Planning for homecare can be a complex process.  People with disabilities, seniors, and their supporters must navigate an array of agencies, evaluate needs, and find qualified attendants.  The process is often overwhelming, especially when individuals or families find themselves at the beginning of this journey.

A planning or support team can come together to help the person clarify their priorities, identify resources, and assist with the hiring of home attendants and setting employment terms.  These teams often consist of loved ones, friends, and other relevant professionals.

Members of planning teams often have the best intentions of supporting the individual to arrange long-term services and supports that will maximize their independence and own goals.  However,  they may inadvertently focus on the perceived weaknesses and limitations of the individual, rather than their strengths and own vision for their lives.  The team may identify all the activities the person cannot do or list the ways they differ from their nondisabled peers.

Focusing on a person’s limitations rather than their strengths may be rooted in ableism and ageism.

What is Ableism and Ageism?

According to disabled writer, activist, and scholar Lateef McLeod, “ableism is the system of oppression that prioritizes people with abled bodies and minds over people with disabilities.” Ageism is discrimination based on a person’s age. Our society values younger, nondisabled people over older adults and people with disabilities. Even people in these two groups can internalize these beliefs and undervalue their own lives.

Ableism and ageism can also intersect with racism and other “isms” to create unequal power dynamics in support relationships.  These power dynamics can go in any direction between planning team members, attendants and the people they support.  As Lateef McLeod explains, “Ableism and ageism intersect with the system of racism that prioritizes people that are designated white over people of color. So in the end result, the different forms of oppression intersect to form a hierarchy that produces more layers of oppression once you move away from the white, straight, able-bodied male dominant group.”

Person-Centered Planning 

One way to avoid ableism, ageism, racism, and all the other negative “isms,” is to work with the individual to develop a detailed person-centered plan.  In this type of plan, the person’s strengths and abilities help guide the decisions related to homecare.  Their voice is fully acknowledged and respected throughout the planning process. To the greatest extent possible, the person takes a leadership role.  They have the power to decide where they want to live and who supports them in their home and in the community.

Sometimes these plans are developed during formal meetings in which a person’s supporters or planning team gathers together with the individual.  At the direction of the individual, the team may decide what type and how much homecare or other forms of long-term services and supports are needed.  To learn more about the person-centered planning process, please read this information from the Administration for Community Living:  https://acl.gov/programs/consumer-control/person-centered-planning

Best Practices for Hiring and Employing Attendants

Often attendants and the people they support form close working relationships.  Attendants can be intimately involved in the lives of the people they support.  Depending on the amount and type of assistance needed, the pair may spend long periods of time together.  In a healthy working relationship, respect should flow in both directions.  Just as attendants should honor the autonomy and wishes of their clients, people with disabilities, seniors, and planning teams should also respect the attendants.  This respect may come in the form of fair wages, paid time-off, and regular rest periods as well as regular check-ins to ensure all parties can communicate about what is working and what needs to be changed in the relationship.  When an agency controls wages, clients and their teams can advocate on behalf of attendants or find other ways of showing respect and appreciation such as offering flexibility in their schedule or providing bonuses if they can afford them.

The planning  team should take all of these factors into account when hiring new attendants. Additionally, they should consider the individual’s values, interests and personality when identifying attendants that are a good match.  One strategy is to evaluate both the wants and needs of the individual.  Our basic needs make us human, but oftentimes, our wants define us as separate individuals.  For example, Tom needs an attendant to prepare dinner for him.  However, Tom is a foodie, so he really wants an attendant with advanced cooking skills.

Members of the team may also want to help the person interview prospective attendants and determine what to include in written contracts (check out Hand in Hand’s sample work agreements).  Ideally, the planning team should stay involved throughout the process.  The type and duration of this involvement should always be determined by the preferences of the person at the center of the plan.  Occasionally, candidates do not work out in the long run.  The team may want to suggest a two-week, paid trial period for all newly hired attendants.  Both the new attendant and the person being supported may benefit from extra help establishing a personal care routine or learning to communicate with one another and establishing regular check-ins.

After the trial period, the new attendant should become an integral member of the planning team.  When the team includes their attendants, they can build a solid foundation of support that endures.