Attendant Management

Determining Attendant Care Need

From the book Yes, You Can! A Guide to Self-care for Persons with Spinal Cord Injury
published by Paralyzed Veterans of America (PVA), 1989
edited by Margaret C. Hammond, M.D., Robert L. Umlauf, Ph.D., Brenda Matteson and Sonya Perduta-Fulginiti, M.S.N.

As an employer of an aid or attendant, you will be running a small business and will be using the skills of a personnel manager. The purpose of this paper is to help you succeed as an employer.

The first step in looking for an attendant is deciding what activities you will need help with. This is called a "needs assessment." The needs assessment checklist provides a general outline of duties an attendant might perform. Go throughthe list and mark each activity with which you will need assistance. If you need assistance in areas not listed, write them in the blank or "other" spaces.

Now that you have outlined your attendant needs, your next step is to clearly outline what is expected for each task listed. This may help you avoid conflicts about duties your attendant is to perform. This will also ensure that you get the care you need. An example of a personalized care checklist is given below. The checklist gives step-by-step instructions for your personal care.

Needs Assessment Checklist

I need help with...	[ ] Yes [ ]No
1. Bathing	[ ] Yes [ ]No
2. Dressing	[ ] Yes [ ]No
3. Housekeeping Daily Weekly Monthly
[ ] Yes [ ]No
[ ] Yes [ ]No
[ ] Yes [ ]No
4. Medications	[ ] Yes [ ]No
5. Range of Motion/Exercise	[ ] Yes [ ]No
6. Eating Feeding Shopping Meal preparation Clean up
[ ] Yes [ ]No
[ ] Yes [ ]No
[ ] Yes [ ]No
[ ] Yes [ ]No
7. Toilet Bowel program Bladder program Other: 1. ______________ 2. ______________
[ ] Yes [ ]No
[ ] Yes [ ]No
[ ] Yes [ ]No
[ ] Yes [ ]No
[ ] Yes [ ]No
8. Transfers Bed to wheelchair Wheelchair to toilet Into shower Into tub Other: 1. ______________ 2. ______________
[ ] Yes [ ]No
[ ] Yes [ ]No
[ ] Yes [ ]No
[ ] Yes [ ]No
[ ] Yes [ ]No
[ ] Yes [ ]No
[ ] Yes [ ]No
9. Wheelchair maintenance	[ ] Yes [ ]No
10. Miscellaneous Recreation Errands Driving to work/appt.
[ ] Yes [ ]No
[ ] Yes [ ]No
[ ] Yes [ ]No
11. Other: Skin Care ________________ ________________ ________________
[ ] Yes [ ]No
[ ] Yes [ ]No
[ ] Yes [ ]No
[ ] Yes [ ]No

CHECKLIST FOR PERSONAL CARE

It would be impossible for you to include every detail of every step in your individualized checklist. But on the other hand, if important information is left out, the step might not be performed properly. Here are some general guidelines for developing specific steps in an individualized checklist.

1. Be brief--Try to make the steps as short as possible.

2. Put steps in correct order--Make sure the steps are arranged in the order in which they will be performed.

3. Include what, when, where--Make sure the attendant knows what materials are needed and when and where the job will be performed.

A. Avoid how--Much of the "how to" of many steps is too detailed to include in the checklist, and you should teach them while the task is being performed. However, make sure to specify those steps that are essential or often neglected.

Items on the checklists should come from your needs assessment. It is often best to arrange the checklists in a workable order. For example, if bathing is the first task to be done each morning, the bathing checklist should be first. (See sample checklist for morning routine) Some people find it helpful to arrange the checklists in daily (e.g., dressing, eating), weekly (e.g., shopping), or monthly (e.g., wheelchair maintenance) order. Having the checklists arranged in an orderly manner will simplify both you and your attendant's responsibilities. The checklist then becomes a very clear and complete job description for your attendant.

Sample Checklist for Morning Routine

GETTING READY

1. Get clothes ready
2. Prepare bath water
3. Check bathroom temperature
4. Make sure needed materials are available
5. Ensure privacy

ROUTINE

1. Assist with bladder, such as catheterization
2. Assist with bowel care, such as inserting suppository and digital stimulation
3. Assist in clothing removal
4. Move from bed to bath
5. Wash and rinse body
6. Assist with hair care
7. Move from bath to dressing area
8. Dry body thoroughly
9. Conduct health check (such as check for pressure sores)
10. Apply lotion or powder
11. Apply deodorant, makeup, and/or shave
12. Assist in dressing
13. Move to wheelchair
14. Assist with dental care
15. Move to breakfast area

CLEAN UP

1. Put away all materials
2. Clean bathroom
3. Clean and disinfect bladder and bowel care materials

The checklist and job description need to be clear in your mind so that you can describe them to a possible employee. This allows an applicant to see if the job is acceptable. Do not try to make the job sound easier or less time consuming than it actually is in order to persuade an applicant to take the job.

You may need more than one employee. For example, one in the morning and another at night if you do not need assistance during the day. Or you may need one for weekdays, then another for weekends so that each has time off. You may also want to ask someone you know to work for you when one of your regular employees is on vacation, or needs time off for a special occasion, or is sick. Sometimes previous attendants who are no longer working for you will do this, as they know your care.

USING A CONTRACT

Now that you have identified your needs as an employer, have written a job description, and decided on the number of employees, it is time to develop an employment contract. A contract clarifies the duties and responsibilities of the employer and the employee. Preferably, it is in writing and signed by both the employee and the employer. This will serve as a guide for discussion of the duties and responsibilities for each of you. Areas covered in the contract are tailored to your individual situation. Examples of possible subjects to cover are as follows:

1. Duties: personal care, range of motion, shopping, cooking, housekeeping, driving (use your job description)
2. Hours and schedule of work: include days off, holidays, vacation
3. Salary: room and board (for live-in attendants), deduction, other non-cash benefits
4. Utilities: phone, newspaper, shared costs, long-distance bills
5. Clarify use of your personal items such as shampoo, detergent, car, wheelchair, food, etc.
6. Smoking
7. Alcohol use
8. Swearing
9. Who pays when the attendant accompanies you to the theater, restaurant, travel, bus
10. Terms of unacceptable behavior that can lead to termination
11. Termination notice: length of notice, condition in which the live-in employee is to leave his/her room

If you would like to see a sample contract, ask a member of the rehab team. There are many different ways to write them.

IDEAS FOR RECRUITING

Suggestions for finding an attendant vary, but here are a few:

• Advertise in the local newspaper
• Place notices on bulletin boards
• By word of mouth through friends, churches, and clubs
• Use an agency, either for-profit or nonprofit, that will screen and refer applicants to you

Newspaper Ads
In writing your ad, your first objective is to attract the eyes of the prospective attendant(s). A heading of "Help Wanted" or "Handicapped Needs Help" will hardly do it. What is the incentive for the help?

Weekly salary? Free furnished apartment? Use this as the heading to spark curiosity.

The next line reinforces the incentive of the heading with finer detail to further develop interest.

The third part of the ad should tie the incentive to a brief, but fair, idea of the obligation. Do not sugarcoat this part and you will get a more serious, mature applicant. The final line must provide a way of contacting you directly or indirectly (first name, phone, or a purchased newspaper box number). It is a good idea not to include your last name or home address for your own safety and independence.

The ad should include days of week, parttime or live-in, brief description of duties, sex of the person with disabilities, nonsmoker if required, salary, phone number, and time to call. If you are going to school, working, or have special hobbies or interests, you may want to word your ad differently. Because of discrimination laws, you cannot advertise your preference of sex, age, or race. You also cannot ask height or weight, but you can ask if they are able to do lifting. (See examples of newspaper ads)

Examples of Newspaper Ads

SALARY AND ROOM AND BOARD

"Dependable person to assist male student with a disability in housekeeping and personal care. Monday through Friday. Driver's license and references required. Prefer nonsmoker. $400 a month plus room and board. Call 739-6620."

SHARED LIVING

"Job working for an employed man with a disability: Helping with personal care and household chores. Ample time off during the day. Weekends off. Driving and references required. $400 per month, plus room and board. Call 464-9921 after 5 p.m."

Posters & Bulletin Boards
Various college campus locations, personnel bulletin boards, hospital staff lounges, and even public notice places such as those found in some supermarkets all offer you free recruiting places.

The strategy of content and layout for a poster or index card is much the same as for newspaper ads. Reproduction costs can be minimal, and the greater freedom for attractive art forms lets you be really creative.

Use your splashy headline to attract curiosity wherever possible, then include the newspaper ad objectives (see section above). Tear-tabs at the bottom of your poster can be a very important feature.

Posting strategies have two primary objectives:

1. To make your message as easily seen as possible, and
2. To make it as long-lived as possible.

In finding the best places, first be sure you are well-equipped with notices, and preferably, a full staple gun. Where staples are permitted, use in each corner of your poster. These last longer than tacks or tape. Here are some other considerations:

1. If you can do your posting independently, fine, if not, bring a friend with you.
2. To make your message seen, pick a good place! Choose posting areas with high- pedestrian traffic of the type of people who might be interested in your offer. Within these high-traffic areas, favor places either where people check out notices by habit (job notice board or a favorite bulletin board), or where people must wait for something and may read from boredom (outside of elevators or cafeterias). Now that you have a good place, find a good spot within it, where your message can be seen.
3. Observe any rules imposed for the posting area, and check your postings regularly to ensure no one has covered them with others.

Example of Bulletin Board Advertisement

FREE FURNISHED APT *

• University area within quarter block of bus stop
• Very modern, full-kitchen, 8th-floor, outside balcony
• Share in return for live in help to working, college age male with wheelchair mobility (2-3 hours/day)
• Mature male individuals preferred. No experience necessary.
• Need now!!!

Call Gary, after 6, 567-4313 for details.*

(*LARGE, HAND PRINTED, RED-MARKER USED FOR HEADING AND CONTACT IINFORMATION TEAR-TABS, EACH SLIT APART AT THE BOTTOM OF THE POSTER with the following written on each tab "Live-in help, Gary, 567 4313")

Word of Mouth
Don't overlook the obvious: the people around you every day. Friends from class activities and dorm or apartment living might well include today's reserves and tomorrow's attendants. The big advantage of recruiting in this manner is your knowledge of the interested individual. Advertise during informal conversation. Some people you might think least interested in helping you may pleasantly surprise you.

Some Other Approaches to Finding an Attendant

• Refugee employment through refugee agencies is an excellent source of help. You offer an individual exposure to advanced English, and you may have external support from the agency.
• Clients of the Departments of Developmental Disabilities and Vocational Rehabilitation are another good resource. Sometimes a mentally retarded person can make a good attendant. Other persons with disabilities may work out also.
• Don't hesitate to get a second opinion when you are unsure. Someone else may have helpful ideas in deciding how to select an attendant.

PEOPLE WHO MAKE GOOD ATTENDANTS

There is no specific profile of the perfect attendant, but there are a few tips that may make the task a little easier:

1. Consider a wide variety of options. Maybe consider someone with a specific ethnic background or different culture, different educational level, age, or social group.

2. When selecting attendants, do not expect a long-term relationship, but do expect dependable care. Select people based on whether you feel they can be trusted. You are trying to select an employee who you believe will care for you on a regular basis.

3. Family can be useful, but remember the employer/employee role. Hiring a family member may have drawbacks!

4. Use friends, the SCI team, or family to help check someone out when you are really stuck or having trouble. Be careful, though, not to over-use your privilege of friendship or family ties.

5. Know your own likes and dislikes. Besides basic care needs, know what you like and dislike in other people. Trust and dependable care depend on your knowing yourself and letting others know what you like. Who do you like to be around and why?

6. It may be helpful to learn to assess "personality" (general style and behavior patterns) and "emotions" (how people express feelings). Pay attention to how people look, talk, and act. Notice if they are well-groomed and confident. Does conversation flow smoothly?

Also, trust your "gut reaction": Does it feel right to be around this person? If you feel sad, angry, confused, etc., when with this person, do you want to spend a great deal of time with them? Another part of how you feel towards a potential attendant may be your attraction to them. Remember, you're not hiring a friend or a lover.

HOW TO HANDLE CALLS ABOUT THE JOB

Give a brief description of what the job entails: personal care, housekeeping, meal preparation, shopping, and driving. If the person is still interested, you may want to set up an appointment to meet in person or ask further questions. Keep the following things in mind throughout this process:

1. Do not hire someone you have not seen just because they sound nice on the phone.
2. Do they mind doing personal care? Can they handle nudity that goes along with personal care? If they cannot, there is no sense wasting their time and yours. If they do not mind it, then discuss basically what is involved.
3. Describe basic household duties and other chores.
4. Describe your living environment. Emphasize the positive.
5. If you need a driver, find out whether they mind driving the type of vehicle you own and whether they have a good driving record. If you need someone who has a car. can they provide that?
6. Discuss your social lifestyle and what you consider appropriate and allowable.
7. Ask what kind of work they have done and whether they have work references.
8. Ask if there are any physical or emotional limitations that would make it difficult or prevent them from doing this job.
9. If people call and you do not want to hire them, just tell them the position has been filled or that you are considering other people for the job. When you feel ready to meet this person for an interview, pick a convenient time and place to meet. You may want to meet somewhere other than your home or apartment, for your own safety and independence.

continued...Interviewing