Personal Assistance Services
History of PA Services in Ireland
It was recognised by Centres for Independent Living that in practical terms, Personal Assistance was at the core of Independent Living (IL), and the early days were greatly concerned with creating a consumer-controlled Personal Assistance (PA) service.
What is a PA?
A Personal Assistant (PA) is someone who provides a person with a disability (referred to as a 'Leader') with physical assistance to help them in all aspects of daily life from personal care, household tasks, assistance in college or the workplace, driving and interpretation. A Personal Assistant's tasks are customised to the individual needs of the Leader and may include personal care, household help, assistance in college or at the workplace, driving, interpretation etc.
The PA works to their employer's - the Leader's - agenda. Their role is to assist, not to provide care for or tell the Leader what is best for them. PA services enable the Leader to make their own decisions and be in control of their own life, opening up opportunities in education, employment, social and community life. A Personal Assistant, when on duty, only takes instruction from the Leader.
The major difference between a Personal Assistant and a carer is that in case of Personal Assistance, the service is designed and managed by the service user directly.
What is a Leader?
Leader is the term to describe a person with a disability that manages their own Personal Assistant service on a daily basis. They recruit and retain their own Personal Assistants and direct the service appropriate for his/her needs.
A Leader is in charge and takes full responsibility for the instructions given to the Personal Assistant, for the actions and consequences that follow from these, for training and day-to-day management of the service.
How PA Services Work
Essentially a PA service is a service for persons with significant disability who need assistance in aspects of daily living, at home, travelling, at work, college or socially. The individual first identifies what their needs are, whether by self-assessment, or often where they have not been in a position to make decisions about their own lives heretofore, facilitated assessment. The identified needs then determine the level of service required (ie number of hours and how many PAs each person needs) to enable a Leader to achieve independent living.
Following assessment, the Leader is approved for an agreed number of PA hours per week. The service is funded through the Health Services Executive (HSE) in different areas of the country, and is currently administered through a number of service providers, e.g. CILs, Enable Ireland, Irish Wheelchair Association (IWA). The Leader has a contract with one of these providers and following training they either recruit Personal Assistants directly, or in conjunction with the service provider. The Leader provides most of the training, while the service provider provides essential health, hygiene and safety training. Fundamental to the achievement of independent living for each person is the support to allow them to manage their own service with support and training where identified. Although the PA is employed by the service provider, the Leader is the PA's line manager, determining the work to be done and the hours of duty. The Leader then submits timesheets to the service provider in order for the PA to be paid.
An alternative to the service provider administered PA service is a direct payments system where the Leader becomes the direct employer and invoices the service provider/funding agency. This facilitates the Leader having complete control of their service. However, it also places a higher administrative and legal obligation on the Leader. This version of service is available in many other countries and whilst not yet widely available in Ireland, it is currently being trialled by a number of Leaders around the country.
Accessing PA Services
There is no one process for individuals to access PA services as it varies around the country. Leaders can apply directly to the service providers, but may be more successful though the Disability Area Manager in their local HSE area. Recent services have been organised through 'service packages' by Disability Area Managers. These services are contracted by the HSE directly with a Service Provider to provide a defined number of PA hours to a named individual with disability. The Service Provider then invoices the HSE for the cost of providing the service.
CILs in Ireland
Today there are 25 Centres for Independent Living (CILs) nationwide, all operated by people with disabilities at a local level, and mostly governed by companies limited by guarantee. They still have a vital advocacy role in representing members and supporting them with their integration into mainstream living. For many CILs however, the flagship of their company is its PA services. CILs fund these services largely through Health Services Executive (HSE) funding, and to a lesser extent, Community Employment (CE) schemes. Some CILs have developed into significant PA service providers in their county.
