alzheimer’s disease demonstration grant (Project c.a.r.e. [Caregiver Alternatives to Running on Empty] grant)

93.051 / Alzheimer’s Disease demonstration grants to states
State Project/Program: / alzheimer’s disease demonstration grant (Project c.a.r.e. [Caregiver Alternatives to Running on Empty] grant)

U. S. department of health and human services

administration on aging

Federal Authorization: / Public Health Service Act, Title III, Part K, Section 398, as amended; Home Health Care and Alzheimer’s Disease Amendments Act of 1990, Section 302, Public Law 101-157; Health Professionals Education Partnerships Act of 1998, Section 302

N. C. Department of Health and Human Services

Division of Aging and Adult Services

Agency Contact Person – Program:
Mark Hensley, C.A.R.E. Project Director
(919) 855-3417

Agency Contact Person – Financial:
Helen Tack, Business Officer
(919) 855-3445
/ N. C. DHHS Confirmation Reports:
SFY 2014 audit confirmation reports for payments made to Counties, Managed Care Organizations (MCOs and, formerly, Local Management Entities), Boards of Education, Councils of Government, District Health Departments and DHSR Grant Subrecipients will be available by early September at the following web address: At this site, click on the link entitled “Audit Confirmation Reports (State Fiscal Year 2013-2014)”. Additionally, audit confirmation reports for Nongovernmental entities receiving financial assistance from the DHHS are found at the same website except select “Non-Governmental Audit Confirmation Reports (State Fiscal Years 2012-2014)”

The auditor should not consider the Supplement to be “safe harbor” for identifying audit procedures to apply in a particular engagement, but the auditor should be prepared to justify departures from the suggested procedures. The auditor can consider the Supplement a “safe harbor” for identification of compliance requirements to be tested if the auditor performs reasonable procedures to ensure that the requirements in the Supplement are current. The grantor agency may elect to review audit working papers to determine that audit tests are adequate.

The Division of Aging and Adult Services (DAAS) issues a Notice of Grant Award (NGA) each fiscal year when funds are allocated to the Area Agencies on Aging (AAA). DAAS also revises NGAs during the fiscal year as necessary. Auditors should review the NGAs on file at the AAA to determine actual funding amounts. The last NGA issued for the year shows the total amount of funds by source awarded to the AAA.


Alzheimer’s Disease (AD) is a progressive, degenerative disease of the brain, and most common form of dementia. Discovered and described in 1906 by Dr. Alois Alzheimer, AD now affects approximately 4 million Americans. Unless a cure or prevention is found, it is estimated that the number of Americans with Alzheimer’s will climb to 14 million by the middle of the next century.

The purpose of the Alzheimer’s Disease Demonstration Grants to States is to provide funding for innovative programs which (1) focus attention on the needs of individuals with Alzheimer’s Disease and other dementia; and (2) encourage close coordination and incorporation of services into the broader home and community based care system. The Administration on Aging will fund the project for three years (contingent on the availability of federal funds).

The Division of Aging and Adult Services (DAAS) is the State Unit on Aging (SUA) as referenced in the Older Americans Act of 1965. The Division administers funding under Titles III, V, and VII of the Older Americans Act as well as a variety of other funds both Federal and State in nature.

The largest program or set of programs administered by the Division is the Home and Community Care Block Grant (HCCBG). This block grant is a pooling of resources used to fund services authorized by both the Older Americans Act and the North Carolina General Assembly. This pool is made up of Parts III-B, C1, and C2 of Title III and State funds. In addition, the HCCBG is also funded with Social Services Block Grant (SSBG) funds administered by the Division of Social Services via the State’s Block Grant Funding Plan which provides for a substantial transfer of SSBG funds to the DAAS for the HCCBG. Area Agencies on Aging, through contract with local service providers, utilize HCCBG funding to provide home based services for older adults including, In-home aide, Respite care, home delivered meals, Adult day care/day health and transportation.

The mission of the NC DAAS and the Area Agencies on Aging (Area Agencies are sub-units of the 16 Lead Regional Organizations) is to provide services to the State’s elderly (60+) population, enabling those individuals to remain in their homes for as long as possible while at the same time providing care and a safe environment in their later years.


The object of this program is to improve the access, choice, use and quality of respite services and identify gaps and barriers in the existing North Carolina home and community-based care system through implementation of a family consultant service offering consumer-directed respite care in targeted rural and minority areas. Supports are provided to family caregivers of those suffering from memory-loss and dementia related conditions including Alzheimer’s Disease.


Through this grant, the Division has developed Project C.A.R.E. (Caregiver Alternatives to Running on Empty). The DAAS has contracts with the Park Ridge Hospital, Duke University’s Aging Center Family Support Program, Mecklenburg County Department of Social Services, Lumber River Council of Governments Area Agency on Aging, and the Mid-East Commission Area Agency on Aging to improve the quality, access, choice, and use of respite and other aging services for families caring in the community for individuals with Alzheimer’s Disease or a related dementia.


NOTE: In developing audit procedures for testing the compliance requirements for aging grants, auditors should review the matrix to identify which of the 14 types of compliance requirements (Part 3 of the A-133 Compliance Supplement) are applicable. In addition to the general requirements reflected on the matrix, the following compliance requirements also apply.

A.  Activities Allowed or Unallowed

Participants of the C.A.R.E. Project will be provided dementia-specific counseling, information, problem solving, capacity-building, individualized training, and appropriate respite care in these targeted areas of the State serving 36 counties for family caregivers who are not receiving services currently.

Direct services can be purchased for participants that include: in-home services, adult day services, or short-term residential respite care. Each family can receive services totaling $1,800 per year (reduced from $2,500 in prior years). These funds cannot be used to fund existing services currently being received and provided with other funding (HCCBG or Community Alternatives Program (CAP), however, additional days/hours of service can be provided in addition to service provide with HCCBG funds.

Through the grant, Family Consultants will share program findings, evaluations, and information with local leaders, state policy makers, Area Agencies on Aging, the Duke Aging Center Family Support Program and the Division of Aging and Adult Services.

B.  Allowable Costs/Cost Principles

All grantees that expend State funds (including federal funds passed through the N. C. Department of Health and Human Services) are required to comply with the cost principles described in the N. C. Administrative Code at 09 NCAC 03M .0201.


·  No age limitation applies to the individual with dementia or the caregiver.

·  Participants in the program must be a resident of Avery, Beaufort, Bertie, Bladen, Buncombe, Columbus, Cumberland, Forsyth, Gates, Graham, Halifax, Haywood, Henderson, Hertford, Hoke, Hyde, Jackson, Macon, Madison, Martin, McDowell, Mecklenburg, Mitchell, Northampton, Pitt, Polk, Robeson, Rutherford, Scotland, Stokes, Surry, Swain, Transylvania, Washington, Yadkin, or Yancey County.

·  Individuals cannot be receiving services under the Community Alternatives Program (CAP) (Medicaid)

G.  Matching, level of effort, earmarking

Grantees were required to provide a match as established in the contract or Notice of Grant Award (NGA).

H.  Period of Availability of FEDERAL FUNDS

Funding is for the duration of the State fiscal year (July through June). Carry forward of unobligated funding must be authorized by the Division.

I.  Procurement and Suspension and Debarment

All grantees that expend federal funds (received either directly from a federal agency or passed through the N. C. Department of Health and Human Services) are required to conform with federal agency codifications of the grants management common rule accessible on the Internet at

All grantees that expend State funds (including federal funds passed through the N. C. Department of Health and Human Services) are required to comply with the procurement standards described in the North Carolina General Statutes and the North Carolina Administrative Code, which are identified in the State of North Carolina
Agency Purchasing Manual accessible on the Internet at:

L.  Reporting

Grantees are required to submit a Request for Reimbursement to the Division of Aging and Adult Services monthly to receive reimbursement through the Aging Resources Management System (ARMS). Expenditures are report based on an approved line-item budget for the program and reported as a non-unit reimbursement item utilizing the following codes:



Suggested Audit Procedures

·  Determine that reimbursed amounts are within the approved line-item budget.

·  Determine that no family receives reimbursement for services beyond $1,800 per year.

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