The Self-Direct Program is designed for people who are aging or have a disability and require additional support in their homes from a personal care attendant. When people choose to self-direct, they can hire and manage attendants that they choose and gain greater control over their own lives. Ability Montana can compensate personal care attendants through the Self-Direct Program.

Eligibility

To qualify for the Self-Direct Program, a person must:

• Have standard Medicaid insurance.

• Need assistance with daily living tasks.

• Be willing to hire a personal care attendant and self-direct their own care

Personal care and tasks of daily life can be an overwhelming challenge to people with disabilities who want to remain living at home. In-home care through our Self-Direct program provides assistance with these daily tasks. This empowers people to make choices about how, when, and by whom these personal care tasks are performed.

Personal care attendants can help with:

Bathing, Dressing, Grooming, Toileting, Eating, Exercising, Meal preparation, Light housekeeping, Grocery shopping, and Medical escort.

More Information

Contact Ability Montana to see if the Self-Direct Program is right for you. We can check your Medicaid status and offer guidance about how to hire a personal care attendant.

The Self-Direct Program is made available through the Montana Department of Public Health and Human Services (DPHHS).

Introduction

The information in this manual specifically applies to Consumers using the Self-Direct Program at the Ability Montana (Ability Montana). This manual is meant to be used as a tool to empower and guide Consumers to be confident in the position of an employer so that they may be able to hire, train, and manage a Personal Care Assistant (PCA).

The Self-Direct Program is a Medicaid program designed especially for persons 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.  

If you would like to Self-Direct your care at home and are looking to hire one or more caregivers, please read the manual for tips to consider.

Identify what you are looking for in a Personal Care Assistant:

Since you are now the boss, take charge of directing your personal assistance services. Start by drafting a list of key areas that could be improved and make your life better if you had personal assistance in your home.

What kind of assistance do you need?  

Which tasks can you do on your own and which do you require assistance with? 

When will you need a Personal Care Assistant and for how long?  

This would include the amount of time you will need assistance each day and during which periods of the day.  

Personal Assistance Preferences:

What characteristics might a PCA have that will make you most comfortable? Taking time to consider your personal preferences and needs in the beginning will go a long way in helping you effectively recruit, interview, hire and manage your PCA in the future. However, it is illegal to discriminate against employees based on race, gender, age, religion, or sexual orientation, as well as other categories.  

How many Personal Care Assistants will you have?  

Will you have one PCA or multiple? Consider what happens when one person goes out of town or is sick. Having a backup plan is essential for managing your care and is a requirement of the program.

On the pages that follow are some checklists and tools meant to help guide you through these important topics. Keep in mind these are only examples and other community resources may also have helpful planning tools and tips.

Posting a Job:

Depending on your style, you may find it helpful to develop a brief job description. This will require you to think through exactly what you want/need an assistant to do.

Things to keep in mind:

How to advertise is as important as where to advertise. The local college, hospital or job service might be a smart place to find possible candidates. Do not rule out your friendly neighbor, family, or friend. You do not need to list your full name, address, and telephone number or put too much information in the advertisement. Details can wait until the interview.

Sample Job Advertisement

Telephone Interview:

The initial screening will be one of your most important steps. The point is to be sure that you are sorting through the applicants. Think about the easiest way for you to screen potential applicants and how to handle requests for more information. How will potential applicants contact you? How much information do you want to provide over the telephone or an e-mail?

When potential PCAs call to discuss the job, you should ask them about themselves, why they are interested in the job, and what made them decide to call you. Have them do all the talking at first. Once you have a sense that they are serious, share the specific requirements of the job and ask if they understand or have any issues performing the tasks.

Ask open-ended questions rather than questions that provide simple “yes” or “no” answers. You want to be able to get as much information on the telephone as possible to decide whether this potential PCA should be invited into your home. If all their questions are about money, hours, and/or benefits, then you will know that maybe you are not their primary interest. Be consistent with each applicant who calls.

• A general job description, including duties.

• When (during the day, during the week, etc.) you will need his/her services.

• Your general location.

• Whether or not you have a service animal or pets (is the potential PCA allergic to animals?).

• Salary and method of payment.

• Some of your likes and dislikes as they relate to the PCA. (Do you like to play loud music when he/she is there, or do you need your space to be nice and quiet?).

Tell me about your experiences with persons with disabilities:

There are pros and cons to hiring someone with experience. While someone who has worked as a PCA before may require less training, they may also come with preconceived ideas about how things should be done.

Why are you interested in this job?

You want to pay close attention to not only what they say, but also how they say it. Are the first and only concerns/questions related to money? This could be a red flag. In any job interview, issues of money/salary should be some of the last questions. Besides, if it was mentioned in the ad, the applicant should have some idea of what to expect.

What is your current schedule, and how would this work fit into it?

If the candidate has other commitments, will they interfere with providing you with the services you require? How far will they have to travel to get to you? If a person has only a little bit of flexibility in their schedule, this may impact the flexibility you have in getting their assistance.

Do you have reliable transportation?

This may be important if you need rides to the doctor, shopping, community activities, etc. as part of your service plan.

Everyone who works as a PCA will be subject to a public background check. Would this be a problem for you?

If the PCA expresses any hesitation or refusal to submit to a background check, this may be a red flag for you. If he/she offers up information that may come up in the process of a background check, but insists that they have made a concerted effort to change, it is up to you to determine your comfort level. It may be helpful to consider both the nature of the offense and the type of help you will need. For example, if the offense is stealing or forging a check and your PCA’s have access to your mail and other personal property; at the very least, you may want to consider requesting two additional professional/personal references.

Ability Montana will conduct a background check upon completion and delivery of the PCA Application and inform you of any criminal history.

Do you have any questions about the job that have not been answered?

If you are interested in meeting someone for an in-person interview, be sure to have all his/her relevant contact information. Set up a specific interview time and place and ask the interviewee to please call at least one day ahead of time if he/she needs to cancel or reschedule the meeting. Also, be sure to let the interviewee know if you would like them to bring any additional information or documents (copy of resume, references, etc.).

Interviewing Candidates Face-To-Face:

If you think the applicant may be a good fit, arrange for a face-to-face interview. Initially, it may not seem like this type of interview is that much different than the phone interview, but do not discount the wealth of information that you can gather from watching and interacting with someone in person. Body language, facial expressions, attentiveness, and talkativeness will often provide clues as to how he/she will interact with you daily.

Meeting Applicants:

It may be best to arrange to meet in a public place near your home or even in the lobby of your apartment building, especially as you are still trying to determine whether the person is a good fit.

If meeting in your home is the only option, consider having a friend or family member present. You should still be the one conducting the interview, but having another person’s perspective of the interviewee can sometimes be helpful. It can be useful to watch how the interviewee acts when another person is present. For example, do they talk to you directly or talk to the friend/family about you? You want to make sure the person talks to you directly.

Both your questions and the information you provide about the job should be much more detailed than during the telephone interview. For example, if you weigh 150 pounds and need assistance transferring from your bed to a wheelchair, make sure the interviewee knows that. Also, if you have specific care needs like bathing or bowel program; that information should be conveyed clearly to avoid potential problems in the future.

Evaluating Applicants:

A critical part of the interview process is evaluating the applicant’s ability to adequately perform the job duties described in the job ad. Although it may seem like most people could do what you need done, this is not always the case. Some people may be uncomfortable helping with very personal tasks, others may not like animals and still others may be uncomfortable interacting with people with disabilities. These types of things are much easier to hide over the phone than in person. It is important to ask a lot of personal questions so you can get a good handle on whether the applicant is responsible and trustworthy. You should also take the time to call references. Be sure you are being honest and explicit about your needs.

Remember, you will be spending a lot of time with this person. You do not need to be best friends, but you should probably be able to have a basic conversation and enjoy each other’s company. Also, communicate that confidentiality is expected regarding your personal information.

Questions to ask:

Have you ever worked as a PCA before? Where? How long?

A person does not necessarily need previous experience to be a good PCA. In fact, some people prefer to hire individuals who come with no preconceived ideas about what will work best and can be trained to your specific needs.

Are you looking for temporary or permanent work?

You should consider how often you want to be looking for PCAs. Are you interested in hiring someone for only a few months? Or are you looking for someone to help you longer term?

Discuss in detail the duties the PCA would perform. Do any of these tasks make you uncomfortable? Why?

It is important for your PCAs to feel comfortable with the required tasks. If they are not, it may be best to consider other applicants for the job. Remember that you are hiring individuals to help you with your daily activities. While it is important to be flexible at times, you should not compromise your health or general well-being to accommodate others.

Do you prefer a job that is highly structured or one that is more flexible?

Consider your own needs and preferences. Do you function best when your schedule is highly structured or more flexible? Do the applicants’ preferences match your own?

How do you like to receive feedback from your employer?

Does the applicant do better with oral or written instructions/feedback? It is best to determine this sooner rather than later. This will give you a better understanding of the best way to train and supervise an applicant.

What is the biggest mistake you made in your last job? How did you correct the problem?

Does the applicant readily share an instance when they made a mistake? It is important that the individual be able to take instruction/correction from you, especially as he/she learns what works best. A good personal assistant is usually confident enough to try new things and is not overbearing.

Contacting References:

Because of the intimate nature or your relationship with a PCA, you will want to check their references before hiring. These references can be with both past employers and with friends or other social relations that can vouch for the individual’s character. Contacting the references can be uncomfortable, but it is essential for making a good hiring decision. If you call the reference, listen not only to what is said, but also how it is communicated. Does the reference hesitate? Does he/she answer the question directly?

Questions to ask an Employment Reference:

• How long did the applicant work for you?

• Was this applicant dependable?

• Do you consider the applicant to be honest?

• How does the applicant respond to directions being given by a supervisor?

• Would you hire the applicant again?

Questions to ask a Personal Reference:

• What is your relationship with the applicant?

• How long have you known the applicant?

• In your opinion, is the applicant trustworthy?

• Would you want the applicant to work for you if you were in my situation?

• Are there any outstanding things, either positive or negative, I should know about the applicant before hiring him/her?