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.
PLEASE DISTRIBUTE!

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)?  
Salary:
$8 -$10 per hour ____
$10 - $12 per hour ____
$12-$15 per hour ____
$15 and above per hour ____
Benefits:
-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: flacacata@aol.com , or  ncrowther21@gmail.com
Text to 512-808-7486 - 0r - 512-650-6543          Deadline July 31, 2018