Personal Attendant Care

Personal attendants are people who can help children and adults with disabilities and special health care needs with the things they do each day. They can be a great support for your child and family. Many thousands of people across Texas use them.

However, it can be expensive if you are not in a program that covers the costs. This page can help you understand more about personal attendant care and if it might be a fit for your family.

What is Personal Attendant Care?

A personal attendant is someone who can help your child with the things they do – or want to do – each day. This could be help with getting dressed, using the bathroom, eating, getting around, working at a job and more. It could also be help related to your child’s health care needs. Personal attendant care can help your child do more. It gives you an extra pair of hands with your child’s needs. These services are for children or adult children.

What Can I Expect for My Child and Family?

Every person has different needs, abilities and goals. Think about:

• What does my child need help with each day?
• What about at night?
• Are there things they could try if they had more help?

Attendant care looks different for each child. Answering these questions can help you and your child think about what it would look like for your family.

When your child has an attendant or more than one, it’s something for the whole family to get used to, especially siblings. This is a new person around in the day or at night. They are helping out with personal tasks in your own space.

What Does Personal Attendant Care Cost?

The cost for personal attendant care depends on what program your child is in, if any, or if you’re paying for it on your own. Medicaid or a Medicaid waiver program may help. But Medicaid waivers have interest lists that are many years long, so sign up as soon as possible.

Some programs will give your family money to pay for a personal attendant. Some programs will pay attendants directly. Also, attendant care is a low paying job. Finding the right person can be hard – it can take months. If you are able, your family might want to pay the attendant extra to help keep a good person. Or for more hours. So, you would be splitting the costs.

If your child has the Medicaid Home and Community Services waiver, there is also a “host home/companion care” option. With it, your child can live with you or another family. And you could get paid as their caregiver. Or you could hire caregivers to come into your home. Your home would have to meet certain criteria and be checked by Health and Human Services (HHS). This is different from personal attendant care.

If you have Medicaid, Medicaid buy-in or another insurance program, the best way to find out about costs is to check with your insurance program. For Medicaid, that would be a managed care coordinator (MCO), which is your insurance company.

Also, some communities have programs that help with attendant care costs. They have rules about your family’s income (money you make). You can connect with other parents, or search on our Find Groups and Services page, for ideas.

Where Do I Find an Attendant or Program?

You can find a personal attendant through an agency or hire one directly. If you have Medicaid, check with your Medicaid managed care organization (MCO) coordinator. They can tell you about the types of aides and attendant care services your child might be able to get.

Some programs that offer attendant care services are connected to Medicaid waiver programs. Learn more about those on our page on waivers. And get on an interest list now if your child might be able to use the program in the future.

Below are some Texas HHS programs that offer personal attendant care. Each one has its own rules on who can get the services. Usually, a doctor has to say that your child needs these services. Most are connected to Medicaid waivers.

• The Consumer Managed Personal Attendant Services program has agreements with different community programs for people with disabilities. Your family chooses, trains and manages the attendant.
• The Community Attendant Services also has attendant care. It is for adults and children with special health care needs. Disability Rights Texas has more information on the program, too.
• Primary Home Care has in-home attendant services for people who have an approved medical need. Attendants help with personal care tasks.
• Under the Medically Dependent Children Program, Family Care can include personal attendant services as long as those services don’t need to be supervised by a nurse.
• The In-Home and Family Support program provides grants (money) and benefits to people with physical disabilities or their families. That way, the family can choose and pay for services that help them stay living in their own homes. These services can include attendant care.
• For people with intellectual or developmental disabilities, there is the Home and Community Services (HCS) waiver program.

To apply for these programs: Find your local Texas HHS office. Or call 1-855-937-2372. See the Disability Rights Texas page on Texas Home and Community-Based Supports and Services to learn more.

If you are part of one of the programs, usually you have a choice on if you will find the attendant yourself – or if the program will. This is called “consumer-directed services” and can be a terrific option for some families.

As one parent put it:

“You can pay a higher wage with the CDS option. There’s more paperwork, but it’s worth it. You want someone who will stay awhile, build a relationship with your child. Otherwise, you have to train a new person all the time. …To me, [CDS is] worth it to have that longevity. I have one [attendant] that’s been with us for 6 years now.”

If you are looking for an attendant yourself, many parents use Care.com or other community searches.

Also, Texas HHS has a long-term care provider search. Use this search to find home health care, which includes personal attendant care.

Choosing an Attendant

Finding the right attendant is an important and personal choice. Interview different people to see who might best fit your child’s needs and your home.

Meet with a possible attendant for the first time in a public place, without your child there. Have a list of questions ready. Also, list out the traits that are important to you and your child, such as nonsmoker, sense of humor, flexibility, creativity, patience, being on time, being reliable, etc. If you like the person, you can schedule a second meeting with your child, maybe in your home.

Before the interview, ask for the attendant’s job history. If you want to hire someone, you can ask them to do a background check first and give you references to call. An agency might do some of this for you.

Here are some things to ask in an interview:

• What experience do you have working with children or young adults with disabilities and special health care needs? Ask about experience with your child’s specific diagnosis and needs.
• How can you help my child have more independence?
• How do you deal with behavior issues, at home and in public?
• How will you build a relationship with my child?
• Can you take my child to places in the community?
• Do you have flexible hours, if needed?
• If this works out, how long can you commit to staying with our family?

You and your child’s gut feelings about a person help to make the decision. See our blog article on Finding a Personal Care Attendant for more ideas and one family’s story.

Once you pick an attendant, plan to stay home for the first few times they come. You can stay out of sight. But be there to answer any questions and see how things go. Then, you can leave for short periods. And eventually longer.

If you think your child will need personal attendant care after they graduate from high school, it’s a good idea to start with an attendant when they are younger. That way, your child and family can get used to having an attendant.