By Ray Glazier

Bob arrived for his interview the week that three other people responding to my newspaper ad for a personal care attendant (PCA) had failed even to show up. I tried to keep the desperation out of my voice.

“So, Bob, what was your last job?”

“Well, I haven’t been working for a while. I was at Frostberg State for the last year, but I left without a degree.” As a once-upon-a-time temporary college dropout myself, I could relate to that. “I have some part-time day work in Boston, and thought I could do PCA stuff for you mornings and evenings to help make ends meet.” He was in his 20s, prematurely losing his hair on top, clean, if shabbily dressed, and was exactly my height and build before I landed in this wheelchair and started putting on weight. By the end of the interview Bob had a second part-time job.

It turned out that Bob’s first part-time job was posing in the nude for art classes at the Museum School. “What if you get a hard-on?” asked Jason, my other PCA. “With 20 people staring at you and a draft in the room,” said Bob, “no way.” Jason looked dubious.

It was late fall, and Bob had almost no clothes, a problem even for a nude model. I gave him my pre-injury winter wardrobe, which fit him exactly. Bob was grateful and dedicated himself to becoming the Perfect PCA. He even learned to cook. Sometime during those first few weeks he owned up to having just been released from Frostberg State Hospital, not having dropped out of Frostberg State College. Bob was sent there by the courts for pursuing his avocation as a Peeping Tom. He was very forthright and honest in these revelations, and was really doing very well for me. So why make waves?

As time went on, Bob’s accounting for the grocery money became sloppy and I realized that $40 or so per week was being siphoned off for marijuana purchases from the kids dealing from the basement apartment next door. But things were going so well with Bob PCA-wise that I decided not to make an issue of it. (And hadn’t I tried the neighbors’ merchandise once or twice myself?) Then my MasterCard statement came in the mail, and I spotted a blatantly bogus $80 mail-order charge that I could ill afford.

“I was desperate!” said Bob when confronted.

“You were that desperate for two ounces of anti-baldness potion?”

“It’s very important in my line of work to have a full head of hair.”

Bob was contrite and agreed to pay off the $80 in four weekly installments with the firm understanding that the police would be called immediately if anything else went missing. But after a week, Bob found the terms too onerous, quit his day job, and skipped town in his new wardrobe.

The PCA Tango
Bob and I were doing what I call the PCA Tango. I’ve seen the pattern repeated over and over, and so have my friends who are PCA consumers. Typically both the PCA consumer and the PCA candidate are equally desperate and living pretty much hand-to-mouth. The consumer can’t find good help for love or money, and the candidate can’t get a mainline job because he or she has no green card, has just come out of a detox unit or has a criminal record. Yet at its best, the relationship between PCA and consumer is a healthy symbiosis in which each party contributes something to the other. At its worst, one party becomes virtually a hostage of the other. The only redemption in that case is the transitory nature of the relationship. PCAs just don’t last that long anyway.

At first I figured I was just too difficult, expecting to go to bed before 2 a.m., get up on time to catch my paratransit ride to work, and be dressed in something more office-appropriate than sweat pants and sneakers. It seemed no PCA ever lasted more than a six-month hitch. Then a friend more experienced with PCAs than I told me the truth: “The half-life of a PCA is three months.” So I stopped beating myself up on the tenure issue, polished up my recruiting and interviewing skills, and learned to appreciate variety and change.

And, man, have I had my fill of both. The best that can be said for certain PCAs is that they beat the alternative–lying in bed all day watching soaps and waiting for a pressure sore.

Yet a good PCA is a true gift. Fred, my very first PCA, still tops my list. He was a college student from Iowa who signed on for the duration of my wife’s pregnancy because he wanted to share in the experience, Lamaze classes and all. He was so excited when the Big Moment came that he drove right past the downtown hospital and we almost didn’t make it there on time. Nowadays Fred is delivering babies himself and stitching up stab wounds as an ER physician in a big-city hospital in the Midwest. He is one of the few doctors I still speak to.

Over the years I’ve preferred to have male PCAs, when I had a choice, which wasn’t always. While I confess to once having had adolescent fantasies of reclining in a hot tub while being bathed by nubile maidens, nothing in my pre-injury life prepared me for how it would actually feel to be assisted in the shower by a female PCA. And who wants anyone’s help with toileting unless it just can’t be avoided? But female PCAs can have the requisite detachment and physical strength, are initially less squeamish than guys, are often handier at dressing and sewing on missing buttons (sexist as that sounds), but can’t deal with neckties that aren’t clip-ons. Yet I know male PCAs working for women with disabilities who have become expert at makeup application and hairstyling, as well as strategic placement of clothing accessories.

Fred excepted, I’ve found aspiring members of the medical establishment–student nurses, medical students, budding therapists–attitudinally unsuited to PCA work because they are trained to objectify patients and distance themselves emotionally from those they treat. They work on people, not for and with us. But students by and large are good PCA candidates. They are in a temporarily needy status, prefer part-time work, don’t mind odd hours, and are young enough to be strong, flexible, learn quickly and adapt to change. Of course they’re also young enough to be fickle, insensitive, unresponsive and unreliable. One must be prepared to make accommodations for heavy dates, exam periods and changes in class schedules.

A PCA Rogues Gallery
Mike was a computer whiz who’d been recruited by Harvard, so PCA work supplemented his scholarship nicely. He was agreeable and helpful, but on Thanksgiving Day, just before dinner guests arrived, he handed me a long list of accumulated grievances along with his resignation. It seems he’d especially resented helping me host a party the previous Halloween, and he was gone in a flash.

Frank was going to physical therapy school on the GI Bill and drawing a 50 percent disability benefit from the Veterans Administration because of a knee injury he’d incurred playing basketball off duty and a social disease he’d also picked up off duty. Frank was strong and agile, despite his disabilities, and I wondered what the VA might think of his PCA work and his physically demanding choice of profession.

And Frank wasn’t my only PCA with a disability. Roger was a preacher who’d had a psychotic break and been carried from the pulpit one Sunday by men in white coats. He happened to be a fantastic vegetarian cook, and I was sad the night he wandered off and simply never returned. Mark was a former high school athlete and ex-Marine coping well with recovery from alcoholism and taking heavy meds to control his bipolar disorder. He saw me through the breakup of my marriage, so I felt a loss when he quit abruptly. I learned later that he sensed he was on the verge of a psychiatric hospitalization and withdrew to spare me that tension.

Gwynne was a middle-aged British divorcée looking to extend her American holiday as a live-in PCA; she answered my ad at a time when I was, as usual, desperate. She was rather ditzy and did things like serve up a supper of beef liver that had been cooked all afternoon with a can of Veg-All thrown in the pot for variety. She did nothing to improve my low opinion of English cooking, and she assured me that everybody in England leaves the fridge door open throughout meal preparation. Gwynne liked to clomp around the house in lavender satin pumps with high heels and big pompoms, wearing a pink chenille bathrobe and with her hair in rollers. She actually handled transfers better than I expected, despite teetering on the high heels and mumbling incantations to levitate me out of bed. But I vividly recall the day Gwynne dressed me for work, and I discovered after a mad dash to the men’s room that she had put my undershorts on backwards. I’m sure it never occurred to her that this could be problematic.

One reason I kept Gwynne on was that she got along so well with Mickey, a physical therapy student moonlighting as a PCA. Between the two of them, they shared my regular morning and evening routines. They also shared each other’s wardrobes; Mickey liked to cross-dress on the weekends and was drawn to Gwynne’s more frilly outfits. That cozy arrangement ended the day I got a legal notice suspending my right to drive in the state of Maine because of an unpaid speeding ticket. I hadn’t driven in years anyway, and hadn’t been to Maine recently. But my extravagance of the moment was maintaining a Saab sedan in which I was transported to and from the office by my PCA. I learned that Mickey and his boyfriend had “borrowed” the Saab to go running nude on the beach in Maine one fine spring day, and were nabbed for speeding as they raced back to Boston to pick me up after work. He didn’t have the sense–or maybe the funds–to pay the ticket, else I wouldn’t have been the wiser.

And then there was Rod. He’d been my PCA all during his senior year at a local university, then left to take a counseling job on campus. Months later he phoned to suggest that he accompany me to Bermuda, where I’d never been, for spring break; I was to pay half his expenses in exchange for on-site PCA services during the vacation. Shortly after we checked into our Bermuda hotel room, Rod ducked into the bathroom and emerged quite some time later wearing nothing but a big smile and an erection of porn-star proportions! This was day one of a week-long stay, so I had to think quickly. I looked up from the postcards I was writing, pushed my glasses up my nose, cleared my throat, and said, “Rod?”

“Yes,” he grinned.

“How do you spell Albuquerque?”

Raymond E. Glazier, Ph.D., directs the Center for the Advancement of Rehabilitation and Disability Services for Abt Associates, Inc., in Cambridge, Mass. He has published extensively on vocational rehabilitation and personal assistance services.

Hiring a PCA
How to Interview and Screen Applicants
By Alfred H. DeGraff

It is a regrettable fact. The majority of people who answer your newspaper or Internet ad for a PCA should not work for you. Most of them either won’t qualify for the job or will decide they don’t want it.

That’s the objective of the interviewing and screening process–to weed out the people who shouldn’t work for you. Here are some suggestions for making it work well.

• The first step to finding quality applicants is to spend a few extra dollars for a first-class, attractive ad. The more applicants you get (within reason), the more selective you can be.
• You will next receive phone inquiries. Rather than answer the phone directly, record the inquiries on an answering machine. You never get harassed, and can take your time deciding who to call back and who to simply erase.
• Is it important to check references? Some people have rarely had a problem and will not take the time, while others feel a formal background check is an essential prerequisite to hosting an at-home interview. Consider your experience and your neighborhood.
• Whether the initial interview meeting is held at your residence or a public place, consider including one of your current PCAs. The PCA helps an applicant identify with being your next aide.
• Your selection of a current PCA to greet applicants and perform any demonstrations should be made carefully. Choose one who sets a good example and can demonstrate the details of the job well. What applicants see as your current standard is what they will imitate if they’re hired.
• When you schedule an interview appointment, some applicants will either cancel or fail to show up. At the end of the interview, ask applicants who do show up to make an overnight decision about the job and call you back the next day. Some will decide they’re not interested, or simply fail to call back at all. This is an expected and useful part of the screening process. Let applicants screen themselves.
• A good interview is a two-way street–you make decisions about them, and they decide about you. Applicants are often nervous. This is, after all, a job interview. Help them feel comfortable, and they will tell you more about themselves. Be sure to ask if they have questions.
• You and a current PCA should demonstrate a significant part of your routine. Applicants get to see the nature of the work–work that is not meant for everyone. Avoid sugarcoating your routine by hiding the less attractive tasks. This is a time for full disclosure.
• While applicants watch you and the current PCA go through the routine, both of you should be observing them. Do their reactions and body language tell you they would be comfortable doing this work?
• You will sometimes disqualify all of your applicants. This is not necessarily a sign that you are being too picky, but rather that your screening techniques are doing their job. Place your ad again.
• In choosing from finalists, remember that your intuition is important. A successful businessperson was once asked for advice on hiring employees. He replied quite simply, “Never hire anyone you do not trust. If you suspect that somehow someone might screw you, they probably will.” 

Alfred H. DeGraff is writing Caregivers and Personal Assistants: Managing the People Who Help You, Saratoga Access Publications. To receive a publication announcement, contact 800/474-4010 or caregiver@saratoga-publications.com