  

Some people are uncomfortable with compliments, but giving sincere compliments is an excellent way to express feelings and build a good rapport with your Employer. 


For example: “I really enjoy working with you in your home.”  


Think, act, and speak positively whenever possible  

Your Employer may not want to know about your relationship problems, money issues, or disrespectful children. 

Listening Techniques

Focus on the speaker  

Give the person you are listening to your full attention. Do this by not interrupting and by making good eye contact.  


Verbal communication and nonverbal communication  

People will use words to express their needs, along with body language. Thumbs up signs, a smile, or a nod of approval are signs of body language. Also be aware of frequent yawning, tapping of a foot, or slumped shoulders that may indicate your Employer is tired or ready to move on with another activity 


Ask questions  

Asking questions can show people that you care about what they are saying and want to know more. 

Things to know as a Personal Care Attendant

Managing A Safe, Clean, and Efficient Environment

Maintaining a safe, clean, pleasant, and efficient household can contribute to the general well-being of your Employer. Although many items in this section may seem like common sense, there are certain household management skills that can make your job more efficient for both you and your Employer. 


Universal Precautions  

Universal precautions are practices that help protect against infectious diseases. Clean anything that encounters bodily fluids to help maintain a clean home. For instance, immediately launder sheets or clothing that become soiled. 


Hand Washing  

Hand washing is the best way to prevent the spread of germs that cause infection. Hand washing helps to prevent infection from the Personal Care Attendant to the Employer and from the Employer to the Personal Care Attendant. 


Wash Your Hands  

  • After using the bathroom  
  • After handling soiled items like linens, clothing, and garbage  
  • Before and after meal preparation  
  • After sneezing and coughing into your hand  


Household Maintenance  

It is important to ask your Employer about household preferences and practices before making changes to household routines. Homes may be set up in such a way to assist those with limited mobility.  


Cleaning assistive equipment and devices   

Wheelchairs, hand grips, railings, boards, and other assistive devices should be washed regularly with hot soapy water.  


Using Proper Body Mechanics to Transfer 

Using proper body mechanics means using lifting and moving techniques that reduce stress and strain on your body. Proper body mechanics are necessary when transferring a person from one place to another.  


Techniques for Proper Body Mechanics    

  • Plan the job before starting.  
  • Never try to lift beyond your strength.  
  • Maintain a broad base of support. Keep feet apart, one foot slightly in front of the other. 
  • Keep back straight, with knees and hips flexed; keep your heels on the floor.  
  • Get a firm grip.  
  • Use the large muscles of the legs to lift, not the small muscles of the back.  
  • Never bend from the waist. Bend the knees.  
  • Keep your head up and your back slightly arched while lifting. 
  • Lift smoothly, letting your shifting weight do the lifting; avoid jerking.  
  • Pivot with your feet or shift your feet to turn and set the load down.  
  • Shift your weight backward slightly and bend your knees to set the object down. 


Observing Abuse or Neglect  

As a PCA, you will have the most hands-on contact with your Employer. Knowing what to look for in homecare abuse will be your Employer’s best defense for helping to prevent further abuse. 


Definition of Abuse  

Abuse is the infliction of physical, emotional, or psychological harm to a person. Abuse can also take the form of financial exploitation or intentional or unintentional neglect by the family, a friend, or a caregiver. 


Physical Abuse  

Physical abuse can range from slapping or shoving to severe beatings. When a caregiver or other person uses enough force to cause unnecessary pain or injury, even if the reason is to help the person, the behavior can be regarded as abusive. Hitting, pushing, pinching, burning, and biting are all forms of physical abuse. Abuse can also include depriving the person of food, over- or under-medicating, or exposing the person to extreme weather. It does not matter if these actions are done deliberately or inadvertently. 


What to look for:

  • Sunken eyes  
  • Bed sores  
  • Extreme thirst  
  • Bruises 
  • Evasiveness  
  • Fear  
  • Repeated unexplained injuries   
  • Dismissive attitude about injuries 


Emotional Abuse   

Emotional abuse can range from name-calling or giving the “silent treatment” to intimidating and threatening the person. When a family Consumer, caregiver, or other person behaves in a way that causes fear, mental anguish, or emotional pain or distress, the behavior can be regarded as abusive. It can also mean treating an older person like a child or isolating the person from family, friends, and regular activities- either by force or by manipulation through threats. 


Financial Exploitation  

Financial exploitation can range from misuse of the person’s funds to embezzlement. Financial exploitation includes fraud, taking money under false pretenses, forgery, forced property transfers, or purchasing expensive items without the person’s knowledge. Financial abuse can mean denying the person access to their own funds or home. It can also include a variety of scams perpetrated by salespeople for health-related services, mortgage companies, and financial managers—or even so-called friends.   


Other Types of Abuse   

There are many different forms of abuse. Caregiver neglect can range from caregiving strategies that withhold appropriate attention from the individual while intentionally failing to meet the physical, social, or emotional needs of a person. Sexual abuse can range from sexual exhibition to rape. Sexual abuse can also include inappropriate touching and taking sexual photographs.   


What To Do If Abuse Is Suspected  

The previously mentioned characteristics are intended to be used as a guide to help you recognize a potential abuser. These suggestions are not all-inclusive.


Be aware of these behaviors and know that you have a duty as a Personal Care Attendant to report any signs of abuse!   


Who To Call?  

Whether the harm is happening at home, an assisted living facility, or nursing home, it is important to make a report.   


 If harm is happening right now, call 911  


Adult Protective Services at 1-844-277-9300   


You can also call a Self-Direct Specialist Ability Montana if you are unsure of what to do in the situation.  


Closing Statement   

You have accepted a very important position working as a personal care attendant so someone can live independently in their own home. The work you do is significant in the life of your Employer, their family, and community.  


If you have any questions, please call the Ability Montana office, and talk to the Self-Direct Team. We are always available to provide information and resources.   

Glossary of Terms

Activities of Daily Living (ADL) – These are things you do every day such as dressing, grooming, bathing, eating, positioning, transferring, and toileting.  

Health Maintenance Activities (HMA) – Services that must be delegated or assigned by a licensed healthcare professional, such as a nurse or doctor.   

Instrumental Activities of Daily Living (IADL) – These activities include light housework, laundry, meal preparation, transportation, grocery shopping, using the telephone and money management.   

Consumer – Employer who uses the Self-Direct Program to remain independent in their home.   

Mileage Record – A form used to keep track of mileage, medical escort trips, shopping, community integration, and waiver trips.   

Pay Period Calendar – A schedule of pay periods, holidays, and timesheet due-dates that can be picked up at the Ability Montana office and are provided in your application.   

Personal Assistance Services (PAS) – Range of human assistance provided to persons with disabilities and chronic conditions of all ages, which enables them to accomplish tasks they would normally do for themselves if they did not have a disability.   

Personal Care Attendant (PCA) Person who performs personal assistance services.  

Timesheet – A form used to keep track of times worked and tasks completed when working with a Consumer. 


Bradshaw, Yvonne M., Vanessa R. Nehus, and Andrea D. Hart. “Consumer Directed Personal Care Attendant Handbook.” Consumer-Directed Personal Care Attendant Handbook., Centers for Disease Control.  

Accessed 20 Oct. 2016.  


Senior, & Care, L. T. Policy manual. Retrieved October 31, 2016, from Montana Official    

State Website, http://dphhs.mt.gov/SLTC/CFC- 


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