Selecting and hiring a PCA

Posted by Reeve Staff in Daily Dose on June 04, 2019 # Health, Caregiving

The prospect of searching for a personal care attendant (PCA) may seem like a daunting task. And while some enlist a trusted friend or family member, hiring a trained and motivated PCA to provide your essential care is usually the best decision. The following outlines the process for hiring a caregiver who will enhance your lifestyle and independence.

Identify Needs
Start at the beginning of your day and outline all daily living activities that require assistance, everything from bathroom routines and grooming, to preparing meals, household duties and travel. Next determine times of day help is needed. Can a PCA working in the morning prepare nightly tasks and ready access to an environmental control unit (ECU) instead of involving an evening caregiver?

Know Payment Options
Contact an agency to determine eligibility for vocational rehabilitation benefits based on your medical conditions and residence, as benefits are typically offered through Medicaid programs and vary significantly from state to state. You may want to consider creating an online fundraiser through crowdfunding websites, however fundraising through crowdfunding sites may leave you open to tax and benefit ramifications. While each tout certain benefits and tools, at their core they offer personalized platforms to share background and circumstances while encouraging support and accepting donations.

You may want to look into the services of HelpHopeLive. If you open an account with them, they maintain discretion over the funds you raise so that the funds don’t usually jeopardize your eligibility for asset-based assistance programs. You should check with your state’s Medicaid office to verify that is the case in your state.

Prepare a Job Description
In one to two paragraphs, provide an overview of the job and personal background. Include your level of injury via ASIA score and needs for everyday care, including personal hygiene tasks, workouts, cooking, household duties and errands, but stay high-level and avoid revealing every responsibility. Call out the time commitment – part time, full time or in-home – and any requirements such as a driver’s license or weight lifting capability. Since caregivers are involved in many personal facets, include personality preferences to ensure an emotional match as well.

Certifications and training for PCAs vary by state, therefore research local requirements. Suitable caregivers are found via three main options – an agency, an independent contractor or serving as the employer – all with their own pros and cons.

If your health needs are complex and/or the hours of coverage exceed more than 20 hours per week, it may be beneficial to use an agency instead of serving as an employer otherwise you will require a backup pool of individuals on call if a PCA does not show for their shift. Agencies employ a wide pool of candidates, many with prior experience who have been prescreened and passed background checks. Case managers are available to act as mediators regarding disputes, problem-solve and replace caregivers if necessary. As medical conditions change or questions surface, they can quickly identify issues, offer treatment options and provide a suitable PCA. There are downsides, as personality clashes may exist as agencies pair caregivers based on daily living requirements, not character traits. Overall, agencies are more expensive and charge overage time fees. Many PCAs also have regimented duties, resulting in multiple caregivers, increased costs, training time and thus negatively impacting your quality of life.

Independent contractors are found through job search websites including They typically have more flexibility in their availability, fees, agreements and policies. Lifestyle and shared interests can be identified to find a caregiver who fulfills tasks and is also a good companion. Time is a concern as you must find, vet and train caregivers, whereas agencies fill positions quicker. Insurance coverage is also required. If you hire someone, you should require that they bond themselves. The above pertains to sole employers, as well as developing a personalized care description, determining compensation and hours. While many individuals post jobs through employment websites such as Indeed, consider past facility caregivers, trusted helpers, and those who run in shared circles. Try posting the position at a community college that offers EMT, paramedic, or nursing programs with their job placement services. Some people may need a certified nurse assistant (CNA) if their medical needs are complex as in the case of high quadriplegia. If you are on a ventilator, you may need a registered nurse (RN) to assist with your medical needs. These suggestions may apply to any type of worker you need to hire. Your local independent living center may be a good resource for finding a PCA.

Safety precautions are of the utmost concern when interviewing prospective candidates.

Conduct phone interviews first to verify qualifications, background, work style and personality. Next schedule in-person interviews to narrow the field and observe composure while determining comfort and compatibility. Meet in a public place, commonly in a local café, and have family or a friend attend. Finalists must comply with a background check and provide driver’s license, PCA certificate (if applicable) and two referrals of employment. Finally, invite them for a home tour to witness your environment and responsibilities with a trusted individual present.

Most agencies schedule four-hour blocks of time to benefit everyone, therefore, if a caregiver is not in-home, two PCAs may be needed. Both individuals must meet to understand how to prepare each other for their shift. It is also vital to select caregivers that serve as emergency backups during vacations, illnesses or family situations.

Training is essential in setting routines and good habits for a healthy relationship. Past caregivers, friends or family members should run through your typical day, while outlining instructions and preferences. Caregivers must document all guidelines to ensure consistency, however smart speakers are becoming common with lists and procedures. Patience is the key throughout the process.

Once complete, communicate arrangements to friends, family and close neighbors as well as police, firefighters and EMTs. Provide their schedule, general tasks and contact information in case of emergency. Lastly, visit his or her family to understand their dynamic, and ultimately influence and deepen this new relationship.

Part Two of this blog series will be about managing your PCA while Part Three will deal with 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.