Fact Sheet 7: Attendant Care Services

Reader: Family, Professional

What Is Attendant Care?

Attendant Care is any action to assist a person with a disability in accomplishing activities of daily living. These cover a broad spectrum of activities including bathing, dressing, feeding, toileting, transferring, mobility, cooking, cleaning, laundering, dispensing of routine medications and similar tasks. Primarily, these are tasks that the individual is unable to physically perform or has a great deal of difficulty doing.

Attendant Care is also known as personal care assistance, personal assistance services or home health care.

How Does It Differ From Nursing Care?

The tasks performed by an attendant are typically non-medical in nature and do not require medically trained personnel to carry out. Though the provision of these services are essential to the well-being and health of the individual with a disability, they can typically be performed by a lay person who has received appropriate training.

Who Utilizes Attendant Care?

People who need attendant care are a heterogeneous group. They range in age from infants to senior citizens. Their disabilities range from respirator dependent quadriplegics to ambulatory individuals with multiple sclerosis. Their common characteristics are that each has a permanent or temporary disability that prevents them from independently accomplishing their needed activities of daily living in their home environment. Many individuals with spinal cord disabilities require attendant care in order for them to prepare to go to work each day.

Why Utilize Attendant Care?

Attendant care is a COST EFFECTIVE way for people with disabilities to receive needed assistance to accomplish daily living tasks that allow them to live independently in the community. The provision of care often prevents institutionalization of individuals who are then able to fulfill functional roles in society. Attendant Care also reduces the physical, emotional and financial drain on family members of the individual with a disability, often preventing injury, dissolution of the family unit and allowing parents and/or spouse to return to work (decreasing need for public assistance).

What Does Attendant Care Cost?

The hourly cost of attendant care will vary by location and provider, but is typically in the range of $5.35 to $10.00 per hour. Individuals will utilize attendant care a few hours per week to 24 hours per day. According to a 1990 national survey on "The Cost of Spinal Cord Injury" by the Paralyzed Veterans of America (Paraplegia News, August 1990), the average annual cost of attendant care for individuals with spinal cord injuries is $6,180. A 1990 survey of Arkansas Spinal Cord Commission Long Term Attendant Care recipients reflected a similar annual cost.

Is Attendant Care Cost Effective?

An Arkansas Spinal Cord Commission Study on Long Term Attendant Care recipients in 1990 reflected that the annual cost of attendant care provided by ASCC was 27% of the cost of level one skilled nursing home care (the level which would be required for these quadriplegic individuals). Other studies have noted the increased complications and acute hospitalizations for individuals in nursing homes. Attendant care prevents costly secondary conditions such as pressure sores (decubitus ulcers). The average cost for acute hospitalization of a spinal cord injured person for treatment of a pressure sore was $92,723.

The provision of attendant care by trained individuals who are not medical care providers (i.e., licensed practical nurses, registered nurses, physical therapists) is significantly less expensive, frequently costing 50-75% LESS than medical care for assistance with those activities of daily living that are non-medical in nature.

The cost effectiveness that attendant care provides in increasing the independence, autonomy and quality of life of individuals with physical disabilities is not quantifiable!

Who Pays The Cost Of Attendant Care?

• Medicaid - for individuals who meet the criteria, Medicaid will cover personal care assistance (attendant care). Specialized programs are available for ventilator dependent individuals and through the Developmental Disabilities Waiver Program.
• Medicare - home health care is provided to home bound individuals with physical disabilities.
• Specialized Programs - in many states, the Division of Vocational Rehabilitation or Department of Social Services have established attendant care programs. There are no such programs in Arkansas.
• Arkansas Spinal Cord Commission - provides up to four hours per day of long or short term attendant care to spinal cord injured individuals meeting the financial /medical criteria (there is presently a waiting list for long term care).
• Insurance Carriers - Health and Workers Compensation insurance carriers sometimes find attendant care a beneficial, cost effective method of meeting the long term care needs of individuals with physical disabilities or catastrophic injuries.
• Veteran's Administration - provides attendant care funding to qualified disabled veterans.
• Out of Pocket - The most common payment source for attendant care is the individual or family who is receiving the service. Many individuals, particularly those in middle income brackets who do not financially qualify for many programs listed above, must pay for the care themselves. Individuals who litigate or obtain a settlement should include attendant care as a component of the planned trust or settlement.

Summary

Attendant Care is diverse service that assists individuals with physical disabilities in activities of daily living. It is not necessarily medically based and is provided by trained lay individuals. It is a cost effective service, provided in the home or community, at a cost 50-75% less than institutionalization or medical care. The average annual cost for individuals with spinal cord injuries is $6,100. It prevents medical complications and promotes gainful activity, independence, preserves family unity and promotes quality of life. The service is provided by some public service agencies and third party carriers, but the cost is often absorbed by the individual or family receiving the service.

Attendant Care is a Cost Effective method to keep people independent.