ADAPT of Texas and Personal Attendant Coalition of Texas (PACT) are conducting a survey to gather information from you to develop a report on the needs and benefits of personal care attendants(PCA) in everyday use. Please take time to fill this out and/or send it to individuals with disabilities that use personal attendant services. You can fax/email/mail or text a photo of the completed survey. The contact information is at the end of the survey.
I have pasted the survey below. If you have any question about the survey, please contact Cathy or Nancy at 512.442.0252.
Thank you for your assistance,
ADAPT of Texas/PACT Organizer
1100 S. IH 35
Austin Texas, 78704
ADAPT/PACT of Texas is conducting this survey to gather information from you to develop a report on the needs and benefits of personal care attendants (PCA) in everyday use. Please feel free to pass this questionnaire to others who also use PCAs.
** All information will be held in strictest confidence. **
INSTRUCTIONS: Please Print out this survey. Fill out the questions. Please pass this questionnaire/survey on to your friends, contacts, anyone who has attendant services. You can fax, scan and email, text it (as a photo) or mail it back. But PLEASE be sure to send it back. Contact information at the end of the survey. DUE: July 31, 2018.
1. In what city/town do you receive services? ____________________________________
2. What is your age? (please check)
___ 18-24 ___ 25-34 ___35-44 ___45-54 ___55-64 ___65-74 ___75 Plus
3. At what age did you acquire your disability? ______
4. Do you receive services in your:
Home: ___YES___ NO
Community ___YES ____NO
5. Are your personal attendant services provided via traditional agency model or consumer directed service model?
a. Agency Model ________
b. Consumer Directed Services Model ________
6. Who pays for your personal attendant services?
a. Medicaid _____
b. Medicare _____
c. VA Benefits____
d. Insurance ____
e. Private Pay____
f. Other ____________________________________
7. How long (Yrs./Mos.) have you been using attendant assistance? ___________
8. How long did the “longest” employed attendant work with you? ___________
9. What is your means of recruiting an attendant?
a. Want ads in local newspapers _____
b. Social Media _______ Specify: ____________________________________
c. Word of mouth _____ Social Connections________
d. Agency referral _____ Online employment forums _______
e. Flyers, posters, schools, community centers _____
10. In your opinion, what do you find to be the best means for attendant recruitment? ______________________________________________________
11. What is the age of your current attendant(s)? ________
12. Is your attendant male or female, or how do they identify? ______________
13. How many PCA service hours do you receive weekly? _________
14. How many different attendants do you have working for you? _______
15. What salary and benefits do you or the Agency provide the Attendant(s)?
$8 -$10 per hour ____
$10 - $12 per hour ____
$12-$15 per hour ____
$15 and above per hour ____
-Vacation time ____
-Sick leave ____
16. Have you trained your own attendant or had help with training your attendant(s)? -You Trained: YES ____ NO ______
-You had help training: YES____ NO _____
17. How long has your current attendant(s) been working for you? ________
18. Are you and your attendant required to use any Electronic Visit Verification system? YES ____ NO _____
THANK YOU! Your contribution to this critical issue is very appreciated! If you have other comments, feel free to provide added input.
Mail: ADAPT/PACT, 1100 S. IH35, Austin, TX 78704
Questions: Phone 512-442-0252
FAX: 512-906-1166, EMAIL: email@example.com , or firstname.lastname@example.org
Text to 512-808-7486 - 0r - 512-650-6543 Deadline July 31, 2018