The number of individuals facing financial challenges yet needing respite services in the Capital region is so great that Catholic Charities Caregiver Support Services, in cooperation with the NYS Office for the Aging, has led an initiative to “stretch” the funds available through the issuance of respite vouchers. The Consumer Directed Respite (CDR) Reimbursement Vouchering Model provides flexibility and saves costs for caregivers by allowing them to choose a respite provider that is already known by the caregiving family. It is designed to augment traditional respite services and not replace it. Eligible caregivers are those who may be family members or friends caring for someone 60 years of age or older with a cognitive impairment or who needs assistance with two or more “activities of daily living”. The caregiver assumes full responsibility for selecting, training, supervising and discharging the respite care provider. Along with support groups, counseling, mentorships, information and referral, assistance is provided by CCSSS to caregivers for respite expenses through financial stipends. The caregiver pays the respite care provider directly and the CDR Reimbursement Vouchering Model defrays the fiscal burden to the caregiver up to the designated amount. This has enabled caregivers and family members not eligible for Medicaid to overcome barriers of access, geographic location, and cost while increasing the availability of persons able to provide respite care.

Background

The New York State Office for the Aging recently received a Community Living Program grant to enhance the functions of NY Connects: Choice for Long Term Care. This grant allows NYSOFA to build upon the Consumer Directed service model created through the Nursing Home Diversion and Modernization Program. These efforts are designed to reach individuals at high risk of nursing home placement as well as spending down all their income and assets to the Medicaid level. The goal of the program is to help those individuals maintain their independence and remain in the community.

The New York State Caregiver Survey similarly reflected a need for strategies to relieve the financial as well as emotional stresses associated with caregiving. Conducted in 2008, the survey indicated that caregivers bear “…immense burdens resulting from the intensive care needed by many care receivers.” Caregivers consistently report emotional strain, lack of time for oneself, and physical stress with serious health consequences that is now considered a public health concern. Investments in respite services not only help caregivers and their loved ones, but also ease the burden on our health and long term care systems.

In addition, Section 307 of the State Plan for the Older Americans Act addresses the special needs of older individuals residing in rural areas. There are those among this group who have difficulty accessing traditional forms of respite care.

Definitions

• Caregiver – (also known as the consumer for this program) is a friend or family member who regularly provides care to a care receiver
• Care receiver – an older adult, at least 60 years of age, who is disabled or frail
• Respite care provider – a person who provides infrequent and temporary substitute care or supervision to a care receiver.
• Respite care – a service provided on behalf of the caregiver designed to provide them relief from the stress of caregiving and allow care receivers to maintain their independence in the community for as long as possible. .
• Respite Coordinator – a Catholic Charities Caregiver Support Services (CCCSS) staff member responsible for assessing caregiver needs and determining the most appropriate course of respite based on the individual needs and wishes of the caregiver family.

Requirements

• Caregivers must be able and willing to make informed choices regarding the management of the services they receive, or have a legal guardian, designated relative or other adult able and willing to help make informed choices.
• In addition to being responsible for selecting, training, supervising and discharging the respite care provider, the consumer or designee must arrange for back-up coverage when necessary, coordinate other services, and keep payroll records.
• The caregiver is required to use the CDR Reimbursement Vouchering Model timesheets and reimbursement forms to demonstrate proof that the respite care provider worked and was paid for those services.

Process

• Caregivers interested in the CDR Reimbursement Vouchering Model need to contact a Respite Coordinator at the Catholic Charities Caregiver Support Services (CCCSS).
• The caregiver completes and signs the CDR Reimbursement Vouchering Model application form and submits it to CCCSS. The application form includes caregiver as well as care receiver information.
• A Respite Coordinator will contact the caregivers and discuss the amount, frequency, and duration of respite care assistance.

Caregiver Responsibilities

• Interview, select and hire a respite care provider 18 years of age or older.
• Ask for and check references for the respite care provider (if needed)
• Set the rate of pay within guidelines provided by CCCSS
• Train the respite care provider on the specific needs of the care receiver

Payment

• The caregiver will be reimbursed only up to the approved amount
• Reimbursement for respite will be provided only during the approved time period
• The caregiver completes the information on the voucher form and indicates the total payment made to the respite care provider as well as the total number of respite hours provided. Instructions for completing vouchers are printed on the back of each voucher.
• The voucher is not to be signed until after the respite care has been provided
• The voucher must be mailed to the address noted on the voucher. It cannot be cashed at a bank or any other store.
• Vouchers are expected to be used in numerical order and submitted once per month
• If sufficient funds remain but there are no more voucher forms then contact CCCSS for a second set. The second set of vouchers will have the same expiration dates.
• The caregiver must provide a current address as vouchers and payment checks will not be forwarded.

Non-allowable Costs

Funds from respite vouchers must only be used for the reimbursement of respite services. In addition, caregivers (the “consumer”) are not allowed to use their CDR voucher for the following:

• payment for nursing home care
• payment under the aged of 18
• payment for food, clothing or other bills