Attendant Care Consumer Employer by mikesanye


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                             Attendant Care Consumer-Employer
                          Training Guide for Personal Care Assistants

Consumer-Employers are required to review this Guide with their Personal Care Assistant (PCA). Both

the PCA and the Consumer-Employer must sign the cover sheet and return it to: JEVS Supports for

Independence, Monroe Office Center, Suite 100,

One Winding Way, Philadelphia, PA 19131

                            FOR PERSONAL CARE ASSISTANTS

   1.    Purpose of the Attendant Care Program
   2.    Service Plan
   3.    Complaint Form
   4.    Universal Precautions Training
   5.    Hepatitis B and Hepatitis B Vaccination
   6.    Interviewing Tips
   7.    Physical Impairments
   8.    Social and Communication Skills & Working With Persons With Disabilities
   9.    Cultural Sensitivity
   10.   Body Mechanics & Transfers
   11.   Fire Safety
   12.   How To Use A Fire Extinguisher
   13.   Act 28- Neglect of a Care- Dependent Person
   14.   PCA Time Sheet Procedures
         a. Consumer Model Time Sheet Schedule
         b. Agency Model Time Sheet Schedule
         c. Time Log Sheet
   15.   Total Pay Card
   16.   Job Hot Line Information
   17.   Notice of Discontinued Employment
   18.   Agreement Between Consumer-Employer and Personal Care Assistant
   19.   Addendum to Agreement Between Consumer-Employer and Personal Care
         Assistant (PCA)
   20.   Attendant Care Program Agency Model
   21.   Acceptance/Declination of Hepatitis B Vaccination
   22.   Fraud and Abuse Statement
   23.   Direct Deposit Enrollment Authorization
   24.   Emergency Employment Opportunities Notice
   25.   Verification of Training Completion

                          PURPOSE OF ATTENDANT CARE PROGRAM
       The purpose of the Attendant Care Program is to enable eligible adults ages 18-59 who are
mentally alert and physically disabled to perform activities of daily living (such as eating, personal
hygiene, transporting themselves, and working) that they would ordinarily perform themselves
were it not for their disability. Using state and federal funding, in addition to the consumer-
employer’s own resources, the Pennsylvania Attendant Care Program enables disabled individuals
to obtain assistance from Personal Care Assistants (PCAs) in performing these activities and to live
as independently as possible.

         The Attendant Care Service is designed to support eligible adults in improving their quality
of life by achieving one or more of the following goals:

(1)    Enabling consumers-employers to live in the least restrictive environment as independently
       as possible.
(2)    Enabling consumers-employers to remain in their homes and preventing unnecessary
       admission to nursing homes or other similar institutional settings.
(3)    Enabling consumers-employers to seek and/or maintain employment.

       To meet these objectives, in home Attendant Care Services are provided to enable
consumers/employers to achieve maximum independence in their daily lives. The Attendant Care
Service is in-home personal care and other approved support activities for consumers/employers
requiring assistance to accomplish daily living tasks.

       There are two models of service. Consumer Model consumers are employers of their PCAs.
They interview, hire, train, supervise and fire their PCA’s. Agency Model consumers receive services
from PCAs who are employed by JEVS SFI and sent to the consumer’s home. These consumers do
not interview, hire, train, supervise or fire their PCAs.

                                          SERVICES PROVIDED

      The Attendant Care Service consists of BASIC, ANCILLARY, and HEALTH
MAINTENANCE services provided by PCA’s in accordance with the consumer’s-employer’s
approved service plan. The following are the types of Attendant Care Services that are provided by


       1. Assistance in getting out of a bed, wheelchair, and/or motor vehicle.

       2. Assistance with routine bodily functions, including, but not limited to:
              -Bathing and personal hygiene
              -Dressing and grooming
              -Eating, including meal preparation and clean-up
              -Health Maintenance Activities (see below)


        If a person is assessed as needing one or more of the basic services above, the following
services may be provided in conjunction with the basic services

       1. Homemaker-type services
       2. Companion-type services
       3. Assistance with cognitive tasks


   Personal Care Assistants (PCAs) may be asked to provide Health Maintenance Activities
(HMAs) if requested by the consumer-employer and/or if required by the consumer-employer’s
service plan. HMAs are those activities that are necessary to maintain the health and normal
bodily functions and would be carried out by the consumer-employer if the consumer-employer
were physically able. HMAs include, but are not limited to activities such as administration of
medications, enemas and suppositories, catheter irrigation and wound care.

    PCAs may perform HMAs under the following conditions:

1. The Provider has assessed the consumer-employer as being capable of directing and supervising the
   PCA in the specified HMAs. This is the Consumer Model of Attendant Care Services.

2. The PCA is trained and supervised in the prescribed activities by the consumer-employer’s
   physician and/or qualified health professional.

3. The PCA’s ability to carry out the activities safely has been documented by the provider agency.

4. The PCA’s prior experience and work history do not indicate unsafe performance of such activities.

5. Disposable items or devices are used in performing the HMA whenever they are available.

6. The provider has ensured that the consumer-employer has in place appropriate referral
   arrangements with qualified health professionals to respond to health emergencies.

7. The PCA providing the HMAs has read and understands the consumer-employer’s service plan.

                               PA DEPARTMENT OF PUBLIC WELFARE
                                       OFFICE OF SOCIAL PROGRAMS
                                        ATTENDANT CARE PROGRAM
                                         SERVICES TO BE PROVIDED

 NAME OF CONSUMER ( LAST, FIRST, MIDDLE)                                    SOCIAL SECURITY NUMBER
                           C     A     O      SUN     MON TUE     WED   THU    FRI   SAT COMMENTS
                                              15      15     15   15    15     15    15

                                 X            30      15     30   15    30     15    15

                                 X            10      10     10   10    10     10    10

                                 X            5       5      5    30    5      5     30


 SHAVING                   X

                                 X            5       5      5    5     5      5     5

                                 X            20      20     20   20    20     20    20

                                 X            5       5      5    5     5      5     5



                                 X            45      15     45   15    15     45    15

 Catheter Care

 Program                   X

 OTHER: (List)

C-CONSUMER         A-ATTENDANT                 O-OTHER

                                     PA DEPARTMENT OF PUBLIC WELFARE
                                         OFFICE OF SOCIAL PROGRAMS
                                          ATTENDANT CARE PROGRAM
                                           SERVICES TO BE PROVIDED

ANCILLARY                             DAYS SERVICES NEEDED
                           C    A     O     SUN   MON TUE         WED   THU   FRI   SAT COMMENTS
UP:                             X            30      30     30    30    30    30    30

BREAKFAST                       X            15      15     15    15    15    15    15

LUNCH                           X            15      15     15    15    15    15    15

DINNER                     X


HOUSEKEEPING                    X

KITCHEN:                        X            15      15     15    15    15    15    15

LIVING:                         X            20      20     20    20    20    20    20


BATHROOM:                       X            20             20          20          20

OTHER: (List)

LAUNDRY:                        X                           60



SHOPPING                                                                      25






    Universal Precautions are infection control guidelines designed to protect workers
from exposure to diseases spread by blood and body fluids.

Personal Care Assistants should:

1. Wash hands before and after direct patient care and before food preparations, serving
   or feeding.
2. Wear disposable (latex or equivalent) gloves when contact with blood or body fluids is
3. Wear appropriate protective equipment if splattering of blood or body fluids is a
   possibility. i.e., masks, gowns, glasses or goggles.
4. Do not recap needles. Handle sharp objects carefully. Place sharp objects in a puncture
   proof container with a lid.
5. Management of spills of body fluids.
   a. Wear disposable (latex or equivalent) gloves.
   b. Wipe up spills as much as possible with paper towels or disposable cloths. Place in
       plastic bag and throw away.
   c. Clean area with a 10% bleach/water solution.
6. Place contaminated disposables (dressings, blue pads, Attends, tissues, etc.) in a plastic
   bag to be thrown away.
7. Laundry that is soiled with blood or body fluids should be placed in a plastic bag and
   taken to the laundry area. Soiled laundry is to be washed daily.
   a. Machine Washing
       (1) Colorfast- 1 cup bleach in hot water and detergent
       (2) Not Colorfast- 1 cup Lysol in warm water and detergent; rinse twice
   b. Hand Washing
       (1) Colorfast- 2 tbsp. bleach/gallon warm water; soak 10 minutes
       (2) Not Colorfast- 2 tbsp. Lysol in 1 gallon warm water and detergent; rinse at least
           three times
8. Food Preparation
   a. Do not use raw eggs for food-cook thoroughly.
   b. When preparing chicken:
       (1) Wash hands and all utensils and counters with hot soapy water immediately
           after handling chicken. Do not contaminate “clean” food or utensils.

                                 HEPATITIS B AND HEPATITIS B VACCINATION
                                                    Please Read This Carefully
What is Hepatitis B (HBV)?
Hepatitis B is a virus that causes a variety of infections ranging from no symptoms to jaundice (yellowing of the eyes), nausea
and discomfort, to fatal liver damage. The acute and chronic consequences of Hepatitis B virus infection are major health
problems in the United State. An estimated 200,000-300,000 new infections occur every year and more than one million
persons in the U.S. have chronic Hepatitis B and are potentially infectious to others. In addition, many chronically infected
persons may go on to develop chronic liver disease and liver cancer. HBV is transmitted through exposure to blood and blood
products, through sexual contact and from mothers to infants primarily at the time of birth. It also can be acquired by close
contact within families, from person to person through contact between open skin lesions, and possibly by exposure of mucous
membranes (if there is blood visible in the membrane) to other infected body fluids such as saliva. Twelve thousand health care
workers every year will become infected with the virus and half of those infected will develop active hepatitis. Immunization
with Hepatitis B vaccine is the most effective means of preventing the infection and its consequences.
Hepatitis B Vaccine:
The first HBV vaccine in the United States was licensed in 1982. The HBV vaccine is given by injection in a series of three
shots. Studies have shown a high rate (grater than 95%) of protection after the series of three injections is completed and
protection last for at least ten years. Hepatitis B vaccines can be safely administered.
Who should receive the Hepatitis B Vaccine?
Universal vaccination of all infants has been recommended by the U.S. department of Health and Human Services and the
American Academy of Pediatrics. Also, selected high risk groups at risk for contracting Hepatitis B should also be immunized.
These include the following:
        Hemophiliac patients and other recipients of certain blood products.
        Intravenous drug abusers.
        Heterosexual persons who have had more than one sex partners in the previous six months and/or those with a recent
         episode of a sexually transmitted disease.
        Sexually active homosexual and bisexual males.
        Household members and sexual contacts of HBV carriers.
        Members of households with adoptees from HBV endemic, high-risk countries who are carriers of Hepatitis B.
        Staff and residents of institutions for the developmentally disabled.
        Staff of nonresidential day care and school programs for developmentally disabled if attended by known HBV
         carriers; other attendees in certain circumstances.
        Health care workers and others with occupational risk.
        International travelers who will live for more than six months in areas of high HBV endemnicity and who otherwise
         will be at risk. Inmates of long-term correctional facilities.

                                                                                     Supports for Independence

                                      INTERVIEWING TIPS


-   When calling a consumer-employer, identify yourself clearly on the telephone and also
    when arriving at the consumer-employer’s home.

-   Before considering this position, make sure the location and times of the job fit your

-   Know how to get to the consumer-employer’s home.

-   Consider childcare arrangements before starting work. Be sure you have bus fare, a
    Septa Transpass or other means of transportation.

-   Contact your unemployment office to find out the limitations of hours you can work.

-   Do not schedule an appointment to meet a Consumer-Employer unless you intend going
    to the appointment.


-   Discuss and read the consumer-employer’s service plan.

-   Ask any questions you have about the service plan.

-   Practice transferring the consumer-employer when necessary.

-   Get a good night’s rest the night before, so you will be at your best.

-   Ask if you are required to wear a uniform.

- Make a neat and clean appearance.

- If you are unsure whether you want to accept the position, tell the Consumer/Employer
    that you will get back to them.

-   Make a good first impression and make sure the impression lasts for the duration of the

                                     Physical Impairments
Functional Limitations Caused by Physical Impairments
Problems faced by individuals with physical impairments include poor muscle control, weakness and
fatigue, difficulty walking, talking, seeing, speaking, sensing or grasping (due to pain or weakness),
difficulty reaching things, and difficulty doing complex or compound manipulations (push and turn).
Individuals with spinal cord injuries may be unable to use their limbs and may use "mouthsticks" for most
manipulations. Twisting motions may be difficult or impossible for people with many types of physical
disabilities (including cerebral palsy, spinal cord injury, arthritis, multiple sclerosis, muscular dystrophy,

Some individuals with severe physical disabilities may not be able to operate even well-designed
products directly. These individuals usually must rely on assistive devices which take advantage of their
specific abilities and on their ability to use these assistive devices with standard products. Commonly
used assistive devices include mobility aids (e.g., crutches, wheelchairs), manipulation aids (e.g.,
prosthetics, orthotics, reachers) communication aids (e.g., single switch-based artificial voice), and
computer/device interface aids (e.g., eyegaze-operated keyboard) .

Nature and Causes of Physical Impairments

Neuromuscular impairments include:

      paralysis (total lack of muscular control in part or most of the body),
      weakness (paresis; lack of muscle strength, nerve enervation, or pain), and
      interference with control, via spasticity (where muscles are tense and contracted), ataxia
       (problems in accuracy of motor programming and coordination), and athetosis (extra, involuntary,
       uncontrolled and purposeless motion).

Skeletal impairments include joint movement limitations (either mechanical or due to pain), small
limbs, missing limbs, or abnormal trunk size.

Some major causes of these impairments are:

Arthritis. Arthritis is defined as pain in joints, usually reducing range of motion and causing weakness.
Rheumatoid arthritis is a chronic syndrome. Osteoarthritis is a degenerative joint disease. 31.6 million
people in the U.S. suffer from rheumatic disease. The incidence of all forms of arthritis is now estimated
at 900,000 new cases per year10.

Cerebral Palsy (CP). Cerebral palsy is defined as damage to the motor areas of the brain prior to brain
maturity (most cases of CP occur before, during or shortly following birth). There are more than 750,000
in the U.S. with CP (children and adults), and 15,000 infants are born each year with CP 11. CP is a type
of injury, not a disease (although it can be caused by a disease), and does not get worse over time; it is
also not "curable." Some causes of cerebral palsy are high temperature, lack of oxygen, and injury to the
head. The most common types are: (1) spastic, where the individual moves stiffly and with difficulty, (2)
ataxic, characterized by a disturbed sense of balance and depth perception, and (3) athetoid,
characterized by involuntary, uncontrolled motion. Most cases are combinations of the three types.

Spinal Cord Injury. Spinal cord injury can result in paralysis or paresis (weakening). The extent of
paralysis/paresis and the parts of the body effected are determined by how high or low on the spine the
damage occurs and the type of damage to the cord. Quadriplegia involves all four limbs and is caused by
injury to the cervical (upper) region of the spine; paraplegia involves only the lower extremities and
occurs where injury was below the level of the first thoracic vertebra (mid-lower back). There are 150,000
to 175,000 people with spinal cord injuries in the U.S., with projected annual increases of 7,000 - 8,000.

47% of spinal cord injuries result in paraplegia; 53% in quadriplegia. Car accidents are the most frequent
cause (38%), followed by falls and jumps (16%) and gunshot wounds (13%)12.

Head Injury (cerebral trauma). The term "head injury" is used to describe a wide array of injuries,
including concussion, brain stem injury, closed head injury, cerebral hemorrhage, depressed skull
fracture, foreign object (e.g., bullet), anoxia, and post-operative infections. Like spinal cord injuries, head
injury and also stroke often results in paralysis and paresis, but there can be a variety of other effects as
well. Currently about one million Americans (1 in 250) suffer from effects of head injuries, and 400,000 -
600,000 people sustain a head injury each year. However, many of these are not permanently or
severely disabled.

Stroke (cerebral vascular accident; CVA). The three main causes of stroke are: thrombosis (blood clot
in a blood vessel blocks blood flow past that point), hemorrhage (resulting in bleeding into the brain
tissue; associated with high blood pressure or rupture of an aneurysm), and embolism (a large clot
breaks off and blocks an artery). The response of brain tissue to injury is similar whether the injury
results from direct trauma (as above) or from stroke. In either case, function in the area of the brain
affected either stops altogether or is impaired13.

Loss of Limbs or Digits (Amputation or Congenital). This may be due to trauma (e.g., explosions,
mangling in a machine, severance, burns) or surgery (due to cancer, peripheral arterial disease,
diabetes). Usually prosthetics are worn, although these do not result in full return of function. The
National Center for Health Statistics of the U.S. Public Health Service estimated a prevalence of 311,000
amputees in 1970. An incidence of approximately 43,000 new amputations per year is estimated, of
which 77% occur in males, and 90% involve the legs. 40% of amputations are above the knee, 50% are
below the knee, and 10% are at the hip14.

Parkinson's Disease. This is a progressive disease of older adults characterized by muscle rigidity,
slowness of movements, and a unique type of tremor. There is no actual paralysis. The usual age of
onset is 50 to 70, and the disease is relatively common - 187 cases per 100,00015.

Multiple Sclerosis (MS). Multiple sclerosis is defined as a progressive disease of the central nervous
system characterized by the destruction of the insulating material covering nerve fibers. The problems
these individuals experience include poor muscle control, weakness and fatigue, difficulty walking,
talking, seeing, sensing or grasping objects, and intolerance of heat. Onset is between the ages of 10
and 40. This is one of the most common neurological diseases, affecting as many as 500,000 people in
the U.S. alone16.

ALS (Lou Gehrig's Disease). ALS (Amyotrophic Lateral Sclerosis) is a fatal degenerative disease of the
central nervous system characterized by slowly progressive paralysis of the voluntary muscles. The
major symptom is progressive muscle weakness involving the limbs, trunk, breathing muscles, throat and
tongue, leading to partial paralysis and severe speech difficulties. This is not a rare disease (5 cases per
100,000). It strikes mostly those between age 30 and 60, and men three times as often as women.
Duration from onset to death is about 1 to 10 years (average 4 years)17.

Muscular Dystrophy (MD). Muscular dystrophy is a group of hereditary diseases causing progressive
muscular weakness, loss of muscular control, contractions and difficulty in walking, breathing, reaching,
and use of hands involving strength. About 4 cases in 100,000 are reported.18

The Basics
Just because someone has a disability, don't assume he/she needs help.* If the setting is accessible,
people with disabilities can usually get around fine. Adults with disabilities want to be treated as
independent people. Offer assistance only if the person appears to need it. And if he/she does want help,
ask how before you act.

Some people with disabilities depend on their arms for balance. Grabbing them-even if your intention is
to assist-could knock them off balance. Avoid patting a person on the head or touching his/her
wheelchair, scooter or cane. People with disabilities consider their equipment part of their personal

Always speak directly to the person with a disability, not to his companion, aide or sign language
interpreter. Making small talk with a person who has a disability is great; just talk to him as you would
with anyone else. Respect his privacy. If you ask about his disability, he may feel like you are treating
him as a disability, not as a human being. (However, many people with disabilities are comfortable with
children's natural curiosity and do not mind if a child asks them questions.)
*Note: We want you to think of people who have a disability as individuals--your friends, your co-workers,
your neighbors--so rather than use the amorphous group term "they" for people with disabilities, we use
the pronouns "he" or "she" throughout this booklet
People with disabilities are the best judge of what they can or cannot do. Don't make decisions for them
about participating in any activity. Depending on the situation, it could be a violation of the ADA to
exclude people because of a presumption about their limitations.
When people who have a disability ask for an accommodation at your business, it is not a complaint. It
shows they feel comfortable enough in your establishment to ask for what they need. And if they get a
positive response, they will probably come back again and tell their friends about the good service they
Terminology Tips
Put the person first. Say "person with a disability" rather than "disabled person." Say "people with
disabilities" rather than "the disabled." For specific disabilities, saying "person with Tourette syndrome" or
"person who has cerebral palsy" is usually a safe bet. Still, individuals do have their own preferences. If
you are not sure what words to use, ask. Avoid outdated terms like "handicapped" or "crippled." Be
aware that many people with disabilities dislike jargony, euphemistic terms like "physically challenged"
and "differently abled." Say "wheelchair user," rather than "confined to a wheelchair" or "wheelchair
bound." The wheelchair is what enables the person to get around and participate in society; it's liberating,
not confining. With any disability, avoid negative, disempowering words, like "victim" or "sufferer." Say
"person with AIDS" instead of "AIDS victim" or "person who suffers from AIDS." It's okay to use idiomatic
expressions when talking to people with disabilities. For example, saying, "It was good to see you," and
"See you later," to a person who is blind is completely acceptable; they use these expressions
themselves all the time! Many people who are Deaf communicate with sign language and consider
themselves to be members of a cultural and linguistic minority group. They refer to themselves as Deaf
with a capital "D," and may be offended by the term "hearing impaired." Others may not object to the

term, but in general it is safest to refer to people who have hearing loss but who communicate in spoken
language as "hard of hearing" and to people with profound hearing losses as Deaf or deaf.
People Who Use Wheelchairs or Have Mobility Impairments
People who use wheelchairs have different disabilities and varying abilities. Some can use their arms
and hands. Some can get out of their wheelchairs and even walk for short distances.
      Wheelchair users are people, not equipment. Don't lean over someone in a wheelchair to shake another
       person's hand or ask a wheelchair user to hold coats. Setting your drink on the desktop attached to
       someone's wheelchair is a definite no-no.
      Don't push or touch a person's wheelchair; it's part of her personal space. If you help someone down a curb
       without waiting for instructions, you may dump her out of the chair. You may detach the chair's parts if you
       lift it by the handles or the footrest.
      Keep the ramps and wheelchair-accessible doors to your building unlocked and unblocked. Under the
       ADA, displays should not be in front of entrances, wastebaskets should not be in the middle of aisles and
       boxes should not be stored on ramps.
      Be aware of wheelchair users' reach limits. Place as many items as possible within their grasp. And make
       sure that there is a clear path of travel to shelves and display racks. When talking to a wheelchair user,
       grab your own chair and sit at her level. If that's not possible, stand at a slight distance, so that she isn't
       straining her neck to make eye contact with you.
      If the service counter at your place of business is too high for a wheelchair user to see over, step around it
       to provide service. Have a clipboard handy if filling in forms or providing signatures is expected.
      If your building has different routes through it, be sure that signs direct wheelchair users to the most
       accessible ways around the facility. People who walk with a cane or crutches also need to know the easiest
       way to get around a place, but stairs may be easier for them than a ramp. Ensure that security guards and
       receptionists can answer questions about the most accessible way around the building and grounds.
      If the nearest public restroom is not accessible or is located on an inaccessible floor, allow the person in a
       wheelchair to use a private or employees' accessible restroom.
      People who use canes or crutches need their arms to balance themselves, so never grab them. People
       who are mobility-impaired may lean on a door for support as they open it. Pushing the door open from
       behind or unexpectedly opening the door may cause them to fall. Even pulling out or pushing in a chair
       may present a problem. Always ask before offering help.
      If you offer a seat to a person who is mobility-impaired, keep in mind that chairs with arms or with higher
       seats are easier for some people to use.
      Falls are a big problem for people with mobility impairments. Be sure to set out adequate warning signs
       after washing floors. Also put out mats on rainy or snowy days to keep the floors as dry as possible. (Make
       sure they don't bunch up and make the floor impassable for wheelchair users.)
      People who are not visibly mobility-impaired may have needs related to their mobility. For example, a
       person with a respiratory or heart condition may have trouble walking long distances or walking quickly. Be
       sure that your museum, hotel or department store has ample benches for people to sit and rest on.
      Some people have limited use of their hands, wrists or arms. Be prepared to offer assistance with reaching
       for, grasping or lifting objects, opening doors and display cases, and operating vending machines and other

People Who Are Blind or Visually Impaired
People who are blind know how to orient themselves and get around on the street. They are competent
to travel unassisted, though they may use a cane or a guide dog. A person may have a visual impairment
that is not obvious. Be prepared to offer assistance-for example in reading-when asked.
      Identify yourself before you make physical contact with a person who is blind. Tell him your name-and your
       role if it's appropriate, such as security guard, usher, case worker, receptionist or fellow student. And be
       sure to introduce him to others who are in the group, so that he's not excluded.
      If a new customer or employee is blind or visually impaired, offer him a tour of your facility.
      People who are blind need their arms for balance, so offer your arm-don't take his-if he needs to be guided.
       (However, it is appropriate to guide a blind person's hand to a banister or the back of a chair to help direct
       him to a stairway or a seat.)
      If the person has a guide dog, walk on the side opposite the dog. As you are walking, describe the setting,
       noting any obstacles, such as stairs ("up" or "down") or a big crack in the sidewalk. Other hazards include:
       revolving doors, half-opened filing cabinets or doors, and objects protruding from the wall at head level

       such as hanging plants or lamps. If you are going to give a warning, be specific. Hollering, "Look out!" does
       not tell the person if he should stop, run, duck or jump.
      If you are giving directions, give specific, non-visual information. Rather than say, "Go to your right when
       you reach the office supplies," which assumes the person knows where the office supplies are, say, "Walk
       forward to the end of this aisle and make a full right."
      If you need to leave a person who is blind, inform him first and let him know where the exit is, then leave
       him near a wall, table, or some other landmark. The middle of a room will seem like the middle of nowhere
       to him.
      Don't touch the person's cane or guide dog. The dog is working and needs to concentrate. The cane is part
       of the individual's personal space. If the person puts the cane down, don't move it. Let him know if it's in the
      Offer to read written information-such as the menu, merchandise labels or bank statements-to customers
       who are blind. Count out change so that they know which bills are which.
      If you serve food to a person who is blind, let him know where everything is on the plate according to a
       clock orientation (twelve o'clock is furthest from them, six o'clock is nearest). Remove garnishes and
       anything that is not edible from the plate. Some patrons may ask you to cut their food; this can be done in
       the restaurant's kitchen before the meal is served.
      A person who is visually impaired may need written material in large print. A clear font with appropriate
       spacing is just as important as the type size. Labels and signs should be clearly lettered in contrasting
       colors. It is easiest for most people with vision impairments to read bold white letters on black background.
      Good lighting is important, but it shouldn't be too bright. In fact, very shiny paper or walls can produce a
       glare that disturbs people's eyes.
      Keep walkways clear of obstructions. If people who are blind or are visually impaired regularly use your
       facility as customers or employees, inform them about any physical changes, such as rearranged furniture,
       equipment or other items that have been moved.

People Who Are Deaf or Hard of Hearing
American Sign Language (ASL) is an entirely different language from English, with a syntax all its own.
Speech reading (lip reading) is difficult for people who are Deaf if their first language is ASL because the
majority of sounds in English are formed inside the mouth, and it's hard to speech read a second
language. People who are hard of hearing, however, communicate in English. They use some hearing
but may rely on amplification and/or seeing the speaker's lips to communicate effectively.

There is a range of communication preferences and styles among people with hearing loss that cannot
be explained in this brief space. It is helpful to note that the majority of late deafened adults do not
communicate with sign language do use English and may be candidates for writing and assistive
listening devices to help improve communication. People with cochlear implants, like other people with
hearing impairments, will usually inform you what works best for them.

      When the exchange of information is complex-such as during a job interview or doctor's visit or when
       reporting a crime-the most effective way to communicate with a native signer is through a qualified sign-
       language interpreter. For a simple interaction-such as ordering in a restaurant or registering for a hotel
       room-writing back and forth is usually okay.
      Follow the person's cues to find out if she prefers sign language, gesturing, writing or speaking. If you have
       trouble understanding the speech of a person who is deaf or hard of hearing, let her know.
      When using a sign-language interpreter, look directly at the person who is Deaf, and maintain eye contact
       to be polite. Talk directly to the person ("What would you like?"), rather than to the interpreter ("Ask her
       what she'd like.").
      People who are deaf need to be included in the decision-making process for issues that affect them; don't
       decide for them.
      Before speaking to a person who is deaf or hard of hearing, make sure that you get her attention.
       Depending on the situation, you can extend your arm and wave your hand, tap her on the shoulder or
       flicker the lights.
      Rephrase, rather than repeat, sentences that the person doesn't understand.
      When talking, face the person. A quiet, well-lit room is most conducive to effective communication. If you
       are in front of the light source-such as a window-with your back to it, the glare may obscure your face and
       make it difficult for the person who is hard of hearing to speech read.
      Speak clearly. Most people who are hard of hearing count on watching people's lips as they speak to help
       them understand. Avoid chewing gum, smoking or obscuring your mouth with your hand while speaking.

      There is no need to shout at a person who is deaf or hard of hearing. If the person uses a hearing aid, it will
       be calibrated to normal voice levels; your shout will just sound distorted.
      People who are deaf (and some who are hard of hearing or have speech disabilities) make and receive
       telephone calls with the assistance of a device called a TTY (short for teletypewriter; also called a TDD). A
       TTY is a small device with a keyboard, a paper printer or a visual display screen and acoustic couplers (for
       the telephone receiver).
      When a TTY user calls a business that does not have a TTY, she places the call through her state's relay
       service. Likewise, a business that does not have a TTY can reach a customer who is a TTY user through
       the relay service. If you receive a relay call, the operator will identify it as such. Please do not hang up; this
       is the way that people who are deaf are able to place an order at your pizza parlor, call your store to find
       out what hours you are open, or make a reservation at your restaurant.

People With Speech Disabilities
A person, who has had a stroke, is severely hard of hearing, uses a voice prosthesis or has a stammer
or other type of speech disability may be difficult to understand.
      Give the person your full attention. Don't interrupt or finish the person's sentences. If you have trouble
       understanding, don't nod. Just ask him to repeat. In most cases the person won't mind and will appreciate
       your effort to hear what he has to say.
      If you are not sure whether you have understood, you can repeat for verification.
      If, after trying, you still cannot understand the person, ask him to write it down or to suggest another way of
       facilitating communication.
      A quiet environment makes communication easier.
      Don't tease or laugh at a person with a speech disability. The ability to communicate effectively and to be
       taken seriously is important to all of us.

Persons of Short Stature
There are 200 diagnosed types of growth-related disorders that can cause dwarfism and that result in the
person being 4 feet 10 inches or less in height. Average-size people often underestimate the abilities of
dwarfs. For an adult, being treated as cute and childlike can be a tough obstacle.
      Be aware of having necessary items within the person's reach to the maximum extent possible.
      Be aware that persons of short stature count on being able to use equipment that is at their height. Be
       sensitive about not using lower telephones, bank counters, and urinals if they are in limited supply.
      As with people who have other disabilities, never pet or kiss a person of short stature on the head.
      Communication can be easier when people are at the same level. Persons of short stature have different
       preferences. You might kneel to be at the person's level; stand back so you can make eye contact without
       the person straining her neck (this can be hard to do in a crowded room); or sit in a chair. Act natural and
       follow the person's cues.

People With Cerebral Palsy
As a result of injury to the central nervous system, people with cerebral palsy (CP) have difficulty
controlling their muscles.
      Follow the tips above for interacting with persons who have speech disabilities.
      Many people with CP have slurred speech and involuntary body movements. Your impulse may be to
       discount what they have to say, based on their appearance. Monitor your responses and interact with the
       person as you would with anyone else.
      A person who may appear to be drunk, sick or have a medical emergency might in fact have CP or another
       disability. Get the facts before acting on your first impression, whether the situation is business, social or
       law enforcement.

Tourette Syndrome
People with Tourette syndrome may make vocalizations or gestures such as tics that they cannot control.
A small percentage of people with Tourette syndrome involuntarily say ethnic slurs or obscene words. An
employee or other person with Tourette syndrome will benefit from the understanding and acceptance of
co-workers and others.
      If a person with Tourette makes vocalizations during a conversation, simply wait for her to finish, then
       calmly continue.

      The more the person tries to contain these urges, the more the urges build up. It may be helpful for a
       person with Tourette to have the option to leave the meeting or conversation temporarily to release the
       build-up in a private place.

People Who Look Different
A different issue confronts people who may not be limited in their life activities, but who are treated as if
they have a disability because of their appearance. People with facial differences, such as cleft lip or
palate, cranio-facial disfigurement, or a skin condition; people who are way above or way below the
average height or weight; people who may display visible effects of medication, such as a tremor-in
short, people who look different-have the frequent experience of finding people staring at them, looking
away or looking through them as if they are invisible.
      Everyone needs to have a positive self-image to be a fully participating member of society. Be sure that
       you don't contribute to stigmatizing people who look different.
      If you see someone who fits this description, just give him a smile.
      If the situation is appropriate, strike up a conversation and include the person in whatever is going on, just
       as you would for an "average-looking" person.

Hidden Disabilities
Not all disabilities are apparent. A person may make a request or act in a way that seems strange to you.
That request or behavior may be disability-related. For example, you may give seemingly simple verbal
directions to someone, but the person asks you to write the information down. He may have a learning
disability that makes written communication easier for him. Or an apparently healthy person may ask to
sit, rather than stand, in line. This person may be fatigued from a condition such as cancer, or may be
feeling the effects of medication. Even though these disabilities are hidden, they are real. Please respect
the person's needs and requests whenever possible.
Epilepsy (Seizure Disorders)
Epilepsy is a neurological condition characterized by seizures that happen when the electrical system of
the brain malfunctions. The seizures may be convulsive, or the person may appear to be in a trance.
During complex partial seizures, the person may walk or make other movements while he is, in effect,
      If a person has a seizure, you cannot do anything to stop it. If he has fallen, be sure his head is protected
       and wait for the seizure to end.
      When a seizure has ended, the person may feel disoriented and embarrassed. Try to ensure that he has
       privacy to collect himself.
      Be aware that beepers and strobe lights can trigger seizures in some people.

Multiple Chemical Sensitivity (MCS) and Respiratory Disabilities
People with MCS and respiratory disabilities such as asthma or emphysema react to toxins in the air.
Stale air, fumes from cleaning products, perfume, carpeting, air freshener or even the fumes from magic
markers can trigger a severe reaction.
      Try to avoid spray-cleaning tables, windows or other surfaces while people are in your place of business. If
       you must use a spray product, spray or pour it closely into the cloth, not into the air. Use less-toxic products
       when possible. Request that staff who have contact with the public go easy on fragranced body-care
       products like cologne, hair spray, hand lotion, and after-shave.
      Maintaining good ventilation and overall good indoor air quality will not only benefit your customers who
       have MCS and respiratory disabilities, it will also help you and all of your employees stay healthier and
       more alert.
      Second-hand smoke can be particularly harmful to people with MCS or respiratory disabilities. Follow and
       enforce no-smoking regulations, including in restrooms and stairwells. Discourage smokers from
       congregating at the entrance to your business. If appropriate, designate a separate smoking area where
       the door is kept closed and the air ventilates to the outside.


People with human immunodeficiency virus (HIV) or Autoimmune Deficiency Syndrome (AIDS) have
impaired immune systems, so their bodies have trouble fighting off infections.
      You can't catch HIV from casual contact such as shaking hands, so don't be afraid of touching or being
       touched by a person with AIDS.
      A person with HIV or AIDS, however, is at significant risk of picking up an airborne infection. Be conscious
       of not putting someone else at risk. If you have a respiratory infection or any other easily transmittable
       illness, be considerate of all your customers and employees and stay home, if possible.
      Many people with AIDS feel stigmatized. By simply greeting or shaking the person's hand, you are letting
       him know that he is accepted. It will mean a lot to him.

Psychiatric Disabilities (Mental Illness)
People with psychiatric disabilities may at times have difficulty coping with the tasks and interactions of
daily life. Their disorder may interfere with their ability to feel, think or relate to others. Most people with
psychiatric disabilities are not violent. One of the main obstacles they face is the attitudes that people
have about them. Because it is a hidden disability, chances are you will not even realize that the person
has a mental health condition.
      Stress can affect the person's ability to function. Try to keep the pressure of the situation to a minimum.
      People who have psychiatric disabilities have varying personalities and different ways of coping with their
       disability. Some may have trouble picking up on social cues; others may be supersensitive. One person
       may be very high energy, while someone else may appear sluggish. Treat each person as an individual.
       Ask what will make him most comfortable and respect his needs to the maximum extent possible.
      In a crisis, stay calm and be supportive as you would with anyone. Ask how you can help, and find
       out if there is a support person who can be sent for. If appropriate, you might ask if the person has
       medication that he needs to take.
Cognitive Disabilities: Mental Retardation
People with mental retardation (sometimes referred to as developmental disability) learn slowly. They
have a hard time using what they have learned and applying it from one setting or situation to another.
      Speak to the person in clear sentences, using simple words and concrete-rather than abstract-concepts.
       Help her understand a complex idea by breaking it down into smaller parts.
      Don't use baby talk or talk down to people who have mental retardation. Gauge the pace, complexity, and
       vocabulary of your speech according to hers.
      Remember that the person is an adult and, unless you are informed otherwise, can make her own
      People with mental retardation may be anxious to please. During an interview, the person may tell you
       what she thinks you want to hear. In certain situations, such as law enforcement or a doctor's examination,
       it can have grave consequences if your interview technique is not effective. Questions should be phrased in
       a neutral way to elicit accurate information. Verify responses by repeating each question in a different way.
      It can be difficult for people with mental retardation to make quick decisions. Be patient and allow the
       person to take her time.
      Clear signage with pictograms can help a person who has mental retardation to find her way around a
      People with mental retardation rely on routine and on the familiar to manage work and daily living. Be
       aware that a change in the environment or in a routine may require some attention and a period of

Cognitive Disabilities: Learning Disabilities
Learning disabilities are lifelong disorders that interfere with a person's ability to receive,
express or process information. Although they have certain limitations, most people with
learning disabilities have average or above-average intelligence. You may not realize that the
person has a learning disability because he functions so well. Or you may be confused about
why such a high-functioning person has problems in one aspect of his work.
      People with dyslexia or other reading disabilities have trouble reading written information. Give them verbal
       explanations and allow extra time for reading.

      Don't be surprised if you tell someone very simple instructions and he requests that you write them down.
       Because spoken information gets "scrambled" as he listens, a person who has a learning disability such as
       auditory processing disorder may need information demonstrated or in writing.
      Ask the person how you can best relay information. Be direct in your communication. A person with a
       learning disability may have trouble grasping subtleties.
      It may be easier for the person to function in a quiet environment without distractions, such as a radio
       playing, people moving around or loudly patterned curtains.

Cognitive Disabilities: Traumatic (or Acquired) Brain Injury
People with traumatic brain injury have had damage to the brain usually as the result of trauma,
such as an accident or stroke.
      Some of the factors that affect persons with learning disabilities also apply to persons with traumatic brain
       injury. People with brain injury may have a loss of muscle control or mobility that is not obvious. For
       example, a person may not be able to sign her name, even though she can move her hand.
      A person with a brain injury may have poor impulse control. The person may make inappropriate comments
       and may not understand social cues or "get" indications that she has offended someone. In her frustration
       to understand, or to get her own ideas across, she may seem pushy. All of these behaviors arise as a
       result of the injury.
      A person with a brain injury may be unable to follow directions due to poor short-term memory or poor
       directional orientation. She may ask to be accompanied, or she may use a guide dog for orientation,
       although she does not appear to be mobility impaired.
      If you are not sure that the person understands you, ask if she would like you to write down what you were
      The person may have trouble concentrating or organizing her thoughts, especially in an over stimulating
       environment, like a crowded movie theater or transportation terminal. Be patient. You might suggest going
       somewhere with fewer distractions.

Service Animals
Some people who are Deaf, blind or visually impaired, or who have traumatic brain injury, seizure
disorder, or a range of other disabilities may use a service animal to assist them with daily living.
      While you may inquire whether an animal is a service animal, the person may not have information
       identifying it as such. This means that in general, you will need to modify a "no animals" policy to allow the
       person to enter with her service animal. Barring a direct threat to health and safety, this requirement of the
       ADA is generally thought to take precedence over any health codes, such as those for restaurants, and
       personal preferences, such as those of taxi drivers, prohibiting pets.
      Service animals are generally highly trained and well behaved. You may ask the person to remove the
       animal if she does not have the animal under her control.

                                  CULTURAL SENSITIVITY

   An individual’s cultural identity is shaped by the following:

   1. Ethnicity- the ethnic group with which the individual identifies, including the native language the

       person speaks.

   2. Race- the racial group(s) with which the individual identifies.

   3. Religion- the organized religion, denomination, or sect to which the person adheres, has been

       taught, or rejects.

   4. Education- the level and type of education the person has experienced.

   5. Professional/field of work- the type of work the person is trained to do.

   6. Organization- groups, associations, and organizations to which the individual belongs or has

       belonged. For example, the military, the Girl or Boy Scouts, a labor union or a fraternal


   7. Parents- the messages, both verbal and nonverbal, given by our parents about ethnicity, religion,

       values, cultural identity, prejudices, and so on.

   While the above are powerful cultural influences, one’s gender, family, peers, and place of birth also

   significantly impact cultural identity.

                       BODY MECHANICS & TRANSFERS
Basics to Remember In Maintaining Proper Body Mechanics Are:

       Squat, don’t bend (Use hips and knees rather than waist)
       Base of support – Feet should be shoulder distance apart
       Equipment should be close to your body (Center of gravity)
       Hips and shoulders should be parallel – face in the direction of the activity
        (avoid twisting the body)
       Alternate body positions (shift weight – change from sitting to standing)
       Try to keep weight of arms at shoulder level or below.
       Push objects whenever possible – if not possible, pulling is better than lifting
       Standing with a slight pelvic tilt whenever possible during activities helps
Body Mechanics – Useful tips:
   Maintain good posture at all times
   Maintain strength in your stomach/abdominal muscles
   Maintain flexibility in your low back and hamstrings
     Sit evenly on your butt.
     Feet should stretch down towards the floor but should be well supported so that the
       knees are at least level with the hips
     The mid to low back should be kept in a neutral position
     Arrange your seat so that you face the work that you are doing
    Distribute your body weight evenly through your feet
    When standing for long periods, it is best to have feet with a broad base for support
    Do not suddenly change regular shoes from high to low heels or vice versa.
    Maintain an erect but relaxed posture
Safe Lifting Basics:
    Always prepare for a lift – if it is too heavy, get help!
    Watch your line of balance
    Spread feet to get a comfortable, broad base of support
    If movement is in a sideways direction, spread feet sideways
    If movement is forwards or backwards, spread feet in the direction of the movement
       and distribute weight smoothly over feet.
    Pull in your stomach muscles and tilt you hips forward before and during a lift
    Try to arrange the lift so that you get maximum use of the muscles in your thighs and
       hips to push up with
Safe Transferring Basics/Shifting:
    Prepare for the shift. If it’s too heavy or awkward, get help!
    Carry weight as close to your body as possible.
    Arrange the load between your shoulders and mid stomach.
    When possible, move your feet so that you face what you are doing rather than twisting
      or side bending

       If you work action is repetitive, occasionally stop, stretch and move your body in the
        opposite direction a few times to stretch the working muscles.
Some Specific Suggestions:
     Keep back straight, not rigid – use a support pillow for your lower back
     Use a good light source – do not lean into the light source
     Don’t reach across a table when seated
     Select a good chair (with good lower back support) and sit with your feet flat on the
Tabletop Activities:
    Use a higher table if someone has shoulder or neck problems
    Hold books/projects up or use an easel/holder/stand
    Be careful not to lean back or forward (keep body in alignment)
    Stand with one foot up on a box or stool – alternate feet
    Do not stand in one position for too long
    If tall, use a higher/counter to stand at
    Incorporate body mechanics into all activities as possible – pacing, warm up cool down,
      build tolerance for activity participation – as soon as you get tired or fatigued
      discontinue activity before you feel any pain.
   Use a walking stick to help maintain balance on uneven terrain.
    Very therapeutic activity – buoyancy helps eliminate the pull of gravity on the body –
     warm water is much better than cold. Start with exercises first, incorporate stretching
     and flexibility exercises before beginning to swim
    Use a flutterboard to reduce stress on the body
    There is an incredible amount of twisting in this activity. Check with your doctor
      before resuming involvement especially if you have back problems. Use a suction cup
      or squat to pick up the ball.
Other Activities:
    Fishing – instead of twisting when casting use your arms more.
    Cards – If playing at large tables, deal cards in small piles in front of you and then pass
      the piles to each player, use your hips to bend forward when reaching and don’t
      stretch too far, stand up if you need to and support your body with your hand or arm
      on the table.
    Cooking – Use proper body mechanics when getting items from refrigerator, cabinets,
    Driving – keep lower back supported

Removing the Barriers
A Fire Safety Fact sheet for People with Disabilities and their Caregivers







For more information contact:

   1. Although the majority of extinguishers work with our directions, there are exceptions. Read the
      instructions on your extinguisher for variation

   Fix a picture in your mind that will fit the instructions on the extinguisher you will be using.

   2. If there’s a fire, get everyone outside. Call the fire department. Then fight a small fire only. If the
      fire gets large, get out. Close doors to slow the fire spread. Stay between the fire and an exit. Don’t
      let fire block your escape path in case it goes out of control.

   3. Make sure you don’t use one type extinguisher on another type fire- it may make the fire worse.
      Common errors (they can be fatal) are using water (A) on grease or an electrical fire (B or C).

   Learn How to PASS
   1. Pull
   Pull the pin. Some units require the releasing of a lock latch, pressing a puncture lever, or other
   2. Aim
   Aim the extinguisher nozzle (horn, or hose) at the base of the fire.
   3. Squeeze
   Squeeze or press the handle.
   4. Sweep
   Sweep from side to side at the base of the fire until it goes out. Shut off the extinguisher. Watch for re-
   flash and reactivate the extinguisher if necessary.


                                Important Information About Your TelePAY Service.

Dear New Consumer/Employer and Assistant:

JEVS Supports for Independence, your fiscal management service is pleased to introduce TelePAY. It is an exciting
new system designed to automatically record your Assistant’s time and attendance using your home telephone.
Convenient and easy to operate, it will assure that your Assistant will always be paid on time. No sending paper time
sheets each pay period, calculations or paper submission deadlines. No need to fax or send material on time since
TelePAY automatically records, calculates information electronically each day when your Assistant’s begin work and
end work during each visit.

How does TelePAY work?
  1. Assistant arrives at Consumers home and immediately calls the toll free number, 1-866-495-1432. Your
     Assistant is asked to enter 1 – English, 2 – Spanish.
  2. Your Assistant enters their assigned personal identification number (PIN), and follows the prompts to indicate
     when they start work and end work each visit.
  3. In the event an error occurred during your log in/out process, your SFI Payroll Representative will contact you to
     make the correction the following business day.

How am I enrolled in TelePAY?
A New Consumer/Employer is automatically enrolled: Any questions, contact Call Center Monday through Friday,
9:00am to 4:30pm, at (267) 298-1364 or Long distance at (800) 610-7910, to verify that your address and home phone
number is accurate.

A New Assistant will: You will activate your P.I.N.# on your ID Card by contacting the Call Center, Monday through
Friday, 9:00am to 4:30pm, at (267) 298-1364 or (800) 610-7910, to verify your name, address, phone number, the
Consumer and start date. If you cannot use TelePAY when you begin working, then you must continue to send in (Fax
or Mail) a time sheet/ telephone log on your Time Sheet schedule to insure proper payment of hours worked.

Additional TelePAY Instructions can be found on the back of the enclosed Green Telephone Log. JEVS Support for
Independence is excited about this new tool and the value it adds to your home and community based services. Should
you have any questions, please contact the Call Center, at (267) 298-1364 or (800) 610-7910.


Greg Manz, Director of Business Operations


                                           COMPLAINT FORM

CONSUMER-                                PERSONAL CARE
EMPLOYER__________________               ASSISTANT (PCA)          _______________

ADDRESS                                        ADDRESS

PHONE                                                  PHONE

DATES OF EMPLOYMENT:                   FROM: _____________        TO:____________
                                                 MONTH/YR            MONTH/YR

Briefly state facts leading to the complaint against the Consumer-Employer/PCA in the
space below.

This information will be kept confidently and will only be released upon your written
consent or if subpoenaed or requested by a hearing officer.

Please return the completed form to:

Monroe Office Center, Suite 100                Signature:
1 Winding Way
Philadelphia, PA 19131                         Date:
Attn: (Service Coordinator/
Resource Coordinator)                          Title:

                                                Notice of Discontinued Employment
   The purpose of this form is to provide notice of the end of an employment agreement between the
   Consumer/Employer and the Personal Care Assistant. The form provides an opportunity for either or both
   parties to document the reason(s) for the termination of employment. The form can be completed individually
   by the Consumer/Employer or the Personal Care Assistant, or by both parties (the Consumer/Employer and
   the Personal Care Assistant).

                Consumer/Employer                                 Personal Care Assistant/Employee

Name Name:                                                    Name:

       Address:                                               Address:

       Phone:                                                 Phone:

Date   Employment Ended (Last Date Worked):

   Please check off the reason(s) for ending the employment agreement between the two parties. You must give
   an explanation for checking off the box.

   Personal Care Assistant/Employee Voluntary Quit without good cause:
    ____Returning to school
    ____Non-related health reasons
    ____Health reasons                              ____Personal/family
    ____Transportation Problems                     ____Refused other employment locations
    ____Removed themselves from the job
    ____Accepted another job; same type             ____Disliked the type of work
    ____Accepted another job; different type        ____Disliked the Consumer/Employer work


   Personal Care Assistant/Employee Discharged for willful misconduct:
     _____Intentionally falsified records
     _____Unsatisfactory work performance – intentional absence (no call no show) or, missed schedule,
     refused to do work duties, abusive to Consumer/Employer, theft, threats, harassment, intimidation.
     ____Rule Violation – Refused to follow policy direction per Consumer/Employer/Employee agreement.
     ____Damage to equipment or property                  ____Criminal activity
                                                          ____Refused to apply or accept similar work with
                                                  other Consumer/Employers

                                                                                                     Page 2
                                                                     Notice of Discontinued Employment Form

Other reasons for termination:

____Personal Care Assistant does not like work
____Consumer/Employer passed away/Agreement terminated
____Personal Care Assistant does not want to travel to multiple work sites
____Consumer/Employer left, dropped or ineligible to participate in program
____Personal Care Assistant unwilling to accept available work, same type with other Consumer/Employers
in the area
____Personal Care Assistant dislikes Consumer/Employer – threats, attitude, demands, harassment, prejudice


Consumer/Employer Signature_________________________________ Date__________________

Personal Care Assistant Signature_________________________________ Date_________________

Please return this form to:       Fiscal Agent - JEVS Supports for Independence
                                  Monroe Office Center, Suite 100
                                  One Winding Way
                                  Philadelphia, PA 19131
                                  ATTN: Resources Department

*cc:       Resources Coordinator
           Fiscal Agent Benefits Department
           Service Coordinator
           Call Center

                              AND PERSONAL CARE ASSISTANT
Parties to Agreement

This Consumer/Employer agreement is made between*_______________________(Hereafter referred
to as “Consumer/Employer”) and ____________________________ (Hereafter referred to as “PCA”).
The purpose of this agreement is to establish the responsibilities of the parties to each other.

PCA Qualifications

The PCA attests that he or she meets minimum qualifications for employment in the Pennsylvania
Attendant Care Program.

1. PCA is 18 years of age or older
2. PCA has the required skills to perform attendant care services as specified in the
   Consumer/Employer’s service plan.
3. PCA possesses basic math, reading, and writing skills
4. PCA possesses a valid Social Security number
5. PCA is willing to submit to a criminal record check
   Consumer/Employer agrees to select or employ PCA on an interim basis pending completion of a
criminal record check. Consumer/Employer has discussed with PCA and reserves the right to
dismiss the PCA based on the results of the criminal record check.
6. PCA can demonstrate the capability to perform health maintenance activities required by the
Consumer/Employer and/or specified in the Consumer/Employer’s service plan, or be willing to
receive training in performance of the specified health maintenance activities.

PCA Responsibilities

1. PCA agrees to assist Consumer/Employer by providing the services and performing the
activities specified in Consumer/Employer’s service plan.
2. PCA agrees to protect the health and welfare of Consumer/Employer by providing authorized
services in accordance with the policies and standards of the Pennsylvania Attendant Care
Program, including the minimum Qualifications for Employment as a PCA.
3. PCA agrees to provide Attendant Care Services as specified in the Consumer/Employer’s service
plan on a schedule mutually agreed upon between the Consumer/Employer and the PCA. On an
exception basis, occasional variations in the Attendant Care tasks and in the schedule will occur,
based on mutual agreement of the parties.
4. In the event of illness, emergency, or incident preventing PCA from providing scheduled service
to Consumer/Employer, PCA agrees to notify Consumer/Employer as soon as possible so that
Consumer/Employer can obtain assistance from someone else.
5. PCA agrees to participate in training in providing attendant care services, including training in
performing any health maintenance activities, as required by Consumer/Employer and/or as
specified in Consumer/Employer’s service plan.
6. PCA agrees to maintain Consumer/Employer’s confidentiality and respect Consumer/Employer’s
7. PCA agrees to have taken out of his/her check all required federal, state, and/or local wage and/or
income taxes levied against PCA’s wages. PCA agrees to cooperate with Consumer/Employer, JEVS
Supports for Independence and the Consumer/Employer’s fiscal agent in providing information
needed to comply with all income and unemployment taxation laws and regulations.

   8. PCA understands that this agreement does not guarantee employment.
   9. PCA understands that PCA is employed by Consumer/Employer; not by the provider agency
   (JEVS SFI), the Consumer/Employer’s fiscal agent (JEVS SFI), or the Commonwealth of

   Consumer/Employer Responsibilities
   1. Consumer/Employer agrees to orient, train, and direct PCA in providing the attendant care
   services that are described and authorized by the Consumer/Employer’s service plan or that are
   requested by the Consumer/Employer.
   2. Consumer/Employer agrees to establish a mutually agreeable schedule for PCA’s services, either
   orally or in writing.
   3. Consumer/Employer agrees to provide adequate notice of changes in PCA’s work schedule in the
   event of unforeseen circumstances or emergencies, but such notice cannot be guaranteed.
   4. In consideration of PCA’s satisfactory job performance, Consumer/Employer agrees to authorize
   completed PCA time sheets and to pay PCA net wages on a regular and timely basis according to a
   predetermined payroll schedule. Net wages will include gross earnings calculated according to
   PCA’s pay rate minus payroll deductions made from gross earnings. Consumer/Employer agrees to
   provide PCA with a record of payments and deductions made from gross earnings.
   5. Consumer/Employer agrees to authorize all pay for income and unemployment taxes and make
   regular payments of worker’s compensation insurance premiums on behalf of PCA.

   Duration of Agreement

   This agreement will be effective when it is signed by both parties. The agreement will be in effect
   until it is terminated by either of party with 5 (five) calendar days of notice to the other, which may
   be provided orally or in writing.

   Modification and Termination of Agreement

   This agreement can be modified by agreement of both parties. This agreement can be terminated
   immediately by either of the parties for cause. This agreement may be terminated without cause
   with 5 (five) days notice of one party to the other party orally or in writing.

   Mutual Responsibilities

   The parties agree to follow the policies and procedures of JEVS SFI, the Agency’s designees, and the
   Pennsylvania Attendant Care Program. The PCA and Consumer/Employer agree to hold harmless,
   release, and forever discharge JEVS SFI, the Pennsylvania Department of Public Welfare, and their
   agents, from any claims and/or damages that might arise out of any action or omissions.

*Consumer\Employer Signature ____________________________________________*Date__________________

*Personal Care Assistant Signature __________________________________________*Date_________________

              Disclaimer/Addendum to Agreement between Personal Care Assistant and

I _______________________________________ understand and agree that by signing this
Disclaimer/Addendum, I recognize that Jewish Employment and Vocational Service (JEVS) is not my
employer, but rather that my employer is each individual consumer for whom I perform any work activity.
I recognize that JEVS is a Fiscal Agent selected by consumer-employers for whom I may work for the
sole and exclusive purpose of performing payroll, tax and support activities. I further agree that my
signature below indicates that I will adhere to all of the terms and conditions that I agreed to by signing
the Agreement between Consumer-Employer and Personal Care Assistant.

______________________________                 ___________
*PCA Signature                                 *Date

                                   ATTENDANT CARE PROGRAM
                                          AGENCY MODEL

JEVS Agency Model Personal Care Assistants (PCAs) are not permitted to perform the
following Health Maintenance Activities:

       A)      Changing the entire ostomy appliance, or irrigating an ostomy.
       B)      Nail cutting.
       C)      Catheter insertion/irrigations
       D)      Wound irrigation
       E)      IV management
       F)      Suctioning- Tracheal or Naso-Tracheal suctioning
       G)      Tracheotomy care
       H)      Enteral feedings via pump
       I)      Direct medication administration
       J)      Naso-gastric tube feeding

I have reviewed the above information and received a copy for my records. I understand the
Agency Model guidelines when working with an Agency Model Consumer.

*PCA Signature                                                    *Date

Witness                                                           Date

                   Acceptance/Declination of Hepatitis B Vaccination

Dear Personal Care Assistants,

The Attendant Care Program is offering the Hepatitis B series vaccination on behalf of the consumers in
compliance with OSHA.

JEVS Supports for Independence will inform you of various locations in the area where the Hepatitis B
vaccination is available. Although it is not mandatory that you receive the vaccination, we encourage you
to do so. JEVS Supports for Independence will cover the cost for the series of shots. The Hepatitis B
vaccination includes a series of three injections over a six month period. Once the first injection is
administered, the second is given the following month, and the third is given five months after the second.

Please complete the form below and send with your time sheet.
__Yes, I want the Hepatitis B series vaccination.

*ADDRESS__________________________ *COUNTY_______________
*PHONE #___________________________


Philadelphia County______

Bucks County________

Montgomery County________

__No, I do not want the Hepatitis B series vaccination.

______________________________                                    __________________
*Signature                                                               *Date

                             FRAUD AND ABUSE STATEMENT

I understand that payments for Home and Community Based services, including Attendant
Care, Fiscal/Payment Agent, Home Health Care and Personal Assistant services will be
from Federal and State funds, and that any false claims, statements, or documents, or
concealment of material facts may be prosecuted under applicable Federal and State laws.

Commission of the following will result in the immediate termination of your services or
employment and possible legal actions:

       1. Fraud, which includes, but is not limited to furnishing false information,
       submitting time sheets for services not rendered and any falsification of times of
       arrival or departure or of signatures on any documents.

       2. Theft from, threats to, abuse of, or intimidation of consumers, personal care
       assistants, or staff.

I have read, discussed any questions and understand the above statements.

___________________________________________                            _________________
*Personal Care Assistant Signature                                           *Date


*NAME (print)                                    *DEPT#

*SS#                                             *EMPLOYEE#

*BANK NAME:                                              *ACCOUNT#

*CHECKING: ___________           *SAVINGS: _________*ROUTING#





*EMPLOYEE’S SIGNATURE:                                               *DATE

*BANK AUTHORIZED SIGNATURE:                                          *DATE

RE: Emergency Employment Opportunities


        On occasion, consumer-employers need additional assistance. If you would like to work for additional
employers, please contact us.
        We are constantly updating our emergency workers list and consumer-employers would like to know
if you would like to be a part of it. This list is given to an answering service, so that when a consumer-
employer calls for an emergency replacement worker during non-business hours (Monday thru Friday,
5:00pm-8:00am, weekends and holidays), a replacement worker will be available. It is very important that
consumer-employers have reliable and dependable emergency workers available and they are looking to you
for your help.
        Personal Care Assistants who wish to be on this emergency worker list should have flexible schedules,
reliable transportation, and child care readily available, as you may be called on with little notice to work for a
consumer-employer. The pay for working these emergency shifts is $15.00 per hour.
        If you wish to be on the emergency list to be called on for emergency situations, please complete the
bottom portion of this form.

Thank you,
Community Resource Department
JEVS Supports for Independence

Please put me on the Attendant Care Emergency Employment List. Check all that apply.
        *CITY                                           *STATE                  *ZIP
        *I HAVE A CAR:                   YES             NO
        *I AM WILLING TO WORK:                  WEEKENDS                EVENINGS                 HOLIDAYS
        *I CAN READILY GET TO HOMES IN:                       NORTHEAST
                                                              BUCKS COUNTY
                                                              MONTGOMERY COUNTY


I have been oriented to the Attendant Care Program. I have read and understand the topics listed
below. I agree to comply with the rules and regulations and to follow my consumer-employer’s
service plan. I realize any deviation from these procedures may result in termination from the

_________________________________________                ______________
*Personal Care Assistant Signature                            Date

_________________________________________               ______________
*Print Name                                                   Date

_________________________________________               ______________
*Consumer Training Instructor Signature                      Date

_________________________________________                ______________
*Print Name                                                   Date

   1. Purpose of the Attendant Care Program
   2. Service Plan
   3. Universal Precautions Training
   4. Hepatitis B and Hepatitis B Vaccination
   5. Interviewing Tips
   6. Physical Impairments
   7. Social and Communication Skills & Working With Persons With Disabilities
   8. Cultural Sensitivity
   9. Body Mechanics & Transfers
   10. Fire Safety
   11. How To Use A Fire Extinguisher
   12. Act 28- Neglect of a Care- Dependent Person
   13. PCA Time Sheet Procedures
          a. Consumer Model Time Sheet Schedule
          b. Agency Model Time Sheet Schedule
          c. Time Log Sheet
   14. Total Pay Card
   15. Job Hot Line Information
   16. Complaint Form
   17. Notice of Discontinued Employment
   18. Agreement Between Consumer-Employer and Personal Care Assistant
   19. Addendum to Agreement Between Consumer-Employer and Personal Care Assistant
   20. Attendant Care Program Agency Model
   21. Acceptance/Declination of Hepatitis B Vaccination
   22. Fraud and Abuse Statement
   23. Direct Deposit Enrollment Authorization
   24. Emergency Employment Opportunities Notice
   25. Verification of Training Completion


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