CDS Participant


When I began my employment with Paraquad in 2004, the Consumer Directed Program (CDS), then called Personal Assistance Services, was a lot different than it is today.

For starters, in 2004, only Centers for Independent Living could have a contract with the state to provide CDS attendant services. There were 22 centers in Missouri, so there were only 22 CDS program vendors. There are currently more than 380 vendors who provide CDS in the state of Missouri — and 353 of them are in the St. Louis area. (Yes, 92 percent of CDS vendors in Missouri are in the city of St. Louis and St. Louis County.)

In 2005, legislation moved the CDS program from Vocational Rehabilitation under the Department of Elementary and Secondary Education to the newly organized Division of Senior and Disability Services under the Department of Health and Senior Services. Under this same legislation, the definition of vendor was changed to allow anyone with a Department of Health and Senior Services contract to administer CDS, not just CILS, which had been providing CDS since its inception in the mid-1980s.

With the high number of different vendors comes a variance in how a vendor works with a participant. And if I may be blunt, not every vendor conducts business at the high standard the participants in the CDS program deserve. Companies do things differently, and it is important to pick a CDS vendor that will help you be successful with the program.

(Let me digress: Choosing a vendor is not why I am writing this blog. Please see this blog I wrote last year if you want to know more about how to choose a good CDS vendor.)

Through these reflections of where we’ve been, it is important to highlight one very significant aspect that has remained the same about the CDS program: You are the employer, and you can still hire your own attendant.

Hiring an attendant of your choosing is what makes the CDS program unique from other home- and community-based programs, and it’s the main reason why people choose CDS in the first place. Let’s celebrate that.

In the spirit of celebrating the ability to choose your own attendant in the CDS program, here are five benefits of hiring your own personal care attendant:

  1. You can interview your personal care attendant candidate. About 40 percent of participants in Paraquad’s CDS program hire someone outside of their family. This could be a neighbor, friend or someone they didn’t know before. I recommend interviewing any attendant — family member or not. An interview is the standard way to get all of your questions answered before you hire someone.
  2. You have your way of doing things. A CDS vendor will help train you on how to be an employer, but the personal care training between you and your attendant is up to you. The CDS program recognizes that you are an expert in your personal care. So go ahead and tell your attendant exactly how you want things done. Isn’t that empowering?
  3. You want your bath when you want your bath; not when your attendant says it’s time for your bath. CDS is not only hiring an attendant of your choosing but also directing when your attendant completes the tasks. Think about it. Do you really do the same things every day in the same order?
  4. You are the employer. You determine when to hire — and fire — an attendant. Firing may seem like a negative component to CDS, but think about it in this way: Employers should expect the best out of their employees. Having the authority to fire an attendant means that you, as the employer, can determine if an attendant is maintaining the high standard of work that you deserve. If you want to implement a “one strike and you’re out” policy over being late or not showing up for work, you can. It’s up to you.
  5. You can hire a family member, excluding your spouse or significant other. About 60 percent of our participants on Paraquad’s CDS program hire a family member. Hiring a family member can be more convenient simply because you already know and trust them. In addition, you may feel more comfortable with them assisting you with your personal care tasks.

Paraquad has been providing self-directed personal care attendant services in St. Louis for 30 years. If you live in Missouri and need personal care attendant services, contact our Information and Referral Department. We offer private pay and Medicaid-funded self-directed personal care attendant programs.

Amy Cichacki is the Director of Consumer Directed Services (CDS). She can be reached at

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