38-25 Attachment D - Program Standards.pdf

i

ATTACHMENT D – PROGRAM STANDARDS

NEW YORK STATE OFFICE FOR THE AGING

2 Empire State Plaza, Albany, NY 12223-1251

Kathy Hochul, Governor Greg Olsen, Acting Director

An Equal Opportunity Employer

DATE: April 2, 2025

TO: Area Agency on Aging (AAA) Directors, Caregiver Coordinators

SUBJECT: National Family Caregiver Support Program Standards

ACTION REQUESTED: Local AAA compliance with the Older Americans Act (OAA) National Family Caregiver Support Program (NFCSP – Title III-E) Standards effective April 1, 2025. Questions regarding compliance with specific standards should be directed to caregiver@aging.ny.gov.

RESPONSE DUE DATE: None.

PURPOSE: The purpose of this Program Instruction (PI) is to provide AAAs with revised NFCSP Program Standards.

BACKGROUND: The NFCSP was established in 2000 to provide funding to states for a range of supports that assist family and informal caregivers in caring for someone at home for as long as possible. The New York State Office for the Aging (NYSOFA) administers this program through the 59 local AAAs.

All AAAs accepting NFCSP funds from NYSOFA must establish and operate a caregiver support program that:

PROGRAM INSTRUCTION Number: 25-PI-01

Supersedes: 22-PI-15, 23-

PI-13, 24-PI-03

Expiration Date: N/A mailto:caregiver@aging.ny.gov ii

1) Meets the needs of the caregiver and enhances support given to the care receiver.

2) Helps the caregiver become a better advocate and more confident in assisting the care receiver with their needs.

3) Deters placement in a long-term care facility and promotes continuing care within the home and/or alternative community setting for older adults for as long as possible.

4) Provides support to older relatives who are caregivers of children and/or individuals with disabilities (this component is available but not required).

PROGRAMS AFFECTED: ☐ Title III-B ☐ Title III-C-I ☐ Title III-C-2

☐ Title III-D ☒ NFCSP (Title III-E) ☐ CSE ☐ WIN ☐ Energy

☐ EISEP ☐ NSIP ☐ Title V ☐ HIICAP ☐ LTCOP ☐ NY Connects

☐ Other:

CONTACT PERSON: Abbey Derepentigny

TELEPHONE: 518-472-2892

EMAIL: abbey.derepentigny@aging.ny.gov and caregiver@aging.ny.gov mailto:abbey.derepentigny@aging.ny.gov mailto:caregiver@aging.ny.gov iii

Table of Contents

I. INTRODUCTION

A. TITLE III-E OF THE OLDER AMERICANS ACT

B. LEVEL OF NEED

C. GOALS

D. CORE PRINCIPLES

II. IMPORTANT TERMS AND DEFINITIONS

A. ACTIVITIES OF DAILY LIVING (ADLS)

B. ALZHEIMER’S DISEASE

C. CAREGIVER ASSESSMENT

D. CAREGIVER-DIRECTED CARE

E. CHILD

F. DEMENTIA

G. EMERGENCY RESPITE

H. FAMILY CAREGIVER

I. INDIVIDUAL WITH A DISABILITY

J. OLDER ADULT

K. OLDER RELATIVE CAREGIVER

L. PROVIDER

M. RESPITE CARE SERVICES

N. RESPITE PROVIDER

O. RESPITE VOUCHER

P. VOLUNTEER

III. PROGRAM MANAGEMENT

A. GENERAL POLICY

B. MONITORING

C. INSURANCE

D. CONTRACTS WITH SERVICE PROVIDERS

E. ADMINISTRATION

F. QUALITY ASSURANCE

G. RECORDS RETENTION

H. BACKGROUND CHECKS

IV. PARTICIPANT ELIGIBILITY AND ASSESSMENTS

A. NFCSP SERVICES ELIGIBILITY

B. CAREGIVER ASSESSMENT

V. CAREGIVER SUPPORT, SERVICE, AND DELIVERY

A. NFCSP SERVICE DELIVERY

B. CAREGIVER-DIRECTED RESPITE SERVICES

C. EMERGENCY RESPITE

D. SERVICE AUTHORIZATIONS

E. COORDINATION WITH LTSS

F. USE OF VOLUNTEERS

G. ACCESSIBILITY, TARGETING, AND EQUAL ACCESS

VI. NFCSP REPORTING REQUIREMENTS

A. REQUIRED NYSOFA DATA

VII. ALLOWABLE FUNDING SOURCES

iv

A. NFCSP FUNDING STREAMS

VIII. PROGRAM INCOME

A. VOLUNTARY CONTRIBUTIONS

IX. MAXIMUM EXPENDITURES

A. ADMINISTRATION AND SUPPLEMENTAL SERVICES

X. MATCHING FUNDS

A. SERVICE EXPENDITURES AND ADMINISTRATIVE COSTS

I. INTRODUCTION

A. Title III-E of the Older Americans Act

1. In New York State, under Title III-E of the OAA, AAAs and any contractors designated by the AAA, accepting NFCSP funds from NYSOFA must establish and operate a caregiver support program that:

(a) Meets the needs of the caregiver and enhances support given to the care receiver.

(b) Helps the caregiver become a better advocate and more confident in assisting the care receiver with their needs.

(c) Deters placement in a long-term care facility and promotes continuing care within the home and/or alternative community setting for older adults for as long as possible.

(d) Provides support to older relatives that are caregivers of children and/or individuals with disabilities (this component is available but not required).

B. Level of Need

1. The AAA, or contractor designated by the AAA, must assess the level of need for caregiver support services in the planning and service area.

C. Goals

1. The AAA, or contractor designated by the AAA, must include the following goals in the NFSCP:

(a) Increasing awareness of and outreach to caregivers.

(b) Identifying and enhancing the knowledge and skills of caregivers through education.

(c) Empowering caregivers in fulfilling their role as a caregiver and most effectively help the care receiver remain in the least restrictive environment.

(d) Increasing caregiver access to community-based services by helping them navigate the service system and providing the information and support necessary for them to access services.

D. Core Principles

1. The AAA, or contractor designated by the AAA, shall incorporate the following core principles into the NFCSP:

(a) Caregiver-centered: Staff account for the strengths, preferences, needs, and values of the caregiver. This approach actively engages the caregiver in developing and implementing their caregiver support plan.

(b) Flexible: Caregivers needs will change over time. Staff should be aware of this when assessing caregivers and modifying their caregiver support plans. The services available for caregivers shall also be flexible to meet their unique needs.

(c) Culturally humble: Staff are respectful of cultural values when providing services and are committed to continued learning about the beliefs and values of others.

II. IMPORTANT TERMS AND DEFINITIONS

A. Activities of Daily Living (ADLs).

1. Activities of daily living are basic personal everyday activities including, but not limited to, tasks such as eating, toileting, grooming, dressing, bathing, and transferring.

B. Alzheimer’s Disease.

1. Alzheimer’s disease is a type of dementia that affects memory, thinking, and behavior. Symptoms eventually grow severe enough to interfere with daily tasks.

C. Caregiver Assessment.

1. Caregiver assessment is a defined process of gathering information to identify the specific needs, barriers to carrying out caregiving responsibilities, and existing supports of a family caregiver or older relative caregiver, as identified by the caregiver involved, to appropriately target recommendations for support services as described in section 373(b) of the OAA. The assessment shall be administered through direct contact with the caregiver, which may include contact through a home visit, the internet, telephone or teleconference, or in-person interaction.

D. Caregiver-Directed Care.

1. Caregiver-directed care is an approach to providing services under the OAA including programs, benefits, supports, and technology, intended to assist the caregiver and the care receiver, in which:

(a) Services (including the amount, duration, scope, provider, and location of such services) are planned, budgeted, and purchased under the direction and control of the caregiver.

(b) The caregiver is provided with information and assistance as necessary and appropriate to enable them to make informed decisions about available services.

(c) The needs, capabilities, and preferences of the caregiver with respect to such services, and their ability to direct and control the receipt of such services, are assessed by the AAA, or contractor designated by the AAA.

(d) Based on the assessment, the AAA, or contractor designated by the AAA, will complete the following with the caregiver and care receiver:

(i) Develop a caregiver support plan for the caregiver that specifies which services they are responsible for directing.

(ii) Define the role of family members (and others whose participation is sought by the caregiver) in providing services under the caregiver support plan.

(iii) Establish and implement a budget for these services.

(e) The AAA, or contractor designated by the AAA, provides oversight of the self-directed services that the caregiver is receiving, including steps to ensure the quality of services provided and the appropriate use of funds under the OAA.

E. Child.

1. A child is an individual who is not more than 18 years of age.

F. Dementia.

1. Dementia is a general term for loss of memory, language, problem-solving, and other thinking abilities that are severe enough to interfere with daily life.

Alzheimer's disease is the most common cause of dementia.

G. Emergency Respite.

1. Emergency respite is the placement of an in-home respite provider or the temporary placement of the care receiver outside of the home, to substitute for the primary caregiver in the event of an emergency to provide temporary relief from the stress and responsibilities associated with providing constant care.

H. Family Caregiver.

1. A family caregiver is an adult family member, or another individual, who is an informal provider of in-home and community care to an older individual; an adult family member, or another individual, who is an informal provider of in-home and community care to an individual of any age with Alzheimer’s disease or related disorder; or an older relative caregiver who is aged 55 or older providing support to a child under the age of 18 (not the parent) or an adult aged 18-59 with a disability (may be the parent). For the purpose of these standards, family caregiver does not include individuals whose primary relationship with the older adult is based on a financial or professional agreement.

I. Individual With a Disability.

1. An individual with a disability must be between ages 18-59.

J. Older Adult.

1. An older adult is a person aged 60 or older.

K. Older Relative Caregiver.

1. An older relative caregiver is a caregiver who is aged 55 or older, and lives with, is the informal provider of in-home and community care to, and is the primary caregiver for, a child and/or individual with a disability.

(a) In the case of a caregiver of a child:

(i) The older relative caregiver is the grandparent, step grandparent, or other relative (other than the parent) by blood, marriage, or adoption, of the child. They are the primary caregiver of the child because the biological or adoptive parents are unable or unwilling to serve as the primary caregivers of the child; and they have a legal relationship to the child, such as legal custody, adoption, or guardianship, or are raising the child informally.

(b) In the case of a caregiver of an individual with a disability:

(i) The older relative caregiver is the parent, grandparent, or other relative by blood, marriage, or adoption, of the individual with the disability.

L. Provider.

1. A provider is an organization or person providing services to individuals under a formal contractual or grant arrangement with NYSOFA, the AAA, or contractor designated by the AAA.

M. Respite Care Services.

1. Respite care services are services that offer temporary, substitute supports or living arrangements for care receivers to provide a brief period of relief or rest for caregivers.

N. Respite Provider.

1. A respite provider is an organization or person providing respite services to caregivers under a formal contractual or grant arrangement with the AAA, or contractor designated by the AAA.

O. Respite Voucher.

1. Respite voucher is a service delivery method that provides financial assistance to caregivers for the purchase of respite services (in-home, out-of-home [day], and out-of-home [overnight]).

P. Volunteer.

1. A volunteer is a person who performs a service without financial compensation for an individual or community organization.

NOTE: For additional caregiver related service definitions please refer to the most recent issuance of caregiver service definitions.

III. PROGRAM MANAGEMENT

A. General Policy.

1. The AAA, or contractor designated by the AAA, must comply with, and require its NFCSP providers to comply with all applicable local, state, and federal law, regulations, and issuances.

2. The AAA, or contractor designated by the AAA, must have written policies and procedures in place to ensure NFCSP services are compliant with the standards described in this PI. At minimum, policies and procedures must include:

(a) An organizational chart.

(b) Personnel policies.

(c) Job descriptions with specific qualifications (e.g., qualifying professional experience, skill sets, and relevant certifications).

(d) Orientation and training.

(e) Contributions.

(f) Program monitoring.

(g) Record keeping.

(h) Reporting.

(i) NFCSP participant eligibility.

(j) Service parameters (e.g., hourly or monetary caps) for respite care and supplemental services.

(k) Accessibility, equal access, and targeting policies (refer to the most recent issuance of NYSOFA’s Equal Access to Services and Targeting Policy PI).

(l) Safety, including preventive and emergency procedures (e.g., fire, weather, participant illness, and injury).

(m) NFCSP participant survey administration.

(n) Assessments.

(o) Provision of services to older relative caregivers, if applicable.

(p) Grievance procedure (refer to the most recent issuance of NYSOFA’s Title III Grievance Procedures PI).

(q) Termination of services.

(r) Parameters for administering an emergency respite program, if applicable.

3. The AAA, or contractor designated by the AAA, must have written policies and procedures for caregiver-directed respite service delivery, if applicable. At minimum, policies and procedures must include:

(a) Respite provider roles and responsibilities.

(b) Respite provider requirements (e.g., age, training requirements, relationship to participant, use of informal providers vs. agencies).

(c) Resources and methods for assisting caregivers with finding a respite provider if desired by the caregiver.

(d) Respite types being offered (e.g., in-home, out-of-home [day], out-of-home [overnight]).

(e) Payment mechanisms being used (e.g., fiscal intermediaries or respite vouchers).

(f) Respite voucher parameters, if applicable (e.g., timeframe, amount).

(g) Application process.

(h) Listing and description of program forms being used (e.g., Respite Provider Agreement, Hold Harmless Form, timesheets for respite providers).

(i) Program eligibility requirements.

(j) Process for determining eligibility and prioritization of awards.

(k) Referral process for applicants who are ineligible for services.

(l) Administrative functions and processes (e.g., record keeping, data tracking).

(m) Program evaluation and quality assurance methods and processes.

(n) Methods for advertising and public awareness.

B. Monitoring.

1. The AAA, or contractor designated by the AAA, must adopt written policies and procedures for the following:

(a) Monitoring all contracted and directly provided caregiver support services in accordance with NYSOFA’s monitoring requirements, including a review of caregiver support program specific requirements.

(b) Ensuring documentation of all monitoring and technical assistance activities.

2. Sample monitoring tools (Attachment 1) are included in this PI, and may be used by the AAA, or contractor designated by the AAA, for monitoring NFCSP providers.

C. Insurance.

1. The AAA, or contractor designated by the AAA, must require each NFCSP provider to maintain the following forms of insurance coverage when applicable and feasible:

(a) Facility insurance.

(b) Vehicle insurance.

(c) Workers’ compensation.

(d) Unemployment.

(e) Product liability.

(f) Personal liability, including volunteers.

(g) Bonding/commercial insurance policy covering losses from employee theft.

D. Contracts with Service Providers.

1. The AAA, or contractor designated by the AAA, will ensure that all contracts with NFCSP providers include:

(a) Contract terms that are consistent and compliant with all local, state, and federal laws, regulations, and issuances. Contracts must include NYSOFA’s standard assurances, and the program standards identified in this PI.

(b) Contract terms shall specifically delineate requirements for the following, as appropriate:

(i) Service locations.

(ii) Type(s) of services and units of service to be provided.

(iii) Proposed service costs.

(iv) Participant eligibility and target populations to be served.

(v) The respective authorities and responsibilities of the AAA, or contractor designated by the AAA (e.g., maintenance of facility, cancellation clause, hiring and training staff and volunteers).

(vi) Reporting.

(vii) Program monitoring and assessments.

(viii) Contribution policies and procedures.

(ix) Insurance.

(x) Licensing.

(xi) Staff and volunteer qualifications.

(xii) Caregiver support service requirements.

(xiii) Other applicable policies and procedures.

2. A provision that contractors designated by the AAA will allow for, and cooperate with, monitoring visits and audits conducted by the AAA and local, state, and federal officials.

3. Provisions requiring contractors designated by the AAA to:

(a) Engage in interagency coordination.

(b) Adopt one or more mechanisms for targeting individuals in greatest economic need and greatest social need.

(c) Have software for collecting and reporting all required data for caregivers served.

(d) Report and manage program income generated.

E. Administration.

1. The AAA, or contractor designated by the AAA, must:

(a) Designate a Caregiver Coordinator responsible for coordinating NFCSP services with the following skill sets:

(i) Knowledge, awareness, and understanding of the biological, psychological, and social aspects of aging; the impact of disabilities and illnesses on aging; caregiver and caregiving supports; respite care; interviewing principles; community resources; and eligibility requirements for public benefits.

(ii) Skills in establishing and maintaining interpersonal relationships, problem-solving, and advocacy.

(iii) The ability to communicate with individuals of different socio-economic backgrounds and cultures; conduct an effective interview; complete an assessment; arrange and negotiate service referrals; and work independently.

(b) Adopt and maintain written job descriptions for all paid and volunteer positions funded with NFCSP funds. Job descriptions must include scope of work, duties, responsibilities, and minimum entry-level standards for each position.

(c) Require the Caregiver Coordinator to participate in all trainings as required by NYSOFA.

(i) A minimum of 10 hours of training per year is required.

(ii) It is expected that the training be related to working with informal caregivers.

(iii) The AAA must maintain a central record of trainings attended by the Caregiver Coordinator.

(d) Provide staff and volunteers with:

(i) An orientation on agency policies and procedures, participant rights, community characteristics and resources.

(ii) Procedures for conducting the allowable activities under this program.

(iii) In-service training that relates to working with informal caregivers based on the need for professional growth and increasing knowledge, skills, and abilities.

(1) The Caregiver Coordinator shall extend any knowledge learned to all staff and volunteers of the program through in-service training.

F. Quality Assurance.

1. The AAA, or contractor designated by the AAA, must:

(a) Make consultation and supervision available to all staff and volunteers providing services under the NFCSP.

(b) Review participant case records at least annually to ensure compliance with the standards described in this document.

(c) Conduct regular and systematic analysis of the individuals served under the NFCSP.

(d) Assess the impact and quality of the NFCSP services using the NFCSP Quality Assurance Survey (Attachment 2), at least annually. The results of this analysis shall be used as a basis for planning and implementing changes in NFCSP goals, policies, procedures, and resources.

G. Records Retention.

1. The AAA, or contractor designated by the AAA, must require:

(a) Each NFCSP service provider to retain the following records for at least one year after the ending date of the program period:

(i) Caregiver assessments.

(ii) Caregiver education programs, surveys, and units of service.

(iii) Caregiver counseling files and units of service.

(iv) Participant surveys and evaluations.

(b) Each NFCSP service provider to retain the following records for at least six years after the ending date of the program period:

(i) Caregiver participant registration.

(ii) Contribution collection and deposit records.

(iii) All income and expense records.

(iv) Contract, budget, and payroll/timesheet documents.

(v) AAA monitoring reports of contracted NFCSP providers and directly provided caregiver support services.

(vi) Caregiver coordinator training record.

(vii) Participant, staff, and volunteer service records (e.g., sign-in sheets).

H. Background Checks.

1. The AAA, or contractor designated by the AAA, must:

(a) Screen all current and prospective respite care workers (paid and volunteer) using the New York State Division of Criminal Justice Services (DCJS) Sex Offender Registry, or other suitable alternative, prior to a paid or volunteer position being offered and training taking place. The AAA, or contractor designated by the AAA, are also encouraged to conduct criminal background checks on all respite care workers (paid and volunteer).

(b) Prohibit any individual listed on the Sex Offender Registry from providing direct respite care services under the NFCSP.

(c) Inform the caregiver of the option to require a prospective respite care worker to undergo a background check when respite care is delivered using a caregiver-directed service delivery model.

2. If the AAA, or contractor designated by the AAA, conducts a background check that is more comprehensive and includes a check of the DCJS Sex Offender Registry, the AAA, or contractor designated by the AAA, may continue to use its own background check process instead of following the procedure outlined in these standards.

3. If there is uncertainty about an individual’s status on the DCJS Sex Offender Registry, the AAA, or contractor designated by the AAA, must verify that the individual is not listed on the Sex Offender Registry before offering them a paid or volunteer position.

(a) The AAA, or contractor designated by the AAA, may conduct a background check by telephone on up to five prospective employees or volunteers by calling 518-457-5837 or 1-800-262-3257. The person calling on behalf of the AAA, or contractor designated by the AAA, will be asked to provide:

(i) Their name, address, and phone number.

(ii) The prospective employee’s or volunteer's full name.

(iii) One of the following: complete address, social security number, birth date, or driver’s license number of the prospective employee or volunteer.

IV. PARTICIPANT ELIGIBILITY AND ASSESSMENTS

A. NFCSP Services Eligibility.

1. According to the OAA, the following populations of caregivers are eligible for services under the NFCSP:

(a) Adult family members or other informal caregivers aged 18 and older providing care to an individual(s) aged 60 and older.

(b) Adult family members or other informal caregivers aged 18 and older, providing care to an individual(s) of any age with Alzheimer’s disease or related disorder. Related disorders include dementia, traumatic brain injury, mild cognitive impairment, and chronic traumatic encephalopathy.

(c) Older relatives (not the parents) aged 55 and older, living with, and providing care to a child(ren) under the age of 18.

(d) Older relatives (including the parents), aged 55 and older, living with, and providing care to, an adult(s) aged 18 to 59 with disabilities.

2. Caregivers must be assisting the care receiver with two or more ADLs/IADLs to be eligible for respite care under the NFCSP.

3. To provide respite care and supplemental services to family caregivers of adults aged 60 and older or individuals of any age with Alzheimer’s disease or related disorder, the individual for whom they are caring must be determined to be functionally impaired because the individual is unable to perform at least two ADLs without substantial assistance, including verbal reminding, physical cueing, or supervision; or due to a cognitive or other mental impairment, requires substantial supervision because the individual poses a serious health or safety hazard to themselves or others. Caregivers who meet the definition of older relative caregiver are eligible for all five service types.

B. Caregiver Assessment.

1. The AAA, or contractor designated by the AAA, must attempt to assess each caregiver who is referred to the NFCSP (using the prescribed caregiver assessment tool) to identify specific needs, barriers to carrying out caregiving responsibilities, and existing supports in place, as reported by the caregiver.

This assessment will help the AAA, or contractor designated by the AAA, provide appropriate recommendations for caregiver support services.

(a) Caregiver assessments must be conducted by an individual who is trained in case management, as required by NYSOFA. This individual must also meet the criteria outlined in Section III of this PI.

(b) A caregiver assessment, as prescribed by NYSOFA, and a caregiver support plan must be completed prior to initiating respite care services.

2. The purpose of the assessment is to document the needs of the caregiver in a holistic manner that results in a support plan for the caregiver.

3. As a result of the types of respite care services received, the care receiver may be required to complete certain assessments and/or paperwork.

4. A caregiver support plan is a person-centered approach to developing a plan of care for supporting the caregiver in consultation with the care receiver.

5. The caregiver support plan must include one or more of the following goals:

(a) Reduce caregiver stress.

(b) Improve my mental health.

(c) Improve my physical health.

(d) Feel better supported in my caregiving role.

(e) Make more time for myself.

(f) Practice self-care.

(g) Seek out support.

(h) Decrease social isolation.

(i) Improve overall financial well-being.

(j) Improve understanding of the disease process.

(k) Maintain care receiver safely in the home environment.

(l) Other.

6. The caregiver support plan shall include a desired outcome(s) and a plan to achieve the goal(s) and outcome(s). Desired outcomes for caregivers may include:

(a) Decreased levels of caregiver burden.

(b) Improved caregiver mental and physical health.

(c) Improved confidence in caregiving abilities.

(d) Increased knowledge of community resources.

7. There are additional supplemental tools that may be used with caregivers including the Loneliness Scale, Patient Health Questionnaire (PHQ-9), Nutrition Screen, Generalized Anxiety Disorder Screening Tool (GAD-7), and the CAGE substance abuse screening tool.

8. For open cases, reassessments shall be completed at six and 12 months, or when there is a significant change in the caregiver’s situation. Caregiver program staff shall conduct a brief check-in with the caregiver at three and nine months until the case is closed.

(a) A case note shall be completed when staff conduct the brief check-in at three and nine months.

(b) The objective of the reassessment is to review all criteria related to assessment findings so adjustments may be made to the caregiver support plan based on the caregiver’s most recent status and situation.

(c) The AAA, or contractor designated by the AAA, shall set the policy on how many attempts staff should make to contact the caregiver before closing the case.

(d) If a caregiver is on a waitlist for services, the staff shall make regular contact with the caregiver to determine a change in needs.

9. If the caregiver refuses to be assessed, information and assistance, caregiver counseling, caregiver support groups, caregiver training, and supplemental services may still be provided. However, the minimum required data for registered services (caregiver counseling, caregiver training, and supplemental services) must still be collected.

(a) For Supplemental Services_Nutrition services (such as home delivered meals or congregate meals) a short Nutrition Screen (Attachment 3) must be completed to account for any food allergies and/or dietary restrictions the caregiver and care receiver may have.

10. If the caregiver assessment identifies additional needs for the care receiver, a referral for an assessment of the care receiver for long-term services and supports (LTSS) may be made with the care receiver’s consent.

V. CAREGIVER SUPPORT, SERVICE, AND DELIVERY.

A. NFCSP Service Delivery.

1. The AAA, or contractor designated by the AAA, must make the following services available to eligible caregivers in accordance with section 373(b) of the OAA:

(a) Information to caregivers about available services.

(b) Assistance to caregivers in gaining access to the services, including information and assistance and case management.

(c) Individual caregiver counseling, organization of caregiver support groups, and/or caregiver training to assist the caregivers in the areas of health, nutrition, and financial literacy, and in making decisions and solving problems relating to their caregiving roles.

(d) Respite care (in-home, out-of-home [day], and/or out-of-home [overnight], including caregiver-directed respite care) to enable caregivers to be temporarily relieved from their caregiving responsibilities.

(i) If the caregiver is caring for more than one individual, the AAA may choose to offer additional respite care hours to the caregiver.

(e) Supplemental services on a limited basis to complement the care provided by caregivers.

(i) Not more than 30% of the total federal and nonfederal expenditures for the NFCSP may be used to provide supplemental services.

(ii) Service domains for supplemental services include:

(1) Assistive technology, durable equipment, emergency response systems.

(2) Consumable supplies.

(3) Home modifications and repairs.

(4) Legal and financial consultation.

(5) Homemaker, chore, and personal care services.

(6) Transportation.

(7) Nutrition services.

(8) Other.

2. The AAA, or contractor designated by the AAA, may exceed the cap on supplemental services (30% of total allocation) if there is an emergent need with approval by NYSOFA.

3. These services must be designed to work in conjunction with other state and community-based services to provide a coordinated set of supports to family and informal caregivers.

B. Caregiver-Directed Respite Services.

1. The AAA, or contractor designated by the AAA, accepting NFCSP funds from NYSOFA may offer caregiver-directed respite services under Title III-E of the OAA to provide respite care to benefit the caregiver.

2. The AAA, or contractor designated by the AAA, must choose to implement a payment mechanism for caregiver-directed respite services that is approved by NYSOFA. Payment mechanisms include, but are not limited to:

(a) Fiscal intermediaries.

(i) The AAA, or contractor designated by the AAA, may contract with a fiscal intermediary (FI) to perform the administrative functions of their caregiver-directed respite model. Administrative functions include processing payments or vouchers to the respite provider or caregiver.

(ii) The FI must ensure that respite workers comply with all New York

State Department of Health requirements.

(iii) The FI is responsible for training the caregiver and the respite worker on the following:

(1) The roles and responsibilities of the FI.

(2) The respective roles and responsibilities of the caregiver and the respite worker as they relate to the roles and responsibilities of the

FI.

a. At the request of the caregiver, additional training may be provided. If training is available, the case manager or FI, as determined by the AAA, or contractor designated by the AAA, will inform the caregiver of additional training available, and the respite worker, and the entity(ies) responsible for providing it.

(iv) The FI shall maintain a record for each caregiver receiving respite care served by the FI. That record shall be updated in a timely manner and contain at a minimum:

(1) The caregiver’s contact information.

(2) Current and past authorization for services during the FI’s tenure.

(3) Name and other pertinent information of the care receiver.

(4) Name(s) and contact information of the respite worker.

(5) A log of contacts between the FI and the case manager and between the FI and the caregiver that includes date of contact, who the contact was with, summary of contact, and follow up.

(6) Documentation of training provided by the FI to the caregiver.

(7) Copies of any caregiver specific reports request by the AAA, case manager, or caregiver.

(v) The FI shall maintain a current record for each respite worker that contains at minimum:

(1) Enrollment forms for a respite worker.

(2) Contact information.

(3) Documentation of meeting eligibility requirements to be a respite worker. A caregiver-directed respite worker must meet all of the following requirements:

a. Be at least 18 years of age.

b. Be a citizen of the United States or have the legal authority to work in the United States.

c. Have not been convicted of Medicaid or other benefits fraud or any form of abuse, neglect, or exploitation.

d. Cannot be the primary caregiver.

(4) Copies of any agreements signed by the respite worker.

(5) Required payroll and other benefits documents.

(6) Copy of time sheets or electronic time keeping records.

(7) Documentation of any training requests to the FI by the caregiver for the respite worker.

(8) A log of contacts between the FI and the respite worker that includes date, who the contact was with, summary of contact, and follow up.

(b) Respite vouchers.

(i) Respite vouchers may be used to award funds to caregivers. Typically, the caregiver is notified of their award for a certain dollar amount that they may use to redeem respite services during a specified time period.

(ii) For background check requirements, please refer to Section III of this

PI.

(iii) Policies and procedures must be established and shall comply with the standards defined in this PI.

(iv) The Attachment C process must be used when establishing, implementing, expanding, or modifying caregiver-directed respite services.

C. Emergency Respite.

1. The AAA, or contractor designated by the AAA, has the option of offering an emergency respite component. All eligibility requirements applicable to traditional services under the NFCSP apply to this service delivery model.

2. Policies and procedures must be established and shall comply with the standards and requirements defined this PI.

3. A caregiver assessment must be completed within five business days after the start of emergency respite service delivery.

D. Service Authorizations.

1. If the AAA, or contractor designated by the AAA, is authorizing caregiver services, they must send the caregiver’s information to the NFCSP provider.

The caregiver is responsible for providing the necessary information to the NFCSP provider.

2. A sample service authorization form has been developed for use by the AAA and contractors designated by the AAA (Attachment 4).

E. Coordination With LTSS.

1. If there is a documented need for additional respite care services beyond what is provided to the caregiver by home and community-based waiver programs, Medicaid, or the Expanded In-Home Services for the Elderly Program (EISEP), the program staff must obtain approval from their supervisor to authorize the respite and document the justification.

2. If the needs of the caregiver exceed what is offered under the NFCSP, the AAA, or contractor designated by the AAA, may refer the care receiver to LTSS such as EISEP.

3. Caregivers may access caregiver supports funded elsewhere (e.g., Alzheimer’s Disease Caregiver Support Initiative (ADCSI)) at different times of the calendar year if an assessment determines that the caregiver has exhausted supports where they were initially enrolled.

F. Use of Volunteers.

1. The AAA, or contractor designated by the AAA, shall make use of trained volunteers to expand the provision of available caregiver services.

(a) If possible, the AAA, or contractor designated by the AAA, shall coordinate with organizations that have experience in volunteer management, including volunteer placement and training, and the use of stipends. This includes organizations carrying out federal service programs administered by the Corporation for National and Community Service and the New York State Caregiving and Respite Coalition.

G. Accessibility, Targeting, and Equal Access.

1. The AAA, or contractor designated by the AAA, must ensure that NFCSP services are complaint with all local, state, and federal law, regulations, and issuances for accessibility, targeting, and equal access.

2. The AAA, or contractor designated by the AAA, must ensure barrier free access to services, including:

(a) Physical accessibility for individuals with disabilities.

(b) Language accessibility for individuals with limited English proficiency.

(i) At minimum, a telephonic interpretation service contract with a language interpretation services provider must be established and maintained.

(ii) The provision of other accessibility aids if needed, including a qualified sign language interpreter, auxiliary aids and services such as 711/NY Relay, TTY/TTD, large print materials, audio recordings, and Braille.

3. The AAA, or contractor designated by the AAA, must provide maximum service accessibility to caregivers in greatest economic need (meaning need resulting from an income level at or below the federal poverty level).

4. The AAA, or contractor designated by the AAA, must provide maximum service accessibility to caregivers in greatest social need (meaning need caused by noneconomic factors) including:

(a) Physical and mental disabilities.

(b) Language barriers.

(c) Cultural, social, or geographical isolation, including isolation due to racial or ethnic status; Native American identity; religious affiliation; sexual orientation, gender identity, or sex characteristics; HIV status; chronic conditions; housing instability, food insecurity, lack of access to reliable and clean water supply, lack of transportation, or utility assistance needs;

interpersonal safety concerns; rural location; or any other status that restricts the ability of an individual to perform normal or routine daily tasks or threatens the capacity of the individual to live independently.

(d) Other needs as further defined by the state and area plans based on local and individual factors.

5. To the maximum extent possible, the AAA, or contractor designated by the AAA, must make space available for supportive services, educational services, and recreational activities that protects the privacy of caregivers.

6. The AAA, or contractor designated by the AAA, must ensure caregivers are registered in accordance with NYSOFA’s reporting requirements.

7. The AAA, or the contractor designated by the AAA, must monitor caregivers to determine the need for additional caregiver support services and facilitates referrals when necessary.

8. The AAA, or the contractor designated by the AAA, must have processes for NFCSP providers (direct or contracted) to alert the AAA of conditions or circumstances that may endanger the caregiver, care receiver, other participants, workers, or volunteers.

VI. NFCSP REPORTING REQUIREMENTS.

A. Required Data Collection.

1. The AAA, or contractor designated by the AAA, must collect and report all required data for NFCSP services as required by NYSOFA reporting requirements (Attachment 5).

2. The AAA, or contractor designated by the AAA, must use NYSOFA’s most recently issued caregiver service definitions for reporting NFCSP services.

3. The AAA, or contractor designated by the AAA, must create a client profile for all caregivers in the Statewide Client Data System (SCDS).

4. The AAA, or contractor designated by the AAA, must collect and report all NFCSP services provided to the caregiver. For example, respite to a caregiver by the care receiver participating in Social Adult Day Services must be reported as out-of-home respite (day) for the caregiver (see Attachment 6 for a crosswalk of aging and caregiver services).

5. The AAA, or contractor designated by the AAA, must ensure expenditure reporting for caregiver services under the NFCSP is compliant with all local, state, and federal requirements.

6. The AAA, or contractor designated by the AAA, must collect and report data to measure NFCSP service outcomes as required by NYSOFA.

7. The AAA, or contractor designated by the AAA, must complete and submit the CAARS quarterly report for NFCSP services as required by NYSOFA.

8. The AAA, or contractor designated by the AAA, must complete, submit, and verify the data for all NFCSP services as required by NYSOFA.

NOTE: Refer to the SCDS for specific information on reporting accurately within the system.

VII. ALLOWABLE FUNDING SOURCES.

A. NFCSP Funding Streams.

1. The following funding sources may be used to provide caregiver services under the NFCSP:

(a) OAA Title III-E.

(i) A portion of Title III-E funds must be allocated to respite care and supplemental services, at the discretion of the AAA.

(b) Caregiver Resource Center.

(c) ADCSI.

(d) Unmet Need.

(e) Other sources as allowed by NYSOFA.

VIII. PROGRAM INCOME.

A. Voluntary Contributions.

1. In accordance with NYSOFA issuances related to program income, recipients of NFCSP services are provided with the opportunity to voluntarily contribute toward the cost of service. Any voluntary contribution will be referred to as program income and will be used for the sole purpose of expanding supports for caregivers in accordance with funding source requirements.

2. The AAA, or contractor designated by the AAA, must implement voluntary contribution policies and procedures consistent with NYSOFA’s most recent Program Income Policy.

IX. MAXIMUM EXPENDITURES.

A. Administration and Supplemental Services.

1. Not more than ten percent (10%) of allotted NFCSP funds (Title III-E) may be used for administration of the program.

2. Not more than thirty percent (30%) of the total federal and nonfederal expenditures for the NFCSP may be used to provide supplemental services.

X. MATCHING FUNDS

A. Service Expenditures and Administrative Costs.

1. The AAA will match twenty-five percent (25%) of total NFCSP (Title III-E) service expenditures.

2. The AAA will match twenty-five percent (25%) of total NFCSP (Title III-E) administrative costs.