FY20 SRC Family Caregiver GrantORIGINAL CONTRACT
CAPE FEAR COUNCIL OF GOVERNMENTS
AREA AGENCY ON AGING
GRANT AGREEMENT FOR
FAMILY CAREGIVER SUPPORT GRANTS
July 1, 2019 - June 30, 2020
L PARTIES TO THE CONTRACT
This agreement is made and entered into this 31 a day of July 2019 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."
II. EFFECTIVE PERIOD OF CONTRACT
This contract shall be effective July 1, 2019 and shall terminate on June 30, 2020.
III. 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
(2, 3, 4
or 5)
Services
To be
provided
Grant
Amount
Unit Cost
If applicable
Projected
Number of Units
If Applicable
Projected
# to be
Served
2 (823)
Care Management
$ 20
$20
1
1
3 (833)
Support Groups
$ 500
30
3 (835)
Training /Educations
$ 1,000
20
4 (842)
In- home /non - medical
Respite varies
$26,000
$19.00
1368
36
4 (843)
Adult Day Care
Day Health
$ 2,000
$41 /day
49
6
5 (856)
Emergency Response
$ 500
4
6
5 (857)
Incontinence Supplies
$ 1,000
24
5 (859)
Liquid Nutritional
Supplemen tal
$ 980
36
$32,000
158
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 has allocated $20 to Category 823 Care Management.
Category 3 Training, Counseling and Support Groups
The Grantee has allocated $500 to Category 3 (833) Support Group and $1000 to (835) Trainings/Educations to
help with monthly caregiver support group meetings and provide education. They have 4 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 i.e.
eating, dressing, bathing) impairments or individuals with Alzheimer's disease and related disorders with
neurological and organic brain dysfunction. No more than $2000.00 may be used per eligible client during grant
period
The grantee has allocated $26,000 to Category 4 (842) In -Home Respite and $2,000 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 ALL (Activities of Daily
Living i. e. eating, dressing, bathing) impairments. No more than $800.00 may be used per eligible client during
grant period
The Grantee has allocated $500 to Category 856 Emergency Response System, $1000 to Category 857
Incontinence Supplies and $980 to Category 859 Liquid Nutritional Supplements to help with the financial
burden for caregivers purchasing these supplies.
These services are to provide temporary relief and will be a bridging mechanism until consistent services are
available. The NCDiWsion 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 offunding.
IV. GRANT AMOUNT
The total payment under this contract shall not exceed $32,000. 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.
V. DOCUMENTATION AND COMPENSATION
In order to qualify for funding, applicants must agree to comply with the following:
All required assurances (which state the organization must comply with Section 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:
# of records reimbursement is _X $.17 Maintenance cost per service record
Requested for each service budget code
TL.. G.. d.0 !`...lo !`6�.f fnr fV.n Family ('�rnnivcr Cunmrt DrMr.1m is ac fnllnwC'
Information Assistance
822
Care Management
823
Support Groups
833
Training/Education
835
In -home Respite Care
842
Community Respite Adult Day Care
843
Institutional Respite
846
Medical Equipment and Assistive Technology
854
Home Modifications Accessibili rab bars etc
855
Personal Emergency Response Systems
856
Incontinence Supplies
857
Liquid nutritional supplements ensure boost
859
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 7th 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 the 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, Provider Assurance 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 the ARMS system so the Council
of Governments 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 and a signed/dated provider assurance form
must be present in each client file. Please review the Consumer Contributions Policy and Procedures at:
http• / /www ncdhhs gov/ document /consumer - contributions - policy- and - procedures
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.
VIII. AMENDMENTS AND REPROGRAMMING OF FUNDS
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.
IX. MONITORING, AUDITING, AND REPORTING
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) Uniform Guidance 2 CFR Part
200.
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 Uniform
Guidance CFR 2 Part 200, 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 subject to the requirements of OMB Uniform Guidance 2 CFR Part 200, 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
httt)s: / /www.ncgrants. gov/ NCGrants /PublicRet)ortsRegulations. i sp
The following provides a summary of reporting requirements under NCGS 143C -6 -22 and 23 and OMB Uniform
Guidance 2 CFR Part 200 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 N/A
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 N/A
and less that $500,000 Grantee Receipts >$25,000 and
in State Funds or Schedule of Receipts and Expendi-
$750,000 in Federal tures
Funds
OR
Audited Financial Statements in
Compliance with GAO /GAS
(i.e. Yellow Book)
• $500,000 + in State funds Audited Financial Statement in May use State funds, but
but Federal pass through compliance with GAO /GAS (i.e. not Federal Funds
in an amount less than Yellow Book)
$750,000
• $500,000+ in State funds Audited Financial Statement in May use State and Federal
and $750,000+ in Federal compliance with OMB Uniform funds
pass through funds Guidance 2 CFR Part 200
(i.e. Single Audit)
• Less than $500,000 in State Audited Financial Statement in May use Federal funds,
funds and $750,000+ in compliance with OMB Uniform but not State funds.
Federal pass through funds Guidance 2 CFR Part
(i.e. Single Audit)
It is further understood that the community service providers are responsible to the Area Agency for clarifying any
audit exceptions that may arise from any Area Agency assessment, county or community service provider single or
financial audit, or audits conducted by the State or Federal Governments. In the event that the Area Agency or the
Department of Health and Human Services disallows any expenditure made by the community service provider for
any reason, the County shall promptly repay such funds to the Area Agency once any final appeal is exhausted in
accordance with paragraph nine (9). The only exceptions are if the Area Agency on Aging is designated as a
community service provider through the County Funding Plan or, if as a part of a procurement process, the Area
Agency on Aging enters into a contractual agreement for service provision with a provider which is in addition to
the required County Funding Plan formats. In these exceptions, the Area Agency is responsible for any disallowed
costs. The County or Area Agency on Aging can recoup any required payback from the community service
provider in the event that payback is due to a community service provider's failure to meet OMB Uniform
Guidance CFR 2 Part 200, 45 CFR Part 1321 or state eligibility requirements as specified in policy.
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 fully informed concerning the progress of the 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.
X. COMPLIANCE WITH TITLE VI & VIII OF CIVIL RIGHTS ACT, SECTION 504 OF THE
REHABILITATION ACT, AND AMERICANS WITH DISABILITIES ACT
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.
XIII. INDEMNITY
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, their
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.
XV. TERMINATION OF AGREEMENT FOR CAUSE
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
If the Grantee records show that they have negotiated/arranged for any of the service categories to be provided by a
government or not - for -profit organization it must be with a clearly defined contract and/or agreement. If the Grantee
chooses to contract for any of the service categories with a for -profit agency, records must show that they have
followed the reference regulation regarding bidding and awarding of federal funds, if applicable. (Contracting for
the FCSP is allowed with private for -profit agencies without bidding out the contracts provided that the contract is
for $25,000 or less. The contractor may use local bidding procedures that are not in conflict with the referenced
federal guidelines. The price negotiated should be reasonable with fair market value. [DHHS regulations 45 CFR,
Part 92.36.])
XVII. TAX EXEMPT STATUS
If grantee has tax exempt status they must submit a copy of the tax exempt declaration letter with contract.
IN WITNESS THEREOF, THE COUNCIL OF GOVERNMENTS AND THE GRANTEE HAVE
EXECUTED THIS AGREEMENT AS OF THE DATE FIRST WRITTEN ABOVE.
CAPE FEAR COUNCIL OF GOVERNMENTS:
Executive Director
Date
Area Agency on Aging Administrator Date
This instrument has been preaudited in the manner required by the local government budget and fiscal
control act.
Finance Officer Date
GRANTEE. New Hanover County Senior Resource Center
By:
Authori#d Lead Agency Official Date
�0.�, �,+� , Abs; s�4 Coin,
Attachment A
CONFLICT OF INTEREST POLICY
In accordance with G.S. 143 -6.1 and related legislation, we, the undersigned entity, have
adopted the following policy regarding conflicts of interest:
The undersigned entity is aware that in the process of fund allocation by its
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.
Sworn to and subscribed before me,
This the /6 day of , � A
My Commissiod expires:
IJ2u7-l�no�ler �ur�
Name of Agency
hairman, Executive Director, or
other Authorized Official
AA n opt 'i[yl 1.
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