Personal Assistance Services (PAS) are services that another person supplies to a person with a disability. These services can include help with:

• Home activities, such as bathing, dressing, cooking, toileting, and remembering things
• Community activities, such as shopping, going to the doctor, and help getting around
• Work activities, such as reading, sign-language interpretation, and lifting or reaching

The key thing about all of these services is that they can allow you to live your day-to-day life.

Finding Personal Care Assistants

Generally, you have 3 options for finding a Personal Care Assistant (PCA):

1. Through a PAS agency
2. By getting a personal recommendation or looking online
3. By having a family member or friend supply you with these services

If your PCA is funded by the Arizona Long-Term Care System (ALTCS), usually your ALTCS Managed Care Organization (MCO) will contract your PCA through an agency. Depending on your preference, you may know somebody who works with the agency who you would prefer to have as your attendant. Or you may prefer to tell the agency some preferences in an assistant and let the agency find somebody who has those qualifications. For example, you may request a female assistant or one who speaks Spanish.

If you are getting your PCA through ALTCS, you may select the Self-Directed Attendant Care (SDAC) option, which means you could hire a PCA on your own without going through an agency. Either way, whether your ALTCS-funded PCA is through an agency or was hired through the SDAC option, you won’t have to worry about handling the PCA’s paycheck or doing tax withholding. For more information about the SDAC option, click here.

If you use the SDAC option or are paying for your PCA yourself, you will have to find your own PCA, hire the person, do any necessary training, and also handle firing the person if your PCA is not doing an adequate job.

If you don’t get your PAS paid for by ALTCS, you can choose a method to find a PCA that you prefer. If you hire a PCA on your own, you will have the responsibility of hiring, training, and supervising your attendant, and you have the additional responsibility paying your attendant and doing any other paperwork, such as dealing with Social Security taxes.

Ensuring a Good Relationship

You will be spending a lot of time with your Personal Care Assistant and it is very important that you communicate well with each other and have a good relationship. Not only that, but you’ll need to learn about how to hire somebody, train the person, handle payments and payroll taxes, and more. A lot of responsibilities come with having paid assistance, though you can avoid some of them if you get your PCA through an agency.

Personal Assistance Services can be crucial to your ability to live independently. For more information on how to hire and communicate well with your personal assistant, as well as other tips, take a look at the following resources:

• Making the Move to Managing Your Own Personal Assistance Services (PAS): A Toolkit for Youth with Disabilities Transitioning to Adulthood is a complete guide with fact sheets and tips about the same topics, but with a focus on youth.
• A Good Job is a 6-minute animated video that talks about how to improve your relationship with a Personal Care Assistant.

Over the last 40 years, U.S. law has changed, enabling people with disabilities to have greater equality in the workplace. Laws like the Rehabilitation Act in 1973, the Americans with Disabilities Act (ADA) in 1990, and the Workforce Investment Act (WIA) in 1998 have been especially important in this process. Thanks to these laws, people with disabilities can get the support they need to be employed, which can include Personal Assistance Services (PAS) in the workplace.

Reasonable Accommodations

A key part of how these laws have expanded the job possibilities of people with disabilities is requiring that most employers supply reasonable accommodations to their employees. A reasonable accommodation is an adjustment or modification to a job or workplace that enables an employee with a disability to perform the essential functions of the job successfully.

Note that the ADA only applies to employers with 15 or more employees. If you work for an employer with less than 15 employees, that employer may not be legally required to supply you with the accommodation you need. However, many small employers choose to supply accommodations even when they are not required to do so.

The ADA does not apply to employers that are owned and operated by Indian tribes, but Section 504 of the Rehabilitation Act may apply if tribal employers accepted federal financial assistance. Some Indian tribes have also adopted laws which are similar to the ADA.

Personal Assistance Services (PAS) as a Reasonable Accommodation in the Workplace

Some people need Personal Assistance Services in the workplace to be able to perform the essential functions of their jobs. If you need PAS services, they may be considered a reasonable accommodation under the ADA and your employer may have the responsibility to supply PAS services if you request them.

Requesting a Reasonable Accommodation

In order to get any reasonable accommodation at a job, including PAS, you need to understand the rules and protections related to getting an accommodation. One of the keys is disclosing that you have a disability.

In fact, the only time it is required to disclose the existence of a disabling condition in the workplace is when you request a reasonable accommodation. Your reasonable accommodation request will be considered by the employer, who can request documentation that is needed to establish the existence of a disability and the need for a reasonable accommodation.

Once your documentation has been supplied, you and your employer will negotiate what the appropriate accommodation is. If PAS is the best accommodation for you, your employer may choose to accept that. However, your employer may also think of other accommodations that make more sense from their perspective. Their only responsibility is to supply the accommodations that allow you to perform the key functions of your job.

For example, if you request a personal assistant to read documentation out loud, the employer may find it more affordable to get you screen-reading software for your computer that will read documents to you.

DB101’s article on Job Supports and Accommodations has much more detailed information about disclosing your disability and requesting reasonable accommodations.

Funding for Workplace Personal Assistance Services

Workplace PAS are often funded by an employer when they are considered a reasonable accommodation. Additional funding may also be available from the following sources:

• The Arizona Rehabilitation Services Administration (AZRSA)
• The Department of Veterans Affairs
• Workers' Compensation coverage

Resources for Workplace Personal Assistant Services

• Virginia Commonwealth University’s Rehabilitation Research and Training Center on Workplace Supports and Job Retention has a Personal Assistance in the Workplace: A Customer-Directed Guide Manual..
• The U.S. Department of Labor’s Office of Disability Employment Policy (ODEP) has links to several good resources about Personal Assistance Services.

Most people either pay for Personal Assistance Service with their own money or with the support of the Arizona Long-Term Care System (ALTCS). First we’ll describe how you may be able to get ALTCS to pay for your services and then we’ll describe the additional duties you’ll have if you are paying for services on your own.

The Arizona Long-Term Care System (ALTCS)

The Arizona Long-Term Care System (ALTCS) is a public program that supplies some people who are blind, disabled, or over the age of 65 with various services. One of the benefits ALTCS offers to some people is Personal Assistance Services (PAS), so they can live safely in their own homes. PAS can range from assistance with household chores to personal care, such as dressing and bathing. The program is often seen as an alternative to assisted living or nursing facilities.

Eligibility

To qualify for ALTCS, you must meet all of the following requirements:

• Need a nursing home level of care medical and physical needs
• Be an Arizona resident
• Be a U.S. citizen or meet specific noncitizen requirements
• Have a valid Social Security Number
• Apply for any potential benefits
• Meet certain income requirements
• Have less than $2,000 in resources
• Cooperate with the assignment of rights to medical benefits

Note: If your disability began before you turned 26, you can open an ABLE account where you can save up to $19,000 each year and not have it counted by ALTCS. Learn more about ABLE accounts.

If your income and resources are below the income limit and resource limit, and you meet other eligibility criteria, an ALTCS employee will do a Pre-Admission Screening to decide whether your disability qualifies you for ALTCS services.

Not all people with disabilities qualify for these services. For example, many people with disabilities qualify for health insurance through the Arizona Health Care Cost Containment System (AHCCCS) or AHCCCS Freedom to Work, but don’t qualify for the additional services offered by ALTCS.

Application

You can apply for ALTCS by contacting an ALTCS office.

Once you are enrolled in ALTCS, you can get Personal Assistance Services if you:

• Need services that are medically necessary
• Are living in your own home and not in a licensed residential setting
• Are able to make decisions about your own care or have someone who can make decisions for you

You must also need help with one or more of the following:

• Activities of daily living, such as eating, toileting, grooming, dressing, bathing, transferring, mobility, and positioning
• Other common activities, such as meal planning and preparation, managing finances, shopping for essential items, performing essential household chores, communication by telephone and other media, and getting around and participating in the community

How ALTCS Decides if You Need PAS

After you have been screened, if ALTCS decides that you do qualify for long-term care services, you will join a Managed Care Organization (MCO) that will manage your health care and long-term care services. You will be assigned a case manager at your MCO who will evaluate your situation during a home visit and will work with you to figure out what services you need. Depending on your circumstances, Personal Assistance Services (PAS) are one of the services you may qualify for.

If you need PAS, ALTCS will pay for a certain number of hours of personal assistance each week, with the exact amount depending on your needs. For example, if you just need a bit of help a few times per week, ALTCS might pay for just 5 hours per week of assistance. However, if you need a lot of help every day, ALTCS could pay for 40 hours per week of assistance.

The Services You Can Get

Your ALTCS-supplied Personal Care Assistant (PCA) can help you with various things:

• Domestic services, such as sweeping, vacuuming, taking out the garbage, wheelchair cleaning and battery recharging, and changing bed linens
• Related services, such as meal preparation, clean-up, laundry, and shopping
• Personal care services, such as feeding, bathing, grooming, dressing, toileting, and help with medications
• Limited heavy cleaning
• General supervision for individuals with cognitive behavioral health disabilities

These services can let you live in your own home or apartment, giving you the support you need to continue living independently.

How Much You Pay

Typically, you pay nothing if you get Personal Assistance Services through ALTCS. Under limited situations members living in their own home may share in the cost of services. If you need more hours of personal assistance than state programs will pay for, you will have to pay for them yourself.

Your Responsibilities

You, or your representative, will need to make sure that your PCA does what you need. You may have additional responsibilities depending on whether you get your assistant through an agency or hire the assistant on your own.

If your PCA is funded by ALTCS, usually your ALTCS Managed Care Organization (MCO) will contract for your PCA through an agency. Depending on your preferences, you may know somebody who you would prefer to have as your attendant and they can become an employee of an agency or you may prefer to indicate some preferences and let the agency find somebody who has those qualifications. For example, you may request a male assistant or an assistant who can work a split shift.

If you are getting your PCA through ALTCS, you may select the Self-Directed Attendant Care (SDAC) option, which means you could hire a PCA on your own without going through an agency. If you use the SDAC option or are paying for your PCA yourself, you will have to:

• Prepare an outline of duties for the PCA
• Create the PCA’s schedule
• Make a backup plan if the PCA can’t come as planned
• Train your PCA
• Handle all supervision
• Firing your PCA if you are not satisfied with the job he or she is doing

If You Are Paying For Services on Your Own

If you are paying for services on your own, either because you do not qualify to get publicly funded PAS or because you need more hours than state programs will offer, you have the same 2 basic options that are described above:

1. You can hire a PCA through an agency
2. You can hire a PCA on your own

If you hire a PCA through an agency, the agency will help you find an assistant who knows how to do the tasks you need help with. A couple of big advantages of hiring through an agency is that the PCAs they supply have already been trained and if you need a substitute PCA for any reason, your regular PCA is ill, for example, the agency can supply you with a substitute.

If you hire a PCA on your own, you will have the most flexibility, but also the greatest responsibilities. You will have to handle not only all hiring, training, supervision, and possible firing of the attendant, but also all paychecks, taxes, and payroll withholdings. Still, for many people this works best because they get to hire somebody they really know and trust.

Jack is 56 years old and has cerebral palsy. He has been living alone for a number of years and is having an increasingly difficult time taking care of himself and his home. Tasks like cooking, bathing, and getting dressed in the morning take far more energy than they used to.

Jack has become depressed about the situation. He is very independent and has always prided himself on his ability to take care of his affairs on his own. The last thing he wants to do is move into an assisted care facility, but he doesn’t know what else he can do.

He explains his situation to his friend Guillermo over lunch one day. Guillermo suggests that he talk to his Arizona Health Care Cost Containment System (AHCCCS) case worker and see if she has any ideas for him.

So Guillermo and Jack go online to find the phone number for the local DES/Family Assistance Administration office, which is the office that handles AHCCCS Health Insurance for people with disabilities. Jack calls and is transferred to an eligibility worker, Darlene. Jack briefly explains his situation to her.

“It’s good that you called,” says Darlene. “The state of Arizona actually has a program that supplies Personal Assistance Services (PAS) for people who need them. Personal Assistance Services include helping with stuff like cooking, cleaning, and getting in and out of bed.”

“Hmmmm. Sounds like it could be really helpful,” Jack says.

Darlene explains that to get these services, Jack will need to apply for services from the Arizona Long-Term Care System (ALTCS). She explains that not all people with disabilities qualify for ALTCS, only people who are at risk of being institutionalized.

This makes Jack nervous, because he doesn’t want to go to an institution. But Darlene tells him that ALTCS does not mean you have to go to an institution. It just means that the program recognizes that your disability means that you should get services that go above and beyond what standard AHCCCS services offer. She explains, “If you qualify for ALTCS, they’ll review your situation and may recommend that you get Personal Assistance Services so that you can keep living at home.”

“First,” Darlene says, “go ahead and apply for ALTCS. You can do that by calling or visiting your local ALTCS office. When you apply, you’ll have to give information about your income and resources and also tell them about your disability. If you meet the income limit and the resources limit for this program, you’ll be scheduled for a Pre-Admission Screening. During the screening, they’ll decide if your medical condition qualifies you for ALTCS.”

“If you do qualify,” she continues, “you will be accepted into the ALTCS program and assigned to a Managed Care Organization (MCO). You’ll have a case manager at the MCO, who will review your situation and decide what services you need from ALTCS.”

Jack interrupts Darlene at this point with a question, “If I’m approved for ALTCS, does it cost me anything?”

“Not usually. Most people on ALTCS living in their own home don’t have to share in the cost of services,” says Darlene.

“Well, that’s good news,” says Jack.

“It sure is,” agrees Darlene.

Jack goes home, gives ALTCS a phone call the next day, and goes into the ALTCS office the following week when he has some time. He fills out the application while he’s there.

Two weeks later, he gets a call from an ALTCS representative requesting additional documentation. The representative explains, “You can only get ALTCS services if your disability requires the level of care a nursing home would offer. To figure out whether you qualify, we need to schedule a time to come to your home for a Pre-Admission Screening.”

ALTCS does the screening and says that Jack probably will qualify for ALTCS services. After the screening process, Jack asks when he will start getting services. The person who did the screening says that he will get an official letter in the mail within a couple of weeks from ALTCS that will tell him if he is eligible or not. If he is eligible, a Managed Care Organization (MCO) will contact him to set up a meeting in his home to explain to him exactly what services he qualifies for.

Sure enough, 2 weeks later, Jack gets a letter from ALTCS that says he qualifies. Another week later, his case manager, Raven Smith, calls him to schedule a home visit so she can talk to him and they can figure out the exact services that he needs from ALTCS.

Jack schedules the visit and later that week, Raven comes to visit him at his home. She is there to do an in-home interview to figure out what Jack needs help with and how many hours of assistance ALTCS will pay for. She asks him a series of questions about his physical and mental abilities to figure out which tasks he can safely perform on his own and which tasks he needs help with.

Clearly, what Jack needs help with are physical chores, like cooking, cleaning, getting dressed, and getting in and out of bed. Raven decides that Jack needs 20 hours of Personal Assistance Services (PAS) each week. She tells Jack that she can contract with a local PAS agency to help find him a Personal Care Assistant (PCA) or he can look for one on his own and be responsible for hiring, firing (if necessary), and supervising that person. Either way, someone else would take care of handling any taxes and the personal assistant’s paychecks.

Jack is thrilled. He decides that he’d prefer to hire his own assistant, so he signs up for the Self-Directed Attendant Care (SDAC) option. Then he hires Wendy, a retired neighbor and long-time friend to supply the services. Wendy comes by every day to help Jack in and out of bed. She prepares meals for him, cleans, and does some of his laundry. She also offers personal care services like dressing, grooming, and bathing.

It turns out to be a great arrangement. Wendy enjoys the part-time work and Jack is extremely grateful for the help. His depression has lifted, he has more energy than he used to, and he is thrilled to be able to continue living in his own home.