Only if the assessment finds you cannot manage part of the program yourself. It is not about whether you need physical help, it is about whether you can run the employer side: hiring, scheduling, approving time, handling problems. If the answer is no for any part of it, you must name a surrogate, and you have 30 days from the notice to do it.

Let those 30 days pass without naming somebody and MassHealth is notified, which can end your PCA services. That is the one deadline on this page worth writing on a calendar.

Who can be my surrogate?

Anyone you choose who can manage the program and knows your needs. Usually it is a family member, often an adult child, but it does not have to be a relative at all. There is no certification to get and no license required.

If you have nobody to ask, say that out loud rather than naming somebody who will not actually do it. There is a state funded supported living program for surrogacy, and your fiscal intermediary can refer you if you are eligible.

Does a surrogate have to run the whole program?

No, and this is the part most people get wrong. A surrogate can take on only the pieces you find difficult. You, your surrogate and your skills trainer write a service agreement that spells out exactly which parts belong to whom.

So if you can interview and direct your own attendants but the timesheet approvals and paperwork defeat you, that is what the agreement says. The agreement gets reviewed periodically and can be changed as your skills change, in either direction.

Can my surrogate also be paid as my PCA?

No. A surrogate cannot be hired as a PCA, and this trips up a lot of families where one daughter is doing everything. She can be your surrogate, or she can be your paid attendant, not both.

That is a decision worth making deliberately. If she is the one physically providing most of the care, it may be better for her to take the paid role and for somebody else in the family to be the surrogate. The others barred from being paid as a PCA are your spouse, the parent of a minor including an adoptive or foster parent, and any legally responsible relative.

Can my surrogate give the attendant their orientation?

Usually not on your behalf. The exceptions are a parent of a minor child, a legal guardian, or someone holding legal power of attorney. Outside those three, orientation stays with you even when a surrogate handles other parts of the program.

It is worth knowing which category your surrogate falls into before a new attendant starts, because finding out at the wrong moment delays somebody's first shift.

Is a surrogate the same as a guardian or a health care proxy?

No. A surrogate is a role inside this one program and it carries no authority over your money, your medical decisions or anything else. Naming one does not change your legal rights and does not require going to court. A guardianship or a power of attorney is a legal instrument that exists whether or not you are in the PCA program, and it is a much bigger step.

Those can overlap, since a guardian or someone with power of attorney can also serve as the surrogate, but one does not require the other.

What should I ask somebody before naming them?

• Can you approve time every pay period, on a deadline, without being chased.
• Will you be reachable when an attendant calls out at 6 in the morning.
• Are you willing to fire somebody if it comes to that. This is the duty people say yes to and then cannot do.
• Do you want to be paid for care instead, in which case we need a different surrogate.

What if my surrogate stops doing it?

Tell your PCM agency early rather than letting the timesheets pile up. A surrogate can be changed, and the service agreement is rewritten when they are. The program problem is not having the wrong surrogate, it is having one in name only while the approvals stop happening.

Who decides whether I need one?

The question is answered at the evaluation, in the same visit that counts up your hours, and it is revisited as your skills change. If you want to understand how that visit works before it happens, see how MassHealth decides how many PCA hours you get.

Care Remedy is a personal care management agency serving eastern and central Massachusetts from offices in Woburn, Brockton and Springfield. We do the intake, the evaluation, the skills training and the service agreement, and we can talk through who in your family should hold which role. Call 781-957-8076 or email pcm@careremedy.com.

Program requirements change. Confirm current rules with MassHealth, your PCM agency or your fiscal intermediary.