Personal Assistant Services (PAS) in Rural America

A caregiver helps a person with physical disabilities eat.

From Healthy Community Living (www.healthycommunityliving.com).

Approximately 3 million people with disabilities receive paid personal assistance services (PAS) in the United States. For many, these services are critical for social and community participation. However, little is known about rural-urban differences in PAS delivery and consumption, and how these services influence community participation and health.

Centers for Medicare and Medicaid Services have asked states to rebalance their Long-Term Supports and Services Medicaid dollars by shifting away from institutional services, like nursing homes, towards home- and community-based services (HCBS). Growing investment and interest in HCBS, like PAS, needs to be matched with critical research and related training that will ensure these services are meeting the unique needs of people with disabilities in rural places. Currently, fewer HCBS are used in rural than urban areas, and more is spent on institutional costs in rural areas. As well, current HCBS in rural areas are insufficient to replace services previously provided by long-term care facilities, and there are lower ratios of PAS workers to people with disabilities.

This project is both an exploratory and intervention development project designed to address rural PAS outcomes for alternative models of service delivery. It is comprised of two studies:

Study 1: Models of Care and Community Participation in Urban and Rural Places

Study 1 will use a Rural PAS Advisory Board to develop and implement data collection and analysis to determine how rural people with disabilities use alternative models of PAS service delivery. These results will help understand how rural contexts affect the uptake of each PAS service model, which could help improve efficiency and effectiveness of service delivery as well as increase availability of PAS services for rural people with disabilities.

Study 2: Adapting PAS Training for Rural Contexts

Study 2 will modify existing PAS training curriculum using Iterative Participatory Curriculum Development, an approach to forming a working relationship between researchers and decision-makers to collaboratively create a product. Development procedures and pilot test rural PAS training content to improve the community participation of consumers.