How to Hire a Personal Assistant for Self-Directed Care

Entering a self-directed care program involves a profound psychological shift: you stop being a "patient" or "care recipient" and become an Employer of Record.

This is not just a title. When you choose to self-direct your Medicaid services, you assume the legal authority to recruit, hire, train, and fire your staff. While this grants you the power to build a team that truly understands your life, it also triggers strict federal and state labor liabilities.¹

Many families underestimate the rigorous paperwork required by the IRS and the Department of Homeland Security. This guide serves as your operational manual for hiring a Personal Assistant (PA) safely and legally, ensuring you don't face penalties for negligent hiring or tax non-compliance.

Key Takeaways

• You Are the Boss: In self-direction, you dictate the schedule, duties, and culture of care—not an agency.²
• Federal Compliance is Mandatory: You must verify every employee's identity via Form I-9 within 3 days of their first shift.³
• Background Checks: You must follow the Fair Credit Reporting Act (FCRA), obtaining written consent before running a background check.⁴
• Interviewing: Use situational questions to test reliability and emergency response, not just "soft skills."⁵
• Family Hires: Even when hiring a relative, you should execute a formal employment contract to establish professional boundaries.⁶

Phase 1: Needs Assessment & Job Design

Before you post a job ad, you must translate your "care plan" into a functional job description. A generic ad will attract generic applicants.

Be specific about the physical and technical demands:

• Lifting: "Must be able to lift 50 lbs" vs "Must be comfortable with Hoyer lifts."
• Medical: "Must be comfortable with G-tube feeding" or "Must assist with catheter care."⁶
• Schedule: Define firm hours vs. flexible hours.

Pro Tip: Your job description is your first filter. If you require a driver's license and a non-smoking vehicle, state it in the first paragraph.⁷

Phase 2: Sourcing Candidates

Where do you find reliable caregivers?

1. Word of Mouth: This is often the highest-quality channel. Ask your neighbors, church groups, or local disability advocacy organizations.⁸
2. Centers for Independent Living (CILs): Local CILs often maintain registries of PAs looking for work.¹
3. Niche Platforms: Websites like Care.com or specialist disability job boards can widen your net, but require more rigorous screening.⁵

Phase 3: The Interview Framework

Do not just chat. Conduct a structured behavioral interview to assess how the candidate handles stress and boundaries.⁹

Recommended Interview Questions

Instead of "Are you reliable?", ask:

• "Tell me about a time you had a medical emergency with a client. How did you react?"
• "If I refuse to take a medication that is on my schedule, what would you do?" (Tests respect for autonomy vs. safety).
• "How do you handle a situation where you are running 15 minutes late?"¹⁰

Red Flag Warning: If a candidate focuses entirely on the money or complains about previous clients during the interview, proceed with extreme caution.¹¹

Phase 4: Compliance & Background Checks

This is where many families unknowingly break the law. You cannot simply "Google" someone to see if they have a criminal record.

The FCRA Rule: Under the Fair Credit Reporting Act (FCRA), if you use a third-party company to run a background check, you must:

1. Provide a clear, standalone written disclosure to the candidate.
2. Obtain their written consent.⁴

Most Fiscal Intermediaries (FIs) handle the actual processing of criminal and abuse registry checks for you, but you must ensure the candidate completes the paperwork before they start working.¹²

Phase 5: Onboarding & The "Day 1" Paperwork

Once you've selected a candidate, strict federal clocks start ticking.

1. Form I-9 (Employment Eligibility) Federal law requires you to verify that your employee is authorized to work in the U.S.

• Section 1: Must be completed by the employee no later than Day 1 of work.
• Section 2: You (the employer) must physically examine their documents (e.g., Passport or Driver's License + Social Security Card) and sign the form within 3 business days.³

2. Form W-4 (Tax Withholding) Your employee must tell you (via the FI) how much federal tax to withhold from their paycheck.¹³

3. The Employment Agreement Even if hiring your cousin, sign a contract. It should explicitly state:

• Hourly wage.
• Pay schedule (e.g., bi-weekly).
• Call-out policy (e.g., "Must give 4 hours notice").
• Confidentiality rules.³

Compliance Timeline

Deadline	Form / Action	Responsibility
Pre-Hire	Background Check Consent (FCRA)	Employee must sign
Day 1	Form I-9 (Section 1)	Employee
Day 1	Form W-4	Employee
Day 3	Form I-9 (Section 2 Verification)	You (Employer)
Day 3	Direct Deposit Forms	Employee

Frequently Asked Questions (FAQ)

Suggested Interview Cheat Sheet

When you sit down with a candidate, keep these three core competencies in mind:

1. Reliability: "What is your backup plan if your car breaks down?"
2. Competency: "Walk me through how you would safely transfer someone from a wheelchair to a car."
3. Respect: "How do you handle constructive feedback from a designated representative?"

Conclusion

Hiring your own staff is the ultimate expression of the "Dignity of Risk." It allows you to invite people into your life who respect your humanity, rather than strangers sent by a scheduling algorithm.

By following the strict compliance checklist—specifically the I-9 and background check protocols—you protect your right to self-direct. Treat this process with the professional gravity of a CEO hiring a VP. After all, the position is "Vice President of Your Life."

Footnotes

1. MyCIL.org Guide. Explains the distinct differences between traditional agency care and the self-directed employer model. Reliability: Center for Independent Living. ↩ ↩² ↩³

2. Medicaid.gov Self-Directed Services. Defines the scope of "employer authority" and the participant's responsibility in recruiting, training, and firing. Reliability: Federal Agency. ↩ ↩²

3. USCIS Form I-9 Instructions. Mandates the federal verification of identity and employment authorization within three days of hire. Reliability: Federal Government. ↩ ↩² ↩³

4. Checkr / FCRA Guidelines. Details the legal prerequisites for conducting third-party background checks. Reliability: Industry Background Screening Standard. ↩ ↩²

5. Workstream Hiring Guide. Identifies critical soft skills and recommends digital onboarding checklists. Reliability: HR Platform. ↩ ↩²

6. RTCIL Consumer Guide. Outlines the core philosophy of conducting needs assessments and creating customized task checklists. Reliability: High (University Research Center). ↩ ↩²

7. Surewise Carers Insurance Guide. Highlights the necessity of written job descriptions and arranging contingency/backup care. Reliability: Insurance Provider. ↩ ↩²

8. ERI Wisconsin Guide. Recommends sourcing methods including social media and community hubs. Reliability: State Program Intermediary. ↩

9. LinkedIn Talent Solutions Guide. Reliability: HR Industry Leader. ↩

10. LinkedIn Talent Solutions Guide. Suggests specific behavioral interview questions aimed at assessing a candidate's ability to maintain client dignity. Reliability: HR Industry Leader. ↩

11. Elara Caregiver Guide. Suggests telephone screening techniques prior to in-person interviews. Reliability: Home Health Agency. ↩

12. Palco Employer Responsibilities Guide. Reliability: National FMS Provider. ↩ ↩²

13. Palco Employee Packet Example. Provides a comprehensive list of required forms (W-4, I-9, Direct Deposit, Pay Selection) managed by fiscal agents. Reliability: FMS Provider. ↩ ↩²