Funds Provided by Older Americans Act Title III e
National Family Caregiver Support Program (NFCSP)Act as amended in 2006
and state appropriated funds
Case Assistance Service Award Application
Grant Period: July 1, 2014 - June 30, 2015
To be considered:
All applications must be received at Land of Sky Regional Council
by 5:00 pm –Tuesday June 18, 2013. The application must be typed. The
application may be e-mailed, mailed or faxed to the address below. E-mails
may be sent to carol@landofsky.org.
Land of Sky Regional Council
AREA AGENCY ON AGING
339 New Leicester Highway, Suite 140
Asheville, North Carolina 28806
Tel: (828) 251-6622
Fax: (828) 251-6353
The Land of Sky Regional Council Area Agency on Aging (LOSRC AAA) reserves the
right to request additional information and/or references; to accept or reject any or all
applications; to waive technicalities; to accept applications in whole or in part; to
determine the allocation amount and award a contract(s) which, in the opinion of the
grantor, best serves the older adults. This application will become a part of the award
contract. Awards granted as a result of this application are contingent upon the
LOSRC AAA receiving sufficient funds from the North Carolina Division of Aging and
Adult Services.
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Application for Caregiver Case Assistance Service Award
Agency Name
Agency Address:
Phone Number:
Fax Number:
e-mail:
web site:
Contact Person:
Name:
Phone number:
e-mail:
Person responsible for managing this contract ( if different than contact person)
Name:
Phone number
e-mail
County or counties to be served: (Please check all that apply)
Buncombe County ______________
Henderson County______________
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SECTION 1: Narrative of Proposal - Briefly answer the following questions. This narrative
should be no more than 2 pages.
1. How will you assess the caregiver’s needs.
2. What is your process for following up with caregivers to determine if their needs were met?
3. How will you document what you have done specifically for the caregiver?
4.If your agency receives Information and Assistance (I&A) funding, explain how this program
is different. (Family Caregiver Support Program funds should be used to supplement not
supplant existing services)
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5. Attach a 1 page care plan for the caregiver. This care plan must specify services or
activities that will enable the caregiver to perform effectively in their caregiver role and help
them recognize and address their own needs.
Agency Signature
______________________________________________________________
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Case Assistance is a consultation with the family caregiver to identify their needs and inform
them about community resources. The contractor will assist the caregiver in accessing these
services when necessary. Follow-up will be provided to conclude the service.
The contractor receiving these awards will complete a thorough caregiver assessment,
develop a care plan for the caregiver and follow up with the caregiver.
Contactor Responsibilities
1)
The contractor will inform caregivers about community services and resources
including information about the various respite options and providers.
2)
Contractor will ensure that the NC Division of Aging and Adult Services (DAAS) Client
Registration Form 101(CRF) is completed and signed by the caregiver at enrollment
and updated annually if carried over. The registration form must also be updated
whenever there is a change in status and entered into the Aging Resource
Management System (ARMS). Units are to be entered under services code 823
3)
Contractor will complete a thorough caregiver assessment, develop a caregiver care
plan and follow-up. A face-to-face assessment visit is recommended..
4)
Contractor will ensure that enrolled caregivers are informed about the consumer
contributions policy, their client rights and their right to confidentiality.
5)
Family Caregiver Support Program funds should be used to supplement not supplant
existing services. These funds should be reserved for families that do not receive other
federal or state assistance.
For Questions Contact:
Carol McLimans
Family Caregiver Support Program Specialist
Land of Sky Regional Council
339 New Leicester Hwy, Ste 140
Asheville, North Carolina 28806
(P) 828-251-6622
(F) 828-251-6353
carol@landofsky.org
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