Variations in Requirements for Personal Care Attendants May Harm Care Delivery, Warns HHS

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Wide variations within states in both the qualifications required of personal care attendants and the agencies that monitor compliance “may make it difficult for states to ensure that attendant requirements are met,” according to a new report from the Office of the Inspector General at the U.S. Department of Health and Human Services.

States’ Requirements for Medicaid-Funded Personal Care Service Attendants ) found 300 sets of attendant requirements among the 50 states, as requirements often vary among programs and even by delivery models within programs. The six most common requirements, in order of most to least common, are:

  • Criminal or other background checks;
  • Training in some basics, such as CPR, universal precautions, or how to assist with activities of daily living;
  • Some supervision, such as a bimonthly or quarterly home visit by an RN or LPN and more frequent telephone check-ins;
  • A minimum age, most commonly 18 but sometimes as young as 14;
  • Passing a health test, such as testing negative for tuberculosis or passing a physical exam; and
  • Some minimum level of education and/or literacy. This usually means reading well enough to follow instructions or having either graduated high school or completed a GED.

Only seven states apply uniform requirements to all their attendant care programs. Five programs using the consumer-directed delivery model have no requirements at all for their attendants. In addition, states sometimes delegate responsibility for ensuring that attendants met requirements to another entity, such as a home health agency, beneficiary, or case manager.

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