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FY16 Tiitle III D Evidence Based Health Promotion applicationGrant Document Routing Start date: 10/12/2015 From: Teresa Hewett, Finance Department (7408) Signatures required: Avril Pinder, Deputy County Manager Notary of Avril's signature Return to Teresa Hewett, Finance Department (7408) Type(s) of document(s) attached: 1 original — SRC Title RID Evidence Based Health Promotion grant application package Explanation of document(s): Attached is the SRC's grant application for a health promotion grant through the Cape Fear Council of Governments. This recurring grant was included in the FY16 adopted budget. The actual award is $6793 more than expected, so I will prepare a consent BA for the December agenda. The additional match needed of $755 will come from a SRC escrow account. Please let me know if you have any questions. 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VVe were awarded more EBHP funds than what isin the adopted budget. Please let me know if you have any questimns. Thank you. Amber Amber SmmNLh| Senior Rescurce Center Manager Senior Resource C-enter I New Hanover County 2322S. College Road VVi|nningLon, NC 28403 (9I0) 798-64I0 p 1 (9I0) 798-3492 f From: GimnyBhnson Sent: Thursday, September 03, 2015 2:16 PM To: Amanda Harrelson; Smith, Amber; Wes Davis; Fish Jim; YvetteGos||ne Cc:]ones2ama Subject: EBHP Funding Application Package 2015/16 fflost of you have already formulated your upcoming plans for utilization of Evidence Based Health Promotion funds for 2015/16. Allocations for each county are contained in the attached EBHP Pack The packet includes Application Requirements with a simple 5-step process to complete (with instructions on page 4). Please review the packet, complete the 5�stepi process and feel free to call me with any questions. I *'lease s,ubmi�t your completed proposal packet with original signatures to Cape Fear AAA Ify- _BHP reimbursement requests from ARMS cannot be honored until your completed application �ackage is returned, approved, and a contract is executed. Thank you, 1 Serv�ng Brunswick, Columbus, New Hanover & Pender Counties Email correspondence tm and from this address issubjec±to the NCPublic Records Law an6iaconsidered public information. Total Control Y^,o| Tx Rcinol,\,le this andofrom myoUnvlist From: 61 GO 2 11117-0 0 I-IMM-71M 1. Services will be provided in accordance with requirements set forth in: a. Cape Fear Area Agency on Aging Procedures Manual b. The North Carolina Division of Aging and Adult Services Policies and Procedures. c. The Older Americans Act of 1965. 2. Priority will be given to older persons with the greatest economic or social needs, with particular attention to low-income minority individuals. 3. All licenses, permits, bonds, and insurance necessary for carrying out services will be maintained by the Community Service Provider and any contracted providers. 4. Certification, State Grants compliance reporting. If the contractor is a governmental entity, such entity is subject to the provisions of the requirements of OMB Circular A -133 and the NC Single Audit Implementation Act of 1987. Non-government agencies must comply with GS 1430 -6-23 as outlined in the chart below. NON-PROFIT ONLY Required State Grants Reporting $1 -$24,999 $25,000 - $499,999 _�__$500,0.00 and more Certification Form Certification Form i Certification Form Brief accounting and program More detailed accounting Audit and activities and accomplishments (schedule of receipts and Schedule of Awards expenditures) usually included in audit) �jrij Due within six (6) months of Due within six (6) months of Due within nine (9) months of entity's fiscal year to Cape Fear entity's fiscal year to Cape Fear entity's fiscal year to Cape Fear and Office of the State Auditor N/A Separate program activities and Program activities and accomplishments accomplishments 5. Compliance with Equal Employment Opportunity requirements shall be followed. 6. The Community Service Provider will be monitored through on-site visits by the Area Agency on Aging to assure that services are being provided in compliance with the provisions of the contract. 7. The Community Service Provider will submit both monthly financial (ARMS) and quarterly program reports as required by the Area Agency on Aging and the NC DAAS. 8. The Community Service Provider assures that the required 10% match will be provided. 9. The Community Service Provider assures that all consumer contributions collected will be used to expand EBHP Services. 10. The Community Service Provider assures that all terms and conditions as required by the Older Americans Act of 1965, the North Carolina Division of Aging and Adult Services, and Cape Fear Area Agency on Aging will be adhered to. Mrit Signature 6,f C- ) , ),cPCc4,l CoLkA� 0�&Uay_f- CONFLICT OF INTEREST POLL 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 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 arise 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 programs. Name of Agency r L,4 "Chairman, Executive Director, or other AutlWrized Official fib, PuPJY NUAn l Sworn to and subscribed before me,Ge.� This the-144k day of OrJo oar 00 N tart' Pu lack MV ;fir My Commission expires: 0A1 16 b •tl ti'#f 4d u. L� YJfpfJS'jv� {9ijyk�➢. °� TITLE IIID EVIDENCE BASED HEALTH PROMOTION (EBHP) ■ A 0 0- -A .66 Matter of Balance Refer to NC Division of Aging and Adult Services Health Promotion Disease Prevention (111D) Service Standards located on the website littp�,//www'-)'.iicdhh,s..gov/'41 Ling" std/fijd,pidf I FUNDING NARRATIVE EVIDENCE BASED HEALTH PROMOTION (EBHP) GENERAL INFORMATION Statement of Philosophy and Purpose Title IIID of the Older Americans Act (OAA) was established in 1987. It provides grants for education and activities that support healthy lifestyles and behaviors for those 60 and older. In 2012, Congress mandated that Title IIID funding be used only for programs and activities that have been demonstrated to be evidence - based. Evidence -based Health Programs are those which have been developed, researched, and rigorously tested in order to yield consistent, desired results. They reduce the need for more costly medical interventions and enable older adults to live independently longer. Funding support is provided to states under Health Promotion and Disease Prevention Services (Title IIID), to empower older adults to take control of their health. Through these programs, seniors learn to maintain a healthy lifestyle through increased self - efficiency and self- management behaviors. Classes are provided to older adults in their own communities, in familiar non - clinical settings, such as community centers, and in peer learning groups which provide support, socialization and reinforcement of positive behavior changes.. Evidence -based disease prevention and health promotion programs have been an aging network priority in North Carolina for several years; and again this year, requirements demonstrate a commitment to these programs. In keeping with the directive to promote and implement Evidence Based Health Promotion (EBHP) Programs in our North Carolina aging network, the following funding will be distributed to Lead - agencies within Region O. Again, Title IIID Section 316 of the Older Americans Act, which pertains to Disease Prevention and Health Promotion mandates that funding must be used only on programs and activities that have been demonstrated to be evidenced - based and effective. FY 15/16 Health Promotion Disease Prevention FUNDING CHART County Health Promotion Funds HP match Grand Total' Brunswick 8243 916 9159 Columbus 4338 482 4820 New Hanover 8793 977 9770 Tender 3558 395 3953 Page 2 of 7 Mandated Evidence-Based Tiers The Administration for Community Living, (formally The U.S. Administration on Aging), uses graduated criteria known as "tiers" to define evidence-based interventions. Health promotion programs fall within one of three tiers; Minimum Criteria, Intermediate Criteria, and Highest- level criteria, See below for descriptions. MIRM1111101IM40=2 tagm-TON Delivery of Title HID Disease Prevention and Health Promotion Services are tranisitioning to emphasize evidenced-basied programs in the highest tier as determined by Administration for Commiunity Living. In keeping with this focus, in order to be a successful recipient of the Region 0, Evidence Based Health Promotion funds, an agency: must conduct at least one Highest-level Criteria Program (e.g. MOB, Geri-Fit, Arthritis Foundation Tia Chi). In order to assist in planning, implementing and tracking A Matter I of Balance classes, a summary of requirements is provided in A.tachfr?ent A Page 3 , of'7 MinimumCriteria Intermediate Criteria Hi:ghest-level Criteria. DESCRIPTION Demonstrates through evaluation to be Programs published in peer- Programs have undergone effective for improving the health & well- review journal AND are proven experimental design AND are being or reducing disease, disability &/or effective with older adult ready to be presented & injury among older adults AND are ready population, using some type of implemented at the for translation, implementation &/or control condition (for example community level broad dissemination by community- pre and post study) AND have based organizations using appropriate some basis in translation for credentialed practitioners implementation in the community EXAMPLES Programs related to the prevention & Dining with Diabetes A Matter of Balance (MOB) mitigation of the effects of chronic disease, including osteoporosis, Eat Better Move More Arthritis Foundation Tai Chi hypertension, obesity, diabetes, & cardiovascular disease Laughter Yoga Chronic Disease Self-Mgt. Program Most health screenings, when administered by an appropriately Diabetes Self-Management credentialed professional Program NC Senior Games providing funding is Fit and Strong used for events themselves (for example, equipment) & not for items such as tee Geri-Fit shirts & food Powerful Tools for Caregivers Walk with Ease Delivery of Title HID Disease Prevention and Health Promotion Services are tranisitioning to emphasize evidenced-basied programs in the highest tier as determined by Administration for Commiunity Living. In keeping with this focus, in order to be a successful recipient of the Region 0, Evidence Based Health Promotion funds, an agency: must conduct at least one Highest-level Criteria Program (e.g. MOB, Geri-Fit, Arthritis Foundation Tia Chi). In order to assist in planning, implementing and tracking A Matter I of Balance classes, a summary of requirements is provided in A.tachfr?ent A Page 3 , of'7 �as the option to conduct at least one Intermediate C�riteria program or minimum Criteria program, or utilize a portion of funds for NC Senior Games (Refer to Division of Aging and Adult Services (DAAS) Administrative Letter No. DAAS-1 2-05 (April 24, 2012) Titled JIID Reon for info egarding NC Senior Games Atfach'menl B'. MM 2. Consumer Contributions Requirement a) Describe how your agency will notify participants and solicit consumer contributions for participants of BHP. b) Provide a copy of your Agency Policy and Procedures governing the collection of voluntary contributions. ........ ..... 3. Sign the Standard Assurances — Atlachrrws'nt C M333�� WORTIOWIM M 0 Purchase of pill boxes, night lights, line-dancing, exercise videos or health fairs Title IIID funds can be used to support staff salary when they conduct training or attend meetings where they a sharing information about Evidence Based Programs Page 4 of'7 Reimbursement Methodology Agency will submit expense records, including invoices, purchase orders, employee/instructor time records, stipend, travel, etc to the AAA. Receipts will show allowable expenditures and request for reimbursement for non-unit services. Service Code 401 must be used to report Title IIJD activities in the DAAS Aging Resource Management System (ARMS) ffml,lffnft�� http://www,aoa,acl.qov/AoA Programs/HPW/Title 1110/ for background and definition of Evidence-Based Criteria, examples of Highest Level Criteria, frequently asked questions and more NC DAAS Health Promotion Disease Prevention Service Standards and corresponding Administrative Letter No. DAAS-14-05 — attached Q�.ttachrnents E'& F . . ....... .... . ...... Page 5 of 7 U) N C- U) m 0 1 � � W 0 cn L M i N E N o) (6 O C 0) C U Uj O 0 C (n cn 9 p) (cS U (� O '' Q� (g Ue i U Q + 4- i J m 6 n � O F n M O N O M E c (n U u> <n Q U c� cn cn .� U m Q u) G> O O tm L- > O m a co U-) 0 o cQ) Cs o m o c \. � ° \.> ° M > CL tL - o =3 Mm N (n =3 M U) V > p U CL - U) � co U) 0 .� ca ca 5 - (i (n � o .� ca 0 A v w c o .� m U c U � U (D Q- `o sn ry m C)f M >, > :1 M CO 0) O •g" O O O p 0 E wa m 3: m m a c� ctL c�—�m (cn -zs o O 9�:.= °o C L iii / 6 CL co co r- c 3 N W N U) O O O p U) .� N i QI O C O O ui ' ' U t5 v Fn n 0) O E U) ` O O N _ O N x ' ,,1t O (On F— v C` ++ W L o U '>. m o C3 m p CL O O ._, z m 0U 0 cn r ri- �a �r� Ink, 40490111114 The Senior Resource Center follows all Title U| and State guidelines for contribution from participants. The state cost sharing policy has been adopted as the guide for each service area. These guidelines include, but are not limited to: All participants are informed of the total cost of service during emroNrnemT into the program. Suggested contributions are established annually in each service area. Participants are asked to contribute toward cost of service based on their ability to pay. Service is not withheld because of inability tocontribute. See Appendix for copies of packet information. See Appendix B "Recommended Consumer ContributionSchedu|e"w/hi[hiSbasedonUSpovertyGuide|inesforadditloma|retonnrnemdations. Each Congregate nutritio,n participant is provided with an envelope at the time meal is received. Contributions are collected and deposited daily, Home Delivered Meal participants are provided with an envelope on Mondays and envelopes are picked up on each day of the week. All monies /checks are deposited daily. Transportation contributions are received via mail and/or direct from client. Mo�nies are collected h» the Transportation Coordinator and given to Finance for daily deposit. Case Management contributions are received via mail and/or given to Case Manager. Monies/checks are given bo Finance for daily deposit. Evidence Based Health Promotion (EBHP) contributions are received by mail and/or given to class instructor. Monies/checks are given to Finance for daily deposit. All contributions are viewed as confidential. Signs are placed in the Senior Resource Center stating., the Senior Center welcomes contributions to enhance the activity programs. The Grants Coordinator and NHC Budget Office monitor the collection of program income. Annual monitoring is conducted nn all services. 2. CONSUMER CONTRIBUTIONS: The Senior Resource Center has adopted the NC Division of Aging policy on cost sharing as the policy and procedure for collection of contributions for all service areas. Materiels describing the suggested cost for each service are provided during enrollment into the program. These information processes include: * Signage in nutrition site, Social Worker offices, EBHP classroom, and Support Group Sessions 10/12/2015 Sharepoint-tearn site-shared documents-NK SRC General Service Standards • Letters to hnnn2 delivered meals clients • Letter Ln medical transportation clients • Annual cost sharing presentation in nutrition site • Cost sharing explanation at time of enrollment and bi-annual reassessments The Senior Resource Center maintains records of all costs related to the collection of contributions. All client records are viewed as the property of the Senior Resource Center and are confidential. Each client is asked to sign a release of information form when enrolled into Senior Resource Center Programs. This release allows Senior Resource Center staff to share information that is critical to the well-being 0f the client with appropriate agencies. The Senior Resource Center has signed agreements Df understanding with these agencies. Information may also be shared with other employees ofthe agency for the purpose of making referrals and for reporting purposes, with the service provider, Area Agency on Aging and the NC Division of Aging. Client records are stored in a secure place and are available to service provider and authorized staff. All information is held for five (5) years and then destroyed. Client isinformed that contents may be released for definite purpose, client may withhold consent for release, and there are statutes and regulations protecting the confidentiality of the information in his/her files. Client may alter the release form to contain other information which would restrict usage of the information, such as specifying the date or specific purpose of the releases. The client is informed as to how information is to be released, with whom the information will be shared and that all data will not be used without client's consent. Clients may have access to view their own information within a period of five days from date of request. An authorized staff person must be present during the viewing. Record of client's review of his/her file is maintained and included as part of client confidential file. Any correction of information (as related to client contest)shaU become a part of the client file. The Senior Resource Center has the right to withhold information from a client. The client will be informed that information is being withheld. A record of the choice to withhold information will be documented in the client file. A client may contest the accuracy, completeness, Qr relevancy Of the information in his/her files. A correction of the contested information, but not a deletion of the original information if it is required to support receipt of state or federal financial participation, shall be inserted in the file when the director o/ his/her designee concurs that such correction isjustified. All automated files are located in the Client-X computer program, ServTracker, and the State Division of Aging ARMS (Automated Resource Management System) program. All programs are password and firevxaU|proteCted. 4. Training of staff, senior aides, and volunteers is documented in personal and training files. • Area Agency om Aging Workshops • Aging Conference • Safety • Staff Development 10/12/2015 Sharepoint-tearn site-shared documents-NHC SRC General Service Standards w Service Excellence 5. All persons 60+ and their spouses are eligible to participate in the Senior Resource Center Programs. Target groups will be elderly, at risk of institutionalization, and/or referral for protective services, and those with the greatest socio-economic needs. Special eligibility /sseHCCBGrnanma0 Salaried SRC staff are discouraged from participation in grant funded programs to extend funds tO those with greatest need (i.e. Congregate Nutrition) Handled on aCase-hy'caSebasis. 6. INFORMATION, REFERRAL AND CASE ASSISTANCE: Information, Referral, and Case Assistance is a part of each of the service areas and is conducted by all staff within his/her program. For persons contacting the Senior Center via telephone or walk-in, the following plan isutilized: A. Questions pertaining to the activities/classes /general of the Senior Center (recreational and social events) are transferred tn the SRC Ambassadors Desk orto the Senior Center Activities Program Manager or his assistant. B. Questions, other than above, are referred t8 the Case Worker and handled in the following manner: Simple question requiring nnassessment * Provide requested information (pamphlet, etc.) w No follow-up required Questions requiring assessment • Assessment is conducted via telephone, office interview, or home visit • Referrals are arranged • Fo�||nvv-up conducted toassure resolution • Documented imServTnscker The Senior Resource Center Case Worker maintains a comprehensive file on community /referral agencies. This information includes names of contact persons, telephone numbers, and addresses of each agency. Information is made available to elderly persons, their families, and other staff members. The Senior Resource Center has developed a firm working relationship with the community and i6 committed to simplification of service entry for all seniors. This iS accomplished by sharing information and complete understanding and knowledge of commu!nity resources. 11�� Monthly reports and other pertinent data, programmatic reports, financial history, support, and statistical data are maintained on file by the department for five (5) years. Current and past years are maintained in the Administrative Office of the 5R[, or Secured in B locked out-building on-site. 8. UNITS OFSERVICE: A clear definition ofa unit of service is based ontype of service rendered and available for explanation on request. 10/12/2015 Sharepoint-tearn site-shared documents-NHC SRC General Service Standards Coordination is on-going with local community agencies as well as providers in Region {}. Letters from local churches describes transportation linkages. Monthly meetings with in-home service providers, medical organizations, and other contractors offer opportunity to share and expand ideas, thus increasing effectiveness of services toseniors. 10. The Senior Resource Center follows |icensure and safety requirements of New Hanover County policies Linkage established with the fire & health departments meet all Area Agency on Aging requirements. Fire drills and inspections are monitored Onan annual basis. II. GRIEVANCE PROCEDURE: Denial Procedure is: • Informal complaint t0service provider, discussion and resolution being the goal. • Written statement of complaint to service provider. • Formal response from the service provider. • Written statement of complaint to Co�unty Commissioners. 12. TRAVEL: Out mf state travel must 6eapproved b» the: 1\ Department Head, 2) County Commissioners, 3)Area Agency on Aging. Only one staff member may attend out of state meeting. Participants are encouraged to participate |n suggestions pertaining to policies and procedures. Informal site councils are organized when need is obvious to address issues within the immediate site. The day to day fiscal operations are conducted by the Financial Specialist staff in the Senior Resource Center. These include preparation of purchase orders, payment vouchers, deposits of contributions, data entry into ARMS (Aging Resource Management System), and general bookkeeping responsibilities. The Grants Coordinator, located ln the county finance office, is responsible for the monitoring ofgrants and the preparation of all fiscal reports related to the grants. All contributions for Nutrition Programs, Transportation, Case Assistance, EBHP classes, a:nd Senior Center are received by the Senior Resource Center Financial Specialist/Bookkeeper. Deposits are made daily. Contributions are collected from the nutrition site boxes hy the Financial Specialist and one other staff member, All monies are counted and deposits made in accordance to the guidelines established by the NHC Finance Department. 15. POLICY OF REIMBURSEMENT: Staff reimbursement may be requested for mileage at the current State rate. This request will be submitted with record of odometer supported mileage with the staff time sheet. Volunteer reimbursements are made monthly for volunteer drivers in the home delivered meal program. Written request and odometer readings are required. 16. LIABILITY INSURANCE: 10/12/2015 5hnrepoint-temm site-shared documents'NHC SRC General Service Standards Insurance is in compliance with New Hanover County policies. Liability and accident insurance covers volunteers with the department. 17. FISCAL RECORDS: Fiscal records are maintained by the County Finance Office. Bookkeeping records are maintained within the department. 18. DENIAL POLICY: Clients are denied service for the following reasons: • Ineligible (under 6O years ofage) • Inappropriate behavior • Lack of loca|/federa|/stctemonies to operate the programs • Does not meet eligibility U.e.nothnnnebomndf0rHDK4,resideooutsideNHC\ Priority is given to those clients 60+in the following order: * Adult Protective Services Referral • At risk ofinstitutionalization. Referral to DSS for abuse is suspected. • Most needy economically 20. UNEXPLAINED ABSENCE POLICY Client receives and signs a letter upon registration explaining this policy. In the event client is absent from their home when the meal isdelivered: • a staff member will contact the client or emergency contact person t0 ensure client's safety • on second occurrence of absence without notification, meal service will be suspended until the absences are resolved. • Three or more unexplained absences will result in termination of service • Clients are notified by mail of service termination date and reason for termination 2%. TERMINATION POLICY: Clients may be terminated for the following reasons: • Under age 6D • Lack ofboca|/Statp/Federa| funds to operate program • Undesirable behavior • K4edica|/Hea|1hreasons • Services no longer needed • a staff member will contact the client or emergency contact person to notify of termination • Clients are notified by mail Bf service termination date and reason for termination 22. EMERGENCY POLICY: if an incident occurs in the Senior Resource Center, Nutrition site, or County Van, the following procedure isfollowed: ° If the emergency incident invo,lves the health of the client, the Senior Resource Center staff is instructed to: (a) Call 911 (b) Stay with client until help arrives 10/12/2015 Sharepoint-tearn site-shared docurnents-NI-IC SRC General Service Standards (c) Notify client's emergency contact and inform ofincident /d\ Client is to be evaluated by EMS and MAY accept/decline transport to the hospital If client's emergency is related to food, housing, utilities, medication, client is referred to a Social Worker Case Worker. Case Worker will make appropriate referral to resolve emergency issue. In case of inclement weather/other emergency situation, the Senior Resource Center follows the Disaster Plan as developed by the NHC Emergency Management Department. Clients are contacted by the NFIC Special Needs Telephone Response Team and referred to the Special Needs Task Force if additional assistance [sneeded. Once the weather/emergency event is over, the Senior Center staff makes contact with all participants to confirm re-estebUshrmrmtof services. 23. SAFETY PROCEDURE * Regular inspection by the Fire and Health Department are conducted and reports retained by the Department Director • Written EXIT p�lans are clearly di |aved inside the Senior [enter in case of fire or emergency. • First Aid Kit/cart is located in the Case Worker's Office. • Safety Training manual is on First Aid Cad • "Call 911 —then notify Center Staff member" signs are posted by each telephone • All staff and volunteers that may be handling food reed and sign the State "Senior Nutrition Program Employee Health Policy Agreement" (see Attached\. Signed form i5 maintained in individual record. 24. POLICY REGARDING RETENTION OF RECORDS All records of current and previous year are maintained in the SRC office, records 2-5 years prior are stored in exterior locked storage building. After five years, Department Director is notified and records are destroyed. Senior Nutrition Program Employee Health Policy Agreement Reporting: Symptoms ofIllness I agree tnreport to the manager when |have: 1. Diarrhea and/or vomiting Z. Jaundice (yellowing of the skin and/or eyes) 3. Sore throat with fever 4. infected cuts or wounds, ur lesions containing pusonthehand,whst,onexposedbodypart(suchaoboibandinfected wounds, however smnnU). Reporting: Diagnosed Illnesses | agree to report tnthe manager when | have: I. Nomvi/us 2. Salmonella Typhi (typhoid fever) 3. 5higellaspp.infection 4. E. oo|i infection (EnchericMiv co|i 0157:H7 or other EHE[/STECinfection) 5. Hepatitis Note: The manager must report k/ the Health Department when nn employee has one oƒ these illnesses. Reporting: Exposure ofIllness | agree to report to the manager when | have been exposed to any ofthe illnesses listed above through: 1. Am outbreak ofNvrovirus' typhoid fever, Shi#eUa infection, E co|i infection, or Hepatitis A. 2. A household member with Morovims'typhoid fever' ShigeUa sop. infection, E. cu|i infection, or Hepatitis A. 3. AhousehoAd member attending orworking ina setting with m* outbreak ufNmrov|m4 typhoid fever, ShigeUaspp. infection, E. coli infection, or Hepatitis A. Exclusion and Restriction from Work if you have any of the symptoms or illnesses listed above, you may be excluded* or/os ricted**fnomwork. *If you are excluded from work you are not allowed to come towork. **If you are restricted from work you are allowed to come to work, but your duties may be limited. Returning toWork if you are excluded from work for having diarrhea and/or vomiting, you will not be able to return to work until more than 24 hours have passed since your last symptoms of diarrhea and/or vomiting. [f you are excluded from work for exhibiting symptoms ofu sore throat with fever or for having jaundice (yellowing ofthe skin and/or eyes), Nuruvirue` Sulnoomc]{a1-yphii ((yp�o�� f�vor)" ��c|la a�p. �nf��on, E. cnUi infection, and/or Hepatitis A. you may cc\urm to work after receiving 24 hours of antibiotic therapy: negative for Strep or determined by health professional without Strep. Agreement | understand that | must: l. Report when I have or have been exposed to any of the symptoms or illnesses listed above; and 2. Comply with work restrictions and/or exclusions that are given tmme, I understand that if I do not comply with this agreement, it may put my job at risk. Food Employee Name (please print) Signature of Employee Manager Name (please print) Signature mf Manager ______ MM Date 10/12/2015Shaepoim-team site-shared documents-NHCSRC General Service Standards These are some of the Bacterium and Viruses spread from Food Handlers to Food E. Col'i Overview: A bacterium that can produce a deadly toxin and causes an estimated 70,000 cases of foodborne illnesses each year in the U.S. Sources: Meat, especially undercooked or raw hamburger, produce and raw milk. Incubation period: 2-10 days Symptoms: Severe diarrhea, cramping, dehydration Prevention: Cook implicated food to 155F, wash hands properly and frequently, correctly wash rinse and sanitize food contact surfaces. Shigella Overview: Shigella is a bacterium that causes an estimated 450,000 cases of diarrhea illnesses each year. Poor hygiene causes Shigella to be easily passed from person to person. Sources: Salad, milk, and dairy products, and unclean water. Incubation period: 1 -7 days Symptoms: Diarrhea, stomach cramps, fever, chills and dehydration Prevention: Wash hands properly and frequently, especially after using the restroom, wash vegetables thoroughly. Salmonella Overview: Salmonella is a bacterium responsible for millions of cases of foodborne illnesses a year. Elderly, infants and individuals with impaired immune systems are at risk to severe illness and death can occur if the person is not treated promptly with antibiotics. Sources: raw and undercooked eggs, undercooked poultry and meat, dairy products, seafood. fruits and vegetables Incubation period: 5 -72 hours (up to 16 days has been documented for low doses) Symptoms: Nausea, vomiting, cramps, and fever Prevention: Cook all food to proper temperatures, chill food rapidly, and eliminate sources of cross contamination (i,e, proper meat storage, proper wash, rinse, and sanitize procedure) Hepatitis A Overview Hepatitis A is a liver disease caused by the Hepatitis A virus. Hepatitis A can affect anyone. In the United States, Hepatitis A can occur in situations ranging from isolated cases of disease to widespread epidemics. Incubation period: 15 -50 days Symptoms: Jaundice, nausea, diarrhea, fever, fatigue, loss of appetite, cramps Prevention: Wash hands properly and frequently, especially after using the restroom. Norovirus Overview: This virus is the leading cause of diarrhea in the United States. Any food can be contaminated with norovirus if handled by someone who is infected with the virus. This virus is highly infectious. Incubation period: 6 -48 hours Symptoms: Nausea, vomiting, diarrhea, and cramps Prevention: Wash hands properly and frequently, especially after using the restroom: obtain food from a reputable food source: and wash vegetables thoroughly. Staph (Staphylococcus aureus) Overview: Staph food poisoning is a gastrointestinal illness. It is caused by eating foods contaminated with toxins produced by Staphylococcus aureus. Staph can be found on the skin, in the mouth, throat, and nose of many employees. The hands of employees can be contaminated by touching their nose, infected cuts or other body parts. Staph produces toxins that are extremely heat stable and are not inactivated by normal reheating temperatures. It is important that food contamination be minimized. Incubation period: Staph toxins are fast acting, sometimes causing illness in as little as 30 minutes after eating contaminated foods, but symptoms usually develop within one to six hours. Sources: Ready -to -eat foods touched by bare hands. Foods at highest risk of producing toxins are those that are made by hand and require no cooking. Symptoms: Patients typically experience several of the following: nausea, vomiting, stomach cramps, and diarrhea. The illness lasts one day to three days. In a small minority of patients the illness may be more severe. Prevention: No bare hand contact with ready -to -eat foods. Wash hands properly. Do not prepare food if you have a nose or eye infection. Do not prepare or serve food for others if you have wounds or skin infections on your hands or wrists. If food is to be stored longer than two hours, keep hot foods hot (over 135 °F) and cold foods cold (41 °F or under). Properly cool all foods. Reference: NC Food Code Manual, Employee Health. 2 -201. September 2012 10/12/2015 5harepoint -team site - shared documents -NHC SRC General Service Standards Senior Nutrition Program Volunteer Health Policy Agreeml Reporting: Symptoms of illness | agree to report to the manager when |have: 1. Diarrhea and/or vomiting 2. Jaundice (yellowing of the skin and/or eyes) 3. Sore throat with fever 4. infected cuts o/wounds, or lesions containing pus on the hand, wrist, an exposed body part (such as boils and infected wounds, however smmaU). Reporting: Diagnosed illnesses I agree to report to the manager when I have: Norovims Salmonella Typhi (typhoid fever) Shigel|a sop. infection 10/12/2015 Sharepoint-team site-shared documents-NHC SRC General Service Standards 4. E. coli infection (Escherichia coli 0157:H7 or other EHEC/STEC infection) 5. Hepatitis Note: The manager must report u» the Health Department when an employee or volunteer has one oƒ these illnesses. Reporting: Exposure mfIllness | agree to report to the manager when | have been exposed to any of the illnesses listed above through: 1. An outbreak ofWorovirw4 typhoid fever, 3higeUa infection, E.co|i infection' or Hepatitis A. 2, A household member with 0oroviru4typhoid fever, ShigeUa spp. infection' E,co|i infection, or Hepatitis A. 3. A household member attending or working in a setting with an outbreak of Norovirus, typhoid fever, ShigoUaspp. infection, E. coli infection, or Hepatitis A. Exclusion and Restriction from Work M you have any of the symptoms o/ illnesses listed above, you may be excluded* orresihcted**from volunteering. *If you are excluded from volunteering you are not allowed to come in. **If you are restricted from volunteering you are allowed to come in, but your duties may be limited. Returning toWork If you are excluded from volunteering for having diarrhea and/or vomiting, you will not be able to return to volunteer until more than 24 hours have passed since your last symptoms of diarrhea and/or vomiting. lf you are excluded from volunteering fbr exhibiting mympbunsm[a sore throat with fcvcrnrfor having jaundice (yellowing of the skin andor eves), Norov-irus. Salmonella Typh'' (typhoid fexo1,ShWc{|oopp infection, B. oo]i infection. and/or Hepatitis A. You uuuyruturn to volunteer after receiving Z4hours of antibiotic negative for Strepmcletenninedbyhealth proficssiona]without S1rep. Agreement | understand that |must: I. Report when I have or have been exposed to any of the symptoms or illnesses listed above; and 2. Comply with restrictions and/or exclusions that are given to me. I understand that if I do not comply with this agreement, I may not be able to volunteer at the Center. Food Volunteer Name (please print) Signature of Volunteer Manager Name (please print) Signature of Manager Date 71�� TMe$e are some of the Bacterium and Viruses spread from Food Handlers toFood E.Co|U Overview: A bacterium that can produce a deadly toxin and causes an estimated 70,000 cases of foodborne illnesses each year iothe U. S. Sources: Meat, especially undercooked or raw hamburger, produce and raw milk. Incubation period: 2-10 days Symptoms: Severe diarrhea, cramping, dehydration Prevention: Cook implicated food io 155F.wash hands properly and frequently, correctly wash rinse and sanitize food contact Sh~ Ua Overview: Shigella is a bacterium that causes an estimated 450,000 cases of diarrhea illnesses each year. Poor hygiene causes Shigeatobe easily passed from person to person. Sources: Salad, milk, and dairy products, and unclean water. Incubation period: 1-7 days 10/12/2015 Sharepoint-team site-shared documents-NHC SRC General Service Standards Symptoms: Qkarrhee, stomach cramps, fever, chills and dehydration Prevention: Wash hands properly and frequently, especially after using the restroom, wash vegetables thoroughly Salmonella Overview: Salmonella is a bacterium responsible for millions of cases of foodborne illnesses a year. Elderly, infants and individuals with impaired immune systems are at risk to severe iUmsao and death can occur if the person is not treated promptly with antibiotics. Sources: raw and undercooked oggs, undercooked poultry and meat, dairy pmducta, seafood, fruits and vegetables Incubation period: 5'72 hours (up 10 18 days has been documented for low doses) Symptoms: Nauaoo, vomiting, cramps, and fever Prevention: Cook all food to proper temperatures, chill food rapid|y, and eliminate sources of cross contamination (i.*, proper meat storage, proper wash, rinse, and sanitize procedure) Hepatitis Overview: Hepatitis Aisa liver disease caused by the Hepatitis A virus. Hepatitis A can affect anyone. In the United States, Hepatitis A can occur in situations ranging from isolated cases of disease to widespread epidemics. Incubation period: 15-50days Symptoms: Jaundice, nausea, diarrhea, fever, fatigue, loss of appetite, cramps Prevention: Wash hands properly and frequently, especially after using theres&rnunm Norovruo Overview: This virus is the leading cause of diarrhea in the United States. Any food ran be contaminated with norovirus if handled by someone who ia infected with the virus. This virus in highly infectious. Incubation period: 6-48 hours Symptoms Nausea, vomiting, diarrhea, and cramps Prevention: Wash hands properly and frequently, especially after using the restroom: obtain food from a reputable food source: and wash vegetables thoroughly, Steph(Btapby|000cous auraus) Overview: Staph food poisoning in a gastrointestinal illness. It is caused by eating foods contaminated with toxins produced by S(aphyluvnonueaunnuo. Staph can be found on the skin, in the mouth, throat, and nose of many employees, The hands of employees can be contaminated bytouching their nose, infected cuts or other body parts. Staph produces toxins that are extremely heat stable and are not inactivated by normal reheating temperatures. It is important that food contamination be minimized. Incubation period: Staph toxins are fast acting, sometimes causing illness in as little as 30 minutes after eating contaminated foods, but symptoms usually develop within one bo six hours. Sources: Ready-to-eat foods touched by bare hands, Foods at highest risk of producing toxins are those that are made by hand and require mocooking. Symptoms: Patients typically experience several of the following: nausea, vomiting, stomach cramps, and diarrhea. The illness lasts one day to three days. In a small minority of patients the illness may be more severe. Prevention: No bare hand contact with ready-to-eat foods. Wash hands properly. Do not prepare food if you have a nose or eye infection. Do not prepare or serve food for others if you have wounds or skin infections on your hands or wrists. If food is to be stored longer than two hours, keep hot foods hot (over 135'F) and cold foods cold (41 ^F or under). Properly cool all foods. Reference: wC Food Code Manual: Employee Health, 2-2D1. September 2012 10/12/2015 Sharepoint-team site-shared documents-NHC SRC General Service Standards Appendix Recommended Consumer Contribution Schedule NC Division of Aging and Adult Services Recommended Contribution Schedule Based on the 2014 US Poverty Guidelines Service Recipient's Name: Service #1 Rate$ Service #2 Rate $ Service #3 Rate $ % of Monthly Income of: Suggested Recommended Contribution Poverty Percentage Amount per Unit of Service Individual Couple of the Cost Service #1 Service #2 Service #3 of Service 100% $973 — $1,215 $1,311 — 10% $1,638 125% $1,216— $1,639— 20% $1,458 $1,965 150% $1,459— $1,966— 30% $1,701 $2,293 175% $1,702— $2,294— 40% $1,944 $2,621 200% $1,945— $2,622— 50% $2,187 $2,948 225% _ $2,188— $2,949— 60% $2,430 $3,276' 250% _ $2,431 — $3,277— 70% $2,673' $3,604 275% $2,674— $3,605— 80% $2,917 $3,932 "- 300% $2,918— $3,933— 90% $3,403 $4,587 350% $3,404 - - -, $4,588 - -- 100% above' above The Recommended Consumer Contribution Schedule may only be shared with service recipients who are above poverty and receive a Type I service(s). ` Voluntary contributions made toward the cost of services received are not tax deductible. 10/12/2015 Sharepoint -team site - shared documents -NHC SRC General Service Standards 10/12/2015 Sharepoint -team site - shared documents -NHC SRC General Service Standards SRC Contract /MOU /MOA Procedure Purpose of a Contract: An agreement between two or more parties that creates an obligation to do or not do a particular thing. The terms "contract" and "agreement" are interchangeable. Contractual Risk Transfer (CRT): • Through CRT, a business seeks to identify and effectively manage its contractual liabilities arising out of business relationships with other businesses, contractors, owners, architects and engineers. • Risk Management Technique ■ Transfer financial responsibility of risk Types of Contracts: 1) Contracts for Service 2) Contracts for Purchase of Supplies and Equipment 3) Memorandum of Understanding /Agreement 4) Facility Use • Original completed form to Administrative Specialist • E -mail (both sides) to Admin. Specialist to enter into appropriate SharePoint folder. 1) Administrative Specialist will schedule appointment with Program Manager /Coordinator and Vendor to obtain required documents and signatures. 2) Each Program Manager /Coordinator is responsible for obtaining the information needed for their programs and completion of the Contract Check List (see attached) i) Insurance Information (Insurance Requirement Form -IRQ_ ii) Funding available iii) Requisition # confirmation iv) Name of Contractor v) Address vi) Scope of Service vii) Contract Cost or not to exceed amount viii) Any exhibits or attachments ix) Time of performance (dates) x) Certificates of Insurance (COI) xi) Account Numbers (from which Contractor will be paid) xii) Special Instructions 33) Original contracts /forms are to be given to the Administrative Specialist for processing and file retention. 4) Administrative Specialist will provide submitting Program Manager /Coordinator with a copy of the completed /signed contract and maintain a copy /original in Administrative Office. 10/12/2015 Sharepoint -team site - shared documents -NHC SRC General Service Standards Attachment B North Carolina Department of Health and Human Services Division of Aging and Adult Services 2101 Mail Service Center - Raleigh, North Carolina 27699 -2101 Tel 919 733 -3983 • Fax No. 919 733 -0443 Beverly Eaves Perdue, Governor Dennis W. Streets, Director Albert A. Delia, Acting Secretary 919 - 855 -3400 April 24, 2012 Administrative Letter No, DAAS -12 -05 To: Area Agencies on Aging Administrators t' tzl,—�3 From: Dennis Streets, Division Director � -gAvw� w . NC Division of Aging and Adult Services Subject: Title lil -D Health Promotion and Disease Prevention Revision Date: April 24, 2012 Effective July 1, 2012, Title III Part D Section 361 of the Older Americans Act, which pertains to Disease Prevention and Health Promotion, may only be used for programs and activities that have been demonstrated through rigorous evaluation to be evidence -based and effective. Evidence -based disease prevention and health promotion programs have become an aging network priority within North Carolina for several years, and the new requirement demonstrates a national commitment to these types of programs. In February 2012, Congressional appropriations mandated that Older Americans Act Title iii -D funding for Fiscal Year 2012 be used only for programs and activities that have been demonstrated to be evidence - based. The U.S. Administration on Aging (AOA) uses graduated criteria known as "tiers" to define evidence -based interventions. Health promotion programs can fall within any of the tiers. Based on the history of the Title 111 -D program, and the degree of change needed _to transition to the optimal level of evidence -based implementation, each program will be assessed based on the following criteria. While the goal is for all Title ill -D activities to move toward the highest level criteria, programs meeting the minimal or intermediate criteria will satisfy current requirements. The three tiers include: 1. Minimal Criteria • Demonstrated through evaluation to be effective for improving the health and well -being or reducing disease, disability and /or injury among older adults; AND • Are ready for translation, implementation and /or broad dissemination by community -based organizations using appropriately credentialed practitioners. Location: 693 Palmer Drive, Raleigh, NC 27603 • State Courier No. 56 -20 -02 An Equal Opportunity / Affirmative Action Employer North Carolina Division of Aging and Adult Service,, Health Promotion and Disease Prevention Standards Effective date —June 1. 2014 NC DEPARTMENT OF HEALTH AND HUMAN SERVICES Division of Aging and Adult Services 2101 Mail Service Center, Raleigh, NC 27699-2101 Phone 919-855-3400 4g � f 4 #` Health Promotion and Disease Prevention Standards TABLE OF CONTENTS 1. Statement of Philosophy and Purpose ........................................................................ 2 11. Legal Base ........................................................................................ 3 HL Definition of Health Promotion and Disease Prevention Services .................. 5 IV. Client Eligibilit) . ................................................................................ 7 V. Service Provision ............................................................................... 8 V1. Staffing Requirements and Training ............................... ...................... 12 VII. Documentation and Reporting ............................... .............................13 Title 111D Health Promotion and Disease Prevention Standards 6/2/2014 North Carolina Division o[A�/ and /�du|\Services Health Pron-io1oo and Disease Prevention Standards Effectivudmte —Juoe |,2U|4 STATEMENT QFPHILOSOPHY AND PURPOSE 1- Statement of Philosophy and Put-pose Title ll}D o{tbt Older Americans Az1, ()8,A, was established in 1987, It provides SrnotsVn States and Territories hxmcdoodzeirmbmrcofihcpmpulu#ooagedhQumdmvcrDm'eduoxtionond imy|ornoutmtiom activities that support healthy lifestyles and promote healthy behaviors. Evidence-based health promotion programs reduce the need for more costly medical interventions. Priority isuivemto scrvinc, eldcre|ivioa in rmcdicoUyundcrncrvcd nreonufthc State or who are ol'greatest economic need. Older Arnericansare disproportionately affected by chronic diseases and conditions, such as arthritis, diabetes and heart disease. as well uyhv disabilities that result from ' jmrbCS smchms falls. Mmrcthnnonc-dio]oFodubsuucd65oro|Je'OdXeuuhyeoz*Tvveu1y-mnepenen o[|be population aged 60 and older --- |O.3 million people — have diabe/cx." Seven n[evc,yl8 Americans who die eacli year. or more than 1.7 n-tillion people, die of a chronic disease.*"* Fundill" support tm states under Health Promotion and Disease Prevention Services (Title HID) has been provided by the Administration on Aging, AoA, to, empoxver older adults to take control o[ their health. In theuemyrogranzm, seniors |curo to maintain u hcm|1by �i6�y�'|u increased self-efficacy and ad behaviors. These classes are provided to older mdultu� • In their own communities • In familiar non-clinical sd1im�a, such as cnmzmzuo�{� centers • [u peer learning groups which provide muppod,socialization and reinforcement of' Positive health behavior changes. 'Venters for Disease Control and Prevention. Falls AmongOlder Adults: &n Overview. uvai|ub|rat: "Centers for Disease Control and Prevention. Diabetes Public Health Resource: 21007 National Diabetes Fact 5huu, available at: hup:/�"w�n.cdc.(,nv,"diobctcspobu eximuby07.1-igm#2 ***Centers lor Disease Cm,md and Prevention. Chronic Disease Prevention and Health Promotion. Avodmb|c m: Title Dl0 Uouhh Promotion and Disease 9rcvou1koo S1mmdmdo North Carolina Division of AL, -mg and Adult Services Health Promotion and Disease Prevention Standards Effective date --June 1. 2014 LEGAL BASE 11. Legal Base Older Americans Act ol'1965 as Amended: 42 U.S.C. 3001 et se g., as most recently amended by Public Law 109-365, in 2006, Section 102(14); Section 303(d)-, Section 321(a)(1)(7)(8)(17)(23); Part D, Section 361. 102. (14) See Ill. 'Defimitioii of Health Promotion and Disease Prevention Services' Section 303. (d) There are authorized to be appropriated to carry, out part D (relating to disease prevention and health promotion services) Such SUiris as may be necessary for fiscal years 2007, 2008, 2009, 2010, and 2011. 321. (a) The Assistant Secretary Shall Carry Out a program for making grants to States under. State plans approved under section 307 for any of the following supportive services: (1) health (including mental health), education and training, welfare, informational. .recreational, hornen-iaker, counseling, or referral services'- (7) services designed to enable older individuals to attain and maintain physical and mental well -being tlll-OLI(,h programs ofregular physical activity, exercise, music therapy, art therapy, and dance - movement therapy, (8) services designed to provide health screening (including mental health screening) to detect or prevent illnesses, or both. that occur most frequently in older individuals; 17) health and nutrition education services. including information concerninu prevention. diagnosis. treatment., and rehabilitation ofag27 e-rclated diseases and chronic disabling conditions (23) services designed to support States, area agencies on aging, and local service aging, in carrying out and coordinating activities for older individuals with respect to provi C- mental health services, including outreach 66r, education concerning, and screening for such services, and ref-erral to such services for treatment', Part D, 361, (a) The Assistant Secretary shall carry out a program for making grants to States under State plans approved under section 307 to provide disease prevention and health promotion set-vices and information at multipurpose senior centers, at congregate meal sites, through home delivered incals programs, or at other appropriate sites. In carrying out such program. the Assistant Secretary shall consult with the Directors of the Centers for Disease Control and Prevention and the National Institute on Agin`, zn' ' (b) The Assistant Secretary shall, to the extent possible, assure that services provided by other community organizations and agencies are used to carry out the provisions of this part. Title BID Health Promotion and Disease Prevention Standards 6112/2014 North Carolina Division of Aging and Adult Services Health Promotion and Disease Prevention Standards Effective date — June 1. 2014 (c) The Assistant Secretary shall work in consultation with qualified experts to provide information on methods of improving indoor air quality in buildings where older individuals congregate. (42 U.S.C. 3030m) North Carolina G.S. 14313- 181.1(c): the Secretary of Health and Human Services shall adopt rules to implement this Part and title 42, Chapter 35, of the United States code, entitled Programs for Older Americans (http: / /www. ncga. state. nc. zisI Enacte(ILegislatioii IStatattes/PDF/BvSection /Ch(ipter _143BIGS_14 3B- 181.I.pd )). North Carolina G.S. 14313- 181.4(4): Responsibility for developing policy - - -is vested in the Secretary of the Department of Health and Human Service--- to - - -be the bridge between the federal and local level and shall review policies that affect the well being of older people-- - Responsibilities may include: (4) Promoting the development and expansion of services http: / /ii 'ti1'w. ncga. state. rzc. zrs/ Enac tedLegisla tion/ Sta tzrtes/HT111LIBvSection/Chaptez _143BIGS_14 3B- 181.4. h tml The above referenced legal bases also give the Division of Aging and Adult Services the authority to establish broad procedures that address the administration of aging services. These are covered in the North Carolina Home and Community Care Block Grant Procedures Manual for Community Service Providers. This document should be used routinely by providers in administering their programs for topics such as: Confidentiality Policies and Procedures, Applicant /Client Appeals, Reporting Requirements, Reimbursement Procedures, etc. Title IIID Health Promotion and Disease Prevention Standards 4 6/2/2014 North Carolina Division of Aging and Adult Services Health Promotion and Disease Prevention Standards Effective date — June 1. 2014 DEFINITION OF HEALTH PROMOTION AND DISEASE PREVENTION SERVICES 111. Definition of Health Promotion and Disease Prevention Services The OAA Sec. 102 (a) (14) defines the teen - disease prevention and health promotion services" as (A) Health risk assessments; (B) Routine health screening, which may include hypertension, glaucoma, cholesterol, cancer, vision, hearing, diabetes, bone density, and nutrition screening; (C) Nutritional counseling and educational services for individuals and their primary caregivers; (D) Evidence -based health promotion and disease prevention programs, including programs related to the prevention and mitigation of the effects of chronic disease (including osteoporosis, hypertension, obesity, diabetes, and cardiovascular disease), alcohol and substance abuse reduction. smoking cessation, weight loss and control, stress management, falls prevention, physical activity and improved nutrition, (E) Programs regarding physical fitness, group exercise, and music therapy, art therapy, and dance - movement therapy. including programs for multigenerational participation that are provided by (1) an institution of higher education; (ii) a local educational agency, as defined in section 14101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 8801); or (iii) a community -based organization; (F) Home injury control services, including screening of high -risk home environments and provision of educational programs on injury prevention (including fall and fracture prevention) in the home environment; (G) Screening for the prevention of depression, coordination of community mental health services, provision of educational activities, and referral to psychiatric and psychological services; (H) Educational programs on the availability, benefits, and appropriate use of preventive health services covered under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.); (I) Medication management screening and education to prevent incorrect medication and adverse drug reactions; Title IIID Health Promotion and Disease Prevention Standards 6/2/2014 North Carolina Division ofAuim- and Adult Services Health Popnoo1imu and Disease Prevention Standards Effective date —]mnri,Z0|4 (J) Information comccrubn�diagnosis. prevcodom,\oeotu�org,and rcbmbi|i�tiwuconcerning u8c-related dimexmus and chronic dimub| conditions, including osteoporosis, cardiovascular diseases. diabetes. and Alzheimer's disease and related disorders with oourolu-iou\and u brm� dxuc�� organic m-,vn_&- dysfunction: <KJ Gerontological unumselimg-,und (L) Counseling regarding social services and follow up health services based om any o[Lbe services described in subparagraphs (A) through (K). The term shall not include services for which payment rimy be made under titles XVlU and IIX of the Social Security Act (42U.S.C, 1395ciueg_1396c(seq`). The criteria 0/r use mf][ido HID funds I'n'these programs are included under "Service Pro\ ision." which begins on page S. Title HID Health Promotion and Disease Prevention Standards 6 0/2/2014 North Carolina Division ol'Aging and Adult Services Z__ Health Prorriotion and Disease Prevention Standards Fffective date June 1, 2014 CLIENT FL]GIBILITY IV. Client Eligibility The target popul-ation of` Health Promotion and Disease Prevention services is persons 60 years ofauZ;_ e and older. Primary car eolvers of eligible older persons are eligible for educational set-vices. Special emphasis should he placed on servim, those individuals who have the greatest Z7� econon-iic and social need for services, including providing services to low income minority individuals, those who are at increased risk ot'health impairment and/or disparities, those who do not have access to other preventive and health maintenance services, and older individuals residing in rural areas. Title 111D Health Promotion and Disease Prevention Standards 6/2/2014 North Carolina Division ofAehogand Adult Services Health Promotion and Disease Prevention Standards EOechvcdm\e — Jumc |,20]4 SERVICE PROVISION V. Service Provision Im2O|2, the /\dnzimimUndonwu�� in��nn|cnocoksdugrmduo\cdmrdcrcduc1o�ohteiuk> t7i defining evidence-based irdcrvcnt ions iompieucutcddhruo)h the Older /\nuerioon`s Act UeuXtb Poznzu<inn and Dixcuuc Prevention p,og7mrmscuo fbU within any oJ the three lb|kwiug1icm. Based um the history o[1hcpro�ronmum�1bod��rcto[xhmo�c needed \n transition to the optioom|- |eveUofcvidumce-buacdiroplrrocm1uliuu,cacbpoogrmnmvvUinecd1mbcmsucxuodbnsedmmthu 6`Qnvvio,, criteria. While ibcBmu} is for all Title Dl[) activities to move toward the hi-hest-level mhteho, progrurmm meeting the nniuinnul or bz1xomo]im1c criteria will meet the evidence-bnmud requirements. Service providers and Area A-encicmou Aging should check with the North Carolina Division of A,in,, and Adult Services for the Most current allowable evidence-based programs. The 1`611oxving list of pro-rani examples under each of the three tiers is not an exhaustive list of interventions. Program submission is o vo1um1azv, uc]f-nooninudn(l ayskxn in vvbicb io1crpom\on developers elect to participate. New interventions are continually being added, so the list ix always (Yrowin(y Minimal Criteria Demonstrated throuoh evaluation tnhs effective for i img1bebcukbumd`ru|[bcingor reducing Jixcoac,disability and/or injury wozongm\dcrudu1Ls�omd Ready fb, translation, irap|emoenCmdmm and/or broad dissemination by cnmmouoitv-based organizations using appropriately credentialed practitioners. include: 0 Dakini Brain Fitness • Wei Aui t hs • Senior Games /n/eiren/b/nvm/soni/e cXainples inc/ode: • Health uxxexsnne//* and screenings • Myd/myion/nunugC/nen/acTrcn/M� • I/mx/u b 'o(? cmo/rn/s*n'/cex Intermediate Criteria Published iom peer-review 'muroo�and • Senior //e011/' Calendar � Vldrilion' gel'01110logical, uomYhr Proven effective with older adult population, using some form oCu control condition (c.,, pre-post study, case control design, etoj- and Some basis in translation for imn|ccoccdndoohv community \*vo\ organization. Title IDI} Health Promotion and Disease Prevention Standards North Carolina Division of A`uing and ,Adult Services Healtly Promotion and Disease Prevention Standards Effective date — June I , 2014 Prf.grtarrr EacanrrI -Ves include: • Dinim, lVith Diaabocs * Larrrgliter l terra • (;oat Bc °ttcr tiove ,Woa-c? Highest -level Criteria * Undergone Experimental or Quasi - Experimental Design, and Level at which full translation has occurred in a community site; and Level at which dissemination products have been developed and are available to the public. Progrcarnn L:rtaannIVes innchide.` • I Nltattca- a11'Btahmcc • �I rtltr'iti.s I�arrarnticrtie�rn Lifi� Scr•ic�s Prrnga °talrr.s (TOi Chi, E xcrcisc, aand >- fquotic� Pro(YRIrnn.s • Batter Choices, Better Health - onlim, C'l),SMI', Ai-tlwitis OS!VIP). Diabetes (C)S`WP) • Chronic M eaa.sc Self- ticarrtagc trrcrat Pro —rwnn Educulimi Prourtannrs WDS.111': Arthritis Sc1J- altalltt rc °ralcrnt Pr-t grtaanl (11S/11P): Chronic Pain SefJ- .ticrrntrgcnancnnt Prograatra (CPSjWP1, Dicahews Self- Mtaantagemerrt P7-r>< iwinr (DS.111P), Positivc SclJ- rt'ltaancn,r;c�aarc�rtf I'rragrcarnl �cta. III %' (F'SMP), Tonnnrmdo Control de Sat Sctlattl r' 1wi ni.sh CDS,111'), Prograarnno de Waarn(}jo Pca-.so nal de Ica Artritis 61)uni.sh ASEiP), Progrtam a de ,11 anrejo Pcr.somil do Ira I)icahetc.s (Slrrtrnish I)SMI')) • Fit earntl Strcuntr.a • Ile °tahlw IDEAS UtlenntrIjV ng Dtprc.�sion, LrnnlaOrVcrirl(I ACtivitic.s frrrScnniM—S) • I'e it- cl-fid fools lrrr C'careyri7 °ear. • Program tv Es`nnctriwauc Active, Rewarding Lives lbr Scniors (PL- RLS) • Resourccs firm Pralltnrrc irtg 11_llcirlaer's Cm- -giver Health 11(Re(ich 11) • Stcd)lairr,( OII • liti Chi :.t - ovilag frtr Better Btalcanacc • if "allt with Lu.vc A 1lighest -Tier Criteria C ost Chart is available at httpa fi "w,,>rw.jicoa. err -�r"iriiiii- \,e-ltealthl!ceriter- for- healthy -a, nl;/ content - library,' ;title -III - Highest- Tier - Evidence- FIIs1AL.pdfand provides details and casts associated with many of the highest -level Title Illy programs. Priority should be placed on providing those programs and activities which address the leading health problems of older adults in the community. Services are to he provided in settings that are easily accessible to older adults and are appropriate and adequate for the programs arid activities provided. Agencies providing services are strongly encouraged to utilize alder consumers and community agencies concerned with the health and wellness of older adults in the planning, development and delivery of programs and activities. At health fairs, Title IIID funds may be used for programs, interventions and services that meet the minimum - criteria (demonstrated effectiveness and broad dissemination by appropriately credentialed practitioners), which include health assessments, screening, and counseling. Title IIID Health Promotion and Disease Prevention Standards c) 6/2/2014 North Carolina Division of Aging and Adult Services Health Promotion and Disease Prevention Standards Effective date — June 1. 2014 An allowable expense is one that is directly related to the implementation of an evidence -based program; except for food. Food or refreshments are NOT allowable expenditures for IIID funds. Expenses for rental space can only be used for the days the program or service took place. Practice Guidelines: It is recognized that IIID funds will not be sufficient to meet all the disease prevention and health promotion needs of individuals in a given community. Partnership and collaboration are critical to leverage and extend the reach of health promotion programs. It is common practice to braid or blend funding streams to fund different components of the same activity in order to make a complete program. Depending on the health promotion program, partnering agencies and potential funding sources may include public health departments, hospitals, clinics and community health centers. non - profit organizations, city parks and recreation departments, United Way or foundations, universities and community colleges, Cooperative Extension Services, faith -based organizations, professional organizations (such as pharmacy, dental and dietetic associations), voluntary or sliding fee -scale donations. and private donors. Emphasis should be placed on utilizing private funding sources to purchase supplies and incentive items utilized to promote Health Promotion and Disease Prevention services or to reward program participants (ex. tee shirts, water bottles, books, refreshments, etc.). The use of business plans may be especially useful in partnering with health care groups. OAA Title IIIB funds (for supportive services and senior centers) can be used as well as Administration funds. Sonic communities have obtained donated services and /or found volunteers for activities such as informational booths. walk -a -thons and exercise demonstrations. By inviting local organizations to host a booth, give a presentation, or offer a demonstration, they receive free marketing and in return provide a health fair activity free of charge. These activities could include: presentations on healthy diets and grocery shopping tips by a nutritionist paid for by a local grocery store; healthy cooking demo hosted by a local restaurant; benefits of stretching demo by a local gym instructor, presentation on building healthy relationships by a local therapist, psychiatrist, psychologist or psychotherapist; alternative medicines demo by a local acupuncturist, massage therapist or herbalist; bicycle and pedestrian safety demo by a local partner of the National Bicycle Safety Network ; back health demo by a local chiropractor, CPR and First Aid demo by local EMTs; dental care presentation by a local dentist or dental hygienist; and skin cancer prevention demo hosted by a local dermatologist. In addition to partnerships outside the Aging Services Network. AAAs can work together- to pool their Title IIID funding and implement regional and /or statewide evidence -based programs. Agencies which provide exercise, /physical fitness programs are encouraged to have program participants sign liability waiver forms which are maintained on file. Title IIID Health Promotion and Disease Prevention Standards 10 6/2/2014 Forth Carolina Division ol'AgIng and Adult Set-vices z 1� 11� Health Promotion and Disease Prevention Standards Effective date —June 1. 2014 Prohibited Activities: Services covered under Title XVIII (Medicare) ofthe Social Security Act (42 US.C. 1395 et, seq.) cannot be paid for witli Title HID funds. This includes flu sliots, mammograms, pap smears, laboratory services, and durable medical equipment. Consult the Medicare Handbook for itiftm-mation on services covered by Medicare. Elie purchase of medical set-\ ices, prescription drugs. physical examinations. home safety device,; for individuals, and activity of daily living supply items, (ex. grab bars for tubs, etc) are not allowable costs. Health fair activities that do not meet the minimal criteria of evidence-based as outlined on page 8, may not use Title HID funds. Examples of health flair activities that do not meet at least the minimal criteria ofevidence-based include sports competitions, fbod, licalth information booths, and demonstrations. Activities fliat are strictly recreation-al (offered forarnusement) in nature are not allow able costs. Examples of these activities include board/card garnes, puzzles, movies, bingo, billiards, etc. Title HID Health Promotion and Disease Prevention Standards 6/2/2014 North Carolina Division of Aging and Adult Services Health Promotion and Disease Prevention Standards Effective date —.June 1. 2014 STAFFING REQUIREMENTS AND TRAINING V1. Staffing Requirements and Training Staffing and Training Requirements: All evidence -based health promotion and disease prevention programs require that instructors /leaders /coaches be trained in the program and adhere to the curriculum to maintain fidelity, though staff and training requirements may vary. The National Council on Aging provides a summary of initial and update training requirements in their Highest Tier Evidence - Based Health Promotion and Disease Prevention Programs Cost Chart at the following site: littp: / /www. ncoa .org /imin-ove- liealtivicenter- for - healthy- aging / content - library /Title - IIID- Highest- Tier- Evidence- FINAL.pdf When using Title IIID funds to provide health services, appropriately trained professionals or paraprofessionals should be used. An example is using a Registered Nurse to administer blood pressure checks or blood glucose monitoring. Practice Guidelines: Staffing — Many programs require two leaders to facilitate the workshop series and are best facilitated by class peers, or lay leaders. When using a volunteer, a stipend and /or mileage reimbursement may be used to compensate leaders for their time and /or travel. Compensating leaders may help with retention, especially when the leader is a volunteer. Having a memorandum of agreement with leaders may be helpful in outlining expectations and is another tool in retaining leaders. Fidelity Monitoring —To ensure that evidence -based health promotion programs are offered with fidelity, on -site observations and reviews are suggested. If a program requires a license, the responsibility of fidelity monitoring falls to the licensed organization or person. Standardized observation tools exist for some programs and can be adapted to monitor all programs offered in the community. One -on -one technical assistance and problem - solving may be required to ensure fidelity is maintained by leaders. Best practices to ensuring fidelity include: pairing new leaders with experienced leaders; having leaders teach each program in which they are trained yearly; maintaining a memorandum of agreement; and re- training leaders to reinforce or update program information. More information about fidelity can be found on the National Council on Aging's (NCOA) website at http:l /www. ncoa. org / improve- iieaIth/center- for - healthy- aging /content- library,'MaintainFidelityTool.pdf. Title IIID Health Promotion and Disease Prevention Standards 12 6/2/2014 North Carolina Division of Aging and Adult Services Health Promotion and Disease Prevention Standards Effective date — June 1. 2014 DOCUMENTATION AND REPORTING VII. Documentation and Reporting A. Documentation: Each agency providing Health Promotion and Disease Prevention services must establish and maintain appropriate records (sign in sheets. etc.) to document individuals' participation in services. For a Title IIID evidence -based health promotion program meeting the minimal criteria such as blood pressure screenings at a health fair, documentation should be submitted and could include a copy of the CNA, LPN, RN or other performing practitioner's license number along with information about the blood pressure screenings that were performed. In the event student volunteers are used, such as dental students, nutritionists or pharn7acists, a letter or email from the faculty instructor could be retained as a record of the evidence -base of the health promotion program implemented with Title IIID funds. B. Voluntary Contributions: In accordance with the requirements of the Older Americans Act, agencies must provide individuals receiving service the opportunity to contribute to the cost of service. Eligible persons receiving Health Promotion and Disease Prevention services are subject to these requirements. Agencies must establish written policies and procedures governing the collection of voluntary contributions. Documentation requirements for requesting consumer contributions are outlined in Section 5 of the Division of Aging Home and Community Block Grant Procedure Manual. Requirements for documenting, depositing, and reporting contributions follow some common sense guidelines. The contribution should always be counted and recorded by two people, for their own protection and because this is an accepted accounting practice. The person who verifies and deposits the funds should not be the same person who counted and recorded the donations. The contribution record should match the deposit record on the agency's general ledger. This amount should also match the report of program income on Aging Resources Management System, ARMS. An agency must never reduce the amount of contributions reported because of petty cash purchases. Strict accounting procedures should be used. C. Reporting: Providers of Health Promotion and Disease Prevention services shall submit to the Area Agency on Aging each quarter the number of unduplicated persons served for each program or activity offered with Title IIID funds. For programs that collect: demographic and /or outcomes data. the paperwork should also be submitted quarterly with attendance records. Area Agencies on Aging should submit attendance records, demographic, and outcomes data (if applicable) to the agencies collecting data (ie — Living Healthy data to the Title IIID Health Promotion and Disease Prevention Standards 13 6/2/2014 North Carolina Division of Aging and Adult Services Health Promotion and Disease Prevention Standards Effective date — June 1. 2014 Division of Aging and Adult Services, Arthritis Foundation data to the Arthritis Foundation, etc.) at least quarterly. Area Agencies on Aging should also submit the number of unduplicated persons served for each program or activity offered with Title HID funds to the Division of Aging and Adult Services quarterly. D. Reimbursement: Health Promotion and Disease Prevention services will be reimbursed based upon line item expenditures. Specific procedures for service reimbursement are outlined in the Division of Aging Home and Community Block Grant Procedures Manual for Community Scrvice Providers. Title HID Health Promotion and Disease Prevention Standards 14 6/2/2014 r u:� 1 North Carolina Department of Health and Human Services Division of Aging and Adult Services Pat McCrory Governor .June 1. 2014 Administrative Letter No. DAAS -14 -05 To: Area Agencies on Aging Administrators From: Suzanne Merrill, Acting Division Director NC Division of Aging and Adult Services Subject: North Carolina Title 1111) Health Promotion and Disease Prevention Standards Revision Date: .tune 1, 2014 Aldona Z. Wos, M.D. Ambassador (Ret.) Secretary DHHS Suzanne P. Merrill Acting Division Director The Division of Aging and Adult Services (DAAS), in collaboration with the Area Agencies on Aging, updated the North Carolina Division of Aging and Adult Services Health Promotion and Disease Prevention Standards. The revised Standards are based on the Older Americans Act (OAA) Title III Part D (Title IIID) and reflect the federal changes implemented during the 2013 Fiscal Year (FY) and updated language and definitions of the 2006 Reauthorization of the OAA. The Standards are effective immediately and also provide guidance on interpreting the definitions and provide best practices for utilization of funds. Revisions were made in all sections of the Title IIID Standards, with significant additions to the "Service Provision" section. The following information addresses the specific revisions made to each section. Format and Cover Page • In the Table of Contents, section heading names were changed to be consistent with other DAAS Standards and all Appendices were removed. I. Statement of Philosophy and Purpose • The language in this entire section was changed to provide a general overview of Title IIID programs and chronic disease statistics. II. Legal Base • Changes were made in this section to be consistent with revisions made to the Older Americans Act in 2006. The following items that related to Health Promotion and Disease Prevention were changed: Section 303(d); Section 321(a): and Part D, 361. o Mental health language was added to the 2006 revision of the OAA and is reflected in Section 321(a), items 1, 8, and 23. III. Definition of Health Promotion and Disease Prevention Services • Title III Part D of the OAA Section 102(a) (14) now specifies that health promotion and disease prevention programs must be evidence - based. Language was changed to be consistent with the OAA. More information regarding evidence -based health promotion and disease prevention programs is found in the "Service Provision° section of the Standards. www.ncdhhs.gov �a- �znv.ncdhhs.go�/aging Tel 919- 855 -3400 • Fax 919 - 733 -0443 Location: Taylor Hall, 693 Palmer Drive • Raleigh, NC 27603 Mailing Address: 2101 Mail Service Center • Raleigh, NC 27699 -2101 An Equal Opportunity / Affirmative Action Employer IV. Client Eligibility • No significant changes were made to client eligibility. V. Service Provision • Information related to the evidence -based requirement for health promotion and disease prevention programs was added to this section. The new language derives from the Administration of Community Living (ACT.) website (http: / /www.aoa.gov /AOAROOtiAOA Pro(,,rams /HPW /Title IIID). Examples of the three levels of programs were posted on ACUs website at one point, but now only provide information on some of the highest -tier criteria programs by linking to a cost chart on the National Council on Aging's (NCOA) website (http:/ /NVww.ncoa.org /improve- hcalth /center - for- healthy- aging/ content- librarv/ Title -IIID- Highest- Tier - Evidence- F1NAI_.pdt). States have been given the authority to determine if programs meet evidence -based criteria and at what level. • The examples of evidence -based health promotion and disease prevention programs listed in the Standards are subject to change. Over time, programs may move from a lower- criteria to a higher criteria as more evaluation is conducted. Additionally, programs may be added to the list as interest in North Carolina grows and evaluation data is compiled. • Language was added to clarify the leveraging role Title IIID funds may have in addition to solely supporting program implementation. These include interventions and services that may be offered in a location such as a health fair. • Based on guidance from the Administration of Community Living, language was added that food is not allowed with Title IIID funds. • Practice guidelines were added to this section to help guide administrators in utilizing Title IIID funds. These include information on partnerships, business plans, and using other sources of funding (such as Title IIIB). • Examples of prohibited activities at health fairs and in general were added to this section. VI. Staffing Requirements and Training • Because evidence -based health promotion and disease prevention programs require trained leaders, language was changed in this section to reflect that requirement. An example of using an appropriately credentialed /trained professional to provide a service was added. Practice guidelines were added to this section based on best - practices learned by offering evidence -based health promotion and disease prevention programs in North Carolina. These include: support and establishing relationships with staff (leaders), and ensuring fidelity of programs. VII. Documentation and Reporting • The heading for this section was changed to be consistent with other program Standards at DAAS. • Language was added under Part A, "Documentation" to provide examples of supportive documents that would be appropriate for health promotion and disease prevention activities. • A link to the DAAS Home and Community Block Grant Procedure Manual was added under Part B. "Voluntary Contributions." Additionally, a paragraph was added provide some guidelines for documenting, depositing, and reporting contributions. • In Part C. `Reporting," language was added to requesting the submission of evidence -based program data to collecting agencies on a quarterly basis. Service Code 401 must be used to report Title IIID activities in the DAAS Aging Resources Management System (ARMS). Please contact Nicolle Miller, nicolle.miller(a;dhhs.nc.gov or Audrey Edmisten. audrey.edmistenLuidhhs.nc.gov with any questions or concerns regarding the Health Promotion and Disease Prevention Standards and practice guidelines.