Current through Register Vol. 49, No. 9, September, 2024
Section 310 Division of Aging and Adult
Services Policy and Procedures Manual
310.000
Arkansas Family Caregiver Support Program
Each Area Agency on Aging (AAA) shall establish vendor
agreements and/or contracts with community-based organizations to provide
multifaceted systems of support services, including counseling, support groups,
respite, and other home and community- based services to families caring for
their frail older members. The Arkansas Family Caregiver Support Program
(AFCSP) also recognizes the needs of grandparents, who are caregivers of
grandchildren, and to older persons, who are relative caregivers of children
age 18 and younger. An AAA may provide such services directly by
requesting a waiver from DAAS in accordance with DAAS Policy 201. The approval
of such waiver will be at DAAS's sole discretion.
310.010
Purpose
The purpose of this policy is to establish administrative and
service delivery standards for the Arkansas Family Caregiver Support
Program.
310.011
Scope
This policy applies to all AAAs and their subcontractors who
provide Family Caregiver Support Services.
310.012
General Authority
The authority for this Section is Sections 371, 372, 373, and
374 of the Older Americans Act of 1965, as amended [
P.L.
106-501], Grants for State and Community Programs
on Aging.
310.100
Definitions
Area Plan -AAA's plan of operation which has been
approved by the Division of Aging and Adult Service (DAAS).
Subcontractor - An entity that is awarded a
contract from an AAA to provide designated services under the Area Plan.
Elderly client - An eligible (60 years of age or
older) elderly individual who receives OAA services.
Child - An individual who is not more than 18
years of age or who is an individual with a disability.
Family Caregiver - An adult family member or
another individual, who is an informal provider of in-home and community care
to an older individual.
Informal Provider - Care is not provided as part
of a public or private formal service program.
Grandparent or Older Individual who is a Relative
Caregiver - A grandparent or step-grandparent of a child or a relative
of a child by blood, marriage, or adoption who is 55 years of age or older;
and
A. Lives with the child;
B. Is the primary caregiver of the child
because the biological or adoptive parents are unable or unwilling to serve as
the primary caregiver of the child; and
C. Has a legal relationship to the child,
such as legal custody or guardianship, or is raising the child informally.
310.200
Procedural Requirements
310.201
Responsibilities of the
Division of Aging and Adult Services
A. Designate a coordinator to implement and
oversee program development of AFCSP statewide;
B. Develop and maintain consistent standards
and mechanisms for AFCSP to be implemented statewide. These standards and
mechanisms shall be used to assure the quality of services provided in
accordance with OAA, Administration on Community Living regulations and
policies, and the U.S. Department of Health and Human Services policies and
rules;
C. Collect, maintain, and
report information pertaining to AFCSP to the Assistant Secretary for Aging of
the Department of Health and Human Services;
D. Provide technical assistance as needed;
and
E. Assume quality assurance
responsibilities for all caregiver programs to ensure compliance with
standards, policies, and procedures of DAAS and OAA.
310.202
Responsibilities of Area Agency
on AgingA. Assess the needs of
caregivers in the planned service area (PSA) to develop and submit an area plan
(or update) reflecting local needs to DAAS outlining the services to be
provided at least annually;
B.
Publicize AFCSP services to ensure that individuals throughout the PSA know
about the availability of the services;
C. Provide caregiver information and referral
as well as screen individuals for caregiver support services;
D. An assessment of need for each client
should be performed and maintained in a client file. An in-home assessment will
be completed on individuals whose screening indicates a need for respite or
supplemental services;
E. Arrange
for the provision of individually needed family caregiver services directly
and/or through local service providers;
F. Maintain current database of programs and
services, regardless of funding stream, which a person needing caregiver
support services can access;
G.
Organize new and coordinate with existing caregiver support groups;
H. Coordinate AFCSP with other programs and
service systems serving persons with disabilities;
I. Attend training planned by DAAS;
J. Ensure appropriate program/financial
reporting, billing, and budget reconciliation;
K. Negotiate contracts and provide quality
assurance program implementation;
L. Compile, maintain, and report waiting
lists of persons requesting caregiver services for which service is not
available;
M. Give priority for
services to older individuals with greatest social and economic need, with
particular attention to low-income older individuals, and older individuals
providing care and support to persons with mental retardation and related
developmental disabilities (as defined in 102 of the Developmental Disabilities
Assistance and Bill of Rights Act {
42 U.S.C.
6001 });
N. Give priority for services to family
caregivers who provide care for individuals with Alzheimer's disease and
related disorders with neurological and organic brain dysfunction, as well as
grandparents or older individuals who are relative caregivers of children with
severe disabilities;
O. AAAs are
strongly encouraged to seek the input of regional Alzheimer's chapter(s),
relevant and existing support groups, Cooperative Extension Service, and area
mental health and community-based organizations providing various forms of
assistance to family caregivers who provide informal in-home and community care
to older individuals and to grandparents raising grandchildren in maintaining
AFCSP in their region. Additionally, AAAs are encouraged to seek the input of
family caregivers providing care to older adults and grandparents raising
grandchildren on their service needs;
P. The area plan must include a service
budget for each category of service in the AAA's PSA;
Q. AAAs will establish and maintain an
adequate system for record keeping of persons served expenditures and waiting
lists by categories established by OAA and DAAS; and
R. An assessment of needs for each client
will be performed and maintained in a client file.
310.203
Responsibilities of Service
ProvidersA. Each provider shall adhere
to DAAS policies and procedures for programs on aging and shall provide
services in accordance with AFCSP's policies and procedures;
B. Each provider shall comply with all the
provisions of the service descriptions as established by AAAs and
DAAS;
C. Attend training provided
by DAAS or AAAs;
D. Each provider
shall maintain financial records in accordance with standard accounting
procedures and comply with all applicable State and Federal
regulations;
E. Each provider shall
maintain and submit program data and statistics as required by AAAs;
and
F. Forms utilized by providers
shall include all information required by AAAs and DAAS.
310.204
Eligibility for Caregiver
ServicesA. Family caregivers who are
adult family members or other individuals providing informal in-home and
community care to an older individual (60 years of age or older) who is "frail"
and determined to be functionally impaired because of:
1. An inability to perform at least two
activities of daily living without substantial human assistance, including
verbal reminding, physical cueing, or supervision; or
2. Due to cognitive or other mental
impairment, requires substantial supervision because the individual behaves in
a manner that poses a serious health or safety hazard to the individual or to
others.
B. In the case
of a family caregiver of an older individual, respite care and supplemental
services under AFCSP shall be provided only if the care recipient is
functionally impaired and meets either of the following conditions:
1. An inability to perform at least two
activities of daily living without substantial human assistance, including
verbal reminding, physical cueing, or supervision; or
2. Due to cognitive or other mental
impairment, requires substantial supervision because the individual behaves in
a manner that poses a serious health or safety hazard to the individual or to
others.
C. Services may
be provided by grandparents or older individuals who are a relative caregiver
of a child by blood, marriage, or adoption who is 55 years of age or older, and
who:
1. Lives with the child;
and
2. Is the primary
caregiver of the child because the biological or adoptive parents are unable or
unwilling to serve as the primary caregiver of the child;
and
3. Has a legal
relationship to the child, such as legal custody or guardianship, or is raising
the child informally.
310.205
Service Components of the
AFCSP
The five service categories for caregiver services are:
A.
Information provided to
caregivers about available services, including public education and provisions
of information at health fairs and other similar designations as determined by
the State. Included in the definition of information is
"outreach", defined as interventions for the purpose of
identifying potential caregivers and encouraging their use of existing services
and benefits. Services are directed to large audiences of current or potential
caregivers such as disseminating publications, conducting media campaigns, and
other similar activities.
B.
Access/Assistance given to caregivers in gaining access to
services by linking individuals to the opportunities and services available to
the maximum extent. The provider should ensure that the individual receives the
services needed and makes the opportunities available to the individuals by
establishing adequate follow-up procedures. Case management is
assistance either in the form of access or care coordination in circumstances
where the older person or their caregivers are experiencing diminished
functioning capacities, personal conditions, or other characteristics which
require the provision of services by formal service providers. Activities of
case management include assessing needs, developing care plans, authorizing
services, arranging services, coordinating the provision of services among
providers, follow-up and reassessment, as required.
C.
Counseling includes
individual counseling, organization of support groups and caregiver training to
assist caregivers in the areas of health, nutrition, financial literacy, and
making decisions, as well as, solving problems relating to their caregiver
roles.
D.
Respite Care
provides temporary, substitute supports or living arrangements to
provide a brief period of rest for caregivers. It can be in the form of
in-home, adult day care, or institutional respite. The respite period may be an
overnight stay or may be taken on an intermittent, occasional or emergency
basis by the hour. Respite care services may include the following activities:
1. In-home services, including services
provided by volunteers or in-home service providers;
2. Adult day care services; or
3. Institutional respite care.
4. For grandparents caring for children -
this could include summer camps.
E.
Supplemental Services are
provided on a limited basis, not to exceed 10% of the Title III-E Allocation,
to complement the care provided by caregivers. Supplemental Services includes
goods or services to assist the caregiver and/or the care recipient, as needed.
Examples include: blood pressure measuring instruments, insulin test kits,
dental work, eyeglasses (caregiver only),one time medications, homemaker,
chore, and personal care (Note: care recipient must not be Medicaid eligible).
Under the flexible AFCSP, these services or supports could be provided on a
limited basis for either the caregiver or care receiver.
Temporary - No more than seven consecutive days
nor more than fourteen days in a calendar year. A day is considered to be a
24-hour time period. A client can have 336 hours a year of respite services
(fourteen days) but not more than 168 hours of respite services for seven
consecutive days.
Limited Basis -Not more than once per week (or a
total of 8 hours per week)
310.200
Respite Care &
Supplemental Restriction
In order to be eligible for respite care and supplemental
services (i.e., personal assistance), family caregivers must be providing
in-home and community care to older individuals who meet the following
definition of "frail" as outlined in subparagraph (A) (i) or (B) of section 102
(28) of the Older Americans Act:
The term "frail" means that the older individual is
determined to be functionally impaired because the individual -
a.
Is unable to perform at least two
activities of daily living without substantial human assistance, including
verbal reminding physical cueing or supervision,
or
b.
Due to a cognitive or other mental impairment, requires substantial
supervision because the individual behaves in a manner that poses a serious
health or safety hazard to the individual or to another individual.
NOTE: This restriction does not
apply to grandparents or older individuals who are relative caregivers of
children not more than 18 years of age from receiving respite care and/or
supplemental services.
310.206
Funding Requirements
A. No AAA may use more than ten percent (10%)
of its award to provide Title III-E services to grandparents and older
individuals who are relative caregivers of minors.
B. No AAA may budget and/or expend more than
twenty percent (20%) of its federal award to provide supplemental services.
Supplemental services are flexible enhancements to caregiver support programs
designed for the benefit of caregivers.
C. No AAA may use more than ten percent (10%)
of its award for administrative costs.
D. AAAs are not allowed to transfer funds
between Title III-E and any other Titles under the OAA.
E. The current Intrastate Funding Formula
will be used to distribute Title III, Part E funds.
F. The intent of the Title III-E maintenance
of effort provision in Section 374 is that States and AAAs do not
use the funds available under Title III-E to supplement existing
services. Title III-E funds must be spent in addition to, and shall not
supplant, any Federal, State, or local funds expended by an AAA to fund
services described in these guidelines provided prior to the date of enactment
of Part E (effective November 12, 2000).
G. State Aging Services may be used to match
the Title III-E.
H.
All
OAA requirements, regarding program income, apply to Part E
services.
310.207
Reporting Requirements
AAAs and their providers must adhere to all OAA and DAAS
reporting policies and procedures. See Reporting Policy
208.
