Concepts of Independence, Inc. logo

Consumer Directed Personal Assistance Guide

by Concepts of Independence, Inc.

A Letter from the President
of Concepts of Independence, Inc.

I was 15 years old in August of 1955 when the last major Polio epidemic struck Boston, Massachusetts. My stay at a New York City rehabilitation center lasted for a period of 21 years. I was confronted with the reality of living as a quadriplegic with a 24 hour ventilatordependency. When I finally discharged myself in 1976, I was a 36-year-old college graduate with a degree in Psychology, unprepared for the job market.

My disability had left me fully dependent upon personal assistance services to accomplish my most basic needs. Having experienced the emptiness of the institution for so many years, I was determined not to return. After a transition period during which I created a life for myself outside the institution, I was comfortable in the first home I'd known in almost a quarter century.

Using a breath-controlled power wheelchair in conjunction with a portable ventilator, I was as mobile as was feasible, and I had thoughts of returning to the academic world. I did well on my LSAT (Law School Aptitude Test), applied to St. John's Law School and was accepted. Thoughts of spending six years at law school led me to think about the establishment of a means of enabling severely disabled individuals to live functional and productive lives in the community. I felt certain that I would be more capable, than an agency would, of selecting Personal Assistants with whom I would be comfortable, and I would be more successful living on my own in my own home if I made the selection. It seemed to me that the solution lay in the establishment of an agency specifically structured to meet these goals.

At this time, New York City was beginning to utilize not-for-profit "Vendor Agencies." As I spoke with other disabled friends, colleagues, and legal associates, the idea of establishing our own not-for-profit "Vendor Agency" began to take shape. Concepts of Independence for the Disabled was incorporated in New York State in 1977 as a 504(c)3 corporation. After almost three years of meetings with officials from the City and State of New York, and after lengthy discussions with activist members of the disabled community, the initial formula was cast for a provider of Personal Assistance Services that would be operated by the recipients of such services. In March of 1980 Concepts of Independence for the Disabled, Inc. was awarded its first contract with the New York City Human Resources Administration.

With a tiny office employing six people and a contract of $100,000, we were off and running, servicing our initial allocation of four Consumers. We were given a proviso that we must enlist at least 100 clients within a year or the program would be closed. The rest is history. We employ 13 staff members, service more than 420 Consumers, and manage a biweekly payroll which includes more than 800 Personal Assistants. Our cost effectiveness saves New York State taxpayers in excess of $10 million annually.

I am pleased and proud to oversee the continued growth and expansion of the Concepts of Independence, Inc. program to the point where we are now mandated by the New York State Legislature to implement The Consumer Directed Personal Assistance Program statewide. This broadening of our program will enable New York State to realize more significant savings, while providing severely disabled individuals with the ability to structure and independently oversee their personal assistance service plan.

As a Consumer, and as President of Concepts of Independence Inc., I take this opportunity to welcome you to a most innovative and beneficial program. I am certain that your participation, whether as a Consumer, county associate, Personal Assistant or staff member, will afford you a unique opportunity to work within the framework of a progressive program whose time has come. Please use this Consumer Guide as a reference. If our staff can draw upon our 15 years of experience to serve you in any way, please call upon us.

Thank you. We look forward to the implementation and growth of The Consumer Directed Personal Assistance Program throughout New York State and perhaps ultimately nationwide.

Very Best Regards,

Ira E. Holland President

Welcome to the Concepts of Independence, Inc.
Consumer Directed Personal Assistance Program

Concepts of Independence, Inc. is a not-for-profit corporation organized for and by home-care Consumers. Concepts of Independence, Inc. founded the Consumer Directed Personal Assistance Program in New York State, having initiated the first Consumer Directed Personal Assistance Program in New York City in 1980. The Board of Directors of Concepts of Independence, Inc. is comprised of Consumers of our program services and is directly responsible for the selection of administrative staff and the procedures used to serve the Consumers of the plan.

The Consumer Directed Personal Assistance Guide has been designed to facilitate participation in the Concepts of Independence, Inc. program. This information has been prepared with several different readers in mind, each of whom will use the guide for a different purpose. Those establishing Consumer Directed Personal Assistance Programs can use it as a book of procedures; those working as Personal Assistants can use it as an employee handbook; and, most important, those who are Consumers of the Concepts of Independence, Inc. program can use it as a "how to" book that explains how to become a Consumer, how to find a Personal Assistant, how to be an effective employer, and how to take responsibility for living independently. While Consumers need not commit the details of this guide to memory, they will benefit from reading it through at least once in its entirety to find out the kinds of questions this useful reference answers. In addition, most Consumers will find the second section, entitled "To the Consumer: Hiring, Training, and Supervising Personal Assistants," extremely helpful.

This manual is admittedly broad in scope. If you have any questions about the information it contains or you need to know more about a particular topic, please call Concepts of Independence, Inc. at (212)293-9999. Our staff is ready to assist you.

Ira E. Holland, President
Edward Litcher, Director

Please read this Consumer guide carefully and keep it for your future reference

Consumer Directed Personal Assistance Guide

PART ONE: CONSUMER GUIDE

PROGRAM PARTICIPATION

Who is a Consumer?

A Consumer is a client who is authorized to participate in the Consumer Directed
Personal Assistance Program by the local Department of Social Services (the Human Resources Administration in New York City) in accordance with section 365-f and 367-p of the Social Service Law.

What are the advantages of being a Concepts Consumer?

Consumers take an active, responsible role in planning their care.
Consumers independently recruit, interview, hire, train, supervise, schedule and, if needed, dismiss Personal Assistants of their choice.
Consumers hire as many Personal Assistants as they deem necessary to accommodate their lifestyle within the hours authorized by the Local Department of Social Services.
Consumers act as employers; each Consumer will develop a working relationship with their Personal Assistants without intrusion.
Consumers have the option of using Recruitment Assistance Services to assist them in recruiting new Personal Assistants.
Consumers receive our newsletter, The Concepts Voice.

Who can become a Concepts Consumer?

For a disabled individual to become a Concepts Consumer they must:

Be a resident of an authorizing county and be determined to be eligible for Medical Assistance (Medicaid).
Be eligible for long-term care and services provided by a certified home health agency, the long-term home health care program, the AIDS home-care program, or personal services.
Be a self-directing Consumer of the home-care services the individual requires.

What is a self-directing person?

A self-directing person:

Is able and willing or has a legal guardian able and willing to make lifestyle choices or has a legal guardian able and willing to make informed choices, or has designated a relative or other adult who is able and willing to assist in making informed choices as to the type and quality of services, including but not limited to such services as nursing care, personal care, transportation, and respite services.
Has the ability to organize their environment to implement these choices.
Has the capability to understand the consequences of these choices and the willingness to take responsibility for them.

How does a person become a participant in the Concepts Consumer Directed Personal Assistance Program?

To become a participant in the Concepts Consumer Directed Personal Assistance Program, call the Concepts Client Coordinator at (212) 293-9999. The Client Coordinator will be able to answer any questions you may have regarding the Concepts program and will direct you to the appropriate office in your Local Department of Social Services from which you will receive a program application.

When you receive the application for the Consumer Directed Personal Assistance Program, complete the application and return it to the appropriate county office. The county's professional staff will review the application and notify you and Concepts of their determination. If your application is approved, the Concepts Client Coordinator will contact you after Concepts is authorized by the county to begin providing services.

PROGRAM RESPONSIBILITIES

What are the responsibilities of a Concepts Consumer?

A Concepts Consumer is obligated to:

Execute Consumer and Employment/Wage agreements confirming the responsibilities enumerated below.
Recruit, interview, hire, train, supervise, schedule, and, if need be, dismiss the Personal Assistant of their choice, within the structure of the service authorization provided by the Local Department of Social Services and the operational practices of Concepts.
Provide equal employment opportunities to all prospective employees regardless of their race, creed, color, national origin, sex, disability, marital status, and sexual orientation or affectional preference, in all employment decisions, including but not limited to recruitment, hiring, upgrading, demotion, downgrading, transfer, layoff, and terminations, and all other terms and conditions of employment.
Keep the appropriate staff person, either the Client Coordinator or the Timekeeper, informed of any changes in status, including but not limited to the Consumer's address, telephone number, and hospitalization, and also each Personal Assistant's name, address, employment status, and hours worked.
Process in a timely manner the required paperwork, including time sheets, annual worker health assessments, and other required employment documents.
Arrange and schedule backup Personal Assistant coverage for vacations, holidays. and absence due to illness.
Train the Personal Assistant as to the rights and responsibilities of all involved parties.
Accept full responsibility for any personal injury or loss of property that may result from the action or inaction of the Personal Assistant.
Distribute paychecks to each Personal Assistant.
Insure that each Personal Assistant work the hours indicated on the time sheet and mediate all payroll/personnel problems.
Schedule a meeting with a registered nurse once every six months for the required Nursing Assessment.

What are the responsibilities of a Personal Assistant?

A Personal Assistant employed by a Concepts Consumer is responsible for:

Recognizing the authority of the Consumer as the assistant's acting employer and supervisor.
Completing all designated assignments in a manner that enhances the Consumer's ability to live independently.
Respecting the Consumer's person, privacy, and property.
Authorizing Concepts to collect and appropriately distribute employment-related information.
Complying with the policies and practices of Concepts of Independence, Inc.

What are Concepts' responsibilities?

The responsibilities of Concepts are to:

Process the payroll for each Personal Assistant.
Pay the Personal Assistant the prevailing wage in the industry for the hours of service indicated on the Consumer's time sheet and authorized by the Local Department of Social Services.
Monitor the completion of the required annual worker health assessment and all other required employment documents.
Act as the employer of record for all matters which effect the Personal Assistant's withholding tax, insurance, unemployment, and worker's compensation benefits.
Provide equal employment opportunities to all prospective employees regardless of their race, creed, color, national origin, sex, disability, marital status, and sexual orientation or affectional preference, in all business decisions, including but not limited to recruitment, hiring, upgrading, demotion, downgrading, transfer, layoff, and terminations, and all other terms and conditions of employment.
Coordinate annual leave, health insurance, and other benefit programs for each Personal Assistant.
Facilitate and monitor the completion of all other required documents.
Maintain a record for each Personal Assistant that will include, at a minimum, the enrollment forms, the annual worker health assessments, and the information needed for payroll processing and benefit administration.
Maintain a Consumer record, which includes the Local Department of Social Service's service authorizations, the Consumer Agreement, the periodic Nursing Assessment, and other documentation of the effort to monitor the Consumer's ability to meet their obligations.
Provide Recruitment Assistance and Information Assistance Services to assist the Consumer to live as independently as possible.
Coordinate access to health facilities capable of providing the required annual worker's health assessment and other health-related program requirements within budget limitations.
Maintain a Consumer Advisory Committee and a Grievance Committee.
Provide statistical and other pertinent information to the various regulatory, legal and programmatic entities as may be deemed necessary and appropriate.

What are the responsibilities of the Local Department of Social Services?

The responsibilities of the Local Department of Social Services (LDSS) are to:

Establish a Consumer Directed Personal Assistance Program and notify all county residents who are Medicaid-eligible Consumers (individuals eligible for long-term care and services provided by a certified home health agency, long-term home health care program, and AIDS home-care program, private-duty nursing, or personal care services) of the opportunity to participate.
Determine that the consumer, pursuant to an assessment of the Consumer's appropriateness for the program conducted with an appropriate long-term home health care program, certified home health agency, or an AIDS home care program pursuant to the personal care program, as being in need of home-care services or private-duty nursing.
Determine that the Consumer is eligible to participate in the Consumer Directed Personal Assistance Program because they are able and willing or has a legal guardian able and willing to make informed choices or they have designated a relative or other adult who is able and willing to assist in making informed choices as to the type and quality of services, including but not limited to such services as nursing care, personal care, transportation, and respite services.
Determine service eligibility through the approved home-care service authorization procedure including an initial assessment and periodic reassessments, a procedure that will permit the LDSS to authorize the level and amount of services required and to authorize the reimbursement for Personal Assistant services to Concepts as prescribed by the New York State Department of Social Services.
Transfer the Consumer to other programs with more traditional agency control should the Consumer be deemed inappropriate to continue participating in the Consumer Directed Personal Assistance Program.
Provide the Consumer with the appropriate fair hearing notice and the opportunity for a fair hearing with "aid-continuing," if appropriate, at such times as the New York State Department of Social Services requires.

What are the mechanisms used to resolve grievances?

The mechanisms used to resolve grievances are as follows:

Grievances regarding the terms of employment, duties, or the continuation of employment will be resolved by the Consumer.
Grievances regarding payment will be resolved by the Consumer after consultation with the appropriate Concepts staff.
Grievances regarding the Consumer's failure to carry out their responsibilities as outlined in this guide or other written directives will be resolved by the Program Director in consultation with the President.

Should the Consumer object to the decision made by the Program Director in the resolution of the grievance, the Consumer may appeal to the Grievance Committee, in writing, to review this complaint. This committee will comprise the President and the following presidential appointees: a Personal Assistant, a Consumer, and representatives of the Board of Directors.

What is the Client Advisory Committee?

The purpose of the Client Advisory Committee is to secure comments from Consumers receiving services on various operational components of the corporation's program. This committee will be composed of four Consumers, the Executive Committee, and the Program Director.

The Client Advisory Committee will meet at least twice, but not more than four times, per year. This committee will be recruited by the Executive Committee from the Consumers and will be appointed by the President. Committee participants will serve at the discretion of the President. Frequent changes in the composition of the committee will be encouraged to insure the inclusion of a variety of opinions.

LIABILITY

What is the Consumers liability?

According to section 365-f (3) of the Social Service law, the Consumer is liable for the fulfillment of those responsibilities (listed above) which they have agreed to undertake Included in the above list is the full acceptance of responsibility for any personal injury or loss of property that may result from the action or inaction of the Consumer's employee.

Failure of the Consumer to carry out these responsibilities may be considered in determining their continued appropriateness for the program.

It should be noted that work-related injuries or illness that may affect the Personal Assistant are covered under the terms and conditions of the Worker's Compensation Policy provided by Concepts.

What is Concepts' liability?

Concepts is liable for the exercise of reasonable care in properly carrying out its responsibilities under this program, which include monitoring the Consumer's continuing ability to fulfill their responsibilities.

PERSONAL ASSISTANCE SERVICES

What is a Personal Assistant?

A Personal Assistant is an individual employed and supervised by the Consumer to provide services that are determined to be appropriate and necessary by the Local Department of Social Services.

What are personal assistance services?

Personal Assistance services include but are not limited to: assisting the Consumer with bathing, dressing, toileting, and other related personal functions; performing household chores and other activities such as nursing, transportation, and respite services that assist the Consumer to be as functional as possible within the limits of their abilities.

As a result of a modification to the Nurse Practice Act (Section 6908 of Education Law as modified by Chapter 795 of the Laws of 1992), self-directing individuals who participate in the Consumer Directed Personal Assistance Program and who are determined by a registered nurse to be capable of providing all necessary supervision and instruction may receive certain services from Personal Assistants that otherwise are typically provided by a home health aid, licensed practical nurse, or registered nurse. These services include, but are not limited to, tracheal suctioning, administration of medication, the provision of insulin and other injectable medication, ventilator monitoring, catheter care, sterile dressing, and the care of a decubitus ulcer.

What are the requirements for a Personal Assistant to be employed by a Concepts Consumer?

A Personal Assistant must:

Be at least 18 years of age.
Have a Social Security number.
Be interviewed and hired by a Concepts Consumer.
Provide all necessary information to the Consumer to facilitate enrollment in the payroll and insurance systems.
Complete all required enrollment documents with the assistance and direction of the Consumer, hand-deliver the enrollment documents to the Concepts office, and be photographed, for identification purposes, at the Concepts office.
Complete an annual worker health assessment including all appropriate laboratory tests.

A Personal Assistant cannot be a member of the Consumer's immediate family (i.e., spouse, parent, son, daughter, son-in-law, daughter-in-law). However, a sibling (brother, brother-in-law, sister, sister-in-law) may be employed as a Personal Assistant provided that individual does not reside with the Consumer, unless required to do so by the Consumer's service authorization.

Who determines how many hours of Consumer Directed Personal Assistance Services a Concepts Consumer is entitled to receive?

The number of hours of Consumer Directed Personal Assistance services the Concepts Consumer is entitled to receive is determined by the Local Department of Social Services (LDSS) after reviewing the service recommendations provided by a physician, an assessing nurse, and the LDSS caseworker.

In making this determination, the LDSS can authorize any level of service from a few hours a day to a 24-hour sleep-in or dual-shift service program.

Concepts Consumers who believe that their current authorization is inadequate to satisfy their current service requirements should contact their LDSS caseworker and request service reassessment.

When a Consumer makes this request the Consumer and their physician must provide as much detail as possible to justify this request and clearly indicate how the service requirement has changed. The Consumer will be evaluated within 30 days after the LDSS receives all of the necessary documentation.

What process should Concepts Consumers follow if they disagree with the Local Department of Social Services?

If a Consumer disagrees with the Local Department of Social Service (LDSS) determination or if a decision is not forthcoming within the required 30-day period, the Consumer has the right to request a New York State Fair Hearing to review the service request.

If a Consumer disagrees with an LDSS determination to reduce or modify their service plan, the Consumer should request a New York State Fair Hearing and request "aid-continuing." This request will insure that the Consumer's current service plan will continue unchanged until the hearing decision has been rendered.

How many Personal Assistants can a Concepts Consumer employ to satisfy their service requirements?

A Concepts Consumer can employ as many Personal Assistants as the Consumer deems necessary to satisfy their service requirement, as defined by the Local Department of Social Services (LDSS) service authorization. This hiring authority is limited by two factors:

A. No Personal Assistant may be routinely paid for more than 12 hours per day.

B. A sleep-in authorization requires that the Consumer use a single Personal Assistant for each 24-hour interval.

In determining how many Personal Assistants to hire the Consumer can choose to:
i. Divide the days-for example, hire one person for four days and another for the remaining three.

ii. Divide the hours-for example, hire one person to work in the morning and another to work in the afternoon and/or evening.
In making these hiring decisions, the Consumer must determine the appropriate number of employees required to manage their LDSS service authorization in the most effective manner possible and to insure continuity of service even when faced with a staffing emergency.

RECRUITMENT ASSISTANCE SERVICES

How can Concepts help a Consumer find a Personal Assistant?

Concepts offers Recruitment Assistance Services to help Consumers find or recruit new prospective Personal Assistants. These services should be used in addition to and not in place of the Consumer's own method of recruitment, since they are not guaranteed services.

What recruitment assistance services does Concepts offer?

Concepts offers all Consumers the following recruitment assistance services:

Hotline: To help Consumers to find new Personal Assistants, Concepts maintains a tape-recorded listing that includes the Consumer's last name and phone number, a brief job description, and the best time to reach the Consumer. Prospective Personal Assistants who wish to obtain employment call the Hotline. If the prospective Personal Assistant is interested in a job listed on the Hotline, they call the Consumer directly to arrange for an interview..
Fax Search: To expand the Consumer's search for a Personal Assistant, Concepts faxes a copy of the Hotline information to a group of approximately 40 free employment services. When these employment services receive this fax, they are instructed to contact the Consumer directly to arrange for an interview if they have a potential Personal Assistant who meets the Consumer's search criteria.
Network List: Every two weeks Concepts provides a listing of former Personal Assistants who have worked at least 500 hours without a negative evaluation from a Concepts Consumer. Included on this list is the former Personal Assistant's name and phone number and the schedule that person wishes to work. To keep information current, names are kept on this list for no more than 15 days. Consumers who wish to consider any of the former Personal Assistants listed on the Network List should contact them directly to arrange for an interview.

(Subject to local county availability)

Please Remember: A prospective or former Personal Assistant's participation in any of the above services does not constitute or imply any endorsement by Concepts of Independence, Inc.

Table of Contents

PAYROLL PROCEDURES

How does a Consumer enroll a Personal Assistant?

When a Consumer wishes to enroll a Personal Assistant, the Consumer calls the Concepts office within two business days of the Personal Assistant's hire date and provides the following information about the new employee to the appropriate Timekeeper:

Name
Social Security number
Address
Phone number
Date of birth
Race
Sex
Number of dependents
Marital status
Name, address, and phone number of a person to contact in case of an emergency
Starting date and schedule (full-time or part-time)

The submission of the above information will permit the Concepts office to enter the Personal Assistant's information into the payroll system and to send out the required enrollment documents.

What enrollment forms are required?

After the Consumer enrolls a Personal Assistant, the Concepts office will send the Consumer a Personal Assistant enrollment package that includes.

Employment/Wage Agreement.
Tax forms W-4 and IT-2104.
U.S. Immigration Employment Eligibility Verification Form 1-9.
Hepatitis-B form, which provides information about universal precautions, the availability of the Hepatitis vaccine, and the procedure that is to be followed in case of accidental exposure.

To prevent payroll delay, the above documents must he completed by the Consumer and the new Personal Assistant and delivered to the Concepts office before the FIRST payroll is issued. When the Personal Assistant arrives at the office, they must bring two "passport style" photographs, one of these photographs will be used to prepare a Personal Assistant Identification Card and the other will be kept in the Personal Assistant's file. For purpose of identification, the Personal Assistant will be required to sign a Personal Assistant Verification Form. This signature will be compared to that which appears on the already completed enrollment documents.

What are the medical examination requirements?

In addition to the above enrollment documents, the enrollment package will include a Personal Assistant Medical Report, which is required by New York State regulations and which must be completed annually by the Personal Assistant. The initial medical report must be submitted before the Second payroll to prevent payroll interruption.

To insure that the requirements of the medical report, including all laboratory work and drug screening will be completed in an acceptable manner and without cost to the Personal Assistant, we strongly urge the Consumer to direct the Personal Assistant to a screening facility that appears on the list provided with the blank medical report.

When the Consumer or Personal Assistant calls for an appointment, they should specify that the employee is a Personal Assistant working for Concepts of Independence, Inc. To further insure that the screening facility will handle this process properly, the Personal Assistant is instructed to bring to the examination the medical report provided by Concepts.

To prevent a needless payroll delay, the medical examination should be scheduled as quickly as possible and the Concepts Contract Compliance Specialist should be notified by telephone when the examination is completed. When this notification is made, the Consumer or the Personal Assistant should indicate the date of the examination and the name and phone number of the medical facility.

If the Personal Assistant chooses to use their own physician, the Personal Assistant is responsible for insuring that the Concepts office receives the completed report within 30 days of the report's completion. The Personal Assistant will also be responsible for paying the physician for this examination but may seek partial reimbursement either from Concepts or from the Assistant's insurance carrier should coverage for this service be available.

If the Personal Assistant has recently completed a medical report for another purpose, the Concepts office will accept a copy of this report provided the information on the completed form matches the required information. The Personal Assistant is required to complete any items that were not included on the previously completed medical examination.
If the physician notes any findings significant enough to require additional evaluation or treatment, the Concepts office will notify the Consumer in writing and request that the Consumer discuss these findings with the Personal Assistant; if appropriate, the Personal Assistant should seek the recommended medical attention.

In the event the physician has reported a condition serious enough to adversely affect the Consumer's service or safety, Concepts urges that the Consumer suspend this Personal Assistant's employment until the individual obtains medical clearance.

What other information is provided to the Consumer in the enrollment package?

Along with the documents related to the enrollment process and the personal medical report, Concepts includes the following information in the enrollment package:

List of current pay rates
Benefits summary
Recruitment assistance information

How can Concepts help the Consumer train their Personal Assistant?

Each calendar year Concepts provides each Consumer with a 40-hour training budget. Although unused training hours may not be carried over from one year to the next, this budget is renewed each January 1.

During the year, from January 1 to December 31, Concepts will credit the Consumer with an additional eight training hours for each of the first five Personal Assistants they hire during this period. For example, if a Consumer hires two Personal Assistants during the calendar year, the Consumer will have a budget of 56 training hours; 40 training hours that the Consumer received automatically at the beginning of the year and 16 additional training hours for the two new employees.

Consumers can use this training budget to pay a new Personal Assistant while they learn the appropriate personal care, housekeeping, and other routines. Many Consumers have their present Personal Assistant assist in the training process by demonstrating what the Consumer considers to be the more difficult aspects of their care.

When the Consumer wishes to utilize training hours, they should call the Concepts office and speak with the appropriate Timekeeper to verify the training budget; the Consumer should then enter the trainee's name on the time sheet and enter the total number of training hours to be paid on the time sheet in the column marked Training.

The new Personal Assistant will be paid for the training hours at the standard weekday rate of pay. If the Consumer utilizes a current Personal Assistant to assist in the training process, the current Personal Assistant is paid for their work hours, within the authorization provided by the Local Department of Social Services, while the new Assistant is paid for the training time.

Will a Personal Assistant be paid when the Consumer is hospitalized?

If a Consumer is hospitalized, the Personal Assistant will be paid only for the day of admission and the day of discharge (if authorization is active), but will not be paid for the remainder of the hospital stay. During the hospital stay, the Personal Assistant may be paid their accumulated sick or vacation leave, or the Personal Assistant may apply for unemployment benefits.

It is the Consumer's responsibility to inform or have someone inform the Concepts Client Coordinator of the Consumer's hospitalization, the date of admittance, the date of discharge, and the name of the hospital. This responsibility is extremely important because the State of New York prohibits payment for Personal Assistance services while the Consumer is hospitalized. Failure to comply with this requirement could endanger the continuance of services provided by Concepts.

If a Consumer is hospitalized for more than 31 days, the Consumer's service authorization will be closed. To activate the service authorization, the hospital social service staff must request a new service approval from the Local Department of Social Services (LDSS), a process that can take up to 30 days to complete. If the Consumer becomes ready for discharge prior to receipt of this new service approval, the hospital may decide to discharge the Consumer to the Consumer's home through a Certified Home Health Agency. Should this expeditious discharge strategy be utilized by the hospital and should the Consumer wish to return to the Consumer Directed Personal Assistance Program, the Consumer should contact their LDSS caseworker as quickly as possible and request to be reauthorized

How does a Consumer terminate a Personal Assistant?

Below are the official steps necessary for terminating a Personal Assistant; for practical "how to" advice on this topic, see the section of this manual entitled "To the Consumer."

To terminate a Personal Assistant, the Consumer is responsible for calling the appropriate Timekeeper within two regular business days of the termination date with the following information:

The name of the Personal Assistant
The termination date
The reason for termination

A Consumer may choose to direct the Personal Assistant's final payroll check to the assistant's home address to avoid a difficult confrontation.

When the above information is received, the appropriate Timekeeper will complete a
Notification of Termination and Health Insurance Eligibility. The purpose of this form is to confirm the termination information to both the Consumer and the Personal Assistant, to provide information about the termination's effect on the Personal Assistant's health insurance benefits.

When this form is completed by both the Timekeeper and the Health Insurance
Department, the form is distributed to both the Consumer and the Personal Assistant.With the Consumer's copy of the Notification of Termination and Health Insurance Ineligibility the Consumer is provided with a Discharge package that includes an employee evaluation form and a Recruitment Assistance Reminder. With the Personal Assistant's copy the terminated Personal Assistant is provided with a Network Application.

Personal Assistants who are terminated may request payment for all accumulated vacation hours but may not receive payment for accumulated sick leave hours.

What is a time sheet?

A time sheet is an official weekly record of the hours worked by the Consumer's Personal Assistant(s) and the hours paid for training, holiday time sick leave, and vacation.

How does a Consumer complete a time sheet?

To properly complete a time sheet the Consumer should:

Review the information to insure that all of the names and numbers on the time sheet are correct. If an error is noted, the Consumer should correct the time sheet and contact the appropriate Timekeeper.
Use one line for each Personal Assistant employed during the week.
Enter the daily hours for each Personal Assistant in the column corresponding to the days that person worked.
When applicable, enter sick, vacation, holiday, and/or training hours on the line for the appropriate Personal Assistant and in the corresponding column(s). If necessary, the Consumer can contact the appropriate Timekeeper to obtain the current training or leave balances.
The Consumer and Personal Assistant must sign and date the form. Time sheets should not be signed or dated prior to the last day worked by the Personal Assistant.
The Consumer should return the white original in the postage paid envelope by Concepts, and keep the yellow copy for their records. The Consumer is required to complete an original time sheet and mail it to the Concepts office every week.
The Concepts office must receive the original time sheet within two weeks of the "week ending date" to prevent a payroll interruption.
Besides completing a weekly time sheet, the Consumer is required to call in the current service schedule on either Wednesday, Thursday, or Friday of each week, during regular business hours. Should this schedule change, the Consumer must call the appropriate Timekeeper with the service schedule adjustment as soon as possible, but no later than Monday at noon.

Service schedules that are called in late will be processed with the following week's information. The failure to submit a service schedule as required may result in a Personal Assistant's receiving incomplete payroll and may cause the Consumer's Assistant to lose their health insurance benefits.

How will Personal Assistants receive their payroll checks?

A Personal Assistant will receive a payroll check every two weeks, following the processing of weekly time sheets. The payroll checks will be payable to the Personal Assistants and will be mailed to the Consumer's home. When the Consumer receives the payroll, the Consumer is responsible for reviewing the payroll to insure its accuracy. Should the Consumer notice any payroll discrepancy, they must call the appropriate Timekeeper to discuss this problem before the payroll checks are distributed to the Personal Assistants.
If the payroll agrees with the service schedule shown on the time sheet, the Consumer is obligated to expeditiously distribute the payroll to the appropriate Personal Assistants. Although the Consumer is authorized to manage the hiring, supervision, training, and scheduling of a Personal Assistant, the Consumer is not authorized to withhold payroll checks that have been appropriately processed. Please note that personal agreements between the Consumer and Personal Assistant, financial or otherwise, have absolutely no bearing on the Consumer's legal obligation to distribute the payroll.

If a Personal Assistant does not receive a payroll check and notifies the Concepts office of this problem, the Concepts fiscal staff will adhere to the following procedure:

The appropriate Timekeeper will compare the Personal Assistant's payroll to the service schedule shown on the Consumer's time sheet to insure that the payroll has been issued properly
If the payroll agrees with the Consumers service schedule, the Timekeeper will refer this problem to the Assistant Director, who will attempt to contact the Consumer to discuss the problem.
During the telephone conversation, the Assistant Director will attempt to achieve a satisfactory resolution to the payroll distribution problem. Should this effort prove unsuccessful, the Assistant Director will request that a stop-payment be placed on the Personal Assistant's payroll check.

After receiving a stop-payment confirmation from the issuing bank, the Assistant Director will then direct the Bookkeeping staff to process a replacement check. To complete the payroll distribution process, the appropriate staff will be directed to mail the replacement check to the Personal Assistant's home address.

The Assistant Director will record this problem in the Consumer's file.
Should a similar situation arise in the future, Concepts may include this information in an evaluation of the Consumer's ability to continue to manage the responsibilities inherent in the Consumer Directed Personal Assistance Program.

Note: If the Consumer's distance from the Concepts main office precludes the reasonable distribution of the Personal Assistant's payroll checks by mail, Concepts may choose to use an alternative payroll distribution system.

What should a Consumer do if there is an error in the personal Assistant's payroll?

If there is an error in the Personal Assistant's payroll, call the appropriate Timekeeper before issuing the check to the Personal Assistant(s). The Timekeeper will review the problem. If needed, the Timekeeper will direct the Consumer to void the payroll and will prepare a replacement payroll, provided Concepts receives written confirmation of the stop-payment request from the issuing bank.

What should the Consumers do if they do not receive their payroll on time?

If the payroll does not arrive by the Friday following the payroll issue date, the Consumer should contact the appropriate Timekeeper and request the original payroll to be stopped (using the stop-payment request to the bank) and replaced. The replacement checks will be issued with the following payroll, provided Concepts receives written confirmation of the stop-payment request from the issuing bank.

Will a personal Assistant receive a Concepts photo identification card?

Concepts will issue an identification card to a Personal Assistant to facilitate the payroll check negotiation process. To permit Concepts to issue this identification card, the Personal Assistant is required to bring two "passport style" photographs to the Concepts office and to sign a Personal Assistant Verification Form.

OFFICE HOURS

Concepts is open Monday through Friday 9:00 A.M. to 5:00 PM., excluding the
following staff holidays:

New Years' - December 31 and January 1
Martin Luther King Jr. Day - 3rd Monday in January
President's Day - 3rd Monday in February
Good Friday - a Friday in March or April
Memorial Day - May 30
Independence Day -July 4
Labor Day - 1st Monday in September
Thanksgiving -4th Thursday and Friday in November
Christmas - December 24 and December 25

If the holiday falls on a Saturday, the office will be closed on Friday. If the holiday falls on Sunday, the office will be closed on Monday.

If one of these holidays falls on either Saturday or Sunday, the office will be closed on the Friday before and the Monday following the weekend holiday.

PERSONAL ASSISTANT BENEFITS

Are Personal Assistants entitled to any benefits?

Personal Assistants are entitled to the following benefits:

Vacation
Sick leave
Holidays
Jury duty
Health insurance
Life insurance
Pension
Workers' compensation
Disability
Unemployment

How will Personal Assistants receive vacation or sick leave benefits?

Personal Assistants can accumulate a maximum of 120 vacation and 120 sick leave hours per year. They accumulate this benefit at a rate of one vacation hour and one sick leave hour for every 26 hours paid (excluding sick, vacation, holiday, and training hours) for the first 60 hours of pay per week.

For example, if a Personal Assistant is paid for 72 hours in a week, they will accumulate 2.31 hours of vacation and 2.31 hours of sick leave. Note: All hours beyond the 60-hour maximum are not counted.

To assist the Consumer and the Personal Assistant in monitoring the vacation and sick leave balances, these balances are listed on the Personal Assistant's payroll stub. If over a period of time a Personal Assistant accumulates more than 240 sick leave hours, all unused sick leave hours in excess of 240 will be lost as of June 30.

To report vacation hours or sick leave hours the Consumer must enter the number of hours to be paid on the appropriate line of the time sheet, in the respective column marked Vacation or Sick.

To help reduce the possibility of a Personal Assistant's utilizing either sick or vacation hours without informing the Consumer, the Concepts office will not accept verbal requests for either sick or vacation hours from the Personal Assistant. A Personal Assistant may be authorized by the Consumer to receive vacation hours at any time, even without taking time off from work, but sick leave hours may be authorized only when the Personal Assistant is taking time off from their routine schedule.

Personal Assistants who are terminated by a Consumer may request payment for all of their accumulated vacation hours but may not receive payment for their accumulated sick leave hours.

How will Personal Assistants receive holiday benefits?

Personal Assistants are entitled to the following seven holidays:

New Year's Day -January 1 (T 1/2)
Martin Luther King Jr. Day -3rd Monday in January
Memorial Day - May 30 (T 1/2)
Independence Day -July 4
Labor Day - 1st Monday in September (T 1/2)
Thanksgiving -4th Thursday in November (T 1/2)
Christmas Day - December 25 (T 1/2)

Regularly employed Personal Assistants will receive holiday pay (at the regular weekday pay rate) for the number of hours they are typically scheduled to work, on the day (including Saturday and Sunday) upon which the holiday falls, whether they elect to work or not.

Any Personal Assistant (regular or substitute) who elects to work on New Year's Day, Memorial Day, Labor Day, Thanksgiving, or Christmas Day will be paid one-and-one-half times (T 1/2) the Personal Assistant's usual rate of pay for working the holiday.

Any Personal Assistant (regular or substitute) who elects to work on Martin Luther King Jr. Day or Independence Day will be paid at that employee's usual rate of pay for working the holiday.

How do Personal Assistants receive jury duty compensation?

Jury duty compensation can be issued to a Personal Assistant who presents, to the Concepts office, a certificate of jury participation from the court. This certificate must indicate the total number of days served. The appropriate Timekeeper will review the employee's payroll history during the three months prior to jury service to determine the average schedule of this Personal Assistant. Concepts will pay the Personal Assistant their basic average daily salary (without sleep-in or weekend differentials) for each day served, up to a maximum of ten days service. In addition to this payment, the Personal Assistant may keep the check they will eventually receive from the court.

How do Personal Assistants become eligible for health insurance benefits?

A Comprehensive Health Insurance Package is available to Personal Assistants and their families. The details including the required hours of employment, payroll deduction, co-payments, etc. is contained in the Concepts of Independence, Inc. Consumer Directed Personal Assistant Health Insurance Guide. A copy of this guide will be mailed to each employee after their eligibility has been established.

Please note that the details of the Employee Health Insurance Package will vary from county to county. Be sure to contact the Insurance Coordinator at Concepts of Independence, Inc. for more specific information.

How do Personal Assistants become eligible for life insurance benefits?

Personal Assistants who become eligible for health insurance also qualify for life insurance. The eligible Personal Assistant who desires this benefit should complete the Life Insurance Beneficiary card included in the Health Insurance Enrollment Package to insure the payment of this benefit to the appropriate person(s) should it become necessary.

How do Personal Assistants become eligible for pension benefits?

To qualify for the pension benefit a Personal Assistant is required to work at least 1,000 hours for at least five consecutive years. This pension program will provide a small. taxable, monthly benefit which is payable to qualified Personal Assistants after they have reached 65 years of age.

What benefit does workers compensation provide?

Personal Assistants are covered from the first day of employment for job-related injuries. This insurance pays a weekly wage up to a maximum amount established by the New York State Department of Insurance and provides for all related medical bills.

To claim this benefit, the Consumer or Personal Assistant should contact the Concepts; Assistant Director as soon as possible after the accident to report the location of the accident, the accident's time and date, the name and address of the doctor and/or hospital, the probable length of time that the incapacity will last, and the name and address of at least one witness.

What benefit does disability provide?

After four weeks of employment, Personal Assistants are covered for off-the-job illnesses that last more than seven working days. This insurance program pays an average weekly wage up to a maximum amount established by New York State Department of Insurance, for a maximum period of 26 weeks in a 52-week period. Note: Pregnancy is classified as a disabling illness.

To claim this benefit the Consumer or Personal Assistant should contact the Concepts Assistant Director to request a disability claim form. This form should be completed by the Personal Assistant and their physician and then returned to the Concepts office to allow for the completion of the employment information and the submission of the form to the insurance carrier.

What benefit does unemployment provide?

Personal Assistants can become eligible for Unemployment insurance if they:

Are dismissed through no fault of their own
Have worked at least 20 weeks of the year
Are available to work immediately

The dismissed Personal Assistant must apply in person at their local New York State Unemployment Insurance office and provide the Concepts New York State Registration number and the address of Concept's main office.

If the Personal Assistant qualifies for unemployment, they will be eligible for a weekly wage up to a maximum amount established by the Unemployment Insurance Division of the New York State Department of Labor.

To permit terminated employees to return to work as quickly as possible, Concepts encourages every Personal Assistant on unemployment who has at least 500 hours of service and does not have a negative reference from a Concepts Consumer to participate in the Recruitment Assistance Service called the Network List.

Table of Contents

PART TWO: TO THE CONSUMER

HIRING, TRAINING, AND SUPERVISING PERSONAL ASSISTANTS

The day you left the hospital, you made the transition from a dependent to an independent person. With that comes the freedom to make choices in your daily living. As a person with a Personal Assistant you are the employer; your employee is your Personal Assistant. In the role of an employer you have the responsibility and the right to choose the manner in which many daily living activities are done.

We realize the degree of actual physical participation by you, the employer, very often depends on the degree of your disability, but your degree of supervision depends largely on your willingness to acknowledge your role as the employer and to accept your responsibilities and exercise your rights as such. We encourage you to do so. We hope the following information will help you achieve a harmonious working relationship between you, the employer, and your Personal Assistant, your employee.

HOW TO RECRUIT HELP

Finding a Personal Assistant is a very difficult matter depending primarily on your personal needs and the resources in your community. You may choose to concentrate on one resource or develop several potential areas for recruitment. Below are some resource suggestions for finding prospective employees:

Colleges and Universities

Colleges can be a good resource for finding Personal Assistants. Many students are looking for experience in the field of human services, and many need an extra source of income to help them through college.

Colleges provide employment services for their students by listing job opportunities or taking job orders. If you wish to place a job order, ask for the Career Placement or Job Development center. Interested students will contact you directly for additional information.

Be prepared to offer the following information:

Title of job (i.e., Personal Assistant)
Qualifications required
Job description
Part-time or full-time
Days and hours of services needed
Your name, address, and phone number
Salary and benefits

Word of mouth

Friends, neighbors, assistants, neighborhood shopkeepers, and so on may be good resources. Let them know you are looking for a Personal Assistant.

Libraries

Career or employment centers

Nursing homes

Ask at the Personnel Department for an individual who may be interested working part-time.

Local newsletters

These are best utilized for running small classified ads that can be specifically structured to individuals' needs.

Employment agencies

Be aware that most conventional agencies charge the potential employee two weeks' salary, which may be a disincentive. However, there are agencies in some areas that offer more flexible plans. Select one carefully.

Develop your own roster

List your former Personal Assistant. Speak to fellow Consumers enrolled in the
Consumer Directed Personal Assistance Program for names of individuals whose
schedules may be changing or may want to work additional hours for you.

Other sources

Hang a poster or index card in a high traffic area, such as a bulletin board at these
locations:

Supermarket
Banks
Stores
Apartment buildings
Community centers
Houses of worship (e.g., church, temple)
Hospitals

Local newspapers

Newspapers, overall, provide the widest degree of advertising potential. Local newspapers are generally cheaper in comparison to major or citywide newspapers and your ad will reach prospective employees in your neighborhood. When you call a publication, ask to speak to someone in the Classified Department and place your ad in the Help Wanted section.

Following are some samples of how you might place an ad:

Personal Care Worker
Female, nonsmoker, needed to live-in with female adult with disabilities to assist with personal care, housekeeping. Free rent, days negotiable, salary included. Call Carmen at (718) 666-6666.

Personal Assistant
Needed to assist disabled male with personal care. Part-time, 4 days/week. Driver's license preferred. Ideal for a college student, prime location, $5.90/hr. Call (212) 111-111 evenings.

DEVELOPING BACKUP RESOURCES

Be prepared in case your Personal Assistant is not available to work. Here are some
suggestions for finding prospective emergency backup replacements:

Hire more than one permanent Personal Assistant to work per week. If one Personal Assistant is sick or unavailable, the other can substitute. For example, you can hire one person for weekdays and another for weekends.
Request that your Personal Assistant find their own replacement when unable to work.
Maintain an updated list of prospective employees you liked but did not hire as permanent workers. Check with them periodically to see if they are still available to work for you on a substitute basis.
Ask friends or neighbors if they would be willing to assist you in case of an emergency. You can remind them that besides helping you, they will be paid for their services.
Most important, have a telephone nearby that you can always operate. If it is necessary, you can get special telephone adaptions to fit your needs. For more information on services for the disabled, contact your local telephone company.

Note: If you have continuous coverage, be sure to emphasize the point that you cannot be left alone and that the Personal Assistant cannot leave your home before their replacement has arrived. Also, require that your employee give you notice before taking annual or vacation leave and before leaving the job.

HOW TO INTERVIEW

Telephone screening

When prospective employees call you, screen out the individuals who are inappropriate or who cannot meet your needs. This screening procedure will save time for both you and the applicant.

When a prospective Personal Assistant calls, tell him or her the salary and the days and the hours when you will need assistance. This statement will immediately weed out certain callers who either want a higher salary or are not available to work the hours or days you have stated. For those who respond positively, continue the conversation. Ask quick and important questions that will immediately help you decide if the applicant will fulfill your needs.

Here are some sample questions:

What hours are you available?
What days can you work?
Where do you live?
Do you like and/or are you allergic to animals?
Do you smoke?
Do you have a driver's license?
Have you had any personal care experience?
Do you mind assisting me in bathing, toileting, and dressing?
There might be some lifting involved. Are you strong enough to safely accomplish this task?
Are you 18 years of age or over?
Do you have a Social Security number?

If the applicant appears appropriate, ask him or her to participate in a personal interview and to bring identification and proof of their address (for example, a rent bill) to the interview.

Personal interview

Your telephone screening allows you to interview in person only those applicants who are good candidates for the job. The personal interview has a twofold purpose:

It gives you the opportunity to learn as much about the applicant as possible to help you decide if the person is appropriate for the job.
It gives you the opportunity to give a detailed description of the job requirements and your needs so that the applicant can decide whether the job is appropriate for him or her.

The interview

Try to make your prospective Personal Assistant feel as comfortable as possible, to help you get the most accurate response.
Explain your disability as well as you can.
Describe the job requirements in detail and be very explicit. See the section called "Job Description," which follows this section.
Ask the prospective Personal Assistant about jobs they have had in the past. For example:

a. What jobs have you had in the past?

b. How did you feel about those jobs? What did you like? What didn't you like?

c. Why did you leave your last job?

d. Have you had personal care experience? Where? How long?
Ask the prospective employee why they want this kind of work.
Keep in mind that relying on a work or personal reference is not necessary. If the applicant appears to meet your requirements, your own instincts and impressions may be your best guide.
Talk about how you will evaluate the prospective attendant's performance. Let the applicant know that you want feedback from him or her.
Keep records of each person, including the applicant's name, phone number, address, hours and days available to work, references with phone numbers, other relevant information (for example, "has a driver's license"), and a rating with a brief explanation of your impressions. You may choose to refer to these records in the future.

JOB DESCRIPTION

The job description you present to the applicant should be a written description of the services you expect him or her to perform. These services may include assisting you with personal care services, household chores, and other activities inside and outside the home that enable you to be as functional as possible. The advantages of developing and working with a job description are listed below:

It will clarify your needs and provide a realistic picture of your limitations and lifestyle.
It can be used as a guideline for in-depth questioning in the interview.
It will let the employee know what you expect of him or her, so as to avoid future problems.
It can serve as a checklist of duties and responsibilities after an individual has been hired.
It can be used as a tool for evaluating the Personal Assistant's performance on the job.
It can solve disagreements between you and your Personal Assistant regarding his or her duties.
It can help keep the relationship open. You can use it as a point of reference for future discussion about your working relationship.

WHAT TO INCLUDE IN THE JOB DESCRIPTION

In the job description, state everything your Personal Assistant might have to do for you. If they are not comfortable with any of your requirements it is better that you find out during the interview rather than after they starts working for you.

Tasks you may require:

bathing

dressing

grooming

bladder care

bowel care

oral hygiene

lifting

transfer

exercise

meal preparation

housekeeping

laundry

groceryshopping

finances

correspondence

transportation

pet care

mobility.

It is advisable to mention flexibility in routines and procedures when necessary and appropriate. Also, elaborate on each task, explaining in detail how often the service is required and approximately how long the procedure usually takes.

Equipment you might need:

bedpan

walker

commode

wheelchair

respirator

mechanical lifter

hospital bed

water bed

blood pressure monitor

Other considerations that may need to be included in the job description:

school activities

pay rate

social activities

benefits

job activities

time off

occasional assistance to achieve a skill or to increase independence

HIRING YOUR EMPLOYEE

Once you have decided to hire a particular applicant, you have some options. You can hire the person:

On a trial basis (for example, for three months)
As a substitute
As a permanent worker

When you discuss your hiring with your new Personal Assistant:

Summarize the major points discussed in your interview and job description.
Agree on the starting date and remind your new employee of the starting time and salary.
Give the Personal Assistant your phone number so that they can call you if he or she is unable to work, so that you can contact your emergency backup Personal Assistant.
Ask for their phone number.

You may wish to develop a personal written contract between you and your Personal Assistant that both you and your employee should sign. Tailor the contract to your individual needs. Remember, hiring a person does not mean that you must stay with that person for life. If you find that over a period of time the person's work is incompatible with your needs, you may have to remove that individual from your payroll and start the hiring process again.

TRAINING YOUR EMPLOYEE

Below are some suggestions on how to train your Personal Assistant:

Begin by explaining your disability in as much detail as possible.
Explain any technical words that you use; be as descriptive as you can.
To start each training session, present an overview of what you wish to teach. At the end of the session, summarize what you have taught. If you have a second session, briefly review what you have taught in the first session and then move onto new material.
Be sure to emphasize safety precautions and what to do in the case of an emergency.
If you have life support equipment or require universal precautions, explain their appropriate use in detail.
When giving instructions involving a procedure, like transferring, describe each step of the technique.
Do not assume that your Personal Assistant will understand your explanations; ask for feedback and encourage questions.
When you explain any procedure or routine to your employee, describe why it is important to you that something be done in a certain way or at a specific time.
Be consistent in your explanations, and if you change a procedure, explain why you have changed it.
Be patient, your Personal Assistant probably will not get all your directions right the first time or even the second.
Try to be aware of your Personal Assistant's feelings as you train. Try to be conscious of how much new knowledge the Personal Assistant can learn effectively. Some individuals may be able to learn a whole procedure at once, while others may require more gradual training sessions.
If possible, have a friend, family member, or previous Personal Assistant demonstrate techniques and procedures to your new employee.
Give your employee both positive and negative feedback.

a. When your employee does a procedure incorrectly, bring it to their attention and patiently remind him or her of the correct procedure.

b. When your employee does a procedure correctly, compliment him or her. Compliments or a "thank you" reinforce the behavior you wish to see in your new employee.
Write (or have someone else write) the steps in a procedure or a succession of procedures; keep a copy and give a copy to your Personal Assistant.

SUPERVISING YOUR EMPLOYEE

An intricate aspect of your responsibility as an employer is to supervise your Personal Assistant to insure that they do the everyday activities you require. It is advisable to describe the job requirements and duties in a specific, structured, and an assertive manner. We recommend that you schedule a specific task each day. For example:

"Monday we will prepare a list and do the food shopping."
"On Tuesday we dust and mop. For wet mopping I use ammonia." (Be explicit.)
"Wednesday we do laundry. The laundry is done in the basement and I use Brand X soap powder and Brand Y bleach."

We offer these examples and recommend that you continue this type of explicit, structured supervision for each day. It will be easier for you and your Personal Assistant when a routine becomes established. It is also advisable to mention flexibility in routines and procedures when it might be necessary.

LIFESTYLE CHOICES

As an employer, you have the direct responsibility of managing your Personal Assistant and your home. In this section we discuss some choices and decisions involved with fulfilling these responsibilities in a manner that is satisfactory and comfortable for you.

Daily living

Below is a list of some daily living activities you may wish to consider in your role as employer. As you read this list, keep these questions in mind:

For which chores should I be responsible? For which chores should my Personal Assistant be responsible?
Which responsibilities will maintain and/or promote my independence?
Which responsibilities should be strictly allocated? Which are open to compromise.
Which chores can I do myself?
Which chores require some assistance?

a. Buying clothes and daily attire.

b. Preparation of shopping lists; inventory of food, household needs, and bathroom supplies.

c. Going to the store, placing items in the shopping cart, paying the cashier.

d. Paying for food. (Although you are not responsible for paying for your Personal Assistant's food, it is an accommodation you may wish to consider.)

e. Placing the items in their proper place in your home.

f. Menu preparation, sources of recipes, cooking, and kitchen cleanup.

g. Housework, laundry, and ironing.

h. Financial management, payment of bills, balancing the checkbook, and banking.

i. Transportation arrangements and monetary responsibility for your Personal Assistant's carfare.

j. Recreational activities.

k. Managing incoming and outgoing mail.

Sharing the cost of local and long-distance phone calls.

Securing your possessions

To protect property we suggest the following:

Everything should have a place known to you and should be kept in that place.
Keep a careful inventory of your consumables to help you control purchasing.
You may also consider purchasing a home insurance policy that will help you recover some of your property in case of fire, flood, theft, or other loss.

Finally, be certain that none of your keys are with an Assistant you are terminating. You may have to change your lock if the terminated Personal Assistant does not return your keys.

Entertainment

Most people, including home-care Consumers and Personal Assistants, are social
beings. As such, people visit and have visitors. A few considerations:

Do you have visitors? How often? For meals?
Do they stay late?
Do you want your Personal Assistant to participate in your visits? Stay in their room? Leave the house for a while?

We recommend that you begin by not allowing your Personal Assistant to have visitors. It will be easier to change your answer from "no" to "yes" rather than from "yes" to "no." You can allow visitors if the situation and circumstances indicate that they will not inconvenience you. We recommend that you keep this limited.

TERMINATING YOUR EMPLOYEE

Below are various ways to approach employee termination, a task that is often difficult.How you choose to accomplish this task depends on your personality, your employee's personality, and the situation.

Have a neighbor, friend, or relative in the room with you and your Personal Assistant if you feel there may be a problem.
Give your Personal Assistant one, two, three, or four weeks' notice.
Give your Personal Assistant no notice.
Inform your Personal Assistant of their termination via the telephone.

Note that with advance notice of termination you risk an increase in the already unsatisfactory quality of your Personal Assistant's job performance.

We suggest that before you terminate your present employee you have available at least one backup Personal Assistant who knows your unique requirements, knows how to fill them, and is ready to start work immediately.

Some sample dialogue concerning termination of a Personal Assistant:

"I am sorry, but I do not feel that you are appropriate for this job. I need someone who (is stronger; can drive; can work more flexible hours; lives closer; has more experience; etc.) to work for me. I am sure you will make someone else a wonderful Personal Assistant. Thank you for your time and help."
"You are not fulfilling your job obligations. You usually arrive a half hour late and you have taken several days off without notice; I need someone who is reliable and dependable. I am sorry, but I have to let you go."
"I cannot continue to employ you any longer. There have been too many problems between us and I do not feel we can ever solve them. Please take your belongings and leave."

Think carefully before dismissing a Personal Assistant. In some cases it might be better to work things out with the present assistant rather than to seek a new employee, about whom everything is unknown. If after careful thought you decide to hire a new Personal Assistant, we hope you will use some of the information offered in this manual.

PART THREE: MEMORANDUM OF UNDERSTANDING

INTRODUCTION

The following Memorandum of Understanding (MOU) was developed by the New York State Department of Social Services and Concepts of Independence, Inc., and a method of permitting counties to expeditiously implement the Consumer Directed Personal Assistance Program. The MOU is a legal document which details the roles and responsibilities of the entities that would administer the Consumer Directed Personal Assistance Program. These entities include the following:

A. The Local Department of Social Services which would conduct an assessment of the Consumer to determine appropriateness for the program and authorize services;

B. Concepts of Independence, Inc. to act as a fiscal agent to bill the Medical Assistance program and perform administrative functions such as payroll processing at the discretion of the Consumer; and

C. A Local Consumer Organization, located in the district to act as a liaison between Concepts of Independence, Inc. and the Consumer.

SAMPLE AGREEMENT

Memorandum of Understanding
by and between
Concepts of Independence, Inc.,
Local Consumer Organization (LCO), and
Local Department of Social Services LDSS)

Introduction

In accordance with Sections 365-f and 367-p(c) of the Social Services Law, the parties seek to enable Medicaid recipients (the "Consumer") to utilize the Consumer Directed Personal Assistance Program established by Concepts of Independence, Inc. ("Concepts"). Concepts will provide its services in conjunction with the Local Consumer Organization ("LCO"), and the Local Department of Social Services ("LDSS").

Concepts will assume the role of fiscal intermediary and act as the paymaster of record for the Consumer's Personal Assistant (the "CDPA"). The LCO will provide local assistance, quality assurance and facilitate peer support, including the establishment of an advisory committee for the purpose of program review and support. Concepts and the LCO will work closely with the LDSS in all phases of the delivery of Consumer Directed Personal Assistance services to be provided under this agreement.:

Although the Consumer is not a party to the agreement, the Consumer will be required to execute a separate agreement confirming its responsibilities enumerated below.

The parties hereby agree as follows:

Responsibilities of the Consumer

The Consumer and/or the Consumer's guardian will undertake the following:

Recruit, interview, hire, train, supervise, schedule and terminate the CDPA.
Provide equal employment opportunities as specified in the Consumer's agreement with Concepts and the Employment/Wage Agreement which is signed by both the Consumer and the CDPA.
Inform the LCO coordinator of any changes in status including, but not limited to, address, telephone number, CDPA's names, addresses, hours worked and hospitalization. Inform the LDSS of any changes in status, including address and telephone number changes and hospitalizations.
Process the required paperwork for Concepts including time sheets, annual worker health assessments, and required employment documents.
Arrange and schedule back up CDPA coverage for vacations, holidays, and in case of illness.
Distribute paychecks to each CDPA.
Insure that each CDPA works the hours indicated on the time sheet.
Meet with a registered nurse once every six months for the required nursing review.
Enter into a written agreement with Concepts which acknowledges these responsibilities.

Responsibilities of Concepts of Independence, Inc. (Concepts)

Upon the completion of the rate approval process by the New York State Department of Social Services, Concepts will undertake the following:

Process the payroll for each CDPA, including withholdings for Federal, State and local income tax and Social Security (FICA). Act as the employer of record for Social Security (FICA).
Monitor the completion of the required annual worker health assessment and all required employment documents.
Act as the employer of record for insurance, unemployment and worker compensation benefits.
Coordinate annual leave, health insurance, and other benefit programs for each CDPA.
Monitor the completion of the required nursing assessment forms and the Consumer agreement outlining responsibilities assumed thereby.
Maintain a personnel record for each CDPA which will include, at a minimum, copies of the enrollment forms, the annual worker health assessments, and the information needed for payroll processing and benefit administration.
Maintain Consumer record, which includes copies of the LDSS approval/referral, the LDSS service authorizations, the agreement signed by the Consumer outlining the responsibilities assumed thereby, the periodic nursing assessments, and other documentation of the LCO's efforts to monitor the Consumer's ability to meet its obligations.

Responsibilities of the Local Department of Social Services (LDSS)

Determine that the Consumer is a resident of the authorizing county, and be determined to be Medicaid eligible.
Determine that the Consumer is eligible for long term care and services provided by a certified home health agency, the long term home health care program, the AIDS home care program or personal care services.
Determine, pursuant to an assessment of the person's appropriateness for the program conducted by an appropriate long term home health care program, certified home health care program,.certified home health agency, or an. AIDS home care program or pursuant to the personal care program that theConsumer is in need of home care services or private duty.
Determine that the Consumer is able and willing or has a legal guardian able and willing to make informed choices, or has designated a relative or other adult who is able and willing to assist in making informed choices, as to the type and quality of services, including but not limited to nursing care, personal care, transportation and respite services.
Determine Consumer's eligibility for the program through its approved annual plan procedure including the initial assessment and periodic reassessments. LDSS will authorize the level and amount of services required and will authorize the reimbursement for CDPA services to Concepts as prescribed by the New York State Department of Social Services.
Transfer the Consumer to other programs with more traditional agency control should the Consumer be deemed inappropriate to continue participation in the CDPAP.
Provide all eligible individuals receiving home care with notice of the availability of the program and an opportunity to apply for participation in the program.
Provide Consumers with the appropriate fair hearing notice and the opportunity for a fair hearing with aid-continuing, if appropriate, at such times as the Department requires.

Responsibilities of the Local Consumer Organization (LCO)

The LCO will undertake the following:

Assist the Consumer with recruitment and service coverage referrals, and provide informational support for training, supervision advocacy and personal management.
Monitor the Consumer's ability to meet contractual obligations
Provide local support to the Consumer by coordinating payroll distribution, the distribution of forms, and the collection of information
Maintain the original personnel record for each CDPA which will include, at a minimum, the original enrollment forms, the annual CDPA health assessments, and the information needed for payroll processing and benefit administration.
Maintain the original Consumer record, which will include the original LDSS approval/referral, the LDSS service authorizations, the agreement signed by the Consumer outlining the responsibilities the Consumer has assumed, the periodic nursing assessments, and other documentation of the LCO's effort to monitor Consumer's ability to meet its obligations.
Coordinate access to health facilities capable of providing the required annual worker health assessment and other health related program requirements.
Establish an advisory committee which will consist of disabled Consumers, advocates and/or other interested parties. The committee will oversee quality assurance of this agreement and provide the LDSS and Concepts with assistance and support, which may include peer counseling, referral and program monitoring.
Provide Concepts with monthly statistical reports in the manner and form determined by Concepts to be necessary and appropriate, to permit the proper documentation of the growth of the Consumer Directed Personal Assistance Program and the level of savings achieved as a result of this agreement.

Right to Terminate Agreement

Upon thirty days notice, any party may terminate this agreement without further liability;
This agreement will terminate upon notification from the New York State Department of Social Services that State and/or Federal funds are unavailable for these services or for any other reason specified by the Department.

Signatures

Concepts of Independence, Inc.	Date
Local Department of Social Services	Date
Local Consumer Organization	Date

Consumer Directed Personal Assistance Guide

A Letter from the President of Concepts of Independence, Inc.

Welcome to the Concepts of Independence, Inc. Consumer Directed Personal Assistance Program

Consumer Directed Personal Assistance Guide

A Letter from the President
of Concepts of Independence, Inc.

Welcome to the Concepts of Independence, Inc.
Consumer Directed Personal Assistance Program