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Personal Care Assistance

Care plan

Page posted: 11/04/13

Page reviewed:

Page updated:

Legal Authority

Minn. Stat. § 256B.0625 subd. 19(a), Minn. Stat. §256B.0659, Minn. Stat. §626.557 subd. 14(b)


Personal care assistance care plan: A written description identifying the PCA services to be delivered to the recipient based on the PCA Assessment and Service Plan (DHS-3244) (PDF).


The PCA care plan must be completed or updated:

  • • Within the first seven days of starting services with a PCA provider agency
  • • When there is a change in condition, tasks, procedure, living arrangements, responsible party or month to month plan
  • • Annually at the time of the reassessment
  • • The PCA care plan can only include services that are allowable as covered services and cannot include services identified as non-covered services.
  • A copy of the most current PCA care plan must be:

  • • In the recipient's home
  • • In the recipient's file at the PCA provider agency
  • • For shared services, at the location where the shared services are being delivered
  • Individual PCAs must know the location of the care plan.

    PCA Provider Agency Responsibilities

    PCA provider agencies, including PCA Choice agencies, must have a care plan template. The PCA care plan must contain the following required components:

    Demographic information

  • • Recipient/ name, address and telephone numbers
  • • Responsible party and delegate responsible party name, address and telephone numbers
  • • Start and end date of the care plan
  • • Dated signatures of recipient/responsible party and qualified professional (QP)
  • Description of individualized needs of the recipient, the services provided by the PCA, and special instructions or procedures. Covered services include:

  • • Assistance with activities of daily living (ADLs)
  • • Assistance with health-related tasks, including assistance with self-administered medications
  • • Observation and redirection of behaviors
  • • Instrumental activities of daily living (IADLs) (age 18 and older)
  • • IADLs needed for health and hygiene reasons integral to PCA services (age 0-17)
  • Emergency plan including:

  • • Emergency telephone numbers
  • • Emergency procedures for serious, unexpected, dangerous situations that require immediate action
  • • Description of measures to address identified safety and vulnerability issues
  • • Back up staffing plan
  • • The initial care plan development for recipients of traditional PCA services must include a face-to-face meeting with the recipient/responsible party and the QP at the location where PCA services will be delivered.
  • PCA Choice Recipient Responsibilities

    The PCA Choice recipient/responsible party is responsible to develop the care plan using the provider agency care plan template. Recipients can request assistance from their PCA Choice provider agency's QP.

    Additional Information

    Assistance with self-administered medication
    Flexible use of PCA services

    PCA Choice option

    PCA services

    Provider enrollment requirements

    Qualified professional services

    Shared service option for PCA

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