Title III-E National Family Caregiver Support Program

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Attachment F

Title III-E National Family Caregiver Support Program

New York Elder Caregiver Support Program

Frequently Asked Questions

(Prior to 4/1/09)

The following questions were raised prior to the current CAARS reporting requirements, which became effective April 1, 2009, and the answers continue to be in effect. While AAAs should continue to enter caregiving information using the client based system as they had previously, beginning April 2009, AAAs are no longer required to re-enter this information using the CAARS data entry page. This data is now submitted to NYSOFA using the standard client file format.

As questions are received and answered by NYSOFA they will be periodically added to this document and a new series number and date will be indicated.

Eligibility

Q1.Who is eligible for Title III-E National Family Caregiver Support Program

services?

A1. Family caregivers or other adultswho are age 18 and older who care for an

individual who is age 60 years or older;

Family caregivers or other adults who are age 18 and older who care for an

individual with Alzheimer’s disease or a related disorder regardless of age;

Grandparents and other relatives, age 55 years or older, not including natural

or adoptive parents, who care for children no older than age 18; and

Grandparents and other relatives, age 55 years or older, not including

natural or adoptive parents, who care for an adult child aged 19-59 who has a disability.

Allowable Services

Q2. What services are available for caregivers under Title III-E?

A2. AAAs are required to provide at least one service under each of the five Title

III-E Components, i.e., Information, Assistance, Counseling/Support Groups/Training, Respite andSupplemental services. The services that are available under each Component are listed below in the Title III-E Matrix.

Title III-E Service Matrix (Crosswalk)

TITLE III-E SERVICE COMPONENTSwith NAPIS Codes thata caregiver receives when receiving a Title III-E funded service.
/ CORRESPONDING NYSOFA STANDARD SERVICESthat the caregiver orcare receiver is providedin order to show the Title IIIE component services and to provide a linkage to the CAARS expenditures.
Counseling, Support Groups & Training*
(Code 902) / Caregiver Services (Code 527)
Respite (Code 903) / CD In-home Services (206)
PC Level II (Code 202)
PC Level I (Code 205)
Home Health Aide (Code 201)
Adult Day Services--social adult day or adult day
health (Code 510)
In-home Contact and Support--when in-home
supervision and monitoring will be
provided (Code 526)
Other--for those services not separately defined,
e.g., overnight respite, which may be provided at a nursing home, adult home, or other appropriate facility(Code 602)
SupplementalServices (Code 904) / Home Delivered Meals (Code 401)
Congregate Meals (Code 402)
Nutrition Counseling (Code 502)
Assisted Trans./Escort (Code 504)
Transportation (Code 101)
Legal Assistance (Code 301)
Health Promotion (Code 512)
Nutrition Education (Code 501)
Personal Emergency Response
Systems (Code 509)
Other--for those services not separately defined,
e.g., home modifications, etc. (Code 603)
Assistance (Code 905) / Case Management (Code 505)
Information and Assistance(Code 103)
Information (Code 906) / Outreach (Code 102)
Other Services, i.e., Public Information (Code 604)
* Training events that do not require preregistration and are open to the public should be reported as Information.
The CLIENT TYPES/FUNDING SOURCES codes for Title III-E services are16 – III–E Caregiver and 20 – III–E Grandparent.
Title IIIE expenditures are reported on page 3 of the CAARS online form following the above crosswalk.
Title III-E Other has been separated so they are tagged to the specific services.

Service Definitions

Q3. What is the III-E definition of Caregiver?

A3. A caregiver is a traditional or non-traditional family member, friend or neighbor

who is helping another person they are concerned about with the everyday

tasks of living. The caregiver and care receiver may live together, near each

other or far away from one another.

A caregiver’s functions and roles may include information gatherer/coordinator, provider of direct care or assistance, and/or organizer, coordinator and monitor of care others provide. These functions and roles may change over time; they may be performed as needed or on an ongoing basis. The caregiver’s assistance may be infrequent, intermittent, routinely scheduled or 24 hours per day, for short or extended periods.

Q4. If a caller requests information on behalf of a relative, spouse, or neighbor are

they automatically assumed to be a caregiver?

A4. Yes, initial gathering of information in this instance falls within the scope of the

functions and roles of a caregiver.

Q5. What is the III-E definition of Counseling?

A5. Counseling provides caregivers with emotional support, information, advice, guidance and tools to help them cope with their caregiving role and responsibilities. Counseling may include helping the caregiver explore strategies and options to deal with problems/issues/feelings/frustrations. It may include helping the caregiver to better understand their situation, their feelings and the positives and negatives of various options. Counseling can help a caregiver develop an action plan or a roadmap for decision-making. Counseling can take place on an individual basis or in a group setting for caregivers who are involved with the same care receiver.

Q6. What is the III-E definition of Assistance?

A6. In assistance – the core aspects are providing information about available

services and programsthat can help address caregivers issues/needs and helping to link the caregiver to those services and programs needed and wanted. It also includes following up with the caregiver, to the extent practicable and appropriate given the situation, to assure that services are obtained. There are 2 types of assistance – information and assistance, and case management.

We cross walk the five (5) Title III-E service categories with the NYSOFA standard service names (and definitions) so that AAAs can categorize the Title III-E services in other parts of the AIP and for reporting/program monitoring purposes. (cross walk matrix appears above)

Since Title III-E began, NYSOFA has included “case management” and “information and assistance” as services under the Title III-E service category of “assistance”. Information and assistance includes referrals and certainly can be and often is done over the phone. AAAs are not required to provide case management under Title III-E but by including it here we make it permissible. Because we want to maintain flexibility and allow for local decision making we think we should continue to include case management as an allowable service under the Title III-E service category of assistance. Ideally, under Title IIII-E the case management is provided to the caregiver (and not the care receiver). However, we do recognize that by providing case management to the care receiver we can be assisting the caregiver. However, it is important that AAAs recognize that a care receiver who is getting a service as respite for their caregiver doesn’t necessarily need case management because of the role and involvement of the caregiver, and therefore case management need not/should not be provided. However, a Minimum Data Set (MDS) compliant assessment of the care receiver is required if one of the community-based long term care services will be provided as a respite service or supplemental to the care giver.

The standard service definition for information and assistance includes “to the maximum extent practicable, establishes adequate follow-up procedures”. Each AAA decides what is practicable. This will depend on the resources available, as well as on the nature of a call or contact. For example, when staff are on a call with a wife who is looking for assistance for a complicated caregiving situation involving her husband, that requires that staff give her contact information for several services and where staffmay also make a contact on her behalf in one instance, staff may decide to follow-up in a few days to see how she is making out with the referral information provided. On the other hand, where a daughter is calling to get information on local programs that can help her parents get to their doctors’ appointments and some local community events, staff may choose not to follow-up.

Q7. For non III-E services, do we use the CAARS definition of frail, which is

different from the IIIE definition?

A7. In terms of reporting frail clients in CAARS, the definition in the CAARS

instructionsapplies to all services, including III-E. The more restrictive AoA

definition appliesonly to determining the eligibility of a caregiver to receive a III-E

funded respite orsupplemental service when the care receiver meets the more

restrictive AoA definition.

Frail (CAARS)- A person with one or more functional deficits in the following areas:

• Physicalfunctions

• Mentalfunctions

•ActivitiesofDailyLiving[ADL](eating,bed/chairtransfer,dressing,bathing,toiletingand continence)

•Instrumental Activities of Daily Living [IADL] (meal preparation, housekeeping, shopping, medications, telephone, travel and money management)

Frail (AoA) – A person with at last two or more functional deficits in the following areas:

•ActivitiesofDailyLiving[ADL](eating,bed/chairtransfer,dressing,bathing,toiletingand continence) or,

•due to a cognitive or other mental impairment, requires substantial supervision.

Group 1 Services

Q8. The reporting of units for caregiver services (counseling, support groups and

training) requires demographic and relationship data. How will our software

system accommodate this requirement?

A8. Your software system should guide you through entering service units in the

correct manner and reporting the required data for Group I services.

Caregiver Demographic/Relationship Data

Q9. Do we need to capture demographic and relationship data for both Group I

andGroup II III-E services?

A9. No, you only need to collect demographic and relationship data for Group I III-E

services (Counseling/Support Groups/Training, Respite and Supplemental) only.

Q10. What information must be collected on caregivers?

A10. For any caregiver receiving a Group 1 service (Counseling/Support

Group/Training or Respite service or Supplemental service) that is funded with

III-E, you must capture their age, gender, race/ethnicity, rural status and

relationship to the care receiver.

Q11. We are a county that receives State Caregiver Resource Center (CRC) funds

and we use the CRC client profile to collect information on caregivers and carereceivers who attend our training programs. Do we have to collect the demographic and relationshipdata on all caregivers and carereceivers who receive our newsletter or read a newspaper article?

A11. No, you do not collect demographic data for individuals on your newsletter

mailing list.

Public Information(Public Information for Title III-E is reported as Information Other Code 604

Q12. How should an AAA estimate the “audience size” for public informational

activities that fall under the Title III-E service category of “Information”?

A12. If the AAA were to provide Information Services through mass media by one radio

public service announcement, one newspaper article, one issue of a monthly

newsletter, and one television interview, there would be four (4) units (activities)

reported. The estimated audience size for each would be obtained from the

media or newsletter mailing list. For example:

• radio and television stations should provide the estimated number of listeners during that time period;
• newspapers should provide the circulation size; and,
• a monthly newsletter would be the number of people on your mailing list.

Other Examples:

• If an informational brochure or article is mailed, the brochure is 1 activity and the number of people it is mailed to is the estimated audience size.

• If an article is written and it is simultaneously distributed to 5 newspapers, this counts as one (1)unit (activity is the article) and the estimated audience size would be determined by keeping in mind that when aggregating audience size, estimates from multiple media sources are typically duplicated counts.

If multiple Informational events areconducted and monthly newsletters mailed out over the course of a year, the AAA, in aggregating the numbers for the estimated audience size, should bear in mind: (1) repeated messages through the same source will likely be reaching the same audience; (2) with minor/rare exceptions, estimated audience size should not exceed the total number of people living in the PSA. (See also, The Basics ofTitle III-E Reporting, A Work in Progress (revised 10/10/08))

Q13. How would one report dropping off 50 each of pamphlets and magnets at one

church and then 50 more of each at the church down the street?How do we show the expenditures and compute the costs for the pamphlets and

magnets?

A13. This would be 2 units of Public Information (the activity is the pamphlet and the

magnet) and the audience size would be an estimated audience size of 100 (50

at each church). The development and production costs associated with the

pamphlets and magnets should be reported when they were incurred. Similarly,

the expenditures to distribute would include such things aspostage or time spent

distributing the materials and mileage costs to deliver and would be reported when

the distribution costs are incurred.

Q14. What if a coordinator drops off 25 posters with a ‘tear-off’ section?

A14. This would be counted as one unit of Public Information (activity is distributing the

posters) and the audience size of 25.

Website “Hits”

Q15. If I make a referral to our website for specific information after a conversation with

a caregiver, is this then counted as another activity and thus two units of service

would be assigned both to be listed as "Information?”

A15. No, it is reported as one unit of assistance under III-E. “Assistance” under III-E

consists of I&A and/or case management and “Information” under III-E consists of

Outreach and/or Public Information. A unit of I&A (which is what this conversation

is) is one contact that takes place with a caregiver. Assuming the referral is made

during the same conversation (contact) it is just one unit of “Assistance.”

Q16. What about ‘hits’ to the county website where more and more consumers

are accessing and obtaining public information and other resources?

A16. At this time, continue to apply the standard definition for public information, i.e., Internet ‘hits’ are to be counted only if information is requested of the AAA and the AAA provides that information. AoA may revise this guidance in the future and AAAs will be informed if that happens.

Caregiver Newsletters

Q17. If we sent out our monthly AAA newsletter, which includes caregiver related

information, to our mailing list of 3,500, is the estimated audience size 3,500?

A17. Yes, you would count the newsletter as one unit per monthlymailing and the estimated audience size as 3,500 (count the audience size onetime, not each month the newsletter is sent).

Q18. How will the vendors’ software systems be able to determine the

unduplicated count for the mailing of acaregiver newsletter?

A18. Software systems should allow you to enter caregiver mailing information (number

of newsletter recipients) with the first SFY issue of the monthly newsletter. Future

monthly mailings will require only entering that a unit of information has been

provided via the monthly newsletter mailing.

Caregiver Educational Events

Q19. When we present a series of 6 education programs to one company in our

“Caregivers in the Workplace Program” we view this as 6 individual

activities. Employees do not register for these nor is it expected that the same

group will attend each program. Employees chose which one or ones to attend

based on their individual needs and interests. I am not sure how to report

this - 6 individual classes or 1 class? Often a person will attend more than one. Is

that person counted each time?

A19.Training events that do not require preregistration and are open to thepublic can be reported as Information.

Q20. We keep track of each caller who calls our AAA for information; this way we

have a history of that caller and their needs. As a result of this practice, the

individuals get reported under Information and Assistance with our

software system. Will it be a problem to continue this practice?

A20. While the practice of keeping track of who calls your office is a good one under any funding stream, it is an issue when a client database counts individuals who receive Information. Coding changes to the file specifications has added additional codes that can be used to count anonymous units of service.

Q21. How would we report if a caregiver coordinator who is paid totally under Title

III-E spends time on something that is not funded under Title III-E? For example,

a caregiver coordinator answers a phone call and spends time talking to an older

person about various services that are available in the community.

A21. First we should say that AAAs deal with these types of situations regularly and not

just for Title III-E but for many staff and funding streams with very specific purposes. An AAA has a choice -- either it goes unreported, not all of the person’s time is translated into units of service, or the unit is reported under a funding stream that can pay for I & A. Regardless of the choice, the expenditures are absorbed by the Title III-E program. In both these instances the assumption is that the amount of the person’s time spent providing information to non-caregivers is an insignificant amount and thus can reasonably be absorbed by Title III-E (just like other programs would absorb insignificant amounts of staff time doing something other than what the funding streams permit). If, on the other hand, this is not true but rather the person spends more than an insignificant amount of time, for example more than 5% of their time, with individuals not eligible for Title III-E funded services, then the AAA would be advised to re-examine the allocation of the person’s salary and change how and to what funding streams this person’s salary is charged or the AAA would need to review and change office procedures and practices so that this person is not providing support to non-caregivers to the current extent.