Managing a Personal Care Attendant (PCA)

Posted by Reeve Staff in Daily Dose on June 11, 2019 # Health, Mobility

Properly managing your caregiver is the key to creating a positive environment and relationship. Because you rely on your PCA for many personal tasks, it can be a challenge to control roles and responsibilities. Reviewing these topics from the start will ensure responsibilities are met on both sides of the table.

Setting Boundaries and Guidelines

To guarantee there are no gray areas with responsibilities and guidelines, it’s important to create a contract or agreement tailored to your needs. You can draft your own agreement, but if your care is complex you many want a contract drafted by a lawyer or paralegal. Your local independent living center may have a sample employment agreement to review. This will encompass the job description and all tasks, as well as the agreed compensation, contracted time and their schedule. When expectations are defined in the beginning, it sets the tone for a healthy and beneficial working relationship. Employer and employee obligations need to be clear but there also needs to be open communication and respect between the two parties.

Assert Your Role as the Employer

Be clear and confident when outlining care instructions, highlighting your preferences while emphasizing your role as the employer. Guidelines should be strictly followed, correcting procedures done incorrectly immediately as well as improper behaviors if they occur. If questions arise or if standards are not met, reference the criteria and tasks in the contract or agreement to address and resolve with your PCA. Know your needs. If care is not satisfactory after repeated attempts to change, report complaints to the agency or document issues for your caregiver to sign for future reference. On the other hand, be sure to track positive behavior for future evaluations as well. Try to create an environment where if a question arises, your PCA can come back to you for clarification. If needed, have educational materials for them to read.

Tax Responsibilities

It is imperative to ensure tax documents are submitted to properly record compensation. If you are using an agency to supply your PCA, the agency executes payroll paperwork for PCAs. If you hire a caregiver who is working as an independent contractor, you must provide a 1099 form to the PCA each tax year if compensation exceeds more than $600 in that year. If you are the employer and the PCA is your employee, it is your responsibility to arrange tax withholdings and provide a W2 form to the PCA each tax year, therefore research your state laws and work with an accountant and lawyer to ensure guidelines are followed. Please check with your local independent living center as they may have payroll software to lend to you.

Performance Evaluations

Like any job, performance evaluations are essential to assess and address responsibilities and possibly assume new roles. Because PCAs are so involved, reviews should be completed often throughout the year, typically every 90 days. Reference documented care notes (if using an agency) and provide feedback to the agency or schedule a review to highlight exemplary work as well as areas that need improvement. Suggest workshops where they can learn and improve, but also use this as an opportunity to obtain their feedback. Agencies will manage an increase in compensation or termination if needed, but as the employer, consider offering a raise or additional responsibilities if they surpass expectations. It is important to outline in your hiring agreement at which intervals bonuses might be considered and given.

Conflicts Between PCAs

Often with multiple PCAs, conflicts may arise between them. It’s best to be open, honest and direct to avoid long-term problems. A common cause of conflict is that one PCA has left a mess for the next shift to take care of. Emphasize to the PCAs that their duties need to be completed by the end of the shift unless an unusual situation has arisen. Steer clear of contradictory stories by bringing both individuals together to listen to their accounts and resolve the matter at hand. It might be a simple miscommunication or desire for more responsibility.

In-home Caregivers

PCAs that reside in your home often feel like extended family. Resist the urge to treat them like family and keep the relationship professional and respectful. Take time to learn about them, their hobbies and interests as well as their family, and be prepared to share details about yours. It is an evolving relationship, so don’t be concerned if you and/or your PCA are not comfortable opening up right away. Sometimes it helps to make light of uncomfortable situations like bathroom routines to break the ice. Conversely, it’s easy for lines to blur if you become too close, so be present and assertive when dictating responsibilities to continue to identify professional and personal roles. You may want to consider designating a room or area for the PCA to use during breaks. If the PCA is working an overnight shift you must be clear whether or not they are expected to stay awake all night, which may be necessary if you are a ventilator user.

Alcohol and Drug Policies

Since you require care that goes beyond your abilities, PCAs must be clear headed and impairment-free while performing their duties or on their shift. Establish rules for drug and alcohol use to avoid impairment issues in case of an emergency. Remember, they are there to take care of you, and assist with any medicinal drugs, not to indulge themselves. They must also be responsible for your durable medical equipment (DME) at all times. Be sure to outline what is acceptable inside and outside the house, as well as when they are working and on break.

Food and Meals

Eating meals together reveals a lot about one’s personality and character. Caregivers will likely need time to eat while working, which is a great opportunity to discuss tastes, ideas and recipes. Based on your comfort, determine your preference to share meals or if they should bring their own. If so, be prepared to make space for their food. It’s important to be respectful of each other’s choices, therefore determine any allergies, preferences and diets to ensure adequate food is available at all times. While everyone has their own eating habits, take time to learn from each other to connect even more.

Part Three of this blog series will pertain to parting ways with a PCA.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.