SUA Resource Library: 

High-level Administrative Materials 
Foreword 

In 2012, the Administration for Community Living (ACL), an operating division of the US 

Department of Health and Human Services, began a comprehensive evaluation of its National 

Family Caregiver Support Program (NFCSP). This was the first comprehensive federal evaluation 

of the NFCSP, which serves over 800,000 family caregivers annually. The NFCSP evaluation has 

three broad goals to benefit policy and program decision-making: 

1. Collect and analyze information on program processes and site operations; 

Evaluate program efficiency and cost issues for approaches best suited to specific 

contexts; and 

Evaluate effectiveness of the program’s contribution to family caregivers in terms of 

maintaining their health and well-being, improving their caregiving skills, and 

avoiding or delaying institutional care of the care recipient. 

2.

3.

As part of the evaluation survey, State Units on Aging (SUAs) were asked to submit relevant 

documents if they answered ‘yes’ to any of the following five questions: 

 Do you have a statewide task force, commission or coalition specifically to examine 

family caregiver issues? 

Have community needs assessments for caregiver support services been conducted? 

Does your state have a standardized caregiver assessment? 

Does your SUA conduct routine programmatic monitoring of the NFCSP program? 

Do you use a uniform caregiver satisfaction survey across all AAAs? 

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ACL received assessment tools and grouped them into the following categories: 

1. Community Assessment Materials 

General Customer Satisfaction Survey Materials 

Grandparent Assessment Materials 

High-Level Administrative Materials 

Program Monitoring Materials 

State Caregiver Assessments 

State Care Recipient Assessments 

Task Force Materials 

Uniform Satisfaction Materials 

Other Materials 

2.

3.

4.

5.

6.

7.

8.

9.

10.

While ACL does not specifically endorse these tools, we are sharing them because they may be 

helpful to other programs. For more information on the NFCSP please go to: 

http://www.aoa.acl.gov/. For more information on the evaluation of the NFCSP please go to: 

http://www.aoa.acl.gov/Program_Results/Program_Evaluation.aspx
High-level Administrative Materials 

Connecticut 2013 Area Planning Template .................................................................................................. 3 

Idaho Commission on Aging Strategic Plan FYS 2014 -2017 ....................................................................... 26

Oklahoma NFCSP Protocol in State Policy .................................................................................................. 36

Oregon Statewide Family Caregiver Support Program Best Practices Identified through Monitoring ...... 38

Oregon Family Caregiver Support Program Standards ............................................................................... 39

South Carolina Family Caregiver Support Program Budget Worksheet ..................................................... 59

2
1

SECTION II: AREA PLAN ON AGING 

Connecticut 2013 Area Planning Template 3
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Connecticut 2013 Area Planning Template 4
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EXHIBIT II-1 

Area Agency Mission Statement 

Connecticut 2013 Area Planning Template 5
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 Exhibit II-1 

MISSION STATEMENT 

Instructions: Explain your agency’s mission and role within the communities you 

serve. Describe how the 4 Year Plan relates to the mission, how the two will be 

integrated to meet your stated goals and outcomes, and how these will be 

implemented to ensure compliance with the intent and purpose of the Older 

Americans Act. 

Connecticut 2013 Area Planning Template 6
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EXHIBIT II-2 

The Agency’s Vision for Older People

Connecticut 2013 Area Planning Template 7
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 Exhibit II-2 

 The Agency’s Vision for Older People 

Instructions: Explain what the agency’s vision is for older people. How did the 

agency arrive at this vision? 

Connecticut 2013 Area Planning Template 8
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EXHIBIT II-3 

The Agency’s Core Values

Connecticut 2013 Area Planning Template 9
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 Exhibit II-3 

 The Agency’s Core Values 

Instructions: What are the agency’s core values? Explain how the agency in its 

ongoing management of programs and its strategic planning process is guided by 

core values. How do the agency’s core values define the Area Agency’s 

organizational culture? 

Connecticut 2013 Area Planning Template 10
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EXHIBIT II-4 

Review of Area Agency’s Accomplishments

Connecticut 2013 Area Planning Template 11
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 Exhibit II-4 

Review of Area Agency’s Accomplishments

Instructions: Describe the primary accomplishments of the Agency in terms of the 

organization and as a planning, advocacy and funding entity during the previous four 

years. Identify organizational strengths and strategies used to accomplish the goals 

that were attained. Please note areas needing improvement, how they were 

identified and any actions taken or plans you may have made to achieve a higher 

degree of successful outcomes for these areas. 

Connecticut 2013 Area Planning Template 12
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 EXHIBIT II-5 

Description of the Planning Process 

Connecticut 2013 Area Planning Template 13
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 Exhibit II-5 

 Description of the Planning Process 

Instructions: Describe the process used to assess the needs of older adults in its 

Planning and Service Area and to establish priorities. Outline the steps, procedures,

instruments used, type of analysis and committees as applicable to your agency. 

Connecticut 2013 Area Planning Template 14
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EXHIBIT II-6 

Status and Needs of Area’s Elders

Connecticut 2013 Area Planning Template 15
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 Exhibit II-6 

Status and Needs of Area’s Elders

Instructions: Outline (1) the current needs [identified in priority order] among the area’s 

elders and, (2) the needs of the area’s elders projected over the planning period. Use 

information gathered through demographic data, needs assessment, survey instruments, 

community meetings/hearings, documented reports of unmet need and other sources 

relevant to your planning process and planning and service area. Use an organized format 

(such as numbers, letters, outline) so that needs may be easily referenced in the rationales. 

Include how prepared the area agency on aging and service providers in the planning and 

service area are for any anticipated change in the number of older adults during the 

ten-year period following the fiscal year for which the plan is submitted. Tell us the projected 

change in the number of older individuals in the planning and service area. An analysis of 

how the programs, policies, and services provided by the area agency can be improved, 

and how resource levels can be adjusted to meet the needs of the changing 

population of older adults. 

Connecticut 2013 Area Planning Template 16
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EXHIBIT II-7 

Summary of Area Objectives in Priority Order 

Connecticut 2013 Area Planning Template 17
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 Exhibit II-7 

Summary of Area Plan Objectives in Priority Order 

Instructions: List objectives in order of importance. 

Connecticut 2013 Area Planning Template 18
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EXHIBIT II-8 

Area Plan in Detail: Statement of Goals, Objectives and Strategies 

Connecticut 2013 Area Planning Template 19
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 Exhibit II-8 

 Instructions for Completing the Area Plan in Detail 

Instructions: The Area Agency is asked to provide the State Unit on Aging with 

its 4 Year Goals, Objectives and Strategies. This section should reflect the needs

identified in Exhibit II-6. All objectives listed in Exhibit II-7 should be addressed. 

Please use a separate page for each objective. 

The Plan should be written to reflect the Agency’s Goals, Objectives and 

Strategies to meet the needs of elders in its region. 

Definition of Goal, Objective and Strategy for the purpose of the Area Plan: 

Goal: Goals describe the impact an AAA will have within a given 

service area for a specific period of time to address identified 

needs. A goal statement is broad and does not include the 

 specific outcome(s) or objective(s) and/or stated strategies 

to reach the goal/objectives. 

 Goals should be related to the topical areas of need 

addressed by the Plan; 

Goals should be listed in order of their importance; 

 The rationale, objectives, and strategies related to a 

given goal should be together under the appropriate 

goal; 

The rationale for each goal should clearly explain how 

and why an objective was selected; 

The rationale should relate the goal to the findings of 

the AAA during the planning process and specifically 

cite reference; 

The rationale should outline the goal’s basis for 

development (i.e. gaps in service identified as a need 

through planning process, follow up on AAA 

accomplishments/initiative, coordination effort; 

The State Unit on Aging is not requiring the AAA 

to submit a specific number of goals. The AAA 

should determine its own goals. 

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Connecticut 2013 Area Planning Template 20
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Objective: Objective statements provide a specific description of 

what the AAA intend to do to accomplish a particular 

goal in a specific period of time. Generally these statements 

will include a ‘countable outcome by which a goal can be 

measured’. There may be only one stated objective 

identified to ensure a stated goal is met. 

 The AAA should list the objectives to be address 

during the four-year panning period. These objectives 

should relate directly to the goals established for the 

region. They should summarize the accomplishments 

to be expected at the end of the plan and serve as a 

tool to evaluate the agency’s performance throughout 

the next four years; 

The State Unit on Aging is not requiring the AAA 

to submit specific plan objectives for program 

areas. The AAA should develop its objectives 

based on information gathered through its 

planning process; 

Routine administrative functions of an Area 

Agency are not to be included as objectives. 

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Strategies: An activity undertaken to accomplish a particular objective 

that enables the AAA to meet its stated goal. In almost all 

cases, more than one strategy will need to be identified to 

meet each goal/objective. 

 Strategies listed should be specific, single focused, 

measurable or verifiable task/milestones planned to 

achieve each objective; 

Each strategy should stand independently , rather 

than be an action step; 

Include numerical targets where appropriate and 

dates of completion. If the strategy is ongoing 

throughout the duration of the Area Plan, please 

indicate as such. 

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

Note: Timeframes for strategies should correspond to 

reasonable completion dates, not necessarily one year or 

year-end increments. Annual updates will be required 

thereafter. As stated above, if an activity will take eighteen 

months, please note appropriate date of completion. 

Connecticut 2013 Area Planning Template 21
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Example: 

Goal 1: Increase the number of older people who have access to an 

integrated array of health and social supports. 

Objective 1.1 Strengthen the AAA’s capacity to provide information to older 

individuals and their caregivers that can help them access 

health and social support, and educate the public about the 

importance of improving older people’s access to an integrated 

array of health and social supports. 

Strategies the AAA will use to accomplish its objective: 

 Disseminate information to older people, including low-income, 

minority, rural, limited English speaking older people and caregivers 

to help them access health and social supports. Ongoing 

Educate the public, including policy makers about the challenges 

that older people face in trying to access services and the 

resources that can be used to address these challenges. The AAA 

will host four (4) Town meetings in its region and one (1) meeting at 

the State Legislature in collaboration with others in the Aging 

Network. 



 

Connecticut 2013 Area Planning Template 22
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Exhibit II-9 

Summary of Public Comment on Area Plan

Connecticut 2013 Area Planning Template 23
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Exhibit II-9 

 SUMMARY OF PUBLIC COMMENT ON AREA PLAN 

Instructions: Include the following: Publicity date(s), location(s) of hearing(s), 

number in attendance, briefly describe proceedings, and note number of people 

giving verbal and written testimony. Summarize main points/focus of testimony 

noting significance (i.e. number of times mentioned) 

Connecticut 2013 Area Planning Template 24
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APPENDIX 

Connecticut 2013 Area Planning Template 25
IDAHO COMMISSION ON AGING

STRATEGIC PLAN

For the Fiscal Years Ending June 30, 2014 – June 30, 2017

Submitted July 3, 2013

Signed: 

Sam Haws, Administrator 

Idaho Commission on Aging 

Idaho Commission on Aging Strategic Plan FYS 2014 -2017 26
MISSION

To set priorities, develop policy, coordinate, and evaluate state activities relative to the 

objectives of the Older Americans Act and the Idaho Senior Services Act.

OUTCOME BASED VISION

To provide the services and supports that improve the quality of life for seniors and people 

with disabilities, so they can live independent, meaningful, and dignified lives within the 

community of their choice.

KEY EXTERNAL FACTORS:

• Legislation can impact State and Federal programs administered by the Idaho 

Commission on Aging.

Additions or reductions in federal appropriations or program mandates are 

unpredictable and directly impact the activities and expenditure plans of the 

Commission.

Expansion of the aging population increases the demand for aging services, 

impacting the quantity and diversity of aging services that can be provided with level

funding.

Rising healthcare costs and economic variations impact the affordability of 

independent living.

•

•

•

OPERATING PHILOSOPHY

ICOA administers and ensures compliance of federally funded programs under the Older 

Americans Act and state funded programs under the Idaho Senior Services Act. ICOA plans 

and coordinates opportunities for individuals to access private and public pay long term care 

support services, monitors a statewide program of services to address the present and 

future needs of older Idahoans, and serves as a catalyst for improvement in the 

organization, coordination, and delivery of aging services in Idaho.

STRATEGIC PLAN: GOALS, OBJECTIVES, STRATEGIES, PERFORMANCE MEASURES AND 

BENCHMARKS

In developing the performance measures and benchmarks for the Strategic Plan, ICOA used 

demographic data from the 2010 Census and Idaho’s Vital Statistics along with client 

demographics from Social Assistance Management Software (SAMS). ICOA also used the 

2012 Needs Assessment prepared by the Center for the Study of Aging at BSU to identify 

focus areas across the state addressing needs for services and access to information. All 

financial program data was collected by ICOA’s fiscal officer and used as a baseline for 

coordination and future opportunities. ICOA used the Aging and Disability Resource Center 

(ADRC) as a consumer access point for public review and comment on the development of 

the Senior Services State Plan for Idaho. ICOA used Google Analytics to gather website usage 

statistics to evaluate consumer interest. ICOA conducted an analysis identifying partnering 

agencies and community organizations to be used as the baseline for the development of 

strategies to strengthen the Aging and Disability network in Idaho.

Idaho Commission on Aging Strategic Plan FYS 2014 -2017 27
State Fiscal Year 2014 Update

GOAL 1: Improve opportunities to access up-to-date community resources addressing health and 

long-term care options for Idahoans.

Objective 1: Increase outreach efforts to target population

Strategy 1: Partner with the Idaho Assistive 

Technology Project, Community Action 

Partnership and other technology groups to 

identify and market ways for older individuals 

residing in rural areas to access available 

assistive technologies through senior center 

newsletters, calendar of events, Twitter, onsite events and websites such as the ADRC.

Performance Measure: 1. Number of partners

who market assistive technology to rural 

communities. 2. Number of methods used 

that provide access to available assistive 

technologies.

Benchmark: 1. Increase the number of 

partners marketing assistive technology to 

rural communities. 2. Increase the number of 

methods used to provide access to assistive 

technologies.

Strategy 2: Implement the use of multigenerational media to reach caregivers, as 

well as older individuals with greatest social 

needs through Facebook, Twitter, Google +, 

youth groups, education programs and large 

employers around the state. Develop sharable 

content and focus on community partners to 

expand outreach.

Performance Measure: 1. Number of 

community partners who use multigenerational media. 2. Implementation of 

multi-generational media.

Benchmark: 1.Increase the number of 

community partners using multi-generational 

media. 2. Increase the visibility of existing 

social media resources. 

Strategy 3: Collaborate with partnering 

agencies to coordinate outreach programs for 

seniors with low-income: For example, 

increase volunteerism and inform clients 

about Medicare benefits and how to identify 

Medicare fraud through the SMP grant in 

collaboration with the Department of 

Insurance's SHIBA program.

Performance Measure: 1. Number of 

collaborative partnerships with agencies that 

provide outreach programs for seniors with 

low income.

Benchmark: 1. Increase partnerships with 

agencies that provide outreach programs for 

seniors with low income.

Objective 2: Strengthen and sustain the ADRC website and services as the single entry point for public and private resources.

Strategy 1: Modify AoA Options Counseling 

Standards for Idaho and incorporate into 

Performance Measure: 1. Development of 

AoA Options Counseling standards into 

Benchmark: 1. Finalize Option Counseling 

standards for Idaho in 2013. 

Idaho Commission on Aging Strategic Plan FYS 2014 -2017 28
referral procedures and implement through 

collaboration with the ADRC and Centers for 

Independent Living (CIL) sites.

referral procedures. 

Strategy 2: Provide 211 Careline with ADRC 

taxonomy and ADRC site referral training to 

support streamline access for consumers. In 

particular, strengthen database to cover

resources for seniors with limited income.

Performance Measure: 1. Number of ADRC 

referral and aging network training provided 

to 211 CareLine.

Benchmark: 1. Quarterly provide 211 Careline 

Training. 

Strategy 3: Establish website tools such as

the online self-assessment and online MIPPA 

training and link to other agency directories to 

sustain ADRC functions. Utilize website tools 

to generate management report to track 

progress. 

Performance Measure: 1. Number of 

established website tools. 2. Number of links 

to other agency directories established. 

Benchmark: 1. Increase the number of 

website tools, such as: individual needs 

assessments. 2. Increase links to other agency

directories. 

Strategy 4: Sustain the ADRC by identifying 

new partners with mutual benefits: For 

example Medicaid, CILs, Idaho Legal Aid 

Services, Transportation, etc.

Performance Measure: 1. Number of 

identified partners with mutual benefits. 

Benchmark: 1. Increase number of new 

partnerships and include their information on 

the ADRC website. 

Strategy 5: Coordinate ADRC outreach

information and education resources with 

other agencies, including PERSI, in health 

promotion fairs and outreach events: For 

example, assisting low-income older minority 

individuals through Hispanic and Tribal 

community health fairs, Central District Health 

immunization events/promotions and senior 

centers for low-income older individuals, etc.

Performance Measure: 1. Number of 

coordinated ADRC outreach presentations 

that distribute information and educational

resources.

Benchmark: 1. Annually conduct a minimum 

of 4 ADRC presentations.

Objective 3: Improve the collection and distribution of resource information on the ADRC website and local AAA offices.

Strategy 1: Make sure technical Alliance of 

Information and Referral Systems (AIRS) 

standards are incorporated into data 

collection systems: For example, standards for 

options counseling, assessment tools, 

directories, key word searches, multi-agency 

Performance Measure: 1. Number of AAA 

Information & Referral resource databases

that are AIRS standards compliant. 

Benchmark: 1. All AAA’s employ AIRS 

compliant resource databases by SFY 2015. 

Idaho Commission on Aging Strategic Plan FYS 2014 -2017 29
terminology, etc.

Strategy 2: Establish online FAQ's, calendar of 

events, links to manuals and references on 

ADRC website. 

Performance Measure: 1. Frequency of ADRC 

website review/update activities. 2. Frequency 

of website validation activities. 

Benchmark: 1. ADRC website is 

reviewed/updated monthly. 2. ADRC website 

content is validated quarterly.

Strategay 3: Contact tribes and incorporate 

their senior services linkds to the ADRC 

website. 

Performance Measure: 1. Number of tribes 

that have provided senior services links on 

ADRC website. 

Benchmark: 1. Increase number of tribes and 

their senior programs on ADRC website. 

Strategy3: Utilize consumer evaluations 

and feedback on ease of use and material 

content of the ADRC website, for site 

management. Engage state and local 

consumer groups and collaborate with ICOA’s 

administrator to play key roles in the content 

and usability of the ADRC services, and 

provide a semi-annual report to the 

Administrator with corrective action plan if 

needed.

Performance Measure: 1. Evaluate all 

consumer responses on the ADRC website 

content and usability. 

Benchmark: 1. All critical website evaluations

are reviewed by management and Annual 

report is given to ICOA’s administrator. 

GOAL 2: Strengthen existing home and community-based and evidence-based services.

Objective 1: Increase the efficiency and effectiveness of home and community-based services.

Strategy 1: Identify baseline units of service 

and develop goals with the AAAs to 

strengthen services to the target population: 

for example, all service providers prioritize 

service delivery to older low-income minority 

individuals, older individuals residing in rural 

areas, individuals with Alzheimer's and their 

caregivers.

Performance Measure: 1. Track strategies 

that are being used to reach target 

population. 

Benchmark: 1. Identify if there are increase 

registered service enrollment in rural and low 

income population.

Strategy 2: Coordinate with Friends in Action 

and the BSU Center for the Study of Aging to 

develop and expand a Life Span Respite 

coalition.

Performance Measure: 1. Provide access to 

coalition membership and services through 

the ADRC website and resource database.

Benchmark: 1. Access to the Life Span Respite 

coalition membership and services through 

the ADRC website and resource database. 

Strategy 3: Identify those service areas that 

are not "dementia capable". Utilize the 

Performance Measure: 1. Number of service Benchmark: 1. Increase the number of 

Idaho Commission on Aging Strategic Plan FYS 2014 -2017 30
dementia toolkit for evaluation and 

implementation, then provide best practices 

to our partners to better serve individuals 

such as those with Alzheimer's and their 

caregivers.

areas that are “dementia capable”. “dementia capable” services. 

Objective 2: Build participation in evidence-based services.

Strategy 1: Match evidence-based program 

information to agencies and organizations for 

implementation: For example, provide Chronic 

Disease and Self- Management Program 

(CDSMP) to SCSEP participants, explore option 

of providing work experience credit for 

CDSMP participation hours, and provide to 

IDOL One-Stop Career system to encourage 

involvement.

Performance Measure: 1. Number of agencies 

matched to evidence-based program 

information. 

Benchmark: 1. Increase the number of 

evidence based programs that are linked to 

agencies. 

Strategy 2: Collaborate with the Veterans

Administration, Vocational Rehabilitation, 

local Veterans Administration medical centers 

and network with AAAs, home health and 

non-profit organization to implement the 

Veteran-Directed Home and Community 

Based Service (VD-HCBS) program.

Performance Measure: 1. Number of 

operational VD-HCBS sites.

Benchmark: 1. One operational site in SFY 

2014.

Strategy 3: Increase evidence-based programs 

at State and local levels that will focus on the 

health and social needs of older individuals of 

Idaho.

Performance Measure: 1. Number of 

evidence-based programs that focus on 

economic and social needs of older individuals 

of Idaho.

Benchmark: 1. Increase the number of 

Evidence-based programs focused health and 

social needs. 

Strategy 4: Coordinate programs with the 

Idaho Food Bank, Idaho Hunger Coalition, 

Idaho Hunger Task Force and the Community

Action Partnership Association of Idaho to 

improve nutritional services provided to lowincome seniors through the Home Delivered 

and Congregate Meal programs.

Performance Measure: 1. Number of 

strategies to improve nutritional services.

Benchmark: 1. Implementation of new 

strategies to reach target population through 

the Home Delivered and Congregate meal 

programs. 

Idaho Commission on Aging Strategic Plan FYS 2014 -2017 31
GOAL 3: Promote healthy and active lifestyles for Idahoans. 

Objective 1: Provide additional opportunities for older adults to engage in social and physical activity to develop healthy

behaviors.

Strategy 1: Identify existing evidence-based 

programs and make them accessible through 

the ADRC website. 

Performance Measure: 1. Number of AAA 

evidence-based programs incorporated on the 

ADRC website. 

Benchmark: 1. Include all AAA operated 

evidence-based programs and provide 

descriptions and links on ADRC website.

Strategy 2: Support senior centers in their 

efforts to increase the number of participants 

engaged in their services. Increase the 

visibility of senior centers through AAA/ADRC 

websites integration. 

Performance Measure: 1. Number of Senior 

Centers on ADRC and AAA websites.

Benchmark: 1. Incorporate senior center 

information on the local ADRC websites.

Objective 2: Increase volunteerism to support long-term care and home and community based services. 

Strategy 1: Develop and implement an annual

statewide ICOA aging network volunteer 

recognition award program. 

Performance Measure: 1. Volunteer 

recognition program.

Benchmark: 1. Implement recognition 

program.

Strategy 2: Increase volunteer recruitment 

and the development of volunteer programs 

through agency coordination, marketing, 

outreach, and utilizing social media (i.e. 

Facebook networking).

Performance Measure: 1. Number of 

volunteer recruitment events. 2. Types of 

outreach.

Benchmark: 1. Increase volunteer recruitment

events. 2. Implement new types of outreach.

Strategy 3: Incorporate volunteer organization 

services in the online resource database.

Performance Measure: 1. Online resource 

database. 

Benchmark: 1. Access to the resource 

database through the ADRC website. 

Objective 3: Increase employment opportunities by connecting employers with unemployed older Idahoans.

Strategy 1: Provide access to Senior

Community Service Employment Program 

(SCSEP) and Idaho Department of Labor's 

(IDOL) One Stop Shop employment sites.

Performance Measure: 1. ADRC links to IDOL’s 

one-stop-shop employment sites.

Benchmark: 1. Provide links to all IDOL’s 

employment sites.

Strategy 2: Increase options for On-the-Job 

training, identify prioritization for placement 

of participants at Host sites who have a record

of hiring participants and identify funding to 

be used to provide occupational skill training.

Performance Measure: 1. Employment 

training options 2. Training site placement 

Benchmark: 1.Increase training options. 2. 

Link host agencies to training options.

Strategy 3: Link volunteer programs to Performance Measure: 1. Number of Benchmark: 1. Increase the number of 

Idaho Commission on Aging Strategic Plan FYS 2014 -2017 32
training opportunities for low- income seniors 

through the Senior Community Service 

Employment Program (SCSEP), SERVE Idaho, 

and Foster Grandparent Programs.

volunteer program training opportunities. training opportunities.

Strategy 4: Collaborate with the Idaho

Hispanic Commission, Idaho State Veterans

Administration, Idaho Division of

Vocational Rehabilitation, the Idaho 

Department of Labor and the Community 

Council of Idaho to increase training and 

employment opportunities for older lowincome minority individuals and older 

individuals with limited English proficiency.

Performance Measure: 1. Number of 

collaborative partnerships established. 

Benchmark: 1. Increase the number of 

collaborative partnerships.

Objective 4: Increase health promotion and disease prevention outreach through materials and education.

Strategy 1: Coordinate the distribution of free 

community fitness and health programs and 

technical assistance to seniors through the 

ADRC website.

Performance Measure: 1. Number of 

community fitness and health programs 

represented on the ADRC website.

Benchmark: 1. Increase the number of 

community fitness and health programs 

represented on the ADRC website.

Strategy 2: Develop resources and 

partnerships to provide statewide nutrition 

education and counseling through the ADRC 

website, meetings, and training. 

Performance Measure: 1. Number of 

resources developed. 2. Number of nutrition 

education and counseling partnerships 

established.

Benchmark: 1. Increase resources 2. Increase 

partnerships. 

Strategy 3: Provide Title III-D (Health and 

Disease Prevention Program) guidance and 

assistance based on AoA evidence-based 

criteria.

Performance Measure: 1. Number of 

Evidence-Based (EB) programs. 

Benchmark: 1. Increase number of eligible EB 

programs in Idaho.

Strategy 4: Partner with Friends in Action to 

incorporate Living Well in Idaho and Building 

Better Caregivers into other community-based 

service programs.

Performance Measure: 1. Number of other 

community-based service programs.

Benchmark: 1. Increase number of other 

community-based programs that use Living 

Well in Idaho and Building Better Caregivers 

programs.

Strategy 5: Coordinate with Idaho State 

University and other institutions that provide 

free medical screening and education. Include 

access to this information on ADRC calendar 

Performance Measure: 1. Number of 

partnerships with institutions that provide 

free medical screening and education. 

Benchmark: 1. Include free screening and 

education events on ADRC calendar. 

Idaho Commission on Aging Strategic Plan FYS 2014 -2017 33
of events

Objective 5: Identify opportunities to increase community transportation options to enable seniors to travel to community 

events, volunteer work, services, shopping and medical appointments.

Strategy 1: Develop partnerships to increase 

resources for transportation, and participate 

in state and local transportation planning. In 

particular, target older individuals residing in 

rural areas and low-income seniors.

Performance Measure: 1. Number of 

transportation partnerships. 2. Attendance of 

local transportation planning events. 

Benchmark: 1. Stay engaged with the Idaho 

Mobility Council, increase transportation links 

from ADRC website. 2. Increase participation 

at state and local transportation planning 

activities.

Strategy 2: Link to an online transit directory 

and other transportation resources from the 

ADRC website. 

Performance Measure: 1. Number of ADRC 

website link(s) to transportation resources. 

Benchmark: 1. Increase state and local links to 

transportation resources through ADRC 

website.

GOAL 4: Protect the rights of older people and prevent their abuse, neglect and exploitation.

Objective 1: Increase coordination with state entities, organizations, and institutions that protect vulnerable adults from abuse, 

neglect, and exploitation.

Strategy 1: Identify partners who are active in 

preventing the abuse, neglect, and 

exploitation of vulnerable adults and establish 

a community resource network accessible 

from the ADRC website and through face to 

face coordination with partnering agencies.

Performance Measure: 1. Number of active 

partners identified. 2. Establish community 

resource network.

Benchmark: 1. Increase number of partners 

and access to information on ADRC website. 2.

Establish community resource network 

accessible through the ADRC website.

Strategy 2: Incorporate links on ADRC website 

to resources that provide information 

concerning advance directives, power of 

attorney, guardianship, abuse, consumer 

scams and other legal aid services. 

Performance Measure: 1. Number of legal 

service links from ADRC website to community 

resources.

Benchmark: 1. Increase resources and links to

partnering agencies.

Objective 2: Provide additional resources to help people make informed decisions about long-term care or assisted living 

facilities.

Strategy 1: Develop educational materials for

Adult Protection, local Ombudsman and Tribal 

Services to provide public education for staff 

and residents of assisted living facilities about 

rights, prevention of abuse, neglect, and 

exploitation. 

Performance Measure: 1. Number of 

educational publications. 

Benchmark: 1. Increase public education 

material with collaborative partners. 

Idaho Commission on Aging Strategic Plan FYS 2014 -2017 34
Strategy 2: Increase the frequency of regular

visitation to assisted living facilities by 

increasing the number of qualified 

Ombudsman volunteers.

Performance Measure: 1. Number of 

Ombudsman volunteers. 2. Number of visits 

to assisted living facilities.

Benchmark: 1. Increase volunteer programs to 

all six AAAs. 2. Increase quarterly visitations of 

Skilled Nursing Home and Assisted Living 

Facility. Must meet minimum quarterly visits.

Objective 3: Increase public outreach to recognize and report signs of elder abuse, neglect and exploitation.

Strategy 1: Support other organizations

who provide education and outreach to

the public concerning elder abuse, neglect, 

and exploitation of adults, including 

individuals with Alzheimer’s and their 

caregivers through the posting of pertinent 

information on the ADRC website and specific

training with the 211 Careline operators: For 

example, Justice Alliance for Vulnerable Adults 

(JAVA), Ada County Abuse in Later Life.

Performance Measure: 1. Number of postings

on ADRC. 2. Number of specialty area 

trainings for 211 Careline. 

Benchmark: 1. Increase postings on ADRC. 2. 

Provide specific area training to 211.

GOAL 5: Maintain an effective and responsive management and administrative structure.

Objective 1: Update state and federal quality assurance review processes.

Strategy 1: Review ICOA's external compliance 

requirements. Update the onsite review 

monitoring toolkits. Implement monitoring to 

include annual onsite reviews.

Performance Measure: 1. Maintenance of 

monitoring toolkits.

Benchmark: 1. Update monitoring tool kit to 

be used in 2013.

Objective 2: Implement systematic changes to establish administrative and service continuity.

Strategy 1: ICOA defines data quality needs 

for the state and federal reporting. Develop 

data quality assurance plan with AAAs.

Performance Measure: 1. Determine missing 

data elements. 

Benchmark: 1. Reduce missing data.

Strategy 2: Maintain statewide Program

Manual that identifies federal and state 

regulations and provides policies, guidance, 

reports and forms to implement Senior 

Services Act and OAA services in Idaho.

Performance Measure: 1. Frequency of 

Program Manual updates. 

Benchmark: 1. Semi-annual Program Manual 

Updates.

Idaho Commission on Aging Strategic Plan FYS 2014 -2017 35
340:105-10-90.1. National Family Caregiver Support Program 

Revised 6-1-08 

(a) Policy. The Area Agency on Aging (AAA) awards grants to entities to provide support 

services, including information and assistance, counseling, support groups, respite, and other 

home- and community-based services to families caring for their frail older members. The 

National Family Caregiver Support Program (NFCSP) also recognizes the needs of a grandparent 

or step-grandparent who is a relative caregiver of a child or other older person who is a relative 

caregiver of a child who is not more than 18 years of age or who is a person with a 

disability. NFCSP services include: 

 (1) information to caregivers about available services; 

(2) assistance to caregivers in gaining access to services; 

(3) individual counseling, organization of support groups, and training to assist caregivers 

in areas related to their caregiver roles of: 





o (A) health; 

(B) nutrition; 

(C) financial literacy; 

(D) decision making; and 

(E) problem solving; 

o

o

o

o

 (4) respite care to enable caregivers to be temporarily relieved from their caregiving 

responsibilities; and 

 (5) supplemental services, on a limited basis, to complement the care provided by 

caregivers. 

(b) Authority. The authority for this Section is the Office of Management and Budget Notice of 

Action 0985-0008 and Sections 371 through 374 of the Older Americans Act of 1965, as 

amended, Public Law 109-365, Grants for State and Community Programs on Aging. 

(c) Procedures. The requirements for implementing this Section are outlined in this 

subsection. The AAA: 

 (1) incorporates the provisions of this Section into the Title III policies and procedures 

manual; 

(2) provides technical assistance to prospective and funded Title III projects regarding 

this rule; 

(3) monitors Title III project compliance according to OAC 340:105-10-43, except on 

specific projects where the State Agency has agreed with the AAA to provide a service 

and monitoring is not required. The project: 





o (A) gathers information on an approved intake form, including, at a minimum: 

 (i) the family caregiver's identifying information; 

(ii) the caregiver's relationship to the care receiver; 

(iii) the care receiver's identifying information; and 

(iv) a written description of the caregiver's current situation, including the 

care receiver's need for assistance due to inability to perform specific 

activities of daily living (ADLs) or need for supervision due to 

Alzheimer's disease or other neurological and organic brain dysfunction or 

disability; 







Oklahoma NFCSP Protocol in State Policy 36
o (B) conducts a reassessment of NFCSP service recipients annually, at a minimum, 

to evaluate service provision and update participant status; 

(C) ensures the safety and protection of the participants; and 

(D) receives in-service training each fiscal year specifically designed to increase 

the project's knowledge and understanding of the programs and participants 

served; 

o

o

 (4) targets services to caregivers who are older persons in greatest social and economic 

need, giving priority to: 

o (A) family caregivers providing care for persons with Alzheimer's disease and 

related disorders with neurological and organic brain dysfunction; and 

o (B) grandparents or older persons who are relative caregivers providing care for a 

person or child with a severe disability; 

 (5) may provide support services to caregivers providing care for frail older family 

members who are 60 years or older and unable to perform at least two ADLs without 

substantial human assistance or require substantial supervision due to a cognitive or other 

mental impairment. ADLs include: 

o (A) dressing; 

(B) bathing; 

(C) eating; 

(D) transferring; 

(E) toileting; and 

(F) walking; 

o

o

o

o

o

 (6) may provide support services on a limited basis to grandparents and older persons 

who are relative caregivers of a child who is 18 years of age or younger. 

o (A) Child means a person who is not older than 18 years of age or who is a person 

with a disability. 

o (B) Grandparent or older person who is a relative caregiver means a grandparent 

or step-grandparent of a child, or a relative of a child by blood, marriage, or 

adoption who is 55 years of age or older and: 

 (i) lives with the child; 

(ii) is the primary caregiver of the child because the biological or adoptive 

parents are unable or unwilling to serve as the primary caregiver of the 

child; and 

(iii) has a legal relationship to the child, such as legal custody or 

guardianship, or is raising the child informally; 





 (7) ensures the cost of carrying out the program meets the requirement of a minimum 

non-federal share of 25 percent. The non-federal share is provided from state and local 

sources; 

 (8) may not use funds to supplant, replace, or in substitution for, any funds expended 

under any federal, state, or local law for the same purposes; and 

 (9) considers awarding funds to expand successful caregiver activities currently in 

communities, such as respite providers, support groups, outreach, information and 

assistance, adult day services, counseling, and case management. 

(d) Cross references. See OAC 340:105-10-37, 340:105-10-38, 340:105-10-40, 340:105-10-41, 

340:105-10-43, 340:105-10-44, and 340:105-10-50.1(a)(15)(F). 

Oklahoma NFCSP Protocol in State Policy 37
Statewide Family Caregiver Support Program 

Best Practices Identified through Monitoring

Note: The most successful III-E Family Caregiver Support Programs in Oregon are those with strong and 

varied community partnerships that support both elders and children. These partnerships include local 

health care systems, agencies that serve ethnic and “at risk” populations, local APD offices, 

newspapers, and schools 

ADRC Integration: 

 Most AAAs have moved towards integrating the Family Caregiver Support Program (FCGSP) into 

their ADRC. Options Counseling is now being provided where traditional case management has 

been provided. 

Caregiver Training: 

 Many of the Coordinators are trained in leading Powerful Tools for Caregivers or Savvy 

Caregiver classes; however many work with a community partner, such as a staff person from a 

local hospice, or Parrish nurse, to provide the training. 

AAAs work with Coordinated Care Organizations to refer clients for caregiving classes. 

Some AAAs have collaborated with partners to provide one day retreats or conferences to 

“Celebrate Caregivers” that provides training and support that may not be covered in Powerful 

Tools or Living Well classes. Topics include legal planning, community services, providing 

personal care. 

Some AAAs provide services for people with dementia and their care partners such as Reducing 

Disability in Alzheimer’s Disease (RDAD) or Star-C. In addition AAAs refer caregivers to the 

Alzheimer’s Association or Alzheimer’s Network of Oregon for additional support and training. 







Caregiver Support: 

 AAAs partner or contract with local therapists or counselors to provide support groups for 

family caregivers. 

AAAs work with local entities that have support groups for caregivers of people with 

Alzheimer’s disease or Parkinson’s disease. 

AAAs partner with local Boys and Girls clubs that provide support groups for relatives raising 

children and fund “respite” or day care so relatives can attend the support groups. 





Outreach: 

 AAAs conduct outreach by going into key office buildings for several hours a day to provide 

information on the services and programs available to family caregivers and those who are 

relatives raising children.

AAAs partner with a local pharmacy to put information about the FCGSP into RX medication 

bags.

AAAs provide flyers re: FCGSP in medical clinics.

AAAs partners with local senior newspapers to provide information on FCGSP program. 

AAAs participate in monthly respite event for caregivers of tribal elders. 









June 

2014

Oregon Statewide Family Caregiver Support Program Best Practices Identified through Monitoring 38
Family Caregiver Support 

Program Standards 

Older Americans Act 

Prepared by: 

Family Caregivers Support Program Advisory Committee 

In Partnership with Department of Human Services 

Seniors and People with Disabilities 

State Unit on Aging 

676 Church Street, NE 

Salem Oregon 97301 

Modified: June 2012 

Oregon Family Caregiver Support Program Standards 39
i 

Table of Contents 

I. Background.............................................................................................................. 3

A. Introduction .......................................................................................................... 3 

B. Program Eligibility Definitions ............................................................................ 3 

II. Program Authority.................................................................................................. 4

III. Program Overview .................................................................................................. 4

A. Program Purpose .................................................................................................. 4 

B. Program Goals ...................................................................................................... 4 

IV. Federal Requirements and Reporting................................................................... 5

V. Service and Unit Descriptions ................................................................................ 6

A. General Terms and Definitions ............................................................................ 9 

B. Target Priorities .................................................................................................. 15 

VI. Roles of the Aging Network.................................................................................. 16

A. Administration on Aging (AoA) ........................................................................ 17 

B. State Unit on Aging (SUA) ................................................................................ 17 

C. Area Agencies on Aging (AAA) ........................................................................ 18 

D. Service Providers (SP)........................................................................................ 18 

VII. Resources and Useful Links ................................................................................. 19

Oregon Family Caregiver Support Program Standards 40
Page 3 of 20 

I. Background 

A. Introduction 

The National Family Caregiver Support Program (NFCSP) was established in 

November 2000. The NFCSP, administered by the Department of Health and 

Human Services Administration on Aging (HHS), was officially launched by HHS 

Secretary Tommy Thompson in February 2001. 

B. Program Eligibility Definitions 

With the Older Americans Act 2006 Reauthorization, the NFCSP has broadened 

the populations served. The following is a comprehensive list of unpaid 

caregivers that can be served through the FCSP: 

• Caregivers of individuals with Alzheimer’s Disease (and related disorders with 

neurological and organic brain dysfunction). The care receiver and caregiver 

can be of any age. 

Grandparents or older relative caregivers (55 years of age or older) caring for 

a child related by blood, marriage, or adoption. Child is an individual 18 years 

or younger or of any age if the individual has a disability. Adult Child With a 

Disability – A child who is 18 years of age or older who has a disability and is 

financially dependent on an older individual. (OAA 102(a) (3)(A-C)) This 

includes grandparents or older relative caregivers who receive financial 

support payments, such as Temporary Assistance to Needy Families (TANF), 

Foster parent payments, Child Support, Social Security for children, etc. 

Adult family member or another individual, who is a provider of in-home and 

community care to older individuals (age 60 years or older). 

•

•

Care Receiver Caregiver

Person age 60 or older Adult of any age 

Child age 18 or younger Grandparent/Relative Caregiver, age 55 

and older, does not include parent 

Adult or Child with disabilities of any age Grandparent/Relative Caregiver, age 55 

and older, does not include parent 

Alzheimer’s (or related disorder) any age Adult of any age 

Adult Child With a Disability – A child who 

is 18 years of age or older who has a 

disability and is financially dependent on 

an older individual. (OAA 102(a)(3)(A-C)) 

Grandparent/Relative Caregiver, age 55 

and older, does not include parent 

Oregon Family Caregiver Support Program Standards 41
Page 4 of 20 

Caregiver: A ‘family caregiver’ means an adult family member or another 

individual, who is an “informal” provider of in-home and community care to an 

older individual. An individual who “informally” has the responsibility for the care 

of an older individual or individual of any age suffering from Alzheimer’s or 

related disorder; or a grandparent/relative caregiver, age 55 and older who has 

the responsibility for the care of children or adult child with disabilities. 

“Informally” means the care is not provided as part of a public or private service 

program. (AoA Title III/VII Reporting Requirements Appendix – www.aoa.gov) 

Grandparent or Other Older Relative Caregiver of a Child – A grandparent, 

step grandparent or other relative of a child by blood or marriage who is 55 years 

of age or older and lives with the child, is the primary caregiver of the child 

because the biological or adoptive parents are unable or unwilling to serve as the 

primary caregiver of the child; and has a legal relationship to the child, such as 

legal custody or guardianship or is raising the child informally. (AoA Title III/VII 

Reporting Requirements Appendix – www.aoa.gov) 

• lives with the child; 

is the primary caregiver of the child because the biological or adoptive 

parents are unable or unwilling to serve as the primary caregiver of the child; 

and 

has a legal relationship to the child, as such legal custody or guardianship or 

is raising the child informally. 

•

•

II. Program Authority 

Sections 371, 372, 373, and 374 of the Older Americans Act of 1965, as 

Amended (P.L.106-501), Grants for State and Community Programs on Aging, 

and W.S. 9-2-1204. 

III. Program Overview 

A. Program Purpose 

• To assist family caregivers in their expanding roles by providing

program components that will ease family caregiver stress and 

increase coping. 

B. Program Goals 

• Assist family caregivers to successfully meet the challenges of their 

caregiving role, while being supported in that role. 

To deter institutionalization, when feasible, and promote continued 

care within the home and in alternative community settings for seniors 

for as long as possible or desirable by family caregivers. 

Provide highest service levels possible. 

•

•

Oregon Family Caregiver Support Program Standards 42
Page 5 of 20 

IV. Federal Requirements and Reporting 

PROGRAM REPORTING

AAA shall collect and report National Aging Program Information System 

(“NAPIS”) data as directed by DHS for all caregiver services provided, using DHS 

provided software or a DHS approved alternative collection and reporting 

method. For full details on reporting criteria see Group 1 and Group 2 Caregiver 

Services detail published in DHS SPD AR-11-047 

(http://www.oregon.gov/DHS/spwpd/sua/docs/oaa-opi-serv-def.pdf) 

Program Income 

All recipients of Title III-E caregiver services will be provided an opportunity to 

voluntarily contribute towards cost of service. Said contribution, hereby referred 

to as program income shall be used for the sole purpose of expanding caregiver 

services.

Maximum Expenditures

a) Administration - No more than 10% of expended Title IIIE funds may be 

utilized for administration purposes. 

b) Caregivers serving children - No more than 10% of expended Title IIIE funds 

may be utilized to support services to caregivers serving children (under age 

18). 

Matching Funds

Federal funds may not pay for more than 75% of total caregiver expenditures. 

The required match is calculated as shown in the following example for $100 of 

Title IIIE funds expended equals $100 divided by .75 equals $133; $133 minus 

$100 equals $33; the required match to spend $100 of Title IIIE is $33. 

Oregon Family Caregiver Support Program Standards 43
Page 6 of 20 

V. Service and Unit Descriptions 

GROUP 1 CAREGIVER SERVICES 

Requires reporting caregiver’s age, gender, rural, race, ethnicity, 

relationship to service recipient, unduplicated caregiver count, 

and units of service. 

EXCEPTIONS: CG Cash & Counseling requires unduplicated client count only – 

units of service optional. 

CAREGIVER CASH & COUNSELING 

Matrices #73 (serving elderly) 73a (serving children) (1 unit = 1 client served) 

Services provided or paid for through allowance, vouchers, or cash which is provided to 

the client so that the client can obtain the supportive services which are needed. (AoA 

Title III/VII Reporting Requirements Appendix – www.aoa.gov) 

CAREGIVER COUNSELING 

Matrices #70-2a (serving elderly) 70-2b (serving children) (1 unit = 1 session per 

participant) 

Counseling to caregivers to assist them in making decisions and solving problems 

relating to their caregiver roles. This includes counseling to individuals, support groups, 

and caregiver training (of individual caregivers and families). (AoA Title III/VII Reporting 

Requirements Appendix – www.aoa.gov) 

CAREGIVER SUPPLEMENTAL SERVICES 

Matrices #30-7 (serving elderly) 30-7a (serving children) (1 unit = 1 payment) 

Services provided on a limited basis that complement the care provided by family and 

other informal caregivers. Examples of supplemental services include, but are not 

limited to, legal assistance, home modifications, transportation, assistive technologies, 

emergency response systems and incontinence supplies. (AoA Title III/VII Reporting 

Requirements Appendix – www.aoa.gov) 

Note: Home-delivered meals and transportation to caregivers serving elderly or 

caregivers serving children are to be reported under this matrix. Refer to 

Caregiver Standards for expanded list of examples. 

No ADL/IADL is required for supplemental services to caregivers serving 

children. For caregivers serving elderly, service priority should always be given 

to caregivers providing services to individuals meeting the definition of ‘frail’. (See 

General Terms and Definitions)

Oregon Family Caregiver Support Program Standards 44
Page 7 of 20 

CAREGIVER SUPPORT GROUPS 

Matrices #30-6 (serving elderly) 30-6a (serving children) (1 unit = 1 session per 

participant) 

Peer groups that provide opportunity to discuss caregiver roles and experiences and 

which offers assistance to families in making decisions and solving problems related to 

their caregiving roles. (DHS/SPD/SUA definition) 

CAREGIVER TRAINING 

Matrices #70-9 (serving elderly) 70-9a (serving children) (1 unit = 1 session per 

participant) 

Training provided to caregivers and their families that supports and enhances the care 

giving role. For example: Powerful Tools training; Communicating Effectively with 

Health Care Professionals; conferences, etc. (A session for conferences would be equal 

to one day’s attendance at the conference). (DHS/SPD/SUA definition) 

Note: This does not include training to paid providers. 

RESPITE CARE 

Matrices #30-4 (OPI) #30-5 (serving elderly) 30-5a (serving children) (1 unit = 1 

hour see notes) 

Services which offer temporary, substitute supports or living arrangements for care 

recipients in order to provide a brief period of relief or rest for caregivers. Respite Care 

includes: (1) In-home respite (personal care, homemaker, and other in-home respite); 

(2) respite at a senior center or other nonresidential program; (3) respite provided by 

placing the care recipient in an institutional setting such as a nursing home for a short 

period of time; (4) and for grandparents/relatives caring for children – day or overnight 

summer camps. (AoA Title III/VII Reporting Requirements Appendix – www.aoa.gov & 

SPR Q&A #28, 2008)

Note: OAA 373 (a)(2)(A & B) states priority shall be given to caregivers providing 

services to individuals whom meet the definition of ‘frail’. (See General Terms 

and Definitions). 

SPR Q&A #28, 2008 states units of service for overnight institutional respite and 

overnight summer camps are more appropriately reported by days than hours. 

Example: Two days of institutional respite is 2 units (not 48 units) and six days at 

camp equal 6 units instead of 144. 

Oregon Family Caregiver Support Program Standards 45
Page 8 of 20 

GROUP 2 CAREGIVER SERVICES 

Requires reporting service units and estimated unduplicated 

caregiver count or when applicable, an estimated number 

of caregivers and service units. No demographics required. 

CAREGIVER ACCESS ASSISTANCE 

Matrices #16 (serving elderly) 16a (serving children) (1 unit = 1 contact) 

A service that assists caregivers in obtaining access to the available services and 

resources within their communities. To the maximum extent practicable, it ensures that 

the individuals receive the services needed by establishing adequate follow-up 

procedures. (AoA Title III/VII Reporting Requirements Appendix – www.aoa.gov) 

Note: Case management and information and assistance to caregivers is an access 

service. 

INFORMATION FOR CAREGIVERS 

Matrices #15 (serving elderly) and 15a (serving children) (1 activity) 

A service for caregivers that provides the public and individuals with information on 

resources and services available to the individuals within their communities. (AoA Title 

III/VII Reporting Requirements Appendix – www.aoa.gov) 

Note: Service units for information services are for activities directed to large audiences 

of current or potential caregivers such as disseminating publications, conducting 

media campaigns, and other similar activities. 

Oregon Family Caregiver Support Program Standards 46
Page 9 of 20 

A. General Terms and Definitions

The following terms and definitions are related to Oregon’s Older

Americans Act (OAA) and Oregon Project Independence (OPI) service

programs. The source follows each definition.

Act: National Family Caregiver Support Program (NFCSP)

ADL (Activities of Daily Living) – Personal functional activities required

by an individual for continued well being, which are essential for health

and safety. For the purposes of these rules, ADLs consist of eating,

dressing/grooming, bathing/personal hygiene, mobility (ambulation and

transfer), elimination (toileting, bowel, and bladder management)), and

cognition/ behavior as described in Oregon Administrative Rule (OAR)

411-015-0007. (OAR 411-032-0000). For more information on ADL’s, you

can visit: www.dhs.state.or.us/policy/spd/home.htm or find information on

OAR 411-015-0006 (1).

Adult Child With a Disability – A child who is 18 years of age or older 

who has a disability and is financially dependent on an older individual. 

(OAA 102(a)(3)(A-C)). 

Adult Day Services – A community-based group program designed to 

meet the needs of adults with functional impairments through service 

plans. These structured, comprehensive, non-residential programs provide 

health, social and related support services in a protective setting during 

part of a day, but for less than 24 hours per day. (OAR 411-066) 

Aging and Disability Resource Center – A point of entry to 

comprehensive information on the full range of available public and private 

long-term care services, service providers, and resources within a 

community and options counseling to assist individuals in assessing their 

existing or anticipated long-term care needs, and developing and 

implementing a plan for long-term care designed to meet their specific 

needs and circumstances. (OAA 102(a)(4)(A-C)) 

Alzheimer's Disease and Other Related Disorders – A progressive and 

degenerative neurological disease characterized by symptoms of shortterm memory loss, confusion and behavior and personality changes. It 

includes all other related disorders recognized by the National Alzheimer's 

Association including dementia caused from Multi-Infarct Dementia (MID), 

Normal Pressure Hydrocephalus (NPH); Inoperable Tumors of the Brain; 

Parkinson's Disease; Creutzfeldt-Jakob Disease; Huntington's Disease; 

Multiple Sclerosis; Uncommon Dementia such as Pick's Disease, Wilson's 

Disease, and Progressive Supranuclear Palsy. (OAR 411-032-000) 

Oregon Family Caregiver Support Program Standards 47
Page 10 of 20 

Caregiver – An individual who “informally” has the responsibility for the 

care of an older individual or individual of any age suffering from 

Alzheimer’s or related disorder; or a grandparent/relative caregiver, age 

55 and older who has the responsibility for the care of children or adult 

child with disabilities. “Informally” means the care is not provided as part of 

a public or private service program. (AoA Title III/VII Reporting 

Requirements Appendix – www.aoa.gov ) 

Child – An individual who is not more than 18 years of age or an 

individual 19 to 59 years of age who has a severe disability. This definition 

relates to the caregiver services. (AoA Title III/VII Reporting Requirements 

Appendix – www.aoa.gov) 

Civic Engagement – Individual or collective action designed to address a 

public concern or an unmet human, educational, health care, 

environmental, or public safety need. (OAA 102(a)(12)) 

Disability – Except when such term is used in the phrase ‘‘severe 

disability’’, ‘‘developmental disability”, ‘‘physical or mental disability’’, 

‘‘physical and mental disabilities’’, or ‘‘physical disabilities’’ - a disability is 

attributable to mental or physical impairment, or a combination of mental 

and physical impairments, that results in substantial functional limitations 

in one (1) or more of major life activity. (OAA 102(a)(13)(A-I)) 

Disease Prevention & Health Promotion Services – Individual or group 

programs based on best practices and/or evidence-based research, that 

identify health risks and needs, prevent health problems, and/or help older 

adults manage their health conditions. Programs should address identified 

health needs of older adults in the community, and where possible, should 

use evidence-based approaches and evaluated outcomes to address 

needs. These may include health risk assessments and screening linked 

to referrals and/or follow-up education; health promotion programs that 

help participants prevent and/or manage chronic conditions, alcohol and 

substance abuse, health risks such as smoking cessation, weight loss; 

physical activity programs to promote activity and prevent falls; 

educational programs on health risks and conditions or use of preventive 

health services and medication management. (Condensed from OAA 102 

(a)(14)(A-L)) 

Elderly Client – A service recipient who is 60 years of age or older or who 

is less than 60 and has a diagnosis of Alzheimer’s or a related disorder. 

(AoA Title III/VII Reporting Requirements Appendix – www.aoa.gov) 

Ethnicity – Consistent with OMB requirements ethnicity categories are 

Hispanic or Latino or Not Hispanic or Latino. (AoA Title III/VII Reporting 

Requirements Appendix – www.aoa.gov) 

Oregon Family Caregiver Support Program Standards 48
Page 11 of 20 

Evidence-based Program – Evidence-based programs are interventions 

that have been tested through randomized control trials and have been 

shown to be effective at helping participants adopt healthy behaviors, 

improve their health status, and reduce their use of hospital services and 

emergency room visits. (DHHS FFY2011 AoA Justification of Estimates 

for Appropriations Committees) 

Focal Point – A community center, senior center, or multi-purpose 

center/facility established to encourage the maximum co-location and 

coordination of services for older individuals. (OAA 102(a)(21) and 

306(a)(3)(A)) 

Frail – Functionally impaired because the individual is unable to perform 

at least two activities of daily living without substantial human assistance, 

including verbal reminding, physical cueing, or supervision; or due to 

cognitive or other mental impairment, requires substantial supervision 

because the individual behaves in a manner that poses a serious health or 

safety hazard to the individual or to another individual. (OAA 

102(a)(22)(A)(i) & (B)) 

Grandparent or Other Older Relative Caregiver of a Child – A 

grandparent, step grandparent or other relative of a child by blood or 

marriage who is 55 years of age or older and lives with the child, is the 

primary caregiver of the child because the biological or adoptive parents 

are unable or unwilling to serve as the primary caregiver of the child; and 

has a legal relationship to the child, such as legal custody or guardianship 

or is raising the child informally. (AoA Title III/VII Reporting Requirements 

Appendix – www.aoa.gov) 

Greatest Economic Need – A need resulting from an income level at or 

below the poverty line. (OAA 102(a)(23)) 

Greatest Social Need – A need caused by non-economic factors, which 

include physical and mental disabilities; language barriers; and cultural, 

social, or geographical isolation, including isolation caused by racial or 

ethnic status, that restricts the ability of an individual to perform normal 

daily tasks; or threatens the capacity of the individual to live 

independently. (OAA 102(a)(24)(A-C)) 

HCW (Homecare Worker) – A provider, as described in OAR 411-030-

0020 and 411-031-0040, who is directly employed by the eligible individual 

via the Client Employed Provider Program, and who provides hourly 

services to eligible individuals. Homecare Workers also include providers 

in the Spousal Pay Program. (OAR 411-032-0000 (31)) 

Oregon Family Caregiver Support Program Standards 49
Page 12 of 20 

Note: Homecare worker and Client Employed Provider (CEP) are 

synonymous and depending upon age of the document or data 

collection means – either term may be present or appear in DHS 

publications and DHS-owned software applications. 

High Nutritional Risk – A score of six (6) or higher on the Determine 

Your Nutritional Risk checklist published by the Nutrition Screening 

Initiative. 

See http://edis.ifas.ufl.edu/he944 for the checklist and risk summaries. 

(AoA Title III/VII Reporting Requirements Appendix – www.aoa.gov ) 

Note: Nutritional Risk Assessment is on the DHS/SPD NAPIS 

Registration and OACCESS under the Nutrition tab (accessed by 

selecting the Service Icon). 

IADL (Instrumental Activities of Daily Living) aka "Self Management 

Tasks" – Housekeeping, including laundry, shopping, transportation, 

medication management and meal preparation as described in OAR 411-

015-0007. (OAR 411-032-0000) 

In-Home Care Agency – A licensed agency (by DHS Public Health 

Division) that provides in-home care services for compensation to an 

individual in that individual's place of residence. “In-home care agency" 

does not include an agency providing home health services as defined in 

ORS 443.005. (OAR 333-536) 

To request list of licensed agencies serving Oregon send e-mail to: 

mailbox.hclc@state.or.us

Living Alone – A one person household. Household as defined by the 

U.S. Census Bureau - living quarters in which the occupant(s) live and eat 

separately from any other persons in the building and which have direct 

access from the outside of the building or through a common hall. (AoA 

Title III/VII Reporting Requirements Appendix – www.aoa.gov); 

Household is defined and found at www.census.gov.

NAPIS: (National Aging Program Information System) – Information 

describes the services provided under Older Americans Act funding titles 

in collaboration with an aging network that includes 56 State Units on 

Aging, 655 Area Agencies on Aging, 244 Tribal organizations, and over 

29,000 local community service organizations., expenditures, client 

demographics and staffing profiles for each state and U.S. territory. 

(Definition crafted by SUA from information available at www.aoa.gov.) 

Oregon Family Caregiver Support Program Standards 50
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NSIP (Nutritional Services Incentive Program) Meal – A congregate or 

home-delivered meal prepared in compliance with nutritional requirements 

as outlined in the Older Americans Act (OAA) and served to an eligible 

individual as defined in the OAA. (Definition based on OAA and 

condensed by SUA) 

Note: Eligible NSIP meals include those served to the under 60 spouse in 

the company of the 60 years of age or older spouse; any age adult 

with disability who resides with or is in the company of an individual 

60 years of age or older; caregivers and care recipients aged 60 or 

older; caregivers who are the spouse of the care recipient - 

regardless of age; and any age volunteer assisting with meal site or 

delivery of meals. 

Poverty – Persons considered to be in poverty are those whose income is 

below the official poverty guideline (as defined each year by the Office of 

Management and Budget) in accordance with subsection 673 (2) of the 

Community Services Block Grant Act (42 U.S.C. 9902 (2)). The annual 

HHS Poverty Guidelines provide dollar thresholds representing poverty 

levels for households of various sizes and is typically released each 

February. (AoA Title III/VII Reporting Requirements Appendix – 

www.aoa.gov) 

Poverty Level: The income level indicated in the Federal Poverty Income 

Guidelines developed and annually updated and published in the Federal 

Register by the United State Department of Health and Human Services. 

Program Income – Gross income received by the grantee (AAA) or subgrantee (AAA contractor) such as voluntary contributions or income 

earned as a result of a program supported by the OAA grant. (AoA Title 

III/VII Reporting Requirements Appendix – www.aoa.gov; condensed by 

SUA) 

Provider – An organization or person which provides a service to clients 

under a formal contractual arrangement with the AAA. (AoA Title III/VII 

Reporting Requirements Appendix – www.aoa.gov) 

Race – Consistent with OMB requirements, race categories are American 

Indian or Alaskan Native; Asian; Black or African American; Native 

Hawaiian or Other Pacific Islander; and White. Respondents should ideally 

be given the opportunity for self-identification, and are to be allowed to 

designate all categories that apply to them. (AoA Title III/VII Reporting 

Requirements Appendix – www.aoa.gov) 

Registered Client – An individual who received one or more units of 

Cluster 1, Cluster 2, or Group 1 or Group 2 Caregiver services: (Definition 

developed by SUA) 

Oregon Family Caregiver Support Program Standards 51
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Rural – Any area that is not defined as urban. Urban areas comprise (1) a 

central place and its adjacent densely settled territories with a combined 

minimum population of 50,000; (2) an incorporated place or census 

designation with 20,000 or more inhabitants. (AoA Title III/VII Reporting 

Requirements Appendix – www.aoa.gov) 

Target Population – Older individuals, with particular attention to lowincome older individuals, including low-income minority older individuals, 

older individuals with limited English proficiency, older individuals at risk 

for institutional placement and older individuals residing in rural areas. 

(OAA 305(a)(2)(E)) 

Note: 45 CFR 1321.69(a) states the following shall be given priority in the 

delivery of services: Persons age 60 or over who are frail, 

homebound by reason of illness or incapacitating disability, or 

otherwise isolated. 

Unduplicated Client Count– Counting a recipient of a service only once

during the reporting period. (Definition crafted by SUA) 

Unit Count – The number of units of service received by an unduplicated 

client during the reporting period. (Definition developed by SUA) 

Volunteer – An uncompensated individual who provides services or 

support to AAA and/or AAA service providers. (AoA Title III/VII Reporting 

Requirements Appendix – www.aoa.gov; enhanced by SUA) 

Voluntary Contributions – A non-coerced monetary sum provided 

toward the cost of service. (OAA 315(a)(5)(b)(1)) 

Oregon Family Caregiver Support Program Standards 52
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B. Target Priorities 

Priorities were also established with the NFCSP: 

• Caregivers who are older individuals with greatest social need and/or greatest 

economic need with particular attention to low-income older individuals and to 

low-income minority older individuals, older individuals with limited English 

proficiency, and older individuals residing in rural areas; 

For family caregivers who provide care for individuals with Alzheimer’s 

Disease and related disorders with neurological and organic brain 

dysfunction, the Area Agency on Aging (AAA) or State involved shall give 

priority to caregivers who provide care for older individuals with such disease 

or disorder; and 

For grandparents or older individuals who are relative caregivers, the 

AAA/State involved shall give priority to caregivers who provide care for 

children with severe disabilities. 

•

•

Priority: In providing services under this subpart, the State, in addition to giving 

the priority described in Section 372(b) shall give priority to: 

• Caregivers who are older individuals with greatest social need, and older 

individuals with greatest economic need (with particular attention to lowincome older individuals); and 

• Older individuals providing care to individuals with severe disabilities, 

including children with severe disabilities. 

Oregon Family Caregiver Support Program Standards 53
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Oregon Family Caregiver Support Program Standards 54

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Page 17 of 20 

A. Administration on Aging (AoA) 

Under the authority of the Older Americans Act (OAA), the Administration on 

Aging (AoA) works closely with other partners in the national aging network to 

plan, coordinate, and provide home and community-based services to meet 

the unique needs of older persons and their Agencies on Aging (AAA) and 

Indian Tribal Organizations (ITO). 

Under the NFCSP, AoA, through its central office staff and nine regional 

offices, performs a number of tasks, including policy development, technical 

assistance, research and demonstrations, and systems development. 

AoA has provided technical assistance through a number of activities, 

including: 

• Establishing a technical advisory group (TAG) comprising researchers and 

aging network representatives who informed the content of the 2001 

Resource Guide and advised on other AoA technical assistance activities; 

Created a web page devoted to the NFCSP; 

Commissioned more than 20 issue briefs from prominent researchers and 

staff of the aging network and posting them to the NFCSP web site; 

Sponsoring the September 2001 National Family Caregiver Support 

Program: from Enactment to Action conference at which more than 700 

participants exchanged information and generated new ideas; 

Organized a structured listserv to disseminate research-based information 

and to generate the exchange of information among network staff; and 

Commissioned the Resource Guide, which brings together information 

gained from all of the above activities in a practical, easy-to use format. 

•

•

•

•

•

AoA also is administering the National Innovation Program under the NFCSP 

and is engaged in systems development work related to caregivers with other 

federal agencies. For example: Centers for Medicare and Medicaid Services 

[CMS] and the Office of the Assistant Secretary for Planning and Evaluation 

[ASPE] and national organizations. 

B. State Unit on Aging (SUA) 

A state’s governor designates a state government agency as the SUA to 

serve as the focal point for all matters relating to older persons within the 

state. SUA’s are located within a multipurpose state agency and in Oregon 

this agency is the Department of Human Services, Seniors & People with 

Disabilities. SUA’s are responsible for ensuring effective implementation of 

the NFCSP broad policy objectives. SUA functions include: 

• Management and Administration: With input from the AAA’s local 

plans, advisory bodies, and consumers of services, SUA’s develop a state 

Oregon Family Caregiver Support Program Standards 55
Page 18 of 20 

plan inclusive of the NFCSP. SUA’s also assume the primary role for the 

development of an Intrastate Funding Formula (IFF), approving the AAA 

area plans, and monitoring the activities and expenditures under the 

approved area plans. 

Service System Development: SUA’s develop a state-level multifaceted service system in keeping with the NFCSP and integrate this 

system into the social and health services system for older persons. 

Services Development: SUA’s set policies on quality assurance, provide 

guidance, and facilitate information exchange between AAA’s to make 

resources available that help shape services development in the state. 

Advocacy: SUA’s identify areas in which caregiver support programs 

might need legislative support and might advocate greater state funding. 

SUA’s also advocated for programs with other public agencies and private 

organizations and promote caregiver support programs with the public at 

large. 

•

•

•

C. Area Agencies on Aging (AAA) 

AAA’s are public or private nonprofit agencies designated by SUA’s to carry 

out the OAA at the sub-state level. AAA’s assume many of the same broad 

responsibilities as the SUA management and administration, service system 

development, services development, and advocacy but focus more on the 

local area and on direct involvement in services development and delivery. 

AAA’s can be public agencies located within county governments, a regional 

planning council, a unit of city government, an office within an educational 

institution or an independent nonprofit organization. 

How AAA’s carry out their role in implementing the NFCSP likely will be 

heavily influenced by their role relative to other OAA functions. For example: 

needs assessment, contract development, and monitoring will be foremost for 

AAA’s that primarily fund providers to deliver services. For AAA’s more active 

in service delivery, e.g., provision of information and referral and care 

management by in-house staff, issues regarding staff development, 

assessments, and service coordination might be of primary concern. AAA’s 

at both ends of the spectrum will benefit from improved understanding of 

caregiver needs and strategies for meeting their needs. 

D. Service Providers (SP) 

All local SP’s concerned with older persons should consider their role in 

NFCSP implementation. AAA’s will fund some SP’s directly. These and 

other SP’s and community organizations might consider serving as a potential 

referral source as they identify a caregiver in need, raising public awareness 

of caregivers, offering support groups, training caregivers or generating funds 

to supplement caregiver programs. AAA’s can foster this type of service 

development through small service development grants, training providers, 

regular information exchange meetings or co-location of services. 

Oregon Family Caregiver Support Program Standards 56
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VII. Resources and Useful Links 

ADRC – Aging and Disability Resource Connection 

The Aging and Disability Resource Connection of Oregon (ADRC) is the first call 

to make to get information on all aspects of aging or living with a disability. By 

contacting the ADRC you will reach trained professionals who will be able to 

provide you with the information you are seeking or help you determine what 

services might work best for you. 

Eldercare Locator 

http://eldercare.gov/Eldercare.NET/Public/Index.aspx 

Are you a family caregiver in need of information or assistance? Are you 

interested in learning more about the programs and services that may be of 

assistance to you or your loved one? The Eldercare Locator, a public service of 

the U.S. Administration on Aging, is the first step to finding resources for older 

adults in any U.S. community. Just one phone call or Website visit provides an 

instant connection to resources that enable older persons to live independently in 

their communities. The service links those who need assistance with state and 

local area agencies on aging and community-based organizations that serve 

older adults and their caregivers. 

Family Caregiver Alliance - National Center on Caregiving 

http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=368 

Established in 2001 as a program of the Family Caregiver Alliance, the National 

Center on Caregiving (NCC) works to advance the development of high-quality, 

cost-effective policies and programs for caregivers in every state in the country. 

Uniting research, public policy and services, the NCC serves as a central source 

of information on caregiving and long-term care issues for policy makers, service 

providers, media, funders and family caregivers throughout the country. 

National Alliance for Caregiving 

http://www.caregiving.org/ 

Established in 1996, The National Alliance for Caregiving is a non-profit coalition 

of national organizations focusing on issues of family caregiving. Alliance 

members include grassroots organizations, professional associations, service 

organizations, disease-specific organizations, a government agency, and 

corporations. 

The Alliance was created to conduct research, do policy analysis, develop 

national programs, increase public awareness of family caregiving issues, work 

to strengthen state and local caregiving coalitions, and represent the US 

caregiving community internationally. Recognizing that family caregivers provide 

important societal and financial contributions toward maintaining the well-being of 

Oregon Family Caregiver Support Program Standards 57
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those they care for, the Alliance's mission is to be the objective national resource 

on family caregiving with the goal of improving the quality of life for families and 

care recipients. 

The National Family Caregivers Association 

http://www.thefamilycaregiver.org/index.cfm 

The National Family Caregivers Association educates supports, empowers and 

speaks up for the more than 50 million Americans who care for loved ones with a 

chronic illness or disability or the frailties of old age. NFCA reaches across the 

boundaries of diagnoses, relationships and life stages to help transform family 

caregivers' lives by removing barriers to health and well being. 

Generations United 

http://www.gu.org/OURWORK.aspx 

Generations United is the national membership organization dedicated to 

improving the lives of children, youth, and older people through intergenerational 

strategies, programs, and public policies. Generations United represents more 

than 100 national, state, and local organizations representing more than 70 

million Americans. With its emphasis on public policy, advocacy and 

programming, Generations United has served as a resource for policymakers 

and the public on the economic, social, and personal imperatives of 

intergenerational cooperation. 

The Brookdale Foundation Group – Relatives as Parents Program (RAPP) 

http://www.brookdalefoundation.org/RAPP/rapp.html 

Established in 1996 in response to a growing understanding of the need for 

enhanced services and supports for grandparents raising grandchildren, The 

Brookdale Foundation Group established the Relatives as Parents Program 

(RAPP) to encourage and promote the creation or expansion of services for 

grandparents and other relatives who have taken on the responsibility of 

surrogate parenting due to the absence of the parents. Currently RAPP provides 

supportive services, primarily to relative caregivers caring for children outside the 

foster care system, through an extensive network of support groups across the 

country. 

Extension 

http://www.extension.org/family_caregiving 

This website was created by the United States Department of Agriculture 

(USDA), Cooperative Extension System. Here, caregivers and advocates can 

access a wide range of information and materials designed to help them learn 

about and provide supportive services to family and relative caregivers. Topics 

include disaster preparedness, military families, and grandparents raising 

grandchildren, housing, and nutrition. 

Oregon Family Caregiver Support Program Standards 58
South Carolina Family Caregiver Support Program Budget Worksheet 59

WORKSHEET - FCSP BUDGET FOR UPCOMING FISCAL YEAR July 1 _ to June 30 _ 

I Information (To Groups) [ACTIVITIES] 

Community/ Outreach 

Participation in Community Events 

Publicity Campaign 

Resource Development/ Community Assessment & Planning 

TOTAL INFORMATION TO GROUPS 

II Assistance [CONTACTS] 

Assessment I Screening 

Assessment I Screening - Home 

Care Coordination 

Follow-Up I Evaluation 

Information & Assistance 

TOTAL ASSISTANCE 

Ill Support Groups [SESSIONS] (1 session/cg) 

Support - Group 

Support - Individual 

Support- Individual-Home 

TOTAL SUPPORT 

Training [SESSIONS] (1 session/cg) 

Training - Group 

Training - Individual 

TOTAL TRAINING 

Counseling [SESSIONS] (1 session/cg) 

Counseling - Group 

Counseling - Individual 

TOTAL COUNSELING 

IV Respite [HOURS] 

Respite at Adult Day Care/ Adult Day Health 

After School /Summer Programs/Child Day Care 

Group Respite 

In-Home Respite 

Facility Respite 

TOTAL RESPITE 

CG IIIE SRC IIIE Combined 

Budget 

CG Other 

Funding 

Source 

SRC Other 

Funding 

Source 
South Carolina Family Caregiver Support Program Budget Worksheet 60

Supplemental Services 

Assistive Technology 

Emergency Response Installation-Monitoring 

Home Modification 

Incontinence Supplies 

Legal Services 

Nutrition-Supplements 

Other Support Linked to Caregiving 

School Related 

Transportation 

I TOTAL SUPPLEMENTAL SERVICES 

TOTAL (I+ II+ Ill+ IV+ V)! 
Description of the Roles of the Aging Network Flow Chart

Tier 1 in hierarchical order (top to bottom): 

U.S. Department of Health & Human Services > Administration on Aging (AoA) > Oregon State Unit on 

Aging > Oregon Area Agency on Aging (17) > Older Americans Act Programs (Federal Funds). 

Older Americans Act Programs (Federal Funds) leads to Tier 2, which consists of five sections.

Tier 2: 

III-B Supportive Services, III-C Nutrition Services, III-D Disease Prevention, III-E Caregiver Services, Title

VII Elder Abuse Prevention.

All five sections lead to their sub-sections; Tier 3.

Tier 3: 

III-B Supportive Services:

• Adult Day Care/Adult Day Health

• Assisted Transportation

• Case Management

• Cash and Counseling

• Center Renovation/Acquisition

• Chore

• Crime Prevention/Home Safety

• Financial Assistance

• Guardianship/Conservatorship

• Health & Medical Equipment

• Home Repair/Modification

• Homemaker

• Information and Assistance

• Interpreting/Translation

• Legal Assistance

• Long Term Care Ombudsman

• Money Management

• Newsletter

• Options Counseling

• Outreach

• Personal Care

• Public Outreach/Education

• Reassurance

• Recreation

• Senior Center Assistance

• Transportation

• Volunteer Recruitment

• Volunteer Services

III-C Nutrition Services:

• Congregate Meal

• Home Delivered Meal

• Nutrition Counseling

• Nutrition Education

III-D Disease Prevention:

• Chronic Disease Prevention,

Manage/Education

• Medication Management

• Mental Health Screening & Referral

• Nutrition Counseling

• Nutrition Education

• Physical Activity & Falls Prevention

• Preventive Screening, Counsel/Referral

• Registered Nurse Services

61
III-E Caregiver Services:

• Caregiver Access Assistance

• Caregiver Cash & Counseling

• Caregiver Counseling

• Caregiver Supplemental Services

• Caregiver Support Groups

• Caregiver Training

• Information for Caregivers

Title VII Elder Abuse Prevention:

• Elder Abuse Awareness & Prevention

• Guardianship/Conservatorship

NOTE: Individual services are listed under primary expenditure OAA Titles, however in some 

cases other Titles may be used to fund the service. 

62