Personal Care Attendant in Vermont: How to Hire One Through Choices for Care

Your parent needs daily help with bathing, dressing, and meals, but they refuse to go to a facility. You have been providing the care yourself for months, unpaid, and you are burning through your savings because you cut your work hours to be there. Vermont has a program that can pay for a personal care attendant to do this work, and in many cases, that attendant can be you.

What a Personal Care Attendant Does

A personal care attendant (PCA) provides hands-on assistance with Activities of Daily Living (ADLs): bathing, dressing, grooming, toileting, eating, and transfers (getting in and out of bed or a chair). They also help with Instrumental Activities of Daily Living (IADLs): meal preparation, light housekeeping, laundry, medication reminders, and transportation to medical appointments.

PCAs are not nurses. They do not perform clinical procedures like wound care, IV therapy, or catheter management. Those require a licensed home health aide or registered nurse, typically covered separately through Medicare home health or Choices for Care skilled nursing services.

How Choices for Care Funds Personal Care Attendants

Vermont's Choices for Care program, administered under the state's Global Commitment to Health 1115 Medicaid waiver, funds personal care services for eligible individuals in all three needs groups:

• Highest Needs Group: Entitled to home-based services including PCA hours. No waitlist for this group.
• High Needs Group: PCA services available subject to state funding. Waitlist may apply.
• Moderate Needs Group: Limited personal care and homemaker services available. Must need assistance with at least one ADL or IADL at least three times per week. Waitlist is common.

The clinical assessment (conducted by DAIL or a designated agency) determines how many PCA hours per week your parent qualifies for, based on their functional limitations and the availability of informal family support.

The Agency with Choice Model: Hiring Your Own Attendant

Vermont uses an Agency with Choice (AwC) self-direction model that gives the enrolled individual (or their family) significant control over who provides their care. Under this model, your parent can:

• Recruit and select their own PCA, including friends, neighbors, or community members they already trust.
• Set the work schedule to match their routine and preferences.
• Direct the PCA's daily tasks based on what they actually need help with.

The fiscal agent (an Agency with Choice employer) handles payroll, tax withholding, workers' compensation, and background checks. Your parent or their authorized representative manages the day-to-day care relationship.

Can a Family Member Be the PCA?

Yes, with important limitations. Adult children, siblings, and other relatives (except in certain cases) can be hired as paid PCAs through the Agency with Choice model. However, Vermont imposes specific restrictions:

• Spouses are generally barred from being paid as PCAs for companion care or IADLs (meal prep, housekeeping, medication management) under the High and Highest Needs groups.
• Legal guardians face similar restrictions under the Moderate Needs program.
• The family member must pass a background check and meet any training requirements set by the fiscal agent.
• The pay rate is set by the program, not negotiated by the family. Rates are modest but provide real income for family members who have reduced their outside employment to provide care.

If you are an adult child providing care to a parent, the AwC model lets you receive compensation for work you may already be doing for free. This is not a loophole; it is an intentional design feature of Vermont's self-directed care system.

Why Documentation Matters for Medicaid

Every hour of paid PCA work must be documented and submitted to the fiscal agent. But there is a second reason documentation matters: if your parent ever applies for Choices for Care Medicaid and a family member has been providing care informally, the state will review the 60-month look-back period for any financial transfers between family members.

Payments to a family caregiver that are not documented as fair-market-value compensation for services rendered can be reclassified as gifts, triggering a Medicaid penalty period. A properly structured personal services contract, with a written description of care tasks, a schedule, and a rate consistent with local market rates, protects the family from this.

Getting Started

1. Contact your regional Area Agency on Aging to request a Choices for Care clinical assessment if your parent is not already enrolled.
2. If already enrolled, ask the case manager about adding or increasing PCA hours and enrolling in the Agency with Choice self-direction model.
3. If hiring a family member, establish a written personal services contract that documents the care tasks, hours, and rate before any payments begin.

The Hospital-to-Home Vermont guide includes a personal services contract template and a step-by-step walkthrough of the Agency with Choice enrollment process, plus guidance on structuring caregiver payments to survive a Medicaid look-back audit.

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