Personal Assistants on International Exchange Programs
This tip sheet explains the ins and outs of going abroad with a personal assistant.
The information presented here applies to many types of assistant services that maybe used during an international exchange program, including note-takers or a mobility guide who assists a person who is blind, to someone who provides intimate care services for a person with a mobility disability. We encourage exchange program staff and participants to think creatively about the options that will work best in their particular situation.
- What is a Personal Assistant (PA) or Personal Care Assistant/Attendant (PCA)?
- Do I need a Personal Assistant when I go abroad?
- What is the difference in approaches to providing disability-related accommodations and assisting people with disabilities?
- How do I know if it is "accessible" in the country where I am going?
- How can I find and hire a Personal Assistant?
- How will I pay for Personal Assistant services?
- How do I choose the right person, figure out costs, and make firm plans for him/her to be my assistant?
- What are some books and articles on working with Personal Assistants?
- What are some practical tips on traveling with a Personal Assistant?
- Will I need a personal assistant to fly with on an international flight?
- What are some companies that provide travel companions or can connect me with personal assistants?
PA/PCAs assist a person with a disability to do the things he or she would do for him or herself if they did not have a disability.
- Domestic tasks, such as housecleaning, cooking, laundry, and shopping, reading, or notetaking
- Personal care, such astransferring, skin care, positioning, bathing, range of motion exercises, dressing, grooming, toilet assistance, and bladder and bowel care
- Transportation, such as pushing a wheelchair, guiding someone, assisting with transitions and transfers
There are many unknowns for a person with a disability when they are preparing for an international exchange experience. How will I get from place to place? What if there are stairs? How will I take care of myself? How accessible is the city where I will be living? Will friends or host family members be available to assist me? When trying to decide how you will meet your needs, consider:
- Do you use Personal Assistant services at home? People who are already using these types of services at home through a professional or friend/family member may require the same or additional support while abroad.
- What is the environment like? People with disabilities consider the physical environment where they will be traveling. Are the buildings old? Are there a lot of stairs? Are the streets paved, cobblestone, gravel, or dirt? Are the curbs high? Is it noisy, or hyper-stimulating?
- Will you have the time and energy needed to do everything for yourself? International experiences are exhilarating, exciting, and exhausting! Many people with disabilities who manage all the activities of daily life at home find that with the changes in environment, schedules, and differences in approaches to disability issues, a personal assistant becomes necessary while living abroad.
- What will your living arrangements be?
- Host Family? Be careful not to make assumptions about what your host family will help you with. While cooking for you or assisting with laundry may not be a problem, it might be too much to ask that your family help with intimate personal care such as bathing and dressing.
- Dormitory? Often, students living in dorms have access to university cafeterias reducing the need to cook or clean up. In some countries, dorms also come with housekeeping and laundry services.
- Hotel? Though much more expensive, for some people with disabilities planning short-term programs, staying at a nearby hotel might offer close proximity to restaurants, housekeeping and laundry service (for a fee).
- Youth Hostel? While these accommodations are often very affordable, they also are group-oriented with shared sleeping, irregular schedules, and they are sometimes noisy.
Living on your own? If you choose a program where you will need to find your own housing, consider carefully your abilities, the environment, the location and the culture in which you will be living.
To help you decide whether to go abroad with a personal assistant:
- see the "Resources for International Personal Assistant Services" section below on referral providers
- Locate Disability Organizations Worldwide
- Go to Assessing the Disability-Related Needs of Exchange Participants
- Read success stories from people who use personal assistants
What are the approaches to providing disability-related accommodations assisting people with disabilities?
The approach to providing accommodations for people with disabilities varies according to culture, region and laws. Sometimes cultural differences may explain what may be perceived as hesitation, confusion, or inefficiency as you negotiate accommodations.
- Procedural approach
In the United States, the Procedural approach to providing accommodations is most common. According to the procedural approach the individual requesting the accommodation must meet a legal definition of disabled and the institution must work with the individual to provide equal access to programs. There is usually certain assessments, forms and agreements that are arranged in a way that follows policies for providing services and issuing grievances if the services are denied or do not meet with the standards.
- Personal approach
The Personal approach focuses on individuals who know each other arranging accommodations person-to-person either as a favor, personal request, or personal responsibility. Participants living in cultures where the personal approach is more common may feel that the process is slow or ineffective because they haven't asked the right person. In this approach, typically a professor, host family member, local staff person, or counselor takes on the role of arranging and finding accommodations for a person with a disability participating on an international exchange program.
- Community approach
The Community model focuses on a person's disability-related needs as a responsibility of the community. Generally, this responsibility is primarily the individual's friends or family to arrange and sometimes provide accommodations. A sibling or cousin may assist with transportation, note-taking during classes, or guiding a person who is blind around busy streets. For exchange participants living in countries where this model is most common, a host family member or other students may be expected to provide people with disabilities with assistance including laundry, shopping at markets and grooming.
These different models are each effective in providing accommodations and are associated with participants having successful experiences.
Return to Frequently Asked Questions
Just as there will be general cultural adjustments to be made, there will also be disability cultural adjustments must be made. In some countries the standard width of a wheelchair is narrower than U.S. standards, and non-folding wheelchairs and power chairs are extremely rare. Safety bars and shower chairs can also be uncommon. Read about disability laws in each country, talk to someone with a disability similar to yours, and consider geographic, climate and culture when thinking about how accessible the country is. Download Google Earth to help illustrate different aspects of a destination and look at satellite images to determine types of streets and conditions; it provides views of 3D buildings, imagery, and terrain.
Also, in some countries, assistive technology may be used more, while in others there may be more reliance on human resources. Disability organizations in the host country may have information on assistant services available for exchange participants.
Personal assistants can come form a wide variety of sources.
- Current or new Personal Assistant from home
The choice is easier if the personal assistant has traveled before and may already have a passport. Talk with the assistant about the pace of the activities abroad and find someone who is compatible with the schedule and level of adventure involved. The person also should be ready physically and mentally to play a more proactive role when encountering unexpected barriers abroad.
To avoid burnout on longer trips, consider arranging for a backup for the primary support person, if possible. This might be a friend or acquaintance in the destination country, a fellow traveler or a worker hired from a local agency. If that is not feasible, try occasionally to allow the assistant even a short time off during the day or if it can be managed, let the personal assistant have their own room sometimes.
- Personal Assistant in the destination
The program or exchange participant may be able to find an independent personal assistant to be hired in the host country through contacts with people with disabilities and disability or volunteer organizations in the host country. One advantage is saving on travel expenses, splitting the work between more people, and replacing an assistant more easily if the situation isn't working out. It also can give access to language and cultural experiences, but these differences should also be considered in determining if the services can be communicated and provided in a way that is preferred and effective.
Some exchange participants choose to bring along a family member to help them. Consider dynamics in a youth or young adult program and the role that the family member plays. Some individuals find that using a non-family member, even if for the first time, provides them personal growth and confidence in their abilities and feelings of independence.
- Friends/Other program participants
Sometimes the individual or the program has found a fellow participant willing to be trained in assisting. Another exchange participant may be willing to serve as a note-taker, or assist with transportation in mornings and evenings for either a stipend or work-study. This approach requires making sure that the participant receiving this assistance is comfortable with that arrangement, and that the participant assisting is aware the extent of his/her responsibilities.
While fellow participants in general often will offer each other support during the exchanges, it should not be assumed that there would be consistent assistance without a more formal agreement. Remember that in dealing with a group, accommodation is a two-way street. Just as the person needing assistance may expect other people in the group to make adjustments or even compromises in order to be included, likewise this person should expect to make adjustments, share responsibilities and consider other people's needs in addition to his or her own.
- Host Community
Experienced travelers have reported that assistance can come from the community at large when needed. People on the streets are often willing to assist when needed. One exchange participant who is blind found in his extensive travels throughout Latin America and other regions that people were very willing to assist him in navigating an unfamiliar city.
Since this is informal, it is important that participants with disabilities are comfortable asking for assistance when needed and being firm yet positive on how they want that assistance to be given. The need for a personal assistant may change depending on the country or the nature of the trip.
Such as local Lions, Rotary or Kiwanis Clubs in the home or host country.
State Vocational Rehabilitation Programs
If the trip will be of educational or vocational benefit, participants with funding from Vocational rehabilitation may be able to use it for personal assistant services. State policies vary so the participant should contact her or his local vocational rehabilitation office.
Social Security Funds
If the trip will be of educational or vocational benefit, a student may be able to use their current Social security funds to cover these costs. For more information see Social Security or Vocational Rehabilitation for Exchange webpage.
Perhaps the hosting or sending program could waive the costs of housing, transportation, food and/or admission prices for the assistant if arranged prior to the program. We suggest that programs begin building a reasonable accommodation fund into their budgets, so that when needs such as this arise, the resources are available. Personal attendant services are not required by the Americans with Disability Act, however some programs do offer an attendant to assist with program access due to architectural barriers or other obstacles that the participant with a disability would not encounter at home.
Participants who receive funding for a personal assistant through Medicaid or Medicare are not able to use that funding once outside the United States. Travel insurance companies will typically not pay for personal assistants for daily care overseas or durable medical equipment that wasn’t related to a first occurrence of an illness or injury overseas. Since these things are unlikely to be covered for people with existing needs, programs or institutions could work with a participant to cover the costs. For example, Council on International Educational Exchange has pooled funds for participants with disabilities who require broader services or accommodations, and works jointly with the student’s home institution to cost-share expenses to make coverage possible.
Some programs may want negotiate adding coverage for repair or rentals for existing durable medical equipment or personal assistants to group insurance policies. If an individual is duct-taping a crutch or wheelchair or relying on informal assistance for transfers, for example, this could lead to a potential injury to a back, a pressure sore, etc. and added cost for the insurer who now has an injury or illness to cover as a result of lost or faulty equipment or lack of usual personal assistance.
Work Study or Internship
Some participants have obtained need services through working with the exchange program or home university to work-study, internship or scholarship options for another student who will provide personal assistance during the exchange. Students and exchange programs might also want to consider working with university internship or Work Study programs to set up a position so students majoring in fields such as Nursing, Social Services, Physical Therapy, Rehabilitation, Counseling, Adaptive Recreation and others may have an opportunity get an international experience while gaining experience relevant to their future careers.
How do I choose the right person, figure out costs and make firm plans for him/her to be my assistant?
When discussing personal assistant needs, it is important for the participant to be clear about which tasks require assistance and how much assistance is needed. In addition, consider various adaptations to bathrooms, housing, transportation and other places of activity during the exchange that can facilitate independence and participation. Flexibility and creativity in searching for ways to provide assistance on international exchange programs will ensure a better chance of success. It is also important to take steps to define roles maintaining the safety and health of both the person needing assistance and the person or people providing assistance. Here's some sample forms to adapt and use:
- Worksheet for Pricing of Personal Assistant Services Rendered
Books and Articles on Selecting and Working with Personal Assistants
Saratoga Access Publications
PO Box 1427
Fort Collins, CO 80522-1427
Tel: (800) 266-5564 or (970) 484-5595
Fax: (970) 484-5531
- by Paralyzed Veterans of America (PVA). Available for free online.
PVA Distribution Center
PO Box 753
Waldorf, MD 20604-0753
Tel: (888) 860-7244 or (301) 932-7834
Fax: (301) 843-0159
By Debra L. Burdsall, MPH, OTR, funded by the National Institute on Disability and Rehabilitation Research U.S. Department of Education
- appeared in the June 1999 issue of New Mobility Magazine
- appeared in June 2000 issue of New Mobility Magazine and includes great tips on hiring.
- Begin planning several months in advance (at least) before you plan to go abroad.
- Identify the areas where personal assistance is required and how much assistance you will need.
- Think about any special training the personal assistant may need to learn with you before the program (i.e. bathroom assistance, transferring, dressing, medications, recognizing pressure sores, method of communication (especially if your disability affects speech), lifting a wheelchair up and down stairs, operating assistive technology, or etc.
- Make sure your attendant has time off. If you require someone to be with you 24 hours a day then you may need to consider having a second attendant available.
- Allow time for the two of you to get to know each other and get used to working together before going abroad. You may want to have the personal assistant start a few weeks before the program so you and they can get used to the routine and make any adjustments along the way.
- Be patient. These are intense experiences that can be very emotional.
- Set clear expectations in writing and verbally. Make sure you and the attendant are very clear on what is expected of each other. Many people find it helpful to draw up a contact stating the attendant’s duties, any rules for safety (i.e. no drinking, no drugs, any abuse emotional or physical of each other will void the contract, be on time, carry a cell phone, terms of payment, travel insurance that is required, etc.), agreed upon compensation for services, and time off. Regarding international travel, be clear about who and how you will pay for transportation costs, admission to sights or tours overseas, lodging, meals and the fees related to travel insurance, passports, visas, cell phones, etc. Also know each other's emergency contact person back home, just in case.
- Make sure Assistant Services take precedence over the need for a friend. It is very common for people using and providing attendant services to become friends, sometimes, even date. Unfortunately, this can lead to the person needing assistance not asking for or receiving the proper help. Some people with disabilities find that while overseas, it is very important to establish time for both a personal and professional relationship either by having clear ‘on-duty’ hours, or by using cues such as “this is work time” or “ I’m switching to my friend hat” to distinguish roles.
Aside from the above personal decisions, you also need to consider what the requirements are under the laws that relate to air travel. If you need assistance in flying that can be deemed medically-needed, then your personal assistant can fly free on Canadian airlines. This may only be for domestic flights within Canada. Beginning in 2009, Canadian airlines stop charging those with significant disabilities for extra seats they need, after a landmark decision by the Canadian Transportation Agency. The agency ruled that the country's major air carriers must offer a single fare to those with disabilities who require two seats to accommodate them. Under the “one-person, one-fare” policy, passengers don't have to pay extra for medical attendants that must be seated with them on flights. “The airlines failed to demonstrate to the agency that implementation of a one-person-one-fare policy will impose undue hardship on them,” the agency wrote in its. The agency specified that the ruling does not apply to those with disabilities who travel with a companion for non-medical reasons and those who are obese but not disabled as a result of it. This new ruling parallels other transportation policies in Canada. People with disabilities who travel by train, bus or ferry can bring an attendant with them at no extra cost.
If you do not need to travel with a personal assistant, other rulings protect passengers with disabilities from being required to bring one. A 2005 consent order against British Airways ruled in favor of travelers with mobility impairments who were not allowed on to their international flights from U.S. airports. British Airways was assessed $50,000 of which the majority went to retraining their employees. The analysis of the ruling says, "Merely asking whether the individual would be traveling with an attendant or whether he/she could walk without assistance is insufficient to determine whether an attendant is necessary for safety purposes." The U.S. Department of Transportation's regulations, which currently serve as guidelines for foreign carriers require, in pertinent part, that passengers with mobility related disabilities be able to travel without an attendant, unless they cannot "assist in their own evacuation." It goes on to say "Paraplegics have full use of their arms and hands and would under normal circumstances be able to assist in their own evacuation."
If someone is using the UK airline, British Airways, to fly to/from another country other than the United States, the rules may be different since this airline follows at least two regulatory regimes, the UK Code of Practice and the EU legislation entitled, "The Rights of Persons with Reduced Mobility when Traveling by Air". British Airways states that all regimes prohibit "discrimination" against disabled passengers. However, different from the U.S. Air Carrier's Access Act regulations, British Airways points out that the UK Code of Practice provides that UK carriers also consider such factors as whether the passenger can self-feed, self-medicate, go to the toilet or lift without assistance before they can travel without an assistant. Changes in 2006 by the European Parliament and Council of the European Union created new airline regulations protecting the rights of travelers with disabilities, so this UK definition may have changed since the 2005 US ruling.
In June 2012 the European Commissioner for Transport issued guidance on issues of unjustified refusals and Air Passengers' Rights. The guidelines clarify that medical certificates should, as a norm, not be required for those with a stable condition – for example blind people or those who use wheelchairs. The guidelines clarify that if a person with a disability is self-reliant, the norm is that the person should not be required to be accompanied, except where there are specific safety requirements of which the person should be advised.
, based in St. Paul, Minn., with a satellite office in Los Angeles, has private nurses as well as companions for travelers. Services are for air and motor vehicle travel. The company also provides unaccompanied minor services, Mahoney says. The day rate is $1,000, plus the ticket expense, or $5,000 for the week and extra expenses. The rate for a full-time nurse is $1,500 a day or $5,000 for the week. Details: (866) 582-2866 or .
, based in South Pasadena, has 10 travel aides, all with experience helping seniors and disabled people. It was started by a certified home health aide and nursing assistant. Services include escort by air and during the trip. The basic rate is $175 a day, plus other expenses, such as the airline ticket for the aide. Details: (323) 344-1444 or .
, a medical travel service based in Honolulu, has registered nurses who will accompany air travelers and short-distance car travelers. The company also can arrange ground transportation and medical equipment rental. The company works with about 50 critical-care registered nurses as they take a lot of elderly patients on airplanes. In operation since 1996, it charges a day rate of $575 for domestic trips, $625 overseas. Expenses, such as lodging and airfare, are extra. Details: (877) 521-1333 or .
To locate independent living centers, contact:
is a national resource center for independent living in the United States. A list of U.S. and Canadian independent living centers is available online for free or in print for a charge.
2323 Shepherd, Suite 1000Houston, TX 77019
Tel: (713) 520-0232
Fax: (713) 520-5785
TTY: (713) 520-5136
To locate disability organizations around the world, visit the NCDE searchable database online. This database is searchable by disability type, country and region.
Although efforts have been made to ensure accuracy, MIUSA/NCDE cannot be held liable for inaccuracy, misinterpretation or complaints arising from these listings. Mention of an organization, company, service or resource should not be construed as an endorsement by MIUSA/NCDE. Please advise NCDE of any inaccuracies you may find.