What is Consumer Directed Personal Assistance (CDPA)?
Consumer Directed Personal Assistance allows Medicaid recipients in need of personal care, home health and nursing services to recruit, hire, train, supervise and terminate their own personal assistants. Under CDPA, people with long-standing illnesses or disabilities have much greater control and freedom over their own care than under traditional home care services. They are able to hire friends or loved ones to work for them, thus eliminating potential stress from strangers in the home or language/cultural barrier issues. CDPA consumers allocate weekly hours on a flexible day-to-day basis, rather than following a daily schedule of hours set by a third party. The program ultimately provides consumers with controls that many take for granted.
Personal assistants who work for CDPA consumers are able to perform tasks that agency-sent home health aides/personal care aides may be prohibited from doing due to company policy or liability reasons. The Nurse Practice Act (N.Y. Educ. Law § 6908(1)(a) ) creates an exception that allows CDPA aides, along with family and other unpaid informal caregivers, to perform tasks that otherwise may only be performed by licensed nurses. Click here to read the Nurse Practice Act.
Click here for current, unabridged CDPA regulations (While most of the regulations are included in managed care contracts, the regulations in 505.28 only apply to Fee for Service CDPA).
Can I Become My Relative/Roommate/Friend’s Personal Assistant?
As long as you can work legally in the State of New York and the person in need of services is (A) Medicaid eligible and currently receiving benefits, (B) capable of self-direction, and (C) not your spouse or your child, you are eligible to be hired as a Consumer Directed Personal Assistant. According to the regulations, “a consumer directed personal assistant may include any other adult relative of the consumer who does not reside with the consumer or any other adult relative who resides with the consumer because the amount of care the consumer requires makes such relative’s presence necessary.” People serving as Designated Representative for a non-self-directing consumer may not also be the Personal Assistant for that consumer.
If you are in search of work as a PA, many fiscal intermediaries offer services that link consumers to potential PAs. You may want to call an FI in your area and see if they offer such a service. Click here for a list of CDPAANYS member fiscal intermediaries.
Differences Between CDPA and “Traditional” Health Care
In traditional home care programs, an agency employs the different “levels” of home care worker – “homemaker,” “personal care aide,” “home health aide,” “Licensed Practical Nurse,” and “Registered Nurse”. Which type of worker depends on that individuals training and the level of services needed by the consumer. It is the agency who schedules and supervises the traditional levels of workers.
Under Consumer Directed Personal Assistance (CDPA), the home care recipient (consumer) is responsible for the employment responsibilities – recruitment, hiring, training, supervising, scheduling and terminating, if necessary, their choice of personal assistant (PA).
What makes the two programs very different are:
1) the consumer selects the PA;
2) the consumer trains the PA exactly the way s/he wants tasks performed;
3) the consumer schedules and supervises the PA;
4) the consumer terminates the PA (if the employment relationship isn’t working.)
Since the consumer, assumes the employer responsibilities, (to recruit, hire, train, supervise and terminate), the rules shift a bit. PAs work directly for the consumer – there is no agency “middle-man.” The consumer directs you to complete the tasks listed in his/her county/MCO/MLTC developed “Plan of Care.”
What makes CDPA different from traditional models of home care is that consumers are legally able to train PAs to do tasks that a nurse would usually have to do. This is possible because: 1) the consumer is training and supervising the PA to perform a task in the way that s/he wants it done, 2) there is an amendment to the Nurse Practice Act that legally allows anyone to perform tasks that typically only a nurse would be allowed to do, such as administer medications, because the consumer is training and supervising the PA.
The consumer works with a CDPA organization, known as a fiscal intermediary (FI), who will provide administrative support. The FI works to facilitate processes such as: collecting paperwork, payroll, benefits and supporting consumers to navigate directing their program.
Personal assistants are the DNA of independence – empower a consumer and find excellent job satisfaction by working as a PA! Good luck!