Attendant Services FAQ

“What is self-direction?
The key component in the provision of attendant services is self-direction of services by the consumer. The primary responsibility for the way services are delivered rests with the consumer; this means the consumer has to:

• Understand their support service requirements
• Understand what activities or procedures are necessary in meeting their service needs
• Provide instructions to an attendant on how to carry out these activities or procedures

A family member or designated person (by consumer) may provide interpretation of the consumer’s instructions but cannot direct the attendant on the behalf of the consumer.

“What is the waiting time to receive attendant services?”
Attendant Service Providers make decisions about vacancies are based on available funding, resources and other factors. Applicants are advised that all Supportive Housing providers have a large pool of applicants and few vacancies occur. Applicants are encouraged to apply to a number of projects to increase their chances of securing supportive housing. Outreach programs are more likely to have higher service vacancies. Transitional programs generally have a higher vacancy rate due to the length of the Transitional program.

“How is confidentiality maintained?”
ASAC recognizes and respects the confidential nature of the information provided on the ASAC application form. Your information will be released only to the service providers listed in the ASAC application and to any individuals that you have authorized in your ASAC application. We will not release information to any individuals not listed on your application. If you will have someone such as social worker or occupational therapist calling ASAC on your behalf, you must provide their name on the “Consent to Disclosure of Applicant Information” section of the application form. Occasionally, ASAC is required to compile statistics using information from the central database. This information will be presented in a manner that does not identify any of the applicants. ASAC fully complies with the Personal Health Information Protection Act and is considered a health information custodian under this Act.

“How to get more information about the attendant Service providers listed in the ASAC Application?”
Here are the links to these attendant service providers:

• Access Independent Living Services – www.accessils.ca
• Bellwoods Centres for Community Living  – www.bellwoodscentres.org
• Gage Transition to Independent Living – www.westpark.org/Services/GTIL
• North Yorkers for Disabled Persons – www.northyorkersfordisabledpersons.ca
• Nucleus Independent Living – www.nucleusonline.ca
• March of Dimes Canada – www.marchofdimes.ca
• NABORS (Neighbours Allied for Better Opportunities in Residential Support) – www.nabors.ca
• PACE Independent Living – www.pace-il.ca
• Participation House Markham – www.participationhouse.net
• Spinal Cord Injury Ontario – www.sciontario.org
• Vibrant Healthcare Alliance – www.vibranthealthcare.ca (formerly Anne Johnston Health Station – Tobias House Attendant Care)

“How can consumers prepare for an interview?”
The information discussed at an interview will vary, depending on whether the consumer has applied for accommodation with attendant services or whether s/he has applied for outreach services only.  The consumer may also be asked to give references and sign release-of-information forms.  The consumer can prepare for an interview by being ready to discuss the following issues:

• His/her own individual needs in detail;
• His/her ability to direct own services
• His/her insurance arrangements;
• His/her individual financial situation, if a subsidy or rent-geared-to-income assistance is required;
• His/her activities and interests; and
• All information included in the application.

Consumers can also prepare for the interview by making a list of questions about living in that project or receiving outreach attendant services. The following sample questions may help individuals create their own lists of questions:

• What services are available?
• How does the consumer arrange for staff and attendants to assist?
• How are attendants trained?
• What involvement will consumers have in hiring, training and appraising the performance of attendants?
• Will the same person provide attendant services all the time, or will the consumer work with a number of attendants?
• Will attendants assist with shopping or banking, or provide services at school or at work?
• If friends who are disabled visit, will the staff assist them also?
• If a consumer encounters any problems in a relationship with an attendant, is there a resolution/complaint procedure in place?
• Are attendants unionized or non-unionized? Will membership or non-membership in a union have an impact on how services are provided?
• For apartment projects: How many units have one, two or three bedrooms? Can a unit be viewed in advance?
• For shared living situations: Are private bedrooms available? How many people would share facilities? Can the individual bring his/her own furniture?
• For transitional programs: How long is the average stay?
• Is the accommodation furnished or unfurnished?
• Will there be a lease to sign?
• What does the subsidized rent include? For example, does it include heat, hydro, appliances, cable TV, and parking?
• What parking is available for cars and vans?
• Where is the nearest grocery store, drugstore, bank, library, accessible restaurant or movie theatre?
• Are there rules about pets, visitors or parties, etc.?
• How old is the building?
• Are there balconies?

“What are service contracts/plans of service and leases?”
Prior to receiving attendant services, consumers sign a service contract with the attendant services provider. Consumers who are moving into supportive housing also sign a lease with the landlord.

The service contract or the plan of service is an agreement between the consumer and the service provider outlining the services offered by the agency and the conditions under which these services are continued or terminated. The service plan may also include a list of permanent services and the time required to perform those services. An annual review process may be included. The service contract/service plan is signed by both parties, the consumer and the service provider.

The lease is a standard tenant/landlord agreement outlining the conditions of tenancy. Usually the attendant services provider and the landlord are two completely separate entities.

“How can consumers prepare to move?”
Moving can be a difficult time for many people, with or without a disability.  The following points may be helpful for consumers who are getting ready to move, especially for those who have not lived independently before or who are newly disabled:

• How will the consumer make moving arrangements?
• Is apartment insurance necessary? If so, how much will it cost?
• What drugs, specialized supplies and equipment/tools/assistive devices will be needed?
• How much will it cost to buy or rent equipment/tools or assistive devices? How will maintenance be covered if equipment or devices require repairs?
• What government assistance programs are available to cover all or a portion of the cost of assistive devices and equipment?
• What cleaning supplies are needed?
• What is the cost of specialized telephone equipment?
• What commonly used kitchen items are needed?
• Should the consumer obtain a change-of-address form from the Post Office?

“What key skills will consumers require to self-direct?”
This varies with every individual and depends on many factors such as previous experience, motivation and preparation.  The key skills which will serve consumers well are:

• Knowing his/her individual needs;
• Knowing the time required for assistance;
• Being able to explain, step by step, how assistance is to be given;
• Having all supplies on hand;
• Being organized; and
• Using time efficiently.

“How can consumers successfully resolve day-to-day problems with attendants?”
In any relationship between human beings, there are bound to be occasions when problems occur.Lack of communication: Sometimes problems occur between attendants and consumers due to lack of communication. Discussing a problem provides the opportunity for both consumer and attendant to improve the quality of communication. It is essential to find a right time and place to discuss the issue at hand. For example, the consumer might choose to wait until work with the attendant is completed, i.e. at the end of the “booking,” to discuss any concerns. In this way, both parties can be calm, relaxed and on an equal footing, with the time to listen to each other’s points of view.

A consumer should:

• Not be afraid to say how this particular problem has made him/her feel;
• Deal with only one or two issues at a time;
• Be prepared to have a possible solution to the problem in mind; and
• Be prepared to listen to the attendant’s point of view and welcome feedback.

Many experienced consumers of attendant services have observed that if problems are resolved as they occur, relations with attendants will be more positive. It is essential to remember that as the person who is directing services, the consumer has primary responsibility for addressing issues.

It is important not to overreact and threaten to go to management (the service provider) without first discussing the issue with the attendant. This may only make matters worse, lead to resentment and sour the relationship between the individual and the attendant.

Going to management: If the consumer is unable to resolve the problems with an attendant, then s/he could choose to bring the matter to the attention of management (the service provider).

It may be helpful for the consumer to:

• Write down specific concerns, with dates when events occurred;
• Inform the attendant that management has been notified; and
• Have both him/herself and the attendant present at the meeting with management.

Service providers do have procedures in place to resolve problems between consumers and attendants and other program staff. Service providers believe that it is part of their responsibility to assist in successfully resolving interpersonal differences between consumers and attendants.

“What can consumers do if they believe that abuse is taking place?”
It is an unhappy and unwelcome reality of modern life that some people in our society experience an abusive relationship with a caregiver. Although abuse, unfortunately, can occur to anyone, people with disabilities, women and seniors are more vulnerable. Abuse can take the form of verbal, physical, financial or sexual abuse.

If a consumer believes that s/he is being abused by an attendant, there are a number of positive steps that can be taken to resolve the situation. First, consumers should be aware that service providers take a complaint of abuse very seriously and that they do have policies and procedures in place to resolve complaints, including complaints of abuse.

Initially, however, consumers are advised to talk to someone whom they trust: to discuss feelings; to determine what has happened or is happening in order to decide whether abuse is taking place or not; and to discuss options for resolving the situation. Consumers can consult attendant services project or program staff, a staff person at their local ILRC, a trusted family member, a friend, a minister, a doctor or a local crisis centre helpline.

“What can consumers expect in their relationships with attendants?”
To understand what the individual can expect in a consumer-attendant relationship, we need to refer back to the definition of attendant services.

First, attendant services are “self-directed.” This means that consumers need to know:

• What the individual wants the attendant to do;
• When the individual wants tasks performed; and
• How s/he wishes tasks to be performed.

All of these activities are part of the training process. (Self-direction does not mean, however, that the consumer should follow the attendant around his/her home and monitor each step of every activity.)

Second, attendant services involve “physical assistance” with “routine activities of daily living” due to “physical limitations“.

This includes assistance with those activities of daily living which the consumer would do for himself/herself with his/her own hands, arms, and legs. This, therefore, would include assistance with:

• Washing;
• Dressing;
• Bowel and bladder routines, etc.

Accordingly, in a relationship between an attendant and the consumer, it is the consumer who is in control and who takes responsibility for decisions, and it is the attendant who is responsible for carrying out these instructions. If the consumer relinquishes responsibility for making decisions, then the consumer is asking the attendant to provide “care,” rather than to provide “services.”

Training: It is the consumer who takes responsibility for training attendants. Training includes knowing how things are to be done, so that each attendant with whom the consumer works gets to know individual routines.

Even if there is a veteran attendant or a project staff person present who knows daily routines, it is usually the consumer who manages the training process. Under this management, an experienced attendant can demonstrate activities while the new attendant observes and learns the routines.

There may be some situations in which a consumer is not able to take full responsibility for decision making and training. For example, a person who is newly disabled and who is participating in a transitional living program would be learning how to self-direct his/her own services. Clearly, it takes skill and experience to self-direct.