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Review of Personal Assistant Services
Personal Assistant Services (PAS) refers to the pairing of personal assistants (PAs) with those individuals who require assistance in carrying out activities of daily living and/or instrumental activities of daily living (consumers), such as eating, dressing or cooking. Public PAS are delivered through three primary models: the Agency Model, the Consumer-Driven Model, and the Cash and Counseling Model. See: https://umshp.org/hp/resources/sci/snaps/snaps3ca.htm
Demographic Profile of SCI PAs
Because assistants helping consumers with spinal cord injury (SCI) are often grouped with various other paraprofessional health care workers (such as home health care aides and nursing assistants), specific demographic information about PAs is limited. A recent MOMSCIS survey interviewed 110 PAs from both rural and urban locations in Missouri. The preliminary results of this survey are listed in the table in the upper right corner of this page.
Most PAs surveyed were women, with an average age of 45. Most were Caucasian (77%) or black (17%). The U.S. Census Bureau lists Missouri’s population as 84.9% Caucasian and 11.2% black in the 2000 Census. Forty percent of the PAs were married, with 31% divorced or separated, 6% widowed and 23% never married. Nearly 90% of the PAs considered their health status to be good, very good or excellent. A little more than half were related to their current consumer. The average PA had 12.6 years of education.
Occupational Profile
By definition, PAs for consumers with SCI are classified as Personal and Home Care Aides (PHCAs) by the U.S. Department of Labor’s Bureau of Labor Statistics. The Bureau identifies PHCAs as one of the fastest growing occupational types within the U.S. economy. Additionally, the Bureau lists a variety of statistics that profile the occupation itself (see the chart at right). In 2004, about 532,490 individuals provided personal or home care assistance in the U.S. The average hourly wage for these workers was $8.38 with an average annual wage of $17,430. Half of all PHCAs earn between $6.83 and $9.70 per hour.
The PAs participating in the MOMSCIS IMPACT Survey had worked an average of 6.7 years. The PAs were currently assisting an average of 1.4 consumers, and were working an average of 33 hours per week.
Most of the PAs surveyed were being paid through consumer-directed employment programs under the sponsorship of an Independent Living Center or by a home health care agency, as shown in the chart below. See: https://umshp.org/hp/resources/sci/snaps/snaps1a.htm
Turnover and Quality of Care
Much of the information now available would indicate that the PA position has some obvious disadvantages compared to many other occupations. Low reimbursement, inadequate or no benefits, low skill requirements, and the high emotional demands of these attendant positions are currently manifesting themselves in excessively high turnover rates and a shortage of workers within this occupation.
The PA shortage is perhaps one of the most pressing issues currently facing SCI consumers. Brief or intermittent periods of PA employment may result in a fragmented system of health care and social support for persons with SCI. From a psychological standpoint, fragmentation of personal support service provision implies that many consumers must live in an ongoing state of uncertainty. From a biomedical perspective, disruptive turnover effects are likely to translate into an SCI population that is increasingly exposed to low quality, inconsistent medical care.
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For more information about SCI or PAS, view two other Health Snapshots produced by MOMSCIS: "A Brief Overview of Spinal Cord Injury," and "An Introduction to Spinal Cord Injury Personal Assistant Services." Both of these Health Snapshots are available at the following Internet address: https://umshp.org/hp/resources/sci/scisnaps.htm.
