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()FA No. 238 (1\/85)

APPENDIX 1U T~!r F UR YEf\k rL~r~ D~!,;\ FT rCJr~ TH (11/1R/86) OLDEr, i,tiERlC NS I,CI

-J.:- * ~, * f!, ND MYS CO~~lUNI-rY SER1ICES FOR ]'Hf Et_OlRLY P~OGRA~lS

and AD81ication for St~tE Aid UndEr

Expanded 1;I~J1ome Services for the ~lderly Progrilffi ;~ ~_._, , ~ .~~~~__ ,,_-~n.~=~-._~~~~~'----'--~----'-~A"~->----~'''-~~'----'-~-i

I:(

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Fot' the County[ies] of:

PrGgran1 Pf~riod; FrDm _~

----------.-.--.--.---.-------.-.-------

'"~._._._~_, To .__. __.. ._.__

IlI

!! I __ o __~ .~_~ , , ._. .. ,. ... 1

II T b1 -~--~ fO' -~- ~~~~~~~~ II I c: e n t i fie d t ; 0 I! Stalldard Assurances

DESCRIPTION OF CURRENT COUNTY Plan Development Process. Comprehells~ve Description of

Services and Providers.

p. 1 p p 2 - 5

HOME CARE SYSTEM 6

Serv-ices Delivery System p. 7

CliGnt-Leve1 Service Delivery r--lechanisms . p. 8 Current System Probl ems p. 9 Current System Development/Coordination Activitie::; p. 10

INTENDED ACTIONS ElSEP System Development/Coordination Objectives p. 11 ElSEr Se"vices Expansion

Summary (January 1, 1987 - March 31~ 1987) p. 12 Summary (April 1,1987 - March 31,1988) p. 13 Case ~lanagement Homemaker/Persona] Care Housekeeper/Chore Non-Institutional Respite Ancillary Services.

Outreach/Targeting. Pro 9 " a min at icE 1 i 9 i b i 1 itY Subsidy Eligibility Client Prioritization Technical Assistance and Tf~ainiJlg. r'lonitoring. 1~ a i n ten a nceo f Ef for tee r t ; of i cat; 0 n Schedule of

BUDGET Area Agency Support i ng

N.B. THIS WITH

Subcontracts.

Summary Budget Budget Sc hedul es

p. 14 p. 15 p. 16 P. II p. 18 p. 19 p. 20 p. 21 p. 22 p. 23 p. 24

pp. 25-2tJ p. 27

p. 28 p p 29-33

DOCUMENT MUST BE COMPLETED IN COMPLIANCE THE ACCOMPANYING DETAILED IfiSTRUCTIONS.

02A ND. 238 (11/8S)

t" tsix [GJ copi(~:-:; cf thl.,:, !\pplL:e,t.J.on to E,h!2rc1 Lo~~l SeI~ic2s, N~w York St~Jte Office for t~e 1.:nip;LLc St"j ::::=-, Plaza! AgEcrlCy Bldg. ~2; i\lbany H~:::\", YDr k

th,L;J d(~~~~~?~Jir~ c~\~\~~ j~~lC)~~(j~~f~~~:~)~e~'~-~-nq~2ct i ()n~c of :l n'J!

-, l\rea Agency:-' ~

Name~

Zip Code:

:sTgna'Cute--o[--Chlef-E:-,;-ecuflVf::--------------------_._--------of Cou,lty Governn-1ent

I I

SIg-n a tureof--S'DonSo~trn 9 Aqency -jrxec oJ t 02--------- - ..~-----------if other then COUi'ity \~overm;:e'nt

Date-------

.

I I

J

Of!>. no~ 238 \ Lt/UG) -3

, .. ~. ,.._----~----_ ..._...__.. -._-_. --'--~-'"-'--'-~- --~ --_.,--~-----'-'--------- --"~-' _._,,~- ~,"._-- ---'~.- .._.~-

ll,-"'--~~"-;,~~ '~;~~;~~~;L;~'i=~~:;, t~; n';S~::~~;;~i~,"7 ;r.;~~, I\ ~ ~~ ~:';;.:C;~~S:;:;'~~~r t~'~~~ ~y;,~~~J].r~\m\ :~ffjS,',~~ .se~:\'.ic\:c.s for: th2 .1~;:Jcle[J.y PregTaI'n ;.::;h:J.l.l ;~}.? allLx:at.ej a~J r;:':'T:E:,nj~.:-:j f~}t: n::::.n--ins:1ir'::al in-l,cliw::: sC't\'ices.

Ti!-~ l\I-2a ~lg2nc:y ;dill file claHns to:L:' z:, 'Ll p3..'!l'lo:::::nts en a tircr=:J.y cssis :m \,d th lTu.:x.---='E.clL1rc~'_-; p.r:c:riU 19,:-:d:e::1 by U~-::' SLdt2 Crffic"'2 fur th:::-: 11.:9 il1].

n. 'l'pe ~\r:=-Y:I }\g2-,ry srL'lll ,Z1SS\Jrc' -CI1('.i t vincre S;;:ate or :L(;cdl p-..lblic jurisdictIons J~~qiJln,; lJ.~ni:::ur-",; 01 cert.ifiG;:.ic[; for- t11t:' provisio1 oJ!: scvcj County Heme Q-!I':~-:; Plrlll for 1::112 Fu~ct::ionally Irnp.::~irej Elderly .sh3.11 te so lic2n.sE:~ O)~ C2l..t:iic"'\1, ~"rC/Cf.;.SrE':: C~~} i \l'~r:Lng s{~rvices m:l;)'C t-e ;;:'lpprGpri3.t211' qUi:11i fi~('i,.. s:~l;:::cte-Jr trained, C::-'l-J su,l:--'2rvi~(.::-.j "

12. 'LJE:: r-~I2c-'J Fq:_'1!cy sh-?i.l1: CS:3ure 8102.1 aC::::::2::?-'S for l'='drticip:"1tiot1, ,s2rvice.s r activities a.q;] infoDTl3Licn:=..1 ~--;es'3ions \>11 UJOU-[ :re'j3~cd tn p-:Jxtisan affiliation,; :refrain from usin:;1 f'....lI1Cl;;:; to udvance c..ny pdrcisdn canchdate or E-tfort; pre-Jent the use of officiaL a1Jthoritv, inY1.\..}2nce oc cC'Ercion to interfere v.jtJ] or affe.:t elections or nomin~1tj,(jns tor ()fTi~'t~; aSSlJre nu c'Cc:rcion nor c:dvice L() adler p2}:"sons to mntribute anything of: vaJu0': to a j;)3Xt.")-,. C"OITrnitt!O:.t:, organiz:-l.tio!\. ageD~, or p2rson for pJlitical r~..llp:)seSf [101: 2ngd~2 in p3rtisan ac:t..iv'ir12.r:,.

Ccntract.s

a) The Arw Agenc:,' ,;>sSUl"es Ulat it vrill mak2 affiLmatiV2 efforts to (Yll1t l'act wi t}"l mit10I' i ty ard \,!om2r:-,o,,

1 ';

E) r>J S\'}::x:~{)n ..:.r:;:::",

.snCTLej rot r~ds a:.c0..i, The f.I..~r?a l'ige:xy 'Hill prc)"v'ia-2 inr':..Jrwation to the pJbl ic 1..l-1(}l1 request. 1iJh2re 2pprop;::-ic:d::e, the l'-.:::e3 tV;::-:l1cy shc:,ll ma,~2 public informatlon available in lo.ng'Jage.s native to t.he clIent populati(;ns~ Pu.blic ilJformation also ,,-~1r..all 1:.'2 ;T,c..ie dC:"::2ssible t:'Q F2LSOt1S 'Nitb d.isabilit.ies~

16, H~~i..tion of th",: Ny::\/,] .'-!:':~::::~ .tate Offic2 fCJJ::- t.'l>:> Aginq: ThE: Area Agen::.ji ;-:qG~'2S that any pro:-:rrcFTl f f'''--Lb~L ic inEonnCit ion m~ter iaJ s 1 or -other' prTnte=! or p1101 ishe::l mater ials O1'l the vlOrk of this pro-~;rarn \"hi..::'h is SU[.pJlt'O:.:--d \,'1 i th EXf-\,,;.r1'3ed In--Hotne Se::'\llc:es for i.:he Elderly Prcgr3m f 1.JrDs \-'Jill giV2 dj2 :C2

OF~ No. 2:38 (11/86) -5

20. Tt}(~ Area l\']2n.CY

~, 'I]~ " or i-\, Nu" -- '" ~ ,i '

OF~P\/CS,2 -- GP1an

COUnTY HOME CARE Pl~~ DEVELOPM[r~T PROCESS

Des c '( i beT h e p j' (] C f :,.s us 2 d i1 n d 1 is t tho s e iJ. 9 e n c i e son d Ll r 9 ,'] )1 "i L (1 t i CJ:~ :; (in...:lud-TnC] 21t ,~: n:ini",uITI the 50ci31 servir:.es cI-isttict, th2 local publ l ':: health a\jenCj~ and the C;'\51\ CJr CAS!{-like -;qE~'ncy, if it e~~ists lri thE: county) i'ihich \r~ere actively involved r}nci/Of consulted thel(j developmeflt Df the County Heme C

D~~:;,':.'T

iJf'A No. ~~2 (11/86) - 7FU\~'I

r;,;n,Jing

j Il~, t i -f c.'-; F(esD i Tc:

,, - .1 ._,_~ __. __

II i)

31

---------------- ------

OF/! N:::i. 23[ (11/B6)

CiFj\/CS-2 p 1 () n

_._-_.-_.--~-- .__._---~--~ .. _- -, ---,._._"'~--, _.. '"_._---",-------.._.'- ---_.._~-_ ...~,----------,~"' --- - --_.--_._- _...--,---~--- -------_..__..~-~---_.--------,._.---_. ,-_.~, CDUfrrv lJO~IE CARE Pi.-AJJ

CONPREHE11SIVE DESCRIPTION

fUNSTI0NALL Y lJ-1PAJ RED E! DLRL-l CLIEN1--LE~E~ S~kVICE DELIVERY NECHANIS~S

I_~ _ I

Oi-/\ l

/1, r 2 a,", iJ 1=; ,'I C ,'j :

.. 1 [I ..

f'l r) I'

COMPRE~lENSjVf DESCRIPTIOfJ

D[VELOPMFNT/COORDI:ihTlun ;

J,f\CTIV IllES

Clih.t PLA:tCOUnTY HO;1E

CUR}~ENl

----------

OFA/CS-2 - .1 J-AnDlication --!....-'----~-- ._----

-------------------~-- -_._._.,._-----,_.~-~,.,,

Of A NQ. 233 (11/ES)

OF/-\i' \:S~2 t\ ;" [:1 -Ii C Cl t -, u n

- ] 2

(JJnUdry ]007 - M~)'ch 31~ ISS7)

For the three-lnontl1 period' J~tlLIJry 1) 1981 through i~arch 31 1987.I

r~'~---------I~-H:-I~-~~-~--"--~-----"~-'---'-'--Tr~-;~-~-n _--1"-----,,--_. -~--l i CdS P ;,1,1 a 'e p r / i Il Ca' " f - is t 1 t II - I F, nCl I - 'I

') -: " ,- J' J-\ r e C! ,:-~, '-'l f r n (11/?6)

OF"s,/C

UFi\ i\(:. 23;:; (ll/gG) j\rea f\~JPj ~ \'-

D i:'.~/ CS- 2

i~~E:~_:j._~_c~ ~_~_q.~:

rISEr SER~I[[S EX?ANSION ! I I...._-----_._--.__ . -_. --_.._---- -'~'..~---_._.__._._~-_ .. _----_._~_.---j ,

Is the AAA requesting a \Jcliver for use of an dSS~SSI~nL i nsir'L1i-i1t:n L otllrr than the PAT~ij [J yes [ J n 'J

1 f yes, b f- S 1I r f-.' co inc 1 u d 2 2 .1!J.s t i fie aLl 0 n G rl (1 (1 C 0 f' .i eft h e ins t t' Umen t .

Cli(';llt to case ITiclnu(jer r"atio:

Ca.selo~d size:

Description of Case Management:

OFA No. 238 (11/85) A. i' e a ji, q p n '" :\,l

OFA/CS-~~

12 e-p_ ~.~ ~_~. !:.j_ ~_ ~~ -----~------"-----_._ .._._----_._------_._--_._----_._--.._.---_.- --_ ... _.--- ._. ~--~-_._--_._-_ .. _- "._-,-------------..~--_._'"-_ .. ------'"..

I InHENDED HTICiiS I EI S EP S ER1; I C[S EX P/~ NS I G;'1 I I ' Ii .!

110MEnA!(ERjPERSO?lAL CARE

\----------------_._----------------_.._------------------------_.... --- -----_.-------_. -- ---------.....--------- _._...! ! 'eo,n,""""' ""e""'ocn'ocm"l c.Hn I

i

OFA ]10. 23C (lJ/86)

UFA/C~-2

EISEP SfRV1CES EXPANSION

HDUSEKfEP[R/Ci~O~;[ SERVICES

DeSC(lpr.-jon of Housr-::kf't?per/Choff: Serv'\ces:

. , )

OFr~ ).0, (~33 (11/86) Area f\gene)':

[irA/ CS- 2 - 17~eE~j_~_~!.~9_~

I INTENDED ACTIONS I ElSE? SERVICES EXPANSION I I _ jI NON-INSTITU110NAL RESPITE II i ~_.._ .._----_.._-------------------------------------_..------

11/8C)

o!-" :l,;i C. S - 2 - 1 L~ _.

EISEP SERVICES EXPAtISlll1!

AjCIlLARY SERVICES I .. _. _- _ _ _._ -.__ - -._ ~ __.. - _.. '. ----.. 1

[.1 e :, C ( i P 1. i uno f P r LJ c. e sse 5 and pro red Li rES f 0 ;' pro v i d "1 ri g /~rilill2ry 1 SE~(vices: ,i

I I

I\)u. 23[; (11/86)

OFI>.jCS-2

~~ e-e- !_2_ ~~ ~!_ ~~~ ~

1----'- ---------"---"'-->-,-------.-----.~ ".- -~~-,~------._-~-----,--"--".----'-.'------.---~-~'

OF!\ i'o. :3U (11/B6) {"tea Agency:

01/1./ CS-- (' .. 2 I .

~r. 2.l ~ c_ ~~.!_ ~_l~ [.._ _ _ _- _-----_ _ -----_ _-_..'

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