Personal Care Attendant Needs and Benefits Survey

Publication Date: 
Jul 2 2018

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,
Cathy Cranston
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 ____
-Over-time ____
-Sick leave ____
-Other ________________________________
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: , or
Text to 512-808-7486 - 0r - 512-650-6543          Deadline July 31, 2018