Family Caregiver FY13-14 grant contract revisionRevision 1
Ja , 2014
FAMILY CAREGIVER SUPPORT PROGRAM GRANT CONTRACT
FY 2013-2014 New Hanover County Senior Resource Center
The following page will replace page number 2 in your current contract. The amount, time
frame, criteria and all other information remain the same for the grant.
The following statement: (found on the 2nd page in the last paragraph of contract) "The NC
Division of Aging and Adult Services Home and Community Care Block Grant Service Standards
will be used far provided services. " has been removed from the contract. The New Hanover
County Senior Resources Center purchases the respite services for the Family Caregiver
Support Program Grant from any different licensed home care agencies.
CA PE FEA R CO U IL OF GO VERNMENYS.
Executive Director
Date
Area Agency on Aging Administrator Date
and fiscal control act.
Finance Officer Date
REAWW"
New Hanover County Senior Resource Center
Name of Organization
Co. 8 F- Re -s a-u-Ne a- -e r M nit ager-
September 13, 2013
Q&QMM='- TA
2222 S. College Road
Wilmington, NC 28401
ROM
M
Af�
Pleme find the enclosed oppy of your fiffly executed 2013-2014, Cape Fear Council of
Governments Area Agency on Agmg Family Caregiver Support Grant Contract. Please
1=
Serving Brunswick Columbus, New Hanover and Pender Counties
1480 Harbour Drive • Wilmington, NC 28401 • (910) 395-4553 * (800) 218-6675 • Fax: (910) 395-2684
www.capateareog.org
An Equal Opportunity /Affirmative Actlon/ADA Employer/Program
Category 5 Supplemental Services (Services intended as a one -time assistance to caregivers that
compliments the care they are providing. Examples include: purchasing incontinence supplies, home
modifications, home safety interventions) Migible caregivers must be caring for an older adult 60+
with at least two ADL (Activities of Daily Living i.e. eating, dressing, balling) impairments. No more
X500.00 may be used per e ° ' ie chent during graxt period
The Grantee has allocated. $1800 to help with I=n ' l'ies {857) and $500 for Liquid
Nutritional Supplements (859).
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TV. GRANT AMOUNT
The total payment under this contract shall not exceed $239000. The North Caro&&
Division of Aging and Adult Services is providing the match for the Family Caregiver
Support Program; therefore no local match is required.
V. DOCUMENTATION AND COMPENSATION
In order to qualify for funding, applicants must agree to comply with the following:
All required assurances (which state the organization must comply with Section 544 of
the Rehabilitation Act of 1973, as emended (29 U.S.C. 794), the Americans with
Disabilities Act of 1990, and the Department of Health and Human Services Regulation
under Title VI of the Civil Rights Act of 1964) must be signed prior to receipt of funding
under the FCSP.
Aging Resource Management System (ARMS) Requirements: All program performance
and financial reports must conform to the requirements of the Division of Aging and
Adult Services' automated Aging Resource Management System (ARMS). The Grantee
will be required to participate in the automated ARMS by supplying the necessary and
required input data. The Grantee will also be required to participate in appropriate
training workshops by the Division of Aging and Adult Services and or Area Agency on
Aging. Failure to comply with the reporting requirements may result in either
withholding of funds or possible suspension/tam . tion of funding. Grantees are
required to participate in the ARMS user's fee. 7!e fee shall apply to each of the
categories as the reimbursements are requested through the ARMS system. It shall be
based on the following formula:
## of records reimbursement is i X $15 Maintenance cost per service record -
Requested for each service
The Service Cade Chart fur the Family Caregiver Support Program Is as fallnws:
Non -Unit Services cla
Information/Assistance
822
Care Manaaement
823
Support Groups
833
Training/Education
835
In -home Res pro Care
842
Community Respite Adult RUPre
843
Institutional Respite
gob
Medical Equipment and Assistive Technology
854
Home Modification Acaessibli (grab bars etc
855
Personal Emergency Response S s
856
Incontinence Supplies
857
Liquid nutritional supplements ensure boost
859
The whole service code chart for the Aging Resource Management System (ARMS) is available
on -line at htW://www.dhhs.state.nc&M/Aging/aMlWvcode,2df
• Compensation: Grantees must meet the reporting requirements of the NC Division of
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It is expressly understood and agreed that the report procedures established by the Council of
Governments may include, but not be limited to, the names, addresses and social security
numbers of individuals receiving services under the terms of this contract, with the
understanding that no personal information obtained from any individual will be disclosed by the
Council of Governmepts in a form which allows identification of the individual, without the
written consent of the individual.
Audits ofnon-governmental entities, both for -profit and not for - profit; must meet requirements
of OMB Circular A -133. The audit is to be submitted within six months after end of the
Grantee's fiscal year. If the Grantee is a non - governmental entity, a copy of the audit report
should be sent to the Office of the State Auditor in compliance with General Statute 143.1. A
corrective action plan for any audit finding should be submitted with the audit report.
It is further understood that the Grantee is responsible to the Council of Governments for
clarifying any audit exceptions that may arise from an independent audit, the Department of
Human Resources audit, or any federally conducted audit, In addition, the Grantee is responsible
for repaying any federal and/or state funds that may be part of an audit exception.
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The Gmtw, upon request of the Administrator/Designee, will i efforts ' 1 s 1 attend i'
committee or 1e :' meeting relating to the project The Grantee will attend any scheduled
regional Family Caregiver Support Program meetings,
no : f'. shall have the *1 to terminate this Il / by giving the Council 4
•.. 1 1 '. 1 _ t IA 1. If ,... � R . : : 1 .:i ! • 4 1 + -:;.. 1 i :? - 4 11 '.
W61,12 7M : I4 • i�m rM : "!'. • 44 .1
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satisfiLdorily performed under this Agreement.
WT-1-my "'V ATOJAQV�WVV
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AND THE
ABOVE. HAVE EXECUTED THIS AGREEMIZW AS OF THE DATE MRST VVR17TEN
Executive Director
ffl`..1 I {i =-, I6! 1 I
e;° /e
This instrument has been preaudited in the manner required by the Yom government
budget and fiscal control act.
GIUNTEE.-
Date
New Hanover 1 l Senior Resource 1
1�7.. Lead Agency
1 / ! er
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Attachment A
CONFLICT OF INTEREST POLICY
In accordance with G.S. 143 -6.1 and related legislation, we, the undersigned entity, have
adopted the following policy regarding conflicts of interest:
The undersigned entity is aware that in the process of fund allocation by its
mgment, employees, members of the board of directors or other governing
body, instances may arise which have the appearance of a conflict of interest or
appearance of impropriety.
In order to avoid conflicts of interest or the appearance of impropriety, should
instances anise where a conflict may be perceived, any individual who may
benefit, directly or indirectly, from the entity's disbursement of funds shall abstain
from participating in any decisions or deliberation by the entity regarding the
disbursement of funds.
The undersigned entity recognizes the possibility that it may be the recipient of
funds which are allocated consistent with the purpose and goals of its programs.
If such allocations are made, the undersigned entity will strive to ensure that funds
are expended in such a manner that no individual will benefit, directly or
indirectly, from the expenditure of such funds in a manner inconsistent with its
pmt•
Sworn to and subscribed before me,
New Hanover County — Senior Resource Center
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11111111111111111111111111111111111111 11711 11��11111�11111
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Category 2 Assistance in Gaining Access to Services (individual, one on one contact to assist
caregivers in gaining access to services)
The Grantee did not allocate any funds to this category.
Category 3 Training, Counseling and Support Groups
The Grantee has allocated $1500 of funds to this category to help with monthly caregiver support
group meetings.
Category 4 Respite Services (Considered temporary, substitute supports or living arrangements
to provide a brief period of relief to caregivers on an intermittent, occasional or emergency basis)
*Eligible caregivers must be caring for an older adult 60+ with at least two ADL (Activities of
Daily Living i.e. eating, dressing, bathing) impairments or individuals with Alzheimer's disease
and related disorders with neurological and or anic brain dysfunction. No more than $1500.00
maybe used per eligible client during grant period
The grantee has allocated $5,200 for Adult Day Care/Day Health and $14,000 for in -home
respite to Category 4 Respite Care will be used to temporarily provide one of the following;
in -home aide, adult day care, adult day health, respite care stay in nursing homes or adult care
home, hospice and transportation to provide caregiver respite. These services will be provided
for functionally impaired individuals whose primary caregivers need relief from everyday
caregiving responsibilities in order for impaired individuals to remain at home for as long as
possible. The Grantee will give the caregivers as much choice and flexibility as possible by
offering temporary respite through in -home aide (medical and non - medical), adult day care /day
health, group respite, and institutional respite in a licensed adult care /nursing facility. Referral
for these services will be made after assessments (including reviewing currant sen ices that are
being provided to care recipient by completing a comprehensive intake form) are completed and
are appropriate case plan has been developed by the Grantee.
Category 5 Supplemental Services (Services intended as a one -time assistance to caregivers
that compliments the care they are providing. Examples include: purchasing incontinence
supplies, home modifications, home safety interventions) *Eligible caregivers must be caring for
an older adult 60+ with at least two ADL (Activities of Daily Living i.e. eating, dressing,
bathing) impairments. No more than $500.00 may be used per eligible client during grant
period.
The Grantee has allocated $1800 to help with Incontinence Supplies (857) and $500 for Liquid
Nutritional Supplements (859).
These services are to provide temporary relief and will be a bridging mechanism until consistent
services are available. The Family Caregiver Resource Specialist and other AAA staffwill
provide technical assistance for duration of the grant. The terms set forth in this agreement for
payment are contingent upon availability of funding.
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