SUA Survey Form Approved
OMB No. 0985-xxxx
Exp. Date XX/XX/201X
National Family Caregiver Support Program Evaluation
2014 SUA Survey
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National Evaluation of the Title III-E National Family Caregiver Support Program State Unit on Aging Survey
Dear SUA Director,
As part of the Administration for Community Living’s (ACL) continuing commitment to evaluate the effectiveness of programs and services in the Aging Network, we seek information about your State Unit on Aging (SUA) and the important work you do for older adults and those who care for them.
ACL has partnered with The Lewin Group to gather and analyze information about the range of services SUAs provide to caregivers in general and about the National Family Caregiver Support Program (NFCSP) in particular. The efforts of the Aging Network to support caregivers have a significant impact on older adults, their families, employers, and entire communities. Supporting caregivers is essential to maintaining older adults’ independence in their own homes. Demonstrating the effectiveness of these programs provides necessary evidence for advocacy efforts and funding at the federal, state, and local levels.
Completing the survey should take about 90 minutes. Your responses will remain confidential among ACL and the Lewin research team and your answers will not be reported in a way that can identify your agency. We highly encourage all SUAs to join us in this important effort. Please forward this email survey invitation to the person(s) in your organization most familiar with your caregiving programs and services.
The deadline for completion of the surveys is [DATE]. A series of reminders will be sent if you have not completed the survey. If you have questions about completing the survey please contact Dr. Cindy Gruman (703-269-5506 or [email protected]) or Ashley Tomisek (703-269-5632 or [email protected]).
We recognize that all of you are very busy. Thank you for taking the time to complete this very important survey.
Insert Unique SUA survey link.
If you have any trouble connecting to the survey please copy and paste the link directly into your browser.
Sincerely,
[NAME]
Administration for Community Living
E-Mail Reminder
Send every two weeks or as needed
We are writing to remind you about the Administration for Community Living’s (ACL) National Family Caregiver Support Program Survey which is part of the first national evaluation of Title III-E National Family Caregiver Support Program. Please see the link below. The survey is only available until [DATE] so we hope to hear from your organization as soon as possible.
ACL has partnered with The Lewin Group to gather and analyze information about the range of services State Units on Aging provide to caregivers in general and about the National Family Caregiver Support Program (NFCSP) in particular. The efforts of the Aging Network to support caregivers have a significant impact on older adults, their families, employers, and entire communities. Supporting caregivers is essential to maintaining older adults’ independence in their own homes. Demonstrating the effectiveness of these programs provides necessary evidence for advocacy efforts and funding at the federal, state, and local levels.
Completing the survey should take about 90 minutes. We highly encourage all SUAs to join us in this important effort. Please feel free to forward this survey to the person(s) in your organization most familiar with your caregiving programs and services. The link is unique to your state.
The deadline for completion of the surveys is [DATE]. One more reminder will be sent out to your SUA if you have not completed the survey. If you have questions about completing the survey please contact Dr. Cindy Gruman (703-269-5506 or [email protected]) or Ashley Tomisek (703-269-5632 or [email protected]).
We recognize that all of you are very busy. Thank you for taking the time to complete this very important survey.
Insert Unique SUA survey link.
If you have any trouble connecting to the survey please copy and paste the link directly into your browser.
Sincerely,
NAME
Administration for Community Living
Before You Begin/SURVEY Introduction Page—Initial Screen of Web Version
Thank you for taking the time to complete this very important survey on caregiving. The information you provide is an essential part of the Administration for Community Living’s (ACLs) first national evaluation of the Title III-E National Family Caregiver Support Program (NFCSP). State Units on Aging (SUAs) play a vital role in overseeing programs and services provided to caregivers in their local areas. It is the goal of this survey to:
Obtain a broad understanding of the services SUAs provide to caregivers
Understand the variety of ways caregiver programs are implemented and monitored by SUAs nationwide
Examine the features of caregiver programs such as consumer direction, caregiver assessments and case/care management
Your responses to this survey will provide important information to document the scope, effectiveness and impact of caregiver programs in your state and community.
The survey asks a few questions about the characteristics of your caregiver programs and your SUA. Before you begin it may be helpful to gather the following information:
1) Estimated number of unduplicated consumers who received caregiver services from your SUA in your most recent fiscal year.
2) Estimated number of unduplicated grandparents 55+ caring for grandchildren and receiving caregiver services in your most recent fiscal year.
3) Total amount of expenditures in your SUA in the most recent fiscal year.
4) Amount of expenditures on Title III-E (National Family Caregiver Support Program in the most recent fiscal year.
5) NFCSP Waiting List information (number of people on the waiting list for each NFCSP service, as applicable).
6) NFCSP Services cap information.
7) Top three supplemental services for caregivers of older adults and grandparent caregivers who care for grandchildren.
If you are using HIPAA-compliant internet access, your server may log you off after a period of inactivity. Save your work periodically, especially if you step away from your computer, by clicking “next” to get to the next page. Otherwise, your work may be lost.
If you have questions about completing the survey, please contact Cindy Gruman (703-269-5506 or [email protected]) or Ashley Tomisek (703-269-5632 or [email protected]).
Caregiver Intake, Screening, and Assessment 10
Caregiver Service Operation and Quality Assurance 17
Self-directed Care/Consumer Direction 23
Program Funding and Resources 25
National Evaluation of the Title III-E National Family Caregiver Support Program State Unit on Aging Survey
This survey is to be administered in a web-based format to state-level Title III-E coordinators/ NFCSP specialists in all states. There will also be the option of a paper format to be faxed, scanned or returned through mail.
All questions pertain to the State's Title III-E/OAA NFCSP program, which will be referred to as NFCSP throughout the survey.
How many Area Agencies on Aging (AAA) are there currently in your state?
|_|_|_| AAAs
Of the total number of AAAs in your state, please record the number of AAAs that are characterized by each of the various types of planning and service area boundaries.
Planning and Service Area Boundaries |
Number of AAAs |
Don’t Know |
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Does the SUA currently employ a caregiver program manager/coordinator who plans, develops, administers, implements, and/or evaluates the NFCSP?
Yes
No
Don’t know
Currently, does your SUA have a policy or standardized eligibility criteria that defines caregivers as clients?
Yes
No
Don’t know
Does your SUA have a statewide identity for the NFCSP? (Check all that apply)
Consistent logo
Tagline
Statewide toll-free number
Statewide web-based caregiver resource database
Dedicated website
Link within another website
No statewide identity (Programmer note: If a respondent selects this answer, they cannot select any other option)
The next set of questions will ask about staff and volunteer training.
Does the SUA require training for AAA or other staff or volunteers who work with family caregivers?
Yes
No policy on training (Skip to Q7)
6a) If yes, which of the following staff members or volunteers are required to take training?
Information and referral staff
Other Program Administrative Staff
Supervisory Staff
Direct Service Workers (e.g., social workers, counselors, care managers)
Volunteers
Decided at AAA level
Decided at provider level
Other (please specify): __________________
Don’t know
None of the above
6b) How often is training provided? (Check one)
More than once a year/on a regular basis (e.g., quarterly)
Once a year
Occasionally, when the opportunity presents itself
Whenever there’s a new hire, s/he gets one-on-one training
Once every couple of years
Once at time of hire
Never
Don’t know
During your most recently completed fiscal year, which of the following topics did the SUA provide training to staff or volunteers who work with family caregivers? (Check all that apply)
Alzheimer’s disease or a related disorder with neurological and organic brain dysfunction
Caregiver assessment
Care coordination/care management
Caregiver health and well-being
Caregiver intake and screening
Conducting outreach/public awareness activities
Care recipient diseases/chronic conditions
Cultural/ethnic competency
Employed caregivers
Facilitating family meetings/mediation/conflict resolution
Program data collection and reporting
Service delivery specifications (e.g., protocols, referrals)
Specific evidence-based caregiver education programs (e.g., Powerful Tools; SAVVY Caregiver)
Technical aspects of administering consumer directed options (e.g., vouchers, cash payments or fiscal intermediaries)
Grandparents Raising Grandchildren
Other (please specify): ________________
Not applicable
Don’t know
Please mark which of the following funding sources are used to serve NFCSP caregiver clients. (Check all that apply)
Aging and Disability Resources Center initiative (ADRC)
Alzheimer’s Disease Demonstration Grants to States (ADDGS)
Lottery funds
Money Follows the Person (MFP)
Medicaid Aged/Disabled HCBS waiver (A/D Waiver)
Medicaid State Plan
Private foundation
Social Services Block Grant (Title XX)
Tobacco settlement funds
Veterans Directed Home and Community Based Services (VD-HCBS)
Other (please specify): ________________
Don’t know
The next questions are about targeting. Targeting is defined as modifying or adapting services and outreach to attract and meet the needs of identified groups who may be under-represented or are considered in special need of services. Target populations are defined by the Older Americans Act as… “Older individuals with greatest economic need and older individuals with greatest social need (with particular attention to low-income older individuals, including low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas).”
Since program implementation, which special populations of caregivers, if any, has your program made a specific effort to serve? (Check all that apply)
Caregivers, Older (age 70+)
Caregivers, Younger (age 18-25)
Caregivers of persons with Alzheimer’s disease or a related disorder with neurological and organic brain dysfunction
Caregivers of veterans
Employed family caregivers
Grandparents raising grandchildren and other relative caregivers
Rural caregivers
Racially and ethnically diverse caregivers
Other (please specify): _____________
No specific efforts have been made to address special populations (Skip to Q11)
Don’t know
Since program implementation began, which of the following activities has your program undertaken to address those special populations of caregivers? (Check all that apply)
Targeted marketing and outreach campaigns
Translated or adopted materials in languages other than English
Produced culturally specific and appropriate materials
Developed services to meet specialized needs (e.g. mobile adult day services and mobile I&A unit for rural caregivers)
Hired staff or obtained volunteers with specialized knowledge of or skills working with special populations of caregivers
Developed mobile mechanisms to address needs of rural caregivers
Developed partnerships with employers
Developed partnerships with schools
Developed partnerships with VA systems
Other (Please specify)
Don’t know
Do you have a statewide task force, commission or coalition specifically to examine family caregiver issues?
Yes
No
11a) If yes, what is the name and contact information for this entity?
Name: _________________________
Contact information (e.g., e-mail; phone):__________________________________
11b) Please e-mail a copy of the task force’s, coalition’s, or commission’s report if it was completed in the last five years to Cindy Gruman ([email protected]). This report can include a summary of the group’s activities, research, recommendations, etc. You will receive a reminder at the end of this survey.
The next set of questions will ask about your state’s Community Needs Assessment protocol.
Have community needs assessments for caregiver support services been conducted?
Yes, a state-wide community needs assessment that includes caregiver support services has been done (skip to 12b)
Yes, one or more local level (PSA-level) community needs assessments that include caregiver support services have been done (go to 12a)
No assessment has been done (Skip to Q14)
Don’t know (Skip to Q14)
12a) Did the local level community needs assessment(s) follow a consistent protocol (e.g., standard methodology and/or timeframes for community assessment) that included caregiver services?
Yes
No (Skip to Q13)
Don’t know
12b) If yes, how many years ago? If you do not know, enter DK
________________________
12c) Please e-mail a copy of your state’s assessment protocol to Cindy Gruman ([email protected]). You will receive a reminder at the end of this survey.
Were results from the community needs assessment(s) pertaining to caregiver support services utilized or incorporated into the state plan?
Yes
No
Don’t know
The next set of questions will ask about Caregiver Intake, Screening, and Assessment.
What are your state policies around intake activities for caregiver support services? (Check all that apply)
We require a standardized intake process for caregiver support in our state (Programmer note: If this first answer option is selected, the second answer option cannot be selected)
We have, but do not require, a standardized intake process for caregiver support in our state (Programmer note: If this second answer option is selected, the first answer option cannot be selected)
Our family caregiver support program shares relevant caregiver intake data with other programs in which the caregiver might be eligible for support (either verbally or electronically)
Our family caregiver support program receives relevant caregiver intake data from other programs (either verbally or electronically)
The state requires a standardized data set but the AAA or individual providers can develop their own intake process.
Does not apply
Other (please specify): ____________________
What are your state policies around screening activities for caregiver support services? (Check all that apply)
We require a standardized screening process for caregiver support in our state (Programmer note: If this first answer option is selected, the second answer option cannot be selected)
We have, but do not require, a standardized screening process for caregiver support in our state (Programmer note: If this second answer option is selected, the first answer option cannot be selected)
Our family caregiver support program shares relevant screening data with other programs in which the caregiver might be eligible for support (either verbally or electronically)
Our family caregiver support program receives relevant caregiver screening data from other programs (either verbally or electronically)
The state requires a standardized data set but the AAA or individual providers can develop their own screening process.
Does not apply
Other (please specify): ____________________
The next few questions will be about your state’s practices for assessing caregiver needs.
How does your SUA define caregiver assessment?
____________________________________________________________________________________________________________________________________________
Which policies, regulations, or guidance does your state have on individual level caregiver assessments for the NFCSP?
Who is to be assessed
Content of assessments
Who can perform assessments
How often the assessment is conducted
Other (please specify): _________________
Does your SUA have a standardized process (e.g., assessment instrument, policies) for assessing caregiver needs? (Check all that apply)
Yes, for all family caregiver program clients
Yes, for specific services only:
Access assistance
Respite services
Education/Training
Support groups
Counseling
Supplemental services
Other (please specify): ________________
No, we don’t have a standardized process for assessing caregiver needs
Don’t know
In your caregiver support program, who is assessed?
Care Recipient (Skip to 20)
Family caregiver (Skip to 20)
Both (Skip to 20)
No assessment is conducted (Go to 19a)
19a) Can you describe the reasons why you do not conduct assessments? (Open ended): ____________________________________ (Skip to 23)
Does your state have a standardized caregiver assessment?
Yes
No (Skip to Q21)
Don’t know
20a) Which of the following domains are included in your standardized caregiver assessment? (Check all that apply)
Caregiver’s background and the caregiving situation
Caregiver’s perception of care recipient health and functional status
Caregiver’s values and preferences with respect to everyday living and care provision
Caregiver’s health and well-being
Impact of caregiving on the caregiver
Caregiver’s skills, ability, knowledge or other requirements to provide care
Resources available to support the caregiver
Care recipient background (demographics, financial status)
Care recipient’s health and well-being (functional and cognitive status)
Resources available to support the care recipient
Other (please specify): ________________
20b) Please e-mail a copy of your state’s standardized assessment instrument to Cindy Gruman ([email protected]). You will receive a reminder at the end of this survey.
What is your SUA’s policy on the frequency of conducting family caregiver reassessments for services? (Check all that apply)
We do not have a policy for conducting reassessments
Annually
Semi-annually
Prompted by change in caregiver status
Prompted by change in care recipient status
Left up to the AAA
Other (please specify) _________
Don’t know
Does the SUA set the policy for how the caregiver assessments and reassessments are used?
To prioritize who receives services (Skip to Q23)
Care plan development for the caregiver (Skip to Q23)
Measuring caregiver program outcomes (Go to Q22a)
Strategic planning/forecasting and/ or program development (Skip to Q23)
Decided at the AAA level (Skip to Q23)
Other (please specify): _____________ (Skip to Q23)
Don’t know (Skip to Q23)
22a) You indicated that you measure caregiver outcomes. Which of the following outcomes do you measure (Check all that apply)
Monitor caregiver burden
Monitor caregiver depression
Emotional/mental health
Financial/employment
Extent of caregiving load/demand
Balance among caregiving, work, or other life domains
Physical health
Other (please specify): ___________
Has there been an effort at the state level to use the same caregiver and care recipient assessment tools across all home and community-based (HCBS) programs?
Yes
No (Skip to 24)
23a) If yes, indicate which HCBS programs? (Check all that apply)
Medicaid HCBS for elderly
Medicaid HCBS for adults with disabilities
State-funded caregiver program/services
Kinship care program
Other (please specify):________
What is the level of integration of the following components of your state’s home and community-based service system for the elderly and adults with physical disabilities? [Check one for each row]
Level of Integration |
Fully Integrated |
Partially Integrated |
Not Integrated |
Don’t Know |
Intake |
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What are the major barriers limiting/preventing integration of NFCSP with other home and community-based programs in your state. (Check all that apply)
Complexity of accessing and arranging services
Different client population than in other programs
Different eligibility requirements
Different reporting requirements
Federal regulatory or statutory requirements
Lack of access to adequate computer technology and support
Lack of knowledge of opportunities for integration
Low priority given to caregiver support services
Organizational cultural and administrative differences
Staff has too many responsibilities
State regulatory or statutory requirements
Other (please specify): _________________
No barriers to integration
25a) Does your NFCSP have a method for identifying caregivers for referral to other publicly funded services?
Yes
No
Don’t Know
25b) Does your state have a protocol on referral of caregivers between programs?
Yes
No
Don’t Know
Does the Aging and Disability Resource Center site(s) currently use client intake and assessments for caregiver services that are consistent across the state?
Yes, they are consistent
No, they are not consistent
Only one site in state
ADRC does not conduct client intake or assessments
Don’t know
Does the OAA required State Plan on Aging currently include a caregiver supports and services component?
Yes
No
Don’t Know
Does the Area Plan for Aging format currently include a caregiver services component?
Yes
No
Don’t Know
The next set of questions asks about waiting lists for NFCSP services.
Does the SUA currently have policies, guidance or regulations pertaining to the creation and management of waiting lists for NFCSP services?
Yes
No
Don’t know
In your SUA, is there a waiting list for any NFCSP service?
Yes
No
Don’t know
How are waiting lists organized?
A single waitlist is maintained for the NFCSP overall
Multiple waitlists are maintained for NFCSP specific caregiver support services (e.g., respite care, caregiver counseling)
Other (Please specify):___________________
Don’t know
Please indicate how many caregivers are on the lists, and what the typical waiting period is?
Caregiver Service |
# of caregivers on the waitlist |
Typical minimum wait for services |
Typical Maximum wait for services |
Single waitlist for the NFCSP overall |
__________
None Don’t know |
___ yrs ___months ___days
No wait SUA does not keep that data at the state level Don’t know |
___ yrs ___months ___days
No wait SUA does not keep that data at the state level
Don’t know |
Caregiver counseling, training and education |
__________
None Don’t know |
___ yrs ___months ___days
No wait SUA does not keep that data at the state level Don’t know |
___ yrs ___months ___days
No wait SUA does not keep that data at the state level Don’t know |
Caregiver support groups |
__________
None Don’t know |
___ yrs ___months ___days
No wait SUA does not keep that data at the state level Don’t know |
___ yrs ___months ___days
No wait SUA does not keep that data at the state level Don’t know |
Respite care |
__________
None Don’t know |
___ yrs ___months ___days
No wait SUA does not keep that data at the state level Don’t know |
___ yrs ___months ___days
No wait SUA does not keep that data at the state level Don’t know |
Supplemental Services |
__________
None Don’t know |
___ yrs ___months ___days
No wait SUA does not keep that data at the state level Don’t know |
___ yrs ___months ___days
No wait SUA does not keep that data at the state level Don’t know |
Access assistance/case management/care coordination |
__________
None Don’t know |
___ yrs ___months ___days
No wait SUA does not keep that data at the state level Don’t know |
___ yrs ___months ___days
No wait SUA does not keep that data at the state level Don’t know |
The next section asks about how services are prioritized in your state.
Which of the following best describes how the SUA’s current prioritization policy was set for the NFCSP?
Prioritization policy is set by the SUA
Prioritization policy is set by the SUA with input from AAAs
Prioritization policy is set by the AAAs with input from SUA
Prioritization policy is set by the AAAs
Prioritization policy is set by the local service providers
No prioritization policy exists
Don’t know
Are prioritization criteria statewide or do they vary by AAA?
Prioritization criteria are statewide
Prioritization criteria are AAA specific
Prioritization criteria are local service provider specific
Don’t know
Which of the following criteria are used to determine NFCSP service priority according to SUA policy? (check all that apply)
Criteria |
check all that apply |
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The next section asks about protocols for caregiver services and quality assurance in your state.
Please check all of the following services that your family caregiver support program provides specifically to family caregivers (directly through the AAA or local service providers).
Information
Information & Referral
Outreach Presentations
Other (Please specify): ___________________
Assistance
Options Counseling
Care/case management (e.g., assessment, developing care plans, arranging services)
Follow-up and/or reassessments
Other (Please specify): ___________________
Counseling/Education & Training
Support Groups
Individual Counseling
Family Consultation, Counseling, Meetings
Training on various aspects related to caregiving
Other (Please specify): ___________________
Respite Services
In-home respite during normal business hours
In-home respite during evenings
In-home respite overnight
Adult day program respite
Respite weekend, including camps
Overnight in a facility or extended respite (extended respite = 24 hours)
Emergency respite services
Other (Please specify): ___________________
Supplemental Services
Assistive Technology
Cash Grant
Consumable Supplies
Emergency Response
In-Home Assessment
Home Modification/Repairs
Legal and/or Financial Consultation
Homemaker/Chore Services
Transportation
Other (Please specify): ___________________
Must the caregiver live with the care recipient to be eligible for respite assistance?
Yes
No
Are eligible family caregivers offered the same package of NFCSP services in every PSA in your state?
Yes
No, please explain ________
Don’t know
Does your NFCSP caregiver program have a policy that limits or caps the amount or cost of service an individual may receive?
Yes, annual limit
Yes, lifetime limit
Limits vary by service
No limits on the amount of services (Skip to Q40)
39a) Who sets the policy regarding NFCSP service caps? (Check all that apply)
SUA
AAA
Local service provider
SUA sets funding cap for the AAA; the AAA can set additional funding caps for local service providers
Other state-level agencies or policies
Other (please specify) _____________________
Not applicable
39b) Is the cap uniform across each Planning and Service Area?
Yes
No
Not applicable
39c) Please complete the following to describe the service caps in your NFCSP program (Check all that apply):
WEB PROGRAMMER: IF QUESTION 39b = NO, SKIP TO Q40
Services |
Capped |
Type & Amount of Cap |
Cap time period |
All NFSCP services treated the same |
Yes |
Hours: _________hrs Dollars: $_________ |
Lifetime Monthly Quarterly Yearly Other: ___________ |
Respite |
Yes
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Hours: _________hrs Dollars: $_________ |
Lifetime Monthly Quarterly Yearly Other: ___________ |
Training and Education |
Yes
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Hours: _________hrs Dollars: $_________ |
Lifetime Monthly Quarterly Yearly Other: ___________ |
Supplemental Services |
Yes
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Hours: _________hrs Dollars: $_________ |
Lifetime Monthly Quarterly Yearly Other: ___________ |
Care/case
management/ |
Yes
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Hours: _________hrs Dollars: $_________ |
Lifetime Monthly Quarterly Yearly Other: ___________ |
The next section asks about programmatic monitoring activities in your state.
Does your SUA conduct routine programmatic monitoring of the NFCSP program? (Check all that apply)
Yes, at the AAA level
Yes, at the local/provider level
No, the SUA does not conduct routine programmatic monitoring (Skip to Q41)
40a) How does your program use the results?
Advocate for program funding
Budget justification
Ensure compliance to Title III-E
Funding requests
Fundraising
Ongoing implementation purposes
Planning purposes
Program changes
Public Relations
Other (please specify):___________________________
40b) With whom did you/plan to share the results? (Check all that apply)
Internal SUA
AAAs
Provider network
Other state agencies
Advocacy organizations
Legislature
Other (please specify):___________________________
40c) Please e-mail a copy of your state’s programmatic monitoring results to Cindy Gruman ([email protected]). You will receive a reminder at the end of this survey.
Does your SUA assess client satisfaction?
Yes
No (Skip to Q43)
AAA assesses client satisfaction (Skip to Q43)
How frequently does your SUA assess program participant satisfaction?
Annually
Semi-annually
Quarterly
Monthly
Ongoing
Varies by service
Other (Please specify):_______________________
Periodic (no schedule)
42a) Do you use a uniform caregiver satisfaction survey across all AAAs?
Yes
No
42b) Please e-mail a copy of your caregiver satisfaction survey to Cindy Gruman ([email protected]). You will receive a reminder at the end of this survey.
Which of the following requirements are included in your contracts with AAAs pertaining to the NFCSP? (Check all that apply)
Adherence to the Title III-E
Staff certification requirements for staff who work directly with caregivers
Staff training requirements for all staff
Staff training requirements for staff who work directly with caregivers
Delivery of evidence-based interventions and/or practices
IT/MIS infrastructure
Performance-based outcomes
Mode of caregiver contact (Communication – in person, phone, online)
Other (please specify): _________________
Does the SUA currently include assessments in any of the following areas to monitor the AAAs’ implementation of the NFCSP?
Client satisfaction
Targeting of service
Outreach activities
Access to service
Reporting of data
Fiscal management
None of the above
Don’t know
Other (please specify): _________
How do AAAs currently report NFCSP data to the SUA?
Software/computer system
Email (Skip to Q46)
Phone (Skip to Q46)
Mail (Skip to Q46)
Other (please specify): _________________ (Skip to Q46)
Don’t know (Skip to Q46)
45a) Are all AAAs in your state currently required to use the same software for reporting NFCSP data?
Yes
No
Don’t Know
What specific data are currently collected beyond what is required for the State Program Report?
NFCSP reports /program performance data
Quality assurance findings
Fiscal management reports
Other (please specify): _____________
We don’t require data beyond what is required in the AoA State Program Report
Don’t know
Does the SUA or AAA establish NFCSP performance measures at the AAA level?
Yes, the SUA
Yes, the AAA
Yes, both the SUA and AAA
No, not established
Don’t Know
Has your SUA designed a website or webpage for family caregivers? (Check all that apply)
Yes, as a separate website
Yes, as a separate webpage
Yes, as part of the ADRC initiative
Yes, as part of a community database unrelated to/as a separate effort from the ADRC initiative
No website or webpage but there are plans to do so
No website or webpage
Does your SUA work with other state agencies to implement the NFCSP?
Yes
No (Skip to Q50)
49a) If yes, please list these state agencies and describe your relationship in implementing the NFCSP: __________________________________________
The next set of questions ask about provision of supplemental services in your state.
Which entity determines which supplemental services may be purchased under the NFCSP? (Check all that apply)
SUA
AAA
Local service providers
Other (please describe): ______________
Please list your top three supplemental services for NFCSP caregivers of older adults.
1) _________________
2) _________________
3) _________________
Don’t know
Please list your top three supplemental services for NFCSP grandparent caregivers who care for grandchildren.
1) _________________
2) _________________
3) _________________
Don’t know
The next questions are about self-directed care. Self-directed care is defined as programs and services, in which clients can choose to select, manage and dismiss their workers. This may also be referred to as “consumer-directed” care.
Does the SUA currently have policies that permit self-directed home and community-based services for caregivers?
Yes
No
Don’t know
What kinds of choice and control over services does your NFCSP provide for family caregivers? (Check all that apply)
Caregivers can choose the services that best fit their needs from a menu of services
Caregivers can choose who they want to provide respite care (e.g. choosing between contract agencies and independent providers)
Caregivers receive a voucher or budget to use for respite care
Caregivers receive a voucher or budget to use for supplemental services (e.g., consumable supplies, home modifications, etc.)
Caregivers receive a budget for the purchase of goods or services
Other (please describe): _____________________________
None of the above
Can family members other than the primary caregiver be paid through your NFCSP to provide care?
Yes
No (Skip to Q56)
55a) What types of services can they be paid to provide? (Check all that apply)
Respite care
Personal care
Other (please describe): ____________
55b) Are there any family members who cannot be paid? (Check all that apply)
Spouses
Parents/guardians of minors
Adult children
Other (please describe): ______________
Any family member can be paid
55c) What types of special requirements are there for family members who are paid to provide services? (Check all that apply)
Criminal background checks
Minimum training requirements
Other (please describe): _______________
No special requirements
The next set of questions asks about state and federal financing, and single point-of-entry systems.
If your state operates a single point-of-entry system for all home and community-based care programs, does the single point-of-entry include or exclude access to the NFCSP? (Check one)
Include
Exclude
Varies at the local level
No single point-of-entry
In your opinion, how difficult is it for the state to meet the federal match requirements for the NFCSP?
Not at all difficult
Somewhat difficult
Quite a bit difficult
Extremely difficult
I don’t know
How is the federal match requirement for the NFCSP met in your state (check all that apply)
The state provides the match
The AAA provides the match
The service provider provides the match
What effect has your state’s current state fiscal status had on services to support family caregivers and/or state initiatives to explicitly assist family caregivers? Would you say:
A strong negative effect
A moderate negative effect
A little negative effect
No effect at all
A little positive effect
A moderate positive effect
A strong positive effect
59a) Please explain your answer: ___________________
The next questions are about your state’s budget during the most recently completed fiscal year.
How does the state make funding allocation decisions for each of the NFCSP services?
SUA alone determines amount
SUA determines amounts with consultation with AAAs or local providers
SUA and AAAs make a joint decision
SUA determines the amounts based solely on the amounts requested by the AAAs
SUA gives total allocation and AAA determines how much goes to each Title III-E service
Other (please specify): _______________
Don’t know
In your most recently completed fiscal year, how much did your state expend from the following sources to support the caregivers served in the NFCSP? Please provide category totals (i.e., shaded lines below), even if you cannot provide expenditures within each category.
|
Expenditures |
Don’t know |
Total Federal Funding |
$__________ |
□ |
a. Older Americans Act funds |
$__________ |
□ |
b. Other federal (Please specify) |
$__________ __________ |
□
|
Total State Funding |
$__________ |
□ |
c. General Revenue |
$__________ |
□ |
d. State funded caregiver program |
$__________ |
□ |
Other Sources of Funding (e.g., local funding, non-profit, private for-profit, contributions, foundation) |
$__________ |
□ |
During the most recently completed fiscal year, what were the total expenditures for your SUA, including expenditures for the NFCSP?
$|_|,|_|_|_|,|_|_|_|,|_|_|_|
Don’t know
Does the SUA have policy, guidance, or regulations related to AAA and local service provider offering private pay/fee-for-service caregiver services?
Yes
No
Don’t know
Please indicate how much your SUA encourages or discourages AAAs or service providers to operate private pay/fee-for-service NFCSP for older adults?
Strongly encourages
Encourages
Allows private pay but neither encourages nor discourages the activity
Discourages
Prohibits
Don’t know
The next questions are about caregiver programs in your state that are not funded by the OAA.
Prior to the establishment of OAA NFCSP in your SUA, which of the following services did your SUA offer (either directly or via contract with another provider) to caregivers? (Check all that apply)
I&R
Training/Education
Support Groups
Counseling
Respite care
Supplemental service (e.g. home-delivered meals, home modification, emergency response)
Care Coordination
Caregiver Support Coordination
Access assistance
Cash and counseling
Other (please specify): ________________
Don’t know
Did the establishment of the NFCSP result in the creation of standardized eligibility criteria for caregiver services and supports?
Yes
No
Don’t know
Does your state currently administer a separate caregiver program funded outside of the NFCSP?
Yes
No (Skip to Q71)
67a) If yes, what is the caregiver minimum age eligibility requirement?
18+
55+
60+
65+
Other minimum caregiver age. What age?________________
No age requirement if care recipient meets age requirement
No age requirement for caregiver
67b) If yes, what is the care recipient minimum age eligibility requirement?
Under 18
18+
55+
60+
65+
Other minimum care recipient age. What age? ______
No age requirement if caregiver meets age requirement
67c) If yes, what are the care recipient functional status (e.g. ADL limitation) eligibility requirements? (Check all that apply)
Unable to complete at least 1 Activity of Daily Living (ADL)
Unable to complete at least 2 ADLs
Unable to complete 3 or more ADLs
Unable to complete at least 1 Instrumental Activity of Daily Living (IADL)
Unable to complete at least 2 IADLs
Unable to complete 3 or more IADLs
Nursing home eligible
Diagnosed with Alzheimer’s disease or a related disorder with neurological and organic brain dysfunction
Requires 24-hour monitoring or supervision due to cognitive impairment
Judged to have severe disability
No functional status requirement
Other (please describe)
During the last fiscal year, approximately how many caregivers were in your non-OAA caregiver programs?
__________________
When did your non-OAA caregiver program begin?
Before the NFCSP (Go to Q69a, then skip to Q70)
After the NFCSP program (Skip to Q69b)
At the same time as the NFCSP (Skip to Q69b)
Don’t Know (Skip to Q71)
Other [Please specify]:_______________
69a) How did your non-OAA caregiver program(s) change as a result of the NFCSP implementation?
[Skip to Q70]
69b) How did the NFCSP affect implementation of your state’s non-OAA caregiver program?
[Skip to Q71]
Which best describes the current relationship between the OAA NFCSP and pre-existing caregiver programs and services?
Programs are distinct and operate separately (Skip to 71)
Programs are separate with coordinated operations
Programs are integrated into one program with multiple funding streams
Other (please specify): ________________
Don’t know
70a) Please describe how your SUA integrated or coordinated these programs.
The next questions address state efforts to integrate the NFCSP with non-caregiver programs.
Has the NFCSP coordinated with ADRCs in any of the following ways? (check all that apply)
Development or review of policies, guidance or regulations regarding the inclusion of caregiver services
Development or implementation of screening protocols
Development or implementation of intake tools
Development or implementation of referral/assessment processes
Provision of training
Provision of Care Transitions
Provision of Options Counseling
Other (please specify): __________
NFCSP does not coordinate with the ADRC
Now we are going to ask you questions about additional long-term care issues in your state.
What is the current status of the following long-term issues in your SUA?
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Fully Operationalized |
Currently working on this |
Plan to do this in the future |
Not a priority |
Don’t know |
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What do you see as the most significant issues your family caregiver program will face over the next year?
What do you see as the most significant issues your family caregiver program will face over the next three to five years?
Other than additional funding, what suggestions would you make to improve the way the NFCSP caregiver services program works?
Give one example of an NFCSP activity in your state that you would nominate as a “best practice” for caregiver support. Provide the name of the activity/practice and a description and how outcomes were evaluated, if they were.
Contact Information
Your Name: [Type text]
Title: [Type text]
State Department/Division: [Type text]
Mailing Address: [Type text]
Telephone: [Type text]
Fax: [Type text]
Email address: [Type text]
Program contact (if different from person completing survey)
Name: [Type text]
Title: [Type text]
Telephone: [Type text]
Email Address: [Type text]
Thank you for your timely response!
| File Type | application/msword |
| Author | Caitlin Maloney |
| Last Modified By | DHHS |
| File Modified | 2014-07-03 |
| File Created | 2014-07-03 |