316 Caregiver Services | HCBS-5300-MANUAL

This section establishes the guidelines and requirements for Area Agencies on Aging (AAAs) that provide or contract for provision of non-Medicaid-Home and Community Based Services for family and informal caregivers of older individuals, at-risk adults, and persons with disabilities. These requirements apply to services funded wholly or partially by funds received through the Department of Human Services Division of Aging Services (DAS) and are suggested for use by agencies providing caregiver services on a fee-for-service basis.

AAAs can make information available to caregivers about community services and assist in gaining access to those services to enhance decision-making, reduce burden, and improve the health and wellness of those caring for older adults and persons with disabilities. Supportive programs and services for caregivers can strengthen care partnerships and help care receivers to remain in their communities for as long and as safely as possible.

AAAs may choose from a variety of caregiver-targeted programs and services, including but not limited to adult day care, respite services, material aid, assistive technology, community and public education, case management, and kinship care. Some of these caregiver services have their own standards and policy requirements as outlined in applicable sections of the DHS Online Directives Information System Manual 5300, “Home and Community Based Services.”

To be eligible for caregiver services, the caregiver must be providing periodic or ongoing care for a care receiver. The service or services delivered must provide support to and address the needs of the client in their role as a family or informal caregiver.

AAAs should incorporate the following Core Principles when implementing caregiver services:

The goals of caregiver services include:

The desired outcomes of consumers receiving caregiver services include:

Indicators used to measure desired caregiver service outcomes include:

Survey and assessment protocols for caregiver programs are discussed in Section 316.8 “Assessment” of this document.

Caregiver services administered through the AAAs must be targeted toward family and other informal caregivers of older adults and persons with disabilities.

The following eligibility criteria apply for program funding through the Older Americans Act, Title III Part E – National Family and Caregiver Support Program (Title III-E):

This section establishes policy for the first two specific populations. For policy regarding older relative non-parental caregivers of children, refer to Manual 5300, Section 216 “Kinship Care Services”.

In administering caregiver services, AAAs shall give priority to caregivers who are:

Additionally, other allowable, non-federal fund sources may be used for services targeting caregivers who fall outside of the above eligibility criteria: for example, to serve a caregiver under 55 years-of-age caring for a disabled military veteran. DAS encourages this approach to manage gaps that may be encountered by AAAs when administering caregiver programs in the community.

All Area Agencies on Aging must offer at least one service in each of the five (5) core caregiver service categories. If there are any service changes that will eliminate a core service category from that AAA, the AAA must notify DAS immediately for assistance in coming into or maintaining compliance with this requirement.

Core services for caregivers shall include:

Information for Caregivers about Available Services: Caregivers can learn about a range of supports, resources, and services available.

Assistance to Caregivers in Gaining Access to Services: Access assistance helps connect caregivers with services offered by private and voluntary agencies.

Caregiver Education/Training, Individual Counseling, and Support Groups: These services help caregivers better manage their responsibilities and cope with the stress of caregiving.

Respite Care: Trained caregivers provide care for individuals, either at home or at adult day care facilities, so that caregivers can rest or attend to their own needs.

Supplemental Services: Services provided on a limited basis to complement the care provided by caregivers. Supplemental services may include but are not limited to transportation, material aid, home modifications, assistive technology, and telephone reassurance.

The AAAs shall screen potential clients for caregiver services as appropriate. The AAA will refer applicants to provider organizations or other resources; place them on a waiting list for services; or initiate service delivery as determined by the screening and assessment process.

For information regarding screening through Aging & Disability Resource Connection, see MAN 5200, Section 5025. The AAAs will maintain and manage waiting lists for the services, as necessary. See Manual 5200, Section 5038 “Waiting List Management”.

Not every applicant will request, require, or benefit from caregiver services. Each AAA will clearly identify in its Area Plan how services will be coordinated and how resources will be allocated and managed to optimize the effectiveness and efficiency of caregiver services.

AAAs and providers must follow the assessment protocols as outlined in Manual 5300, Section 114 “Guidelines for Client Assessments” and particularly in Section 114.6 “Assessment for Caregiver Services”.

Instruments specifically designed to evaluate caregiver burden and help determine needed caregiver services include “Section H: Caregiver Burden” of the Risk Assessment Tool (Manual 5300, Section 114.5-E and Appendix 114-E) and the Bakas Caregiving Outcomes Scale (Manual 5300, Appendix 114-L).

Questions on Section H of the Risk Assessment Tool (RAT) may be used during client screening to preliminarily assess the level of caregiver burden and intention to place. If caregiver burden is identified during screening, the Bakas Caregiving Outcomes Scale (BCOS) should be performed. All caregivers enrolled in the HCBS-Caregiver Services Program must have a completed BCOS assessment in their client record in the DAS Data System.

For EBP and EIP training sessions, facilitators must use the survey or assessment protocols designed by the developers of the respective programs.

Consumer direction allows the caregiver to manage payment and choose service providers in accord with an established care plan. This approach reflects the family-centered principle that people are the best judges of what assistance they may need and of how that assistance should be delivered. DAS encourages consumer direction of funds to the maximum extent possible for qualified caregivers to meet the varied and changing needs and preferences of a care partnership.

Consumer-directed funds enable the caregiver to purchase services from providers whose service area is located outside that of caregiver residency, i.e., the region where the care receiver resides. DAS encourages the development of consumer-directed funding strategies when regional separation of caregiver and care receiver is at issue.

AAAs may establish referral and payment mechanisms between AAAs to enable reimbursement to caregivers for purchased services. AAAs may establish or use mechanisms already in place to directly reimburse caregivers for:

See O.C.G.A. §49-6-70 to §49-6-77 “Georgia Family Caregiver Support” in Appendix 316-A: “References”.

AAAs may set monetary limits on reimbursement for caregiver services, up to but not to exceed that required in the above statute.

Consumer direction of caregiver funds must comply with the policies, guidelines, and standards established in Manual 5300, Section 212 “Consumer Directed Services”.

Purchased services must benefit the caregiver by providing respite from their usual caregiving duties or by lessening the stress or burden of caregiving as measured by the BCOS assessment.

Each AAA is encouraged to offer caregiver services as a fee-for-service enterprise to enhance the sustainability of the Aging Network. In so doing, the AAA must follow all requirements of the Older Americans Act and MAN 5600, Section 2025 “Fee for Service System Overview” and MAN 5600, Section 2028 “Private Pay Services.”

Caregiver services provided to consumers as a fee-for-service should not differ in quality from service provided to consumers funded through public funds.

In establishing its fee for service structure, the AAA should account for the actual cost of the services, including administrative costs, and consider comparable rates within the service market area.

Each AAA that accepts Title III-E funding shall make use of trained volunteers to expand the provision of the available caregiver services and, if possible, work in coordination with organizations that have experience in providing training, placement, and stipends for volunteers or participants in community service settings.

See Older Americans Act of 1965, Sec. 373 in Appendix 316-A: “References”.

Refer to Manual 5600, Section 4020 “Volunteer Management Procedures”.

Volunteer applicants must comply with background check and fingerprint policy established in Manual 5600, Section 3036 “Criminal History Investigation”.

A sample volunteer application and suggested volunteer interview questions are included in MAN 5600, Appendix D: “Forms and Templates”.

Respite care is a service which offers temporary, substitute supports or living arrangements for care recipients to provide a brief period of relief or rest for caregivers.

Tasks or activities which may provide respite to caregivers include, but are not limited to:

Respite services can be provided in the home or outside the home. Respite care may be available to families through formal programs that hire and train their staff or may be available to families through informal networks such as volunteer programs or faith-based initiatives.

Consumer direction of caregiver funds in the form of vouchers allow family caregivers to purchase appropriate in-home or out-of-home respite care and choose providers according to the changing needs and preferences of the care partnership. Refer to Section 316.9 “Consumer Directed Caregiver Services”.

Agencies providing respite must comply with all regulatory requirements associated with the specific tasks performed. Service providers performing respite tasks must comply with the individual service requirements outlined in Manual 5300 “Home and Community Based Services” where applicable. Licensed private home care providers who perform respite tasks must follow rules and regulations of the Georgia Department of Community Health. See Appendix 316-A “References”: Rules of Department of Community Health, Chapter 111-8 Healthcare Facility Regulation, 111-8-65 Rules and Regulations for Private Home Care Providers.

Community and Public Education is instruction provided to caregivers or the general public regarding available support services for caregivers or practical information on the methods and techniques of caregiving.

AAAs can assess the need for education and training services in the constituent communities based on information obtained through the client intake and screening process; public hearings; community surveys; stakeholder recommendations; and other methods.

Caregiver training includes but is not limited to webinars, face-to-face sessions, tutorials, and conferences organized by agencies or educational institutions. Individual training may be provided by practitioners with experience in or demonstrated knowledge of the training topic.

Service Provider Eligibility: AAAs may provide directly or contract for the provision of education and training services with individuals, agencies, or educational institutions that have demonstrated expertise and efficiency in the topic of training identified in the specified curriculum. The purchase of curriculum content developed by qualified individuals/sources as defined in this section is an allowable expenditure of state and federal funds.

Qualified providers include, but are not limited to:

Individual non-licensed practitioners or contract consultants may qualify to provide services if they have the education, training, or experience directly related to the specified needs of a group of individuals with a common interest.

Staffing and Curriculum: AAAs shall assure that staff who provide community and public education are qualified by having appropriate education, training, or experience. AAAs should review the credentials of speakers prior to the training events. Specific educational programs may require the trainer to undergo a certification process.

Staffing requirements for events will be determined by the AAA, in consultation with the training facilitator(s). Staff support for the event, including publicity, host site, registration details, and other logistics, will be provided or negotiated by the AAA and coordinated with the speaker.

AAAs that develop or contract for the development of curriculum content shall assure that persons responsible for such development are qualified by education, training, or experience, or are supervised by such persons.

Data Collection and Reporting: AAAs shall report Community and Public Education activities under the appropriate group heading on the Client Groups Chapter – Activities Page in the DAS Data System.

Support groups are gatherings of people who share a common health concern or interest. Support groups meet on a regular, defined basis to discuss or focus on a specific situation or condition, such as Alzheimer’s Disease or diabetes. They are often formed by nonprofit or advocacy organizations.

Support groups are:

The benefits of participating in support groups may include:

Support groups are not the same as group therapy sessions, which are a formal type of mental health treatment that brings together people with similar conditions under the guidance of a trained mental health provider. Through regularly scheduled meetings, support groups provide emotional support and educate caregivers to take better care of their own health and provide better care for their care partner.

Staffing: AAAs shall assure that staff, including volunteers (see Section 316.11 “Use of Volunteers”), who lead support groups are qualified to do so by having appropriate education, training, or experience.

Support groups should have co-facilitators whenever possible. This allows for a back-up if one of the facilitators is absent and the back-up to be a person the support group members already know. Additionally, if one needs to leave the meeting, the other facilitator can continue the group without interruption.

An ideal combination of co-facilitators is a professional and a family caregiver.

Potential facilitators for support groups should be screened. The screening process must include:

During the interview process, the screener should ask questions to determine the applicant’s knowledge and experience, as well as look for any potential problems that would inhibit the applicant’s ability to be an effective facilitator.

Support group facilitator applicants must comply with background check and fingerprint policy established in Manual 5600, Section 3036 “Criminal History Investigation”.

Speakers at Support Groups: Support group facilitators may invite speakers to attend and present information on community resources. Speakers presenting to support groups should remain conflict-free, agreeing not to promote their organization or themselves for financial gain.

Interaction between speakers and support group members should be limited to group discussion and, to the extent possible, avoid the appearance of conflicts of interest. Support group members may be provided with contact information to speak with the presenter individually, outside the group format.

Data Collection and Reporting: AAAs shall report Support Group activities under the appropriate group heading on the Client Groups Chapter – Activities Page in the DAS Data System.

This section establishes guidelines and requirements for evidence-based programs (EBPs) and evidence-informed programs (EIPs) targeted primarily towards caregivers.

DAS requires AAAs to offer one EBP or EIP targeted towards caregivers in their planning and service area. DAS strongly encourages AAAs to offer at least two caregiver EBP/EIPs in their region. Approved caregiver targeted EBP/EIPs are listed in the DAS Taxonomy of Services (Manual 5600, Appendix F).

Caregiver EBPs and EIPs must adhere to DAS standards regarding lay leader certification, training, and credentials; number of classes offered; and number of caregivers served. Requirements may vary according to the chosen program. DAS may establish these requirements as needed to meet program goals and outcomes, and to increase regional capacity to serve caregivers.

Caregiver EBP/EIP providers must follow the established protocols and components of the program offered and must comply with licensing and fidelity guidelines as outlined by the developers of the intervention.

Data Collection and Reporting: AAAs and/or providers shall report EBP/EIP activities under the appropriate group heading in the Client Groups Chapter – Activities Page in the DAS Data System.

EBP/EIP data should be reported in the DAS Data System in accordance with DAS and specific program requirements and may include:

AAA staff or service provider program coordinators may contact the DAS Caregiver Services Specialist for technical assistance and support regarding caregiver EBP/EIP programs.

AAAs and service providers shall adhere to policies and procedures as established by DAS or the specific program developers. DAS will periodically monitor the performance of the AAAs to determine the degree to which defined program outcomes and objectives have been or are being accomplished.

Program elements to be monitored and evaluated include, but are not limited to, the following:

See Manual 5300, Appendix B, “Review Guide: Caregiver Services (Ch 316)”.

OLDER AMERICANS ACT OF 1965 [Public Law 89–73] [As Amended Through P.L. 116–131, Enacted March 25, 2020]
acl.gov/sites/default/files/about-acl/2020-04/Older%20Americans%20Act%20Of%201965%20as%20amended%20by%20Public%20Law%20116-131%20on%203-25-2020.pdf

Regulations for the Older Americans Act
www.ecfr.gov/current/title-45/subtitle-B/chapter-XIII/subchapter-C/part-1321?toc=1

Administration for Community Living Older Americans Act
acl.gov/about-acl/authorizing-statutes/older-americans-act

O.C.G.A. §49-6-70 to §49-6-77 “Georgia Family Caregiver Support”
law.justia.com/codes/georgia/2022/title-49/chapter-6/article-6/section-49-6-77/

Rules of Department of Community Health, Chapter 111-8 Healthcare Facility Regulation, 111-8-65 Rules and Regulations for Private Home Care Providers
rules.sos.ga.gov/gac111-8-65