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FY15 Family Caregiver grant contractORIGINAL M. CAPE FEAR COUNCIL OF GOVERNMENTS AREA AGENCY ON AGING GRANT AGREEMENT FOR FAMILY CAREGIVER SUPPORT GRANTS July 1, 2014 - June 30, 2015 I. PARTIES TO THE CONTRACT This agreement is made and entered into this 281h day of July 2014 between the Cape Fear Council of Governments (1480 Harbour Drive, Wilmington, NC 28401), hereinafter referred to as the "Council of Governments," and New Hanover County Senior Resource Center (2222 South College Rd, Wilmington, NC 28403), hereinafter referred to as the "Grantee." EFFECTIVE PERIOD OF CONTRACT This contract shall be effective July 1, 2014 and shall terminate on June 30, 2015. GENERAL PROVISIONS Subject to the terms and conditions hereinafter set forth, the Council of Governments agrees to grant Family Caregiver Support Program funds per the NC Division of Aging and Adult Services authorized through the National Family Caregiver Support Act, (The Older Americans Act, as amended in 2000, Title III, Part E). This grant is intended to sustain the efforts of families and other informal caregivers of older adults by providing supportive services (as defined below) under the following Category 2 Access to Services, Category 3 Training, Counseling & Support Groups Category 4 Respite Care, or Category 5 Supplemental Services. The objective is to give caregivers relief and provide assistance in finding services allowing them to keep their older adult in the community for as long as possible and/or help support older adult relatives raising children 18 years of age or below. The services covered under the grant are intended for caregiver not receiving any other assistance. Category Services Grant Unit Cost Projected Projected (2, 3, 4 To be Amount If applicable Number of Units # to be or 5) provided If Applicable Served 3 (833) Support Groups $ 1,200 N/A n/a n/a 4 (842) In- home/non- medical $14,000 $17.00 823 27 Respite varies 4 (843) Adult Day Care $ 7,000 $50 /day 140 9 Day Health 5 (857) Incontinence Supplies $ 700 5 (859) Liquid Nutritional $ 100 Supplemental X23,000 Note: The Cape Fear Council of Governments Area Agency on Aging must approve any changes to the budget. 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 $1,200 to Category 3 (33) Support Groups to help with monthly caregiver support group meetings. They have 2 support groups to assist caregivers. 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 t. e. eating, dressing, bathing) impairments or individuals with Alzheimer's disease and related disorders with neurological and or anic brain s nction. No more than $1500.00 may be used per eligible client during grant period. The grantee has allocated $14,000 to Category 4 (842) In-Hoene Respite and $7,000 to Category 4 (843) Community Respite- Adult Day Care which will be used to temporarily provide some time off for caregivers. 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 current services that are being provided to care recipient by completing a comprehensive intake form) are completed and an appropriate care 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 $700 to Category 5 (857) Incontinence Supplies and $100 to Category 5 (859 Liquid Nutritional Supplements to help with the financial burden for caregivers purchases these supplies. These services are to provide temporary relief and will be a bridging mechanism until consistent services are available. The NC Division of Aging and Adult Services Home and Community Care Block Grant Service Standards will be used for provided services. The Family Caregiver Resource Specialist and other AAA staff will provide technical assistance for duration of the grant. The terms set forth in this agreement for payment are contingent upon availability of funding. The total payment under this contract shall not exceed $23,000. The North Carolina Division of Aging and Adult Services is providing the match for the Family Caregiver Support Program; therefore no local match is required. o 2 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 504 of the Rehabilitation Act of 1973, as amended (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/termination of funding. Grantees are required to participate in the ARMS user's fee. The fee shall apply to each of the categories as the reimbursements are requested through ARMS. It shall be based on the following formula: 4 of records reimbursement is _ X $.15 Maintenance cost per service record - Requested for each service The Service Code Chart for the Family Caregiver Support Program is as follows: Non -Unit Services Code Information Assistance 822 Care Management 823 Support Groups 833 Training/Education 835 In -home Res ite Care 842 Community Respite Adult Day Care 843 Institutional Respite 846 Medical Equipment and Assistive Technology 854 Home Modifications /Accessibili (grab bars, etc 855 Personal Emergency Response Systems 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: http://www.ncdhhs.goy/aging/arms/servicecodechart2Ol5.od f Compensation: Grantees must meet the reporting requirements of the NC Division of Aging and Adult Services and the Cape Fear Area Agency on Aging Family Caregiver Support Program. Payments will be made monthly upon request for reimbursement through ARMS by Grantee. Reimbursement forms will be due monthly to the Area Agency on Aging and must be received no later than the 71h of each month in order to be considered for payment at the end of that month. These forms should reflect the amount of funds requested through ARMS each month. Payment of funds will be based upon the Aging Resource Management System (ARMS) Provider Reimbursement Report (ZGA370 -12). The Cape Fear Council of Governments will forward payment of the approved budget expenditure at the end of each month. • Documentation of Expenses: Grantee shall maintain full and complete documentation of all expenses associated with performing the scope of work under this contract. Documentation in the form of time sheets or other verification (prior approval required) that services were rendered shall be kept in each client file. Grantee shall maintain all financial and program records for a period of three (3) years from the date of final payment under this agreement. Grantee shall maintain records on each caregiver served including: Family Caregiver In -take Form, Service Cost Sharing form (signed and dated) and Client/Patient Rights form (signed and dated). The grantee should include their individual .privacy /confidentiality form and a comprehensive intake on the care recipient (see page 2) in addition to above listed items. Data Reporting: Grant recipients will keep client information updated in ARMS so we can submit a bi- annual report that will capture required data on caregivers. ARMS will capture client information and report fund usage monthly. The NC Division of Aging and Adult Services and the Cape Fear Area Agency on Aging will provide training and technical assistance as needed. Grantees must allow for ``consumer contributions" (caregiver must be given opportunity to contribute to defray the cost of the service, but may not be denied service should he /she fail to or choose not to contribute). The NC Division of Aging and Adult Services Home and Community Care Block Grant Service Standards for Consumer Contributions will be followed. The Consumer Contributions Policy and Procedures can be found on the web at: http: / /www.ncdhhs.gov/ aging / manual/consumercontributions.12df VII. REALLOCATION OF GRANT FUNDS It is understood and agreed, that in the event that the Grantee's rate of progress on this contract is leading to underutilization of the funds allocated, and if the Grantee cannot demonstrate how funds will be fully utilized during the contract period, then, upon notice to the Grantee, the Council of Governments may decrease the total compensation to be paid hereunder in order to reallocate funds to other Grantees. Family Caregiver Support Grant expenditures will be reviewed after six months to ensure it is on target. if results find that utilization of funds is less than 50 %, the AAA reserves the right to reduce the original grant amount. This contract may be modified by written amendment at any time. It is understood and agreed that, in the event that the amount of funds received from the NC Division of Aging and Adult Services is reduced or increased from the amount(s) quoted, the Council of Governments may, in turn, decrease or increase the total compensation and reimbursement to be paid. Such changes, including any increase or decrease in the amount of the Grantee's compensation shall be incorporated in written amendments to this contract and signed by both parties. The County agrees to have an annual independent audit in accordance with North Carolina General Statutes, North Carolina Local Government Commission requirements, Division of Aging and Adult Services Program Audit Guide for Aging Services and Federal Office of Budget and Management (OMB) Circular A -133. Community service providers, as specified in paragraph one (1), who are not units of local government or otherwise subject to the audit and other reporting requirements of the Local Government Commission are subject to audit and fiscal reporting requirements, as stated in NC General Statute 143C -6 -22 and 23 and OMB Circular A- 133, where applicable. Applicable community service providers must send a copy of their year -end financial statements, and any required audit, to the Area Agency on Aging. Home and Community Care Block Grant providers are not required to submit Activities and Accomplishments Reports. For - profit corporations are not 4 subject to the requirements of OMB Circular A -133, but are subject to NC General Statute 143C -6 -22 and 23 and Yellow Book audit requirements, where applicable. Federal funds may not be used to pay for a Single or Yellow Book audit unless it is a federal requirement. State funds will not be used to pay for a Single or Yellow Book audit if the provider receives less than $500,000 in state funds. The Department of Health and Human Services will provide confirmation of federal and state expenditures at the close of the state fiscal year. Information on audit and fiscal reporting requirements can be found at htWs://www.ncgTants.gov/NCGrants/PubligReportsRegulations.isp. The following provides a summary of reporting requirements under NCGS 143C -6 -22 and 23 and OMB Circular A -133 based upon funding received and expended during the service provider's fiscal year. Annual Expenditures Report Required to AAA Allowable Cost for Reporting Less than $25,000 in Certification form and State NIA State or Federal funds Grants Compliance Re- porting <$25,000 (item # 11, Activities and Accomplishments does not have to be completed) OR Audited Financial Statements in Compliance with GAO /GAS (i.e. Yellow Book) Greater than $25,000 Certification form and Schedule of and less that $500,000 Grantee Receipts >$25,000 and in State or Federal Funds Schedule of Receipts and Expendi- tures OR Audited Financial Statements in Compliance with GAO /GAS (i.e. Yellow Book) $500,00+ in State funds Audited Financial Statement in and Federal pass through compliance with GAO /GAS (i.e. in an amount less than Yellow Book) $500,000 $500,000+ in State funds and $500,000+ in Federal pass through funds (i.e. at least $1,000,000) Less than $500,000 in State funds and $500,000+ in Federal pass through funds Audited Financial Statement in compliance with OMB Circular A -133 (i.e. Single Audit) Audited Financial Statement in compliance with OMB Circular A -133 (i.e. Single Audit) NIA May use State funds, but not Federal Funds May use State and Federal funds May use Federal funds, but not State funds. Representatives of the Council of Governments and the NC Division of Aging and Adult Services may at any reasonable times review and inspect the service activities and data collected pursuant to this Agreement. All reports and computations prepared by or for the Grantee shall be made available to authorized representatives of the Council of Governments, and the NC Division of Aging and Adult Services for inspection and review at any reasonable time in the Grantee's office. Approval and acceptance of such material shall not relieve the Grantee of its professional obligation to discover and correct, at its expense, any errors found in the work. To ensure adequate review and evaluation of the work and proper coordination among interested parties, the Council of Governments shall be kept full }' informed concerning the progress of work and services to be performed. Council of Governments staff will conduct on -site assessments and may also make unannounced visits for the purpose of evaluating the Grantee's work. 1, 1' HIN 1 W411 0 [IN W.V. IN WIWI 1 KALI I DIZ4 ISKJORWAI IV lop § 1 ' The Grantee shall comply with Title VI and VIII of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, and the Americans with Disabilities Act of 1990 (ADA) and all requirements imposed by Federal regulations, rules and guidelines issued pursuant to these Titles and the ADA for both personnel employed and clients served. XI. CONFLICT OF INTEREST The Grantee expressly states that presently they have no interest and shall not acquire any interest, direct or indirect, which would conflict in any manner or degree with the performance of services required to be performed under this contract. The Grantee shall not employ any person having such interest during the performance of this contract. The Grantee further agrees to notify the AAA in writing of any instance that might have the appearance of a conflict of interest. See Attachment A for signature. XII. CONFIDENTIALITY Any reports, recipient information, data, or other materials given to or prepared or assembled by the Grantee under this Agreement which the Council of Governments requests to be kept confidential shall not be made available to any individual or organization by the Grantee without prior written approval of the Council of Governments. Grantee shall indemnify and hold the Cape Fear Council of Governments, its agents and employees, harmless against any and all claims, demands, causes of action, or other liability, including attorney fees, on account of personal injuries or death or an account of property damages arising out of or relating to the work to be performed by the Grantee hereunder, resulting from the negligence of or the willful act of omission of the Grantee, its agents, employees, and subcontractors. XIV. ATTENDANCE AT REGION O AREA AGENCY ON AGING MEETINGS The Grantee, upon request of the AAA Administrator/Designee, will make efforts to attend any committee or special meeting relating to the project. The Grantee will attend any scheduled regional Family Caregiver Support Program meetings. If through any cause, the Grantee shall fail to fulfill in timely and proper manner its obligations under this Agreement or if the Grantee shall violate any of the covenant, agreements or stipulations of this Agreement, the Council of Governments shall thereupon have the right to terminate this Agreement by giving written notice to the Grantee of such termination and specifying the effective date thereof. The date of notice shall be at least fifteen (15) days before the effective date of such termination. The Grantee shall have the right to terminate this Agreement by giving the Council of Governments written notice of such termination at least fifteen (15) days prior to the effective date of the termination. In such event, all finished documents and other materials collected or produced under this Agreement shall, at the option of the Council of Governments, become its property. The Grantee shall be entitled to receive just and equitable compensation for any work satisfactorily performed under this Agreement. XVI. APPROVAL OF SUBCONRACTOR OR ASSIGNABILITY The grantee shall not assign all or any portion of its interests in this contract, nor shall any of the work or services to be performed under this contract by the Grantee be subcontracted, without the prior written approval of the Council of Governments. Any purchase of services with Family Caregiver Support Grant funding shall be carried out in accordance with the procurement and contracting policy of the community services provider or, where applicable, the Council of Governments, which does not conflict with Procurement and contracting requirements contained in 45 CFR 92.36. If services are subcontracted, the Grantee remains liable not withstanding such procedure. XVII. TAX EXEMPT STATUS If grantee has tax exempt status they must submit a copy of the tax exempt declaration letter with contract. 1. a"101 WO 0 DI DIN if I fly,"M 104 04 NO I OWN W-11KI I INN. In I of. MINI 0219�11 Executive Director I" 12 I This instrument has been preaudited in the manner required by the local government budget and fiscal control act. w1i AM - I New Hanover County Senior Resource Center Name of Organization L. 2 /,P//, I= Authorize Lead Agency Official Date Attachrren'- A 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 management employees, members of the board of directors or other governing X. appearance of impropriety. In order to avoid conflicts of interest or the appearance of impropriety, should instances arise where a conflict may be perceived, any individual who may benef Tw*-;wwjjt* &-)r,- .w� 426u from participating in any decisions or deliberation by the entity regarding the disbursement of funds. =M AkAl CA— CLI ki %N Name of Agency RISK FACTOR YES NO A. The family situation involves Adult Protective Services (APS). B. The care recipient has been diagnosed with Alzheimer's disease or related disorders with neurological and organic brain dysfunction C. The caregiver is older (60 +) with greatest social and economic need (with particular attention to low income individuals) caring for older (60 +) individuals with greatest social and economic need (low income minority, rural, and those with limited English proficiency) D. The healthcare needs of the caregiver require significant recovery time (surgery, acute illness or injury). E. A family event of significance requiring overnight or out of state travel (death, sickness, marriage, graduation, birth of grandchild, etc.) F. There are multiple care recipients with only one caregiver. G. A "sandwich caregiver" is providing support to a young child(ren) and an older adult care recipient(s). H. the family caregiver is isolated and has no other family member nearby, then you could reason that the care recipient is at risk for nursing home placement I. The care recipient needs assistance with the majority of ADL's. J. Grandparents or older individuals who are relative caregivers, provide care for children (18 and under) with severe disabilities. TOTAL AFFIRMATIVE RESPONSES (Risk Factors)