The URL can be used to link to this page

Browse Search

Home My WebLink About20030515.tiff RESOLUTION RE: APPROVE FOUR-YEAR PLANNING AND SERVICE AREA AGING PLAN FOR TITLE III AND TITLE VII OLDER AMERICANS ACT AND AUTHORIZE CHAIR TO SIGN WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with a Four-Year Planning and Service Area Aging Plan for Title III and Title VII of the Older Americans Act from the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, Area Agency on Aging, to the Colorado Department of Human Services, commencing October 1, 2003, and ending September 31, 2007, with further terms and conditions being as stated in said plan, and WHEREAS, after review, the Board deems it advisable to approve said plan, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado,that the Four-Year Planning and Service Area Aging Plan for Title III and Title VII of the Older Americans Act from the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, Area Agency on Aging, to the Colorado Department of Human Services be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said plan. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 24th day of February, A.D., 2003. BOARD OF COUNTY COMMISSIONERS WELI5 UNTO', C LORADO/ G ATTEST: //J _ C cry 61 . ; D vid E. Long, Cha' Weld County Clerk to thiso: x"t Rob rt en, Pro-Tem Deputy Clerk to the Boar �r M. J. eile AP OV/AS TO F • i k4,---Ye i - Willia H. Jer lke� ounty A rney / Glenn Vaad Date of signature: 2003-0515 HR0074 Weld County Area Agency on Aging 2B 1551 North 17`"Avenue, P.O. Box 1805 Greeley, CO 80631 (970) 353-3800, Ext 3331 (970)304-6442 (fax) 028-88(FY 2003) STATE OF COLORADO FOUR-YEAR PLANNING & SERVICE AREA AGING PLAN (PSAAP) TITLE III and TITLE VII OLDER AMERICANS ACT Calendar Year 2003-2007 (FEDERAL FISCAL YEAR 10-1-03 TO 9-30-07) COLORADO DEPARTMENT OF HUMAN SERVICES AGING SERVICES UNIT 1575 SHERMAN STREET -- GROUND FLOOR DENVER, COLORADO 80203 303.866.2800 Table of Contents Statement of Intent 1 Advisory Council Review Checklist 2 State Plan Assurances 3 Section II: Executive Summary 7 Section III: Description of the Planning and Service Area 9 Population Profile 9 Geographic Profile 9 Regional Trends 10 Section IV: Identification of Unmet Needs of the Elderly 12 The 1998 Comprehensive Needs Assessment 12 The 2002 Needs Assessment of Caregivers in Weld County 21 Section V: Public Input 28 Section VI: AAA/State Joint Planning Initiative 30 Section VII: Community Initiatives 31 Section VIII: Targeting 34 Section IX: Overview of Services: 2003-2007 36 Information and Assistance 36 Outreach Services 36 Transportation Services 37 In-Home Services 37 Legal Assistance Services 38 Ombudsman Services 38 Disease Prevention and Health Promotion Services 39 Nutrition Services 39 Advocacy, Coordination, and Program Development 39 Other Optional Support Services 40 National Family Caregiver Support Program 40 Title VII Vulnerable Elder Rights Activities Program 40 i Section X: Waivers 42 Direct Service Provision Waivers 42 Waivers of Title III Priority Services 42 Access 42 In-Home Services 43 Section XI : Attachments 44 Attachment A: Organizational Chart 45 Attachment B: Area Agency on Aging Staffing Profile 46 Attachment C: Request for use of Part B Funds 47 Attachment D: Direct Service Waiver Request 48 Attachment E: Waiver of Title III Priority Services Request 49 Attachment F: Senior Center Facilities/Acquisition 51 Attachment G: Purchase of Equipment Request 52 Attachment H: Regional Advisory Council Membership 53 Attachment I: Community Focal Point and Centers 55 Attachment J: Title III Meal Services Chart 57 Attachment K: Four-Year Fiscal Service and Project Income Plan 58 Attachment L: Cost Distribution Method 61 Attachment M: Caregiver Needs Survey 74 ii STATEMENT OF INTENT The Four-Year Planning & Service Area Aging Plan (PSAAP) Is hereby submitted for Weld County Area Agency on Aging 2B For the period October 1, 2003 through September 31, 2007 It includes all assurances and plans under provisions of the Older American's Act, as amended, during the period identified. The Area Agency on Aging identified will assume full responsibility to develop and administer the one-year annual plan in accordance with the requirements of the Act and related State Policy. In accepting this authority, the Area Agency on Aging assumes responsibility to promote the development ofa comprehensive and coordinated system of community services and to serve as the advocate and focal point for older persons in the planning and service area. The four-year area plan has been developed in accordance with the rules and regulations specified under the Older American's Act and Staff Manual Volume 10, and is hereby submitted to the Colorado Department of Human Services, Division of Aging and Adult Services for review and approval. SIGNATURE: SIGNATURE: 2-'47/-03 %gill4 Air-WA v293 ;013 AAA DIRECT DATE CHAIRPE ON, DATE AREA AGENCY ON AGING ADVISORY COUNCIL SIGN SIGNATURE: y(03 J S 2 2 4-6) EX TI E DIRECTOR OF DATE CHA ERSON, OF DATE G TEE GOVERNING BOARD OF GRANTEE AGENCY -1- -:1Oc 3-05iS ADVISORY COUNCIL REVIEW CHECKLIST Weld County Area Agency on Aging 2B The Area Agency on Aging Advisory Council has had the opportunity to review and comment on the following items in the annual plan. (Comments are attached). 1. Statement of intent and justification for transfers budgeted between Parts B, C-1, and C-2, which exceed the allowable percentage of transfers. 2. Statement of intent and justification for use of Part B funds for Advocacy, Coordination, and/or Program Development, which exceed the allowable percentage of transfers. 3. Request for waiver for the Area Agency on Aging to provide direct services. 4. Request for waiver to required support services percentages,which vary from the allowable percentages. (Access Services, 25%, In-Home Services, 15% and Legal Services, 3%). 5. Use of Federal and State funds to increase Program Services to the elderly. -2- STATE PLAN ASSURANCES OLDER AMERICANS ACT,-AS AMENDED IN 2000 Weld County Area Agency on Aging 2B Sec. 306, AREA PLANS (1) Each area agency on aging shall provide assurances that an adequate proportion,as required under section 307(a)(2), of the amount allotted for part B to the planning and service area will be expended for the delivery of each of the following categories of services- (A) services associated with access to services(transportation,outreach,information and assistance, and case management services); (B) in-home services,including supportive services for families of older individuals who are victims of Alzheimer's disease and related disorders with neurological and organic brain dysfunction; and (C) legal assistance; and assurances that the area agency on aging will report annually to the State agency in detail the amount of funds expended for each such category during the fiscal year most recently concluded. ((a)(2)) (2) Each area agency on aging shall provide assurances that the area agency on aging will set specific objectives for providing services to older individuals with greatest economic need and older individuals with greatest social need, include specific objectives for providing services to low-income minority individuals and older individuals residing in rural areas,and include proposed methods of carrying out the preference in the area plan. ((a)(4)(A)(i)) (3) Each area agency on aging shall provide assurances that the area agency on aging will include in each agreement made with a provider of any service under this title,a requirement that such provider will-- (A) specify how the provider intends to satisfy the service needs of low-income minority individuals and older individuals residing in rural areas in the area served by the provider; (B) to the maximum extent feasible,provide services to low-income minority individuals and older individuals residing in rural areas in accordance with their need for such services; and (C) meet specific objectives established by the area agency on aging, for providing services to low-income minority individuals and older individuals residing in rural areas within the planning and service area. ((a)(4)(ii)) -3- (4) With respect to the fiscal year preceding the fiscal year for which such plan is prepared,each area agency on aging shall-- (A) identify the number of low-income minority older individuals and older individuals residing in rural areas in the planning and service area; (B) describe the methods used to satisfy the service needs of such minority older individuals; and (C) provide information on the extent to which the area agency on aging met the objectives described in clause(a)(4)(A)(i). ((a)(4)(A)(iii)) (5) Each area agency on aging shall provide assurances that the area agency on aging will use outreach efforts that will identify individuals eligible for assistance under this Act, with special emphasis on-- (A) older individuals residing in rural areas; (B) older individuals with greatest economic need (with particular attention to low-income minority individuals and older individuals residing in rural areas); (C) older individuals with greatest social need (with particular attention to low-income minority individuals and older individuals residing in rural areas); (D) older individuals with severe disabilities; (E) older individuals with limited English-speaking ability; and (F) older individuals with Alzheimer's disease or related disorders with neurological and organic brain dysfunction (and the caretakers of such individuals); and inform the older individuals referred to in (A) through (F), and the caretakers of such individuals, of the availability of such assistance. ((a)(4)(B)) (6) Each area agency on agency shall provide assurance that the area agency on aging will ensure that each activity undertaken by the agency, including planning, advocacy, and systems development,will include a focus on the needs of low-income minority older individuals and older individuals residing in rural areas. ((a)(4)(C)) (7) Each area agency on aging shall provide assurances that the area agency on aging will coordinate planning,identification,assessment of needs,and provision of services for older individuals with disabilities,with particular attention to individuals with severe disabilities, with agencies that develop or provide services for individuals with disabilities. ((a)(5)) (8) Each area agency on aging shall provide assurances that the area agency on aging,in carrying out the State Long-Term Care Ombudsman program under section 307(a)(9),will expend not less than the total amount of funds appropriated under this Act and expended by the agency in fiscal year 2000 in carrying out such a program under this title. ((a)(9)) -4- 9) Each area agency on aging shall provide information and assurances concerning services to older individuals who are Native Americans (referred to in this paragraph as "older Native Americans"), including- (A) information concerning whether there is a significant population of older Native Americans in the planning and service area and if so, an assurance that the area agency on aging will pursue activities,including outreach,to increase access of those older Native Americans to programs and benefits provided under this title; (B) an assurance that the area agency on aging will,to the maximum extent practicable, coordinate the services the agency provides under this title with services provided under title VI; and (C) an assurance that the area agency on aging will make services under the area plan available,to the same extent as such services are available to older individuals within the planning and service area,to older Native Americans. ((a)(11)) (10) Each area agency on aging shall provide assurances that the area agency on aging will maintain the integrity and public purpose of services provided,and service providers,under this title in all contractual and commercial relationships. ((a)(13)(A)) (11) Each area agency on aging shall provide assurances that the area agency on aging will disclose to the Assistant Secretary and the State agency-- (A) the identity of each nongovernmental entity with which such agency has a contract or commercial relationship relating to providing any service to older individuals;and (B) the nature of such contract or such relationship. ((a)(13)(B)) (12) Each area agency on aging shall provide assurances that the area agency will demonstrate that a loss or diminution in the quantity or quality of the services provided,or to be provided, under this title by such agency has not resulted and will not result from such non-governmental contracts or such commercial relationships. ((a)(13)(C)) (13) Each area agency on aging shall provide assurances that the area agency will demonstrate that the quantity or quality of the services to be provided under this title by such agency will be enhanced as a result of such non-governmental contracts or commercial relationships. ((a)(13)(D)) (14) Each area agency on aging shall provide assurances that the area agency will, on the request of the Assistant Secretary or the State, for the purpose of monitoring compliance with this Act (including conducting an audit), disclose all sources and expenditures of funds such agency receives or expends to provide services to older individuals. ((a)(13)(E)) -5- (15) Each area agency on aging shall provide assurances that funds received under this title will not be used to pay any part of a cost (including an administrative cost)incurred by the area agency on aging to carry out a contract or commercial relationship that is not carried out to implement this title. ((a)(14)) (16) Each area agency on aging shall provide assurances that preference in receiving services under this title will not be given by the area agency on aging to particular older individuals as a result of a contract or commercial relationship that is not carried out to implement this title. ((a)(15)) SIGNATURE: SIGNATURE: AAA DIR 7 — — DATE CHAIRPE7EdSON, i/ DATE AREA AG NCYONAGING ADVISORY COUNCIL -6- Section II: Executive Summary Weld County is a large,mainly rural county situated in northeastern Colorado. The 2001 population estimates from the U.S. Census Bureau indicates the county's population is 194,949. Despite the county's rural nature, it is classified by the Census Bureau as a Standard Metropolitan Statistical area. There are thirty-one (31) incorporated towns and several unincorporated villages scattered throughout the county. Many of these communities, especially those located on the I-25 corridor, have experienced population growth during the past several years. The initiatives described in this Four Year Plan (2002-3-2007) result from information gained through two surveys carried out by gerontology researchers at the University of Northern Colorado: (1)The 1998 Needs Assessment of Weld County Older Adults,conducted by Dr.Robbyn R. Wacker and Dr.Carol A.Gosselink,and(2)The 2002 Weld County Caregiver Needs Survey,also completed by Dr. Robbyn Wacker. The goal of the 1998 needs survey was to collect sufficient data through telephone and mail surveys to assess the needs of Weld County residents age 60 and older. From interviews with 360 Weld County older adults we learned that nearly 44% of them are living on incomes of$15,000 or less. We believe this information debunks the popular myth that most elders are living comfortably at the expense of the needs of younger generations. We also learned that a significant number of elders(22%)reported being lonely. This tells us that even with a wide range of programs and services for elders,there is still a need for communities to do a better job reaching out to lonely, isolated elders. Lack of access to affordable dental care also was reported as a high need. This study also emphasized the fact that Hispanic elders report higher needs in nearly every category. In the 1998 survey, caregivers were identified as a group of individuals who where in need of specialized services such as respite care. We felt this was just the tip of the iceberg and more information was needed.The 2002 Caregiver Survey was completed in an effort to understand more clearly the caregivers and the type of services and assistance truly needed by this diverse population.. The University of Northern Colorado contacted over 8,831 households in an effort to identify individuals who were currently caring for or had been caring for an individual 60 years old or older in the last six months.Once identified,caregivers who agreed to participate in the study were mailed a survey, a postage paid returned envelop, a HelpSource Referral Guide, information about an existing Respite Program and a pill reminder box with the Area Agency on Aging's logo and phone number.A total of 224 useable surveys were returned and used to determine the survey findings.The survey determined that caregivers provide a wide range of services from providing transportation to the grocery store to providing personal care and supervision 24 hours a day. Over half of the caregivers area employed outside of the home and one-fifth have more than one person under the age of 18 living in the household. Many of the caregivers expressed stress over their concerns relating to the care recipient's overall health needs. These types of concerns and stresses were reflected in the survey's recommendations. Caregivers expressed a need for information relating to caregiver services and programs and medical information. Most importantly, the caregivers asked to have a single place to call to obtain this type of information. -7- In 2002 and 2003,the Weld County Area Agency on Aging used an extensive analysis process with board members, staff, and public hearings in an effort to identify seven community initiatives. The initiatives were to: • Alter our methods of impacting needs by concentrating on advocacy and resource development through educational and coordination efforts • Reduce the incidence of loneliness among seniors • Increase transportation options for elders • Increase resources for dental care for low-income elders • Improve access to information and assistance to caregivers providing care to older adults • Improve seniors awareness of medication issues and • Improve seniors access to basic medical services. Other statewide issues that will be addressed by the Area Agency on Aging during the next year is performance-based outcomes. Finally,the Area Agency on Aging will publicize the findings from the 2002 Caregivers Needs Survey of Older Adults in meetings and forums throughout Weld County. We intend to educate policy makers and the public about the needs of Weld's older adults and help communities to mobilize locally to address concerns identified from this first time comprehensive needs survey. -8- Section III: Description of the Planning and Service Area Population Profile The total population of Weld County,according to the 2001 population estimates from the Colorado Department of Local Affairs Demography Section is 194,318.Below is an overview of the key areas of interest regarding the population distribution of older adults in Weld County. Overall the population of Weld County has increased over the last several years with special attention to the number of 75+ and minority elderly. 2001 July Population Estimates Colorado Department of Local Affairs Demography Section 60+ 75+ 60+Poverty 60+ 60+ Total Minority Rural Population of (Primarily Weld County Hispanic) 23,446 7,840 2,110 3,319 7,017 194,318 12% of the 33% of the 9% of the 14% of the 30% of the total senior senior senior senior population population population population population Weld County consists of 31 incorporated municipalities. Five (5) municipalities have annexed portions of Weld County over the last 10 years, such as the City of Longmont and services are primarily provided by their principal counties. Weld County also has several unincorporated small communities such a Carr. Weld's communities vary in size from 108 for the town of New Raymer to 9,514 for the town of Evans; Greeley's estimated population is 76,930, according to the 2000 U.S. Census Bureau. Geographic Profile Weld County is located on the eastern plains of Colorado, north and east of Denver and is 3999 square miles in size. Greeley, the county seat and major city, is located in the east central portion of the county, approximately 60 miles northeast of Denver and 50 miles south of Cheyenne, Wyoming. Greeley, whose population is over 76,930 serves as a regional hub for medical, educational, employment and retail needs for most of its residents. However, residents of south Weld County tend to conduct business in Brighton, Longmont, Boulder, and the Denver suburbs. The twenty five(25)small towns(not including Greeley)and villages(unincorporated areas)ranging in population from 108 to 11,670 are situated primarily in the west and central and southern portions -9- of the county. There are no major geographical barriers between these communities other than distance. Often services are difficult to deliver to these communities because of the cost of transportation or the cost of stationing human services workers closer to the site of service delivery. The most isolated communities are located in the far northeastern sectors of the county. Here residents often transact business in towns across the border in Wyoming and Nebraska. Also,winter storms bring ground blizzards which are hazardous for residents living in small towns and ranches in northeast Weld County. It is in this section of Weld County that the highest percent of older persons reside compared to the total population of this area. Regional Trends • The most significant regional trend impacting Weld County is growth. Most small rural Weld communities whose population has remained fairly stable for many, many years are growing—some quite significantly such as the community of Windsor and Mead Plans are still being made for major housing developments in the coming years for several o f Weld's rural towns. The 1998 Needs Assessment of Weld County Older Adults indicated that 28.6% of respondents cited growth as the most pressing problem facing Weld County. Respondents'feelings centered around concerns that unbridled growth forces living expenses to rise and forces fixed-income persons into poverty. Many others were concerned about the loss of farm land to housing and industrial expansion. Five years after the 1998 needs assessment was completed we continue to see growth in Weld County and seniors continue to express concerns that the growth is impacting the community in many ways. Water issues and loss of farm land are two of the ongoing concerns. • The population growth has stimulated demand for housing. Status of the housing market in the Greeley/Weld market also is changing significantly. Housing costs have been increasing as well. The median home price in Greeley/Weld climbed from $145,000 in 2000 to $165,000 in 2002. The average rent per month increased from $511.00 in 1996 to $688.00 in 1999. These trends have specific implications for aged individuals and couples living independently as renters and receive SSI • Job growth and the economy in Weld County has been positive. The current unemployment rate is 5.6 and increase since November 2001 rate of 4.7.However,according to the Greeley Tribune (January 8, 2003), during 2002 the number of people employed in the county has increased from 86,935 to 89,711 while the overall labor force for the same time frame went from 91,220 to 95,048. • Assisted Living Facilities during the last five years Weld County saw a significant growth. However, currently this growth spurt appears to have run its course and no new facilities appear to be on the horizon.The major problems concerning Assisted Living Facilities relate to the fact that only a very limited number of Assisted Living Facilities will accept Medicaid payment and many of these facilities only offer a limited number of beds for Medicaid -10- clients. This shortage creates a dilemma for seniors who are in need of this resource and do not want to relocate to a nursing home. • Availability of resources specific to senior and caregiver needs continues to grow, particularly services generated in the private sector. The increasing problem is funding support particularly for those just about poverty level. Supporting this phenomena is data from the 1998 Weld County Needs Assessment which shows that 44% of those responding to a question on income indicated that Weld County 60 plus seniors have incomes of$15,000 per year or less. • -11- Section IV: Identification of Unmet Needs of the Elderly Two major surveys were completed in Weld County. The first survey was an community based comprehensive needs assessment that was conducted in 1998 by the University of Northern Colorado,Department Health and Human Sciences. Given the comprehensive nature of this survey and the limited amount of time that has past since this survey was completed the finding will be used in this four year planning process. The second survey, also by the University of Northern Colorado,conducted in the summer of 2002 was followup to the 1998 survey. This survey focused on the need to increase our understanding of the needs and concerns of caregivers who are caring for persons 60 and older. The information obtained from the survey will help guide the Area Agency on Aging and other community entities provide appropriate services and information to this population. Below is an overview of each of the surveys and recommendations that will help guide the Area Aging on Aging over the next four years. The 1998 Comprehensive Needs Assessment The comprehensive needs assessment survey that was conducted for Weld County older adults, age 60 years of age and older in 1998 . The Area Agency on Aging contracted with the University of Northern Colorado Department of Health and Human Sciences to develop and administer the survey. The needs survey used three types of data collection: telephone survey, mail survey, and focus groups. A total of 360 older adults, age 60 and over were contacted through these methodologies. Methods were used to ensure the over sampling of rural and minority respondents. The survey was intended to identify the needs and elicit the opinions of elders living independently or quasi—independently. The questionnaire included topics related to employment, volunteerism, caregiving,transportation,housing,health and health care, financial concerns, attitudes toward life, and knowledge and use of services. The Area Agency on Aging also conducted an analysis of socioeconomic data, solicited input from staff, providers, advisory council members, rural senior coordinators, and the community at large. Socio-Demographic Characteristics of Respondents Of the 360 respondents completing the survey, 66.4%were females and 33.1%were males. Six in 10 (59.7%) respondents were 60-74 years of age, 33.6% were in the age group of 75 or older, and 24-four respondents (6.7%) did not provide their age. The mean age of respondents was 71.7. The vast majority of respondents (84.7%) were white; people of color represented 16.5% of the respondents. Six in ten were married (58.9%). Widowed respondents represented the next largest group (29.4%), followed by divorced/separated (8.9%), and never married (2.2%). The largest -12- percentage (35.6%) of respondents reported their highest level of education as being high school graduates (or GED recipients). The rest reported their educational attainment (in descending frequency) as having some college (24.4%); 6th through 11th grade (21.4%); a graduate degree (8.6%); a bachelor's degree (6.9%); or less than 6th grade (2.2%). One-half(53.3%) of respondents lived in a two-person household, one-third (33.9%) lived alone, and 11.8% lived in households with three or more persons. The average length of Weld County residency was 38.7 years, with a range of less than 12 months to 93 years. One-hundred-seventy respondents (47.2%) resided in urban locations and 188 respondents (52.2%), in rural locations. Thirty-eight respondents(10.6%)reported 1997 annual incomes of less than$8000; 11.4%, $8000- $10,499; 18.1%,$10,500-$14,999;41.7%,$15,000-$49,999,and 9.7%,$50,000 or more. Thirty-one respondents (8.6%) refused to divulge their annual household incomes. Fifty-eight of the 360 respondents, or 16.1%, reported an income below the poverty level, which in 1997 was $7,890 annually for one individual and $10,610 for a couple. Current Employment Nearly one in five (18.9%) of the respondents reported being employed. Males are twice as likely as females to be employed(28.6%vs. 14.2%,respectively). Among those 60-65 years of age,38.6% are employed compared with 3.6% of respondents age 81 and older. Respondents who worked outside the home for pay averaged 33 hours per week, with a range of two to 65 hours per week. Three-fourths of the employed respondents were satisfied with the hours they worked. When asked to identify the reasons they continued to work, the largest percent (64.7%) of the 68 employed respondents stated that they needed the income. All respondents who were not currently employed were asked"Have you been looking for work?" Only five respondents stated that they were seeking employment. The five respondents had been looking for employment an average of 18.4 weeks,with a range from two to 36 weeks. Volunteerism More than four in ten respondents volunteer in their community. Females are more likely that males to volunteer(45.2%vs.37.0%,respectively). Volunteering remains relatively high for those age 60- 75. At age 81 and older, about three in ten respondents volunteer. White elders are almost twice as likely as are elders of color to volunteer(45.2%vs.25.5%). Respondents living below poverty level are significantly less likely than the rest of the respondents to volunteer: only about one in four (24.1%) volunteers. Volunteers averaged 17 hours a month. Primary Caregivers When asked,"Are you the main helper for someone who needs assistance with everyday activities, such as bathing,feeding,or helping someone to walk?"30 respondents said yes. The largest percent of caregivers were providing assistance to a spouse/partner (60.0%). The rest were caring for a parent(16.7%),child(23.3%),other relative(6.7%),or a friend/neighbor(16.7%). About one-fourth -13- of the caregivers were providing care to more than one individual. The average number of hours spent each day as a primary caregiver was 10.4 hours. Eight of the caregivers stated that assistance with meal preparation would be helpful. Four caregivers noted that two hour respite was desirable. Help with bathing and weekend respite were each cited by three caregivers,and vacation respite was requested by two caregiving seniors. Transportation Forty-five individuals(12.5%)stated that they don't drive. When asked if they currently experienced times when they needed to go somewhere but had to stay home because they had no means of transportation, 16(4.4%)of the respondents replied yes. While only 3.4%of those age 60-65 have had to stay home on occasion due to lack of transportation, three times that many seniors age 81+ have experienced this unmet transportation need. Elders of color are nearly twice as likely as white elders to have unmet transportation needs(7.3%for elders of color as compared with 3.9% for white seniors). Being below poverty level makes respondents nearly four times more likely than respondents above poverty level to encounter situations in which they cannot obtain the transportation they need(12.1%vs. 3.3%). Housing The majority of respondents (75.6%) currently lives in a free-standing home. The rest of the respondents live in apartments(9.7%),mobile homes(8.6%),townhouses/condos/duplexes(5.0%), rooms in private homes (0.3%), or some other type of housing (0.6%). Nearly all the participants own the dwelling in which they live (84.2%), 13.9%rent, and 1.4% live with others. Sixty-eight percent of the 303 current homeowners said maintaining the upkeep of their home was not very difficult at all; 26.4% stated that it was somewhat difficult, and 5.6% said it was very difficult. Tit most common repair needed was outside work, which was noted by 28.4% of the homeowners. When asked why they could not get the outside repairs completed, 29 respondents stated that the repairs were not a priority right now. About one-fourth of the 86 respondents needing home repairs reported that they just hadn't had time to get the repairs done. Cost was cited as an obstacle by 19 respondents, 12 stated that the people who were going to do the repairs hadn't finished the job yet, and two respondents stated that they didn't know whom to call for the repairs. The second most common repair needed, cited by 76 homeowners, was inside work. Plumbing repairs were needed by 14.2% of the 303 homeowners,heating repairs by 10.2%, electrical repairs by 9.9%, and other housing accommodations (e.g., bath rails, etc.) were needed by 5.6% homeowners. All respondents were asked whether they were experiencing a variety of housing problems. Having difficulty paying rent or mortgage most months was reported by 1.4% of the respondents. Living in a place where the space was not right, either too large or too small,was mentioned by 14.2%of the respondents. Sixteen respondents (4.4%) said they were having trouble moving around their -14- home because of some physical condition(s). Worrying about crime in their neighborhood was an issue for 7.2%. Nine respondents(2.5%)stated that they were having trouble getting along with their neighbors. Snow removal was a problem for 6.7% of the respondents and getting yard work done was a concern for 10.6% of the respondents Only 10.6%of the respondents anticipated moving in the next year. They said they might move into another house, four stated they would consider moving into an assisted living residence, 14 thought they could move into an apartment,five,into a condo,seven into senior apartments,and 10 into low- income apartments. Moving in with family and moving into a nursing home were each mentioned once by a respondent. Ten of the 38 respondents who expected to move would relocate due to health reasons, five said their current housing situation was too expensive, four noted that they needed an easier place to get around in, seven said their current home is too large and two said their current house was too small. Knowledge and Use of Services Respondents were read a list of 16 services that are available to seniors in Weld County. They were first asked whether they had ever heard of the service. If they had heard of the service, they were asked whether they had ever used the service. The service with which the greatest numbers of respondents were familiar was senior centers. Most respondents had heard of the senior center (91.1%); 31.4%had used the service, and 20.2%had gone to a senior center in the past six months. The second most recognized service was Meals on Wheels, which was identified by 85.3% of respondents. However, actual service use was low,with only 3.9% of the respondents ever having used the program,and only 0.6%having used Meals on Wheels in the last six months. The programs with the smallest amount of name recognition were the Brown Bag Program (recognized by 23.1% of respondents), the ombudsman program (known by 27.2%), and the senior companion program (recognized by 29.2%). For both the senior companion and ombudsman program,respondents had never used either program. Other Unmet Needs Next,respondents were queried,"In the last six months,have you experienced any of the following situations?" Thirteen percent had been discharged from the hospital.23.3%had an illness that lasted more than two weeks, 3.3%had experienced a problem with their Social Security or other type of income benefit,5.8%had encountered a problem with Medicare or other health insurance, 8.6%felt as if they needed to talk to someone about a personal matter but had no one to turn to, 3.6% had trouble making a payment on a bill, 6.4% had been"ripped off'by a business or person, and 6.9% had experienced difficulty making meals or shopping. Attitudes about Service Use In an attempt to discover what some of the attitudinal barriers to service use might be,respondents were read a set of 10 attitudinal statements. After each statement, they were asked to indicate -15- whether they strongly agreed, agreed, disagreed, or strongly disagreed with the statement. It appeared that respondents were somewhat divided in their views on the appropriateness of service use. The statement with which there was highest agreement was, "If I can't find a way to solve the problem on my own, I would consider seeking help from a program or service." About nine in ten respondents concurred with this statement. The statement over which respondents were most divided was,"I would be reluctant to use a community program or service because I have been self- sufficient all my life." In response to this statement, 51.1% agreed while 42.0% disagreed. Social Contact The average number of children was 3.05,with a range of none to 11 children. The largest percent of respondents with children(44.8%)had contact with one or more of their children one to six times a week. The rest had contact once a day(37.3%), 1-3 times a month(12.7%),once a month(2.4%), 1-11 times a year (1.8%), or once a year or less (.3%). Only two respondents with living children claimed to never have contact with any of their offspring. The average number of living siblings reported by respondents was 2.7, with a range from zero to 14. The largest percent of respondents with siblings (27.8%) had contact with them one to three times a month. The rest had contact once a day(7.2%), one to six times a week (22.5%), once a month(16.3%), 1-11 times a year(16.7%),or once a year or less(5.2%). Thirteen respondents with living siblings (4.2%) claimed to never have contact with any of their brothers or sisters. The average number of grandchildren(including great grandchildren)was 6.3,with a range of none to 77 grandchildren/ great grandchildren. The largest percent of respondents with grandchildren (33.9%) had contact with them one to six times a week. The rest had contact once a day(14.2%), 1-3 times a month(24.8%), once a month (14.8%), 1-11 times a year(8.4%), or once a year or less (2.6%). Only four grandparents claimed to never have contact with any of their grandchildren. Respondents with grandchildren were queried, "Have you ever been denied visitation with your grandchildren by their parent(s)?" Of the 306 respondents with grandchildren,only nine(2.9%)said that visitation had been denied. About four in ten respondents (42.5%) had talked to a friend two to six times in the past week. About one-fourth (26.1%)had talked with friends by phone once a day or more, 15.0%had talked with friends once in the past week,but 16.4%of the respondents had not talked with any friends by phone in the past week. Forty percent of the respondents had spent time with a friend two to six times in the past week. Fifty respondents (14.0%)had spent time with friends once a day or more, and 23.3% had spent time with friends once in the past week. Seventy-nine (21.9%) of the respondents had not spent time with any friends in the past week. Health Needs When asked to rate their current health, 17.5% of respondents said their health is excellent, 47.5% -16- said their health is good, 26.1% stated that their health is fair, and 8.6% rated their health as poor. Elders of color were twice as likely as whites to be in poor health. About one in seven elders of color indicated that their health was poor. In comparison, only about one in 13 whites were in poor health. Individuals living in poverty were twice as likely as respondents living above poverty to classify their health as poor (15.5% vs. 7.2%). Of seven health conditions presented to respondents, the most common complaint was arthritis, affecting 60.8%of the respondents. The arthritis interfered with the activities of those with arthritis a great deal(17.8%),50.2%of arthritis sufferers said it interfered a little,but 60(27.4%)respondents said the arthritis didn't interfere with their activities at all. Attitudes Towards Life In response to the statement, "I feel I am useful and needed," 35.6% of the respondents strongly agreed, 54.7% agreed, 5.3% disagreed, and only.8% strongly agreed. In response to the statement, "I feel hopeful about the future," 26.4% of the respondents strongly agreed, 55.0% agreed, 10.3% disagreed, and only 1.7% strongly agreed. Only 13 respondents (3.6%) strongly agreed with the statement,"I often feel lonely." Sixty-five respondents(18.1%)agreed,52.8%disagreed,and 15.6% strongly disagreed. The statement, "I worry about becoming a burden to my family or friends," evoked a strongly agree response from 9.7%of the respondents,31.7%agreed,42.5%disagreed,and 8.6% strongly disagreed. The final statement was, "Older people are valued in my community," 19.4% strongly agreed, 60.3% agreed, 9.4% disagreed, and 1.4% strongly disagreed. Health Care The most common activity for which respondents needed assistance was housework,affecting 16.2% of the respondents. Of these respondents,only five stated that they sometimes had difficulty finding someone to help them. The second most frequent activity for which help was needed was shopping for groceries or other necessities. This affected 11.7%of the respondents. Of these, six stated that they sometimes experienced difficulty in locating assistance. When asked, "Do you have a family doctor that you see on a regular basis when you need health care?"nearly all respondents answered yes(89.4%). The 36 respondents(10.0%)who said no were queried about why they don't have a family doctor. Five of the 35 respondents (18.9%) said they couldn't afford a physician. Four respondents said they couldn't find a doctor that met their needs. One respondent said that finding a physician who would accept Medicaid was a deterrent. The 322 respondents with a regular family doctor were asked to evaluate their satisfaction with the health care they were receiving. Most respondents were either very satisfied (66.8%) or satisfied (26.4%),while 4.3%were somewhat or very(0.3%)dissatisfied. Among those who were somewhat or very dissatisfied, reasons for their dissatisfaction included that the doctor didn't spend enough time with them (nine respondents mentioned this) or that the doctor didn't seem to be able to help -17- them (mentioned by four respondents). Use of Medications When asked whether they ever use any medications, either prescription or over-the-counter drugs, 46 said no. The remaining 314 respondents were asked about their customary behaviors with respect to seven different situations dealing with medication. The behavior of most concern is that only 43.1%check whether there will be drug interactions,despite the fact that 26.1%have prescriptions from more than one doctor. Use of Other Health Services The most common health service for which 7.2%of the respondents had difficultyprocuring service was dental care. The most common barrier to dental care, mentioned by 66.7% of the respondents having difficulty, was cost. Not knowing whom to see for dental care was the primary barrier for 20.0%of the respondents having difficulty procuring dental care. Transportation was the third most common reason, cited by 13.3% of the respondents having difficulty obtaining dental care. The second most common health service that respondents had difficulty obtaining was eye care,affecting 4.7% of the respondents. The most common reason noted by the respondents who had difficulty obtaining eye care was cost,mentioned by 70.6%, followed by transportation,cited by 17.6%of the respondents. Major Financial Concerns Respondents were asked, "Do you have any major financial concerns?" Ninety-five respondents (26.4%) answered yes and 255 (70.8%) answered no. The greatest single financial concerns were retirement (4.7%) and doctor/health care (4.2%). Needs of Weld County Respondents were read the following paragraph: "As you probably know,Weld County is currently in the process of growing and changing. What do you see as the most pressing problem facing Weld County?" The problem mentioned most was growth, cited by 28.6% of respondents. The second most common problem cited was that of transportation,traffic,and road maintenance(11.4%). The third highest response category,into which 10.0%of the respondents fell,was that Weld County is a great place to live and that no pressing problems are interfering with the quality of life of residents. The fourth highest category, mentioned by 9.7%, was concern about crime, teen drugs, gangs, juvenile delinquency, and the judicial/legal system. Focus Groups Although results from focus groups are not statistically representative, the following trends were noted during the participation of Hispanic seniors at a focus group in Greeley and another focus -18- group in Fort Lupton. • Approximately half of the Hispanic seniors experience transportation difficulties. Many cannot drive or do not have a car and so rely almost totally on their adult children. • Housing was not a major issue for participating seniors except for one individual who could not afford the high rent and utility payments. • Getting appropriate eye care appears to be problematic for several Hispanic elders due to cost and eligibility barriers. • Loneliness affects some of the Hispanic seniors,especially those who have lost a loved one. • Many participants claim not to have been affected by racism and discrimination, although two individuals have had extremely difficult interactions with Anglos. Several individuals noted that the racism of Hispanic human service agency workers against other Hispanics is more of a problem. • Most participants did not have difficulties with legal issues. • Many participants feel that problems exist in the elder community of Hispanics and that such services as counseling, legal assistance, or relocation assistance are needed. Integration of Needs Assessment Data The results of this assessment reflect the diversity of older adults who reside in Weld County. As is typical of the older adult population,the majority are relatively active,healthy,and are functioning independently. However, within the this group living in Weld County, there are pockets of individuals who do not have access to transportation,live with housing difficulties,have little social contact,have low levels ofpsychological well-being,struggle with daily activities and gaining access to health care services,and are unaware of the services and programs that exist to assist in improving their quality of life. Key Findings and Recommendations • Volunteering provides a way for respondents to feel useful, enjoy social contact and gain personal satisfaction. Of those who said they were not volunteering, 38% said they might volunteer if asked. Recruiting elders to volunteer within their communities can be psychologically beneficial to the volunteer and provide an important service to the community. Increase volunteer outreach efforts. • Elderly spouses between the ages of 71 and 75 are more likely to be caregivers than any other group. These caregivers are themselves elderly and at-risk of reduced physical and -19- psychological well-being and might also be less likely to use adult day and respite services. Target adult day and respite services to elderly spousal caregivers and increase respite hours. • Mother group of at-risk elders identified by this assessment are those who report they do not drive (13%). These individuals are dependent on others for access to the outside world. Although 4.4% of these elders indicated that they were unable to go somewhere due to a lack of transportation, all of these respondents must negotiate with others to obtain rides. Those at greater risk of having to stay home because of a lack transportation were elderly women, those over age 85 years, elders of color, those living in poverty and elders living in rural areas. Lack of transportation was a major concern voiced during the focus groups. Increase access to transportation to at-risk elders. • The majority of respondents live in single family dwellings. For elderly homeowners, repairs to the inside and outside of the home are in most need. Those at greatest risk of having housing problems are those living below poverty and those over 70 years of age. Of those who anticipate moving,the housing type of choice is an apartment or low-income apartments. Housing needs include providing assistance with home repairs and increasing apartment living housing options. • Awareness of services is the critical first step in accessing the services when a problem or need arises. Awareness of programs ranged from 23% for the Brown Bag program to 1% for the senior center. Awareness levels increased when respondents had more contact with friends. Efforts should be made to increase awareness and understanding of the programs available in the County. Peers appear to be important in disseminating information about programs. Outreach efforts should he mindful of the attitudinal harriers to service use. • There is frequent social contact with children, siblings, and grandchildren among the respondents. Approximately 30% of respondents indicated they would like more contact with siblings and grandchildren. Increased social contact is related to improved psychological well-being. Intergenerational programs can be an indirect way to increase contact with "substitute grandchildren". • Thirty-five percent of respondents indicated that their health was either fair or poor, with elders over 75, elders of color, and those living in poverty reporting lower levels of health status. Health interferes most often with housework, shopping for groceries and meal preparation, and taking a bath or shower. Hispanic elders, elders 75 and older, and those living below poverty have the most difficulty completing instrumental activities of daily living. Target in-home assistance to at-risk groups. • Although most of the respondents reported good psychological well-being, 22% indicated that they were lonely. Those at greatest risk of poor psychological well-being are the oldest old (over 85 years of age), those with less frequent contact with friends and family, and elders living in poverty. Devise a strategy for depression screening and increase the -20- programmatic efforts of the friendly visiting and peer counseling programs. • Low income elders are less likely to have access to health care services typically not covered by Medicare (e.g., dental care, eye care, hearing care). Respondents had the most difficulty accessing dental care. Work with the dental community to increase access to dental care (i.e., a pro bono or sliding fee scale program). • Low income elders are also more likely to be in need of advocacy to help with solving income and consumer problems. Increase efforts of legal assistance to at-risk older adults. • Of the top five financial concerns listed by respondents, three related to health care costs (e.g., health insurance, prescription drugs, and doctor and health care costs). Having enough income in retirement and property taxes were of concern to many. The biggest concerns were having enough income in retirement and paying for doctor and health care. Increase efforts to educate elders about property tax relief programs, home equity conversion programs, retirement planning, long term care insurance and other health care issues. The 2002 Needs Assessment of Caregivers in Weld County The Area Agency on Aging contracted with the University of Northern Colorado Department of Health and Human Sciences to develop and administer the survey. To identify the caregivers, the surveyors obtained a list of households with a householder over the age of 40. Households were then randomly selected and called in order to identify individuals who were currently caring for (in the last six months) a person at least 60 years of age. A total of 8,831 households were contacted and 364 caregivers were identified. Caregivers, if they agreed to participate in the study, were mailed a survey, a postage paid return envelope, a HelpSource Information and Referral Guide, information about a Caregiver Respite Program and a pill reminder box with the Weld Area Agency on Aging's logo and phone number. A total of 224 usable surveys were returned. The survey was intended to identify the needs and elicit the opinions of caregivers providing any and all level of care to a person 60 years or older. In order to capture all caregiving situations the survey included care recipients who lived in their own homes, in the homes of the caregiver, live outside of Weld County or live in any type of long term care facilities. The questionnaire included topics related to the type of assistance the caregiver was providing, services that were being accessed from the community, understanding of available community services, employment issues, and challenges of caregiving. Survey Findings Sociodemographic Characteristics of Respondents Of the 224 respondents completing the survey, 76.6%were females and 23.4%were males. Half -21- of the respondents were the care recipients's daughter or daughters-in-law(50.7%), 16.6%were the sons or the sons-in-law, 12.9 were spouses, 8.3%were non-relatives or friends and the remaining 11.5% were other family members. Twenty-two percent (22%) of the respondents were under the age of 50, 28.9%were between the ages of 50-60, 28.9%were between the ages of 61-70, and 20.2%were over the age of 70. The mean age of respondents was 58.9. The majority of the respondents (51.6%) indicated that their health was good compared to others their age and 30.1% reported their health as excellent. The vast majority of the respondents were(91.3%) were white (non-Hispanic); of the remaining 8.7%, 5.5%were Hispanic, with Asian Americans and persons of mixed race representing the remainder of the respondents. More than 75% of the respondents were married and 10.6% were either divorced or separated. Widows represented 8.3% and 6.0%were never married. In regards to education, the largest percentage (31%) of the respondents reported their highest level of education bing high- school graduates,however, over 47% reported having at least an associate's degree. In regards to annual household incomes, 30.5% indicated an income ranging from less than $15,000 to $24,999; 17.6% , $25,000-$34,999; 15.5%, $35,000-$44,999; and 36.4% indicated an income ranging from $45,000 to over $75,000. Thirty-one (31%) refused to provide their annual incomes. Almost half(50%)reported that they were working. The average number of hours caregivers were working was 36 hours per week. One-fifth (21.5%) reported having I or more persons under the age of 18 living in the household. One-hundred and fifty-five (69.2%) respondents reside in urban locations and 69 respondents (30.8%) live in rural locations. The average number of years that caregivers reported that they have been providing care was 4.6 years. Sixteen percent(16%) have been caregivng less than 1 year; 22.1% one to two years; 24.4% three to four years; 15.2% five to six years; 5.1% seven to eight years, and 17.5% nine or more years. Care Recipients Characteristics Age The age of the care recipients ranged from 60- 101 years. The average age of the care recipients was 82.6 years. Slightly more than 38% (38.4%) of the caregivers provided care for someone between the ages of 60-80; 43.5%between the ages of 81-90 and 18.1% over the age of 90. Residence Over half(53.8%) of the care recipients lived in their own residence. The remainder lived with the caregiver (27.8) and 18.4% lived either in a nursing home or an assisted living facility. Health Problems of Care Recipient -22- Care recipients, as would be expected, had a variety of illness. The majority reported having mobility problems (59.6%), high blood pressure (40.8%), arthritis (38.1%), hearing loss (37.7%), heart disease (32.3%), dementia or Alzheimer's Disease(27.4%),blindness or vision loss (22.9%), osteoporosis (22.8%), incontinence (21.1%), diabetes (17.5%), stroke (14.8%), lung disease (13%), and cancer(11.2%). When asked, caregivers indicated that their main illness was mobility(30.1%) and 20.4% said dementia or Alzheimer's Disease which clearly could impact their ability to provide the level of caregiving services that the care recipient could require. Behavior Problems of the Care Recipient The most common behavior problem (62.5%) that care recipients exhibit is difficulty sleeping at night thereby also keeping the caregiver awake. Other problems that occurred frequently or occasionally included being forgetful, confused or uncooperative (58.4%), unable to be left alone in the house (33.5%); becoming upset or yells(29%); embarrasses caregiver(23.5%) and becoming violent(6.5%). Caregiving Activities Hours of caregiving services Caregivers provide caregiving services from range of one hour per week to more than 41 hours per week. Forty-three percent reported spending 8 hours or less; 27.9%provide 9-20 hours; 11.1 % spend 21-40 hours, and 17.8 report spending 41 hours or more per week. Types of Assistance Provided Most caregivers (91.4%) reported providing assistance with running errands and a similar percent stated they helped with transportation needs (88.7%). Other types of assistance provided by more than half of the caregivers included meal preparation (60.6%), assistance with government programs, such as Medicare and Medicaid (60.2%), making telephone calls (57.7%), and help with getting around with an assistive device (55.1%). Approximately quarter of the respondents provided care with personal needs such as dressing bathing toileting and feeding. Frequency of Assistance Provided Over half(57.3%) stated that they provided assistance at all times for running errands, managing finances (54.32), helping with government assistance programs(53.8%), making medical appointments (53.1%), helping with transportation needs (51.3%). Other assistance provide at all times by high percent of caregivers included help bathing, dong laundry, preparing meals and running errands. Help with Caregiving Assistance -23- More than half of caregivers indicated that they had assistance with caregiving activities from _ one other person. Twenty percent of these secondary caregivers were spouses and 38.7% were brothers or sisters. Most helped less than 5 hours per week. One third reported having a second person helping with caregiving activities and 13.8%had three people who helped them. Use of Community Resources Caregivers were provided in the survey with an extensive list of available community services. They were asked a variety of questions from service usage as well as level of understanding of what each service could provide. Slightly less than half(42.7%) of the respondents reported using home health services. Other services such as LifeLine,homemaker assistance, ombudsman services, and hospital care were used by less than one-fifth of the caregivers. Caregivers most often reported that the reason for non-use of community services was that they did not need the service. In addition to not needing the services and not knowing what the service provided, the caregivers most reported that the reason for not using the service was due to the fact that the care recipient would not accept the service. Caregiver attitude toward community services was explored. Over 50% of the caregivers indicated that they would like to have someone they could talk with who could tell them about what services exist and how these service could help them in their caregiving role. Forty-five percent of the caregivers stated that they did not know who to call to find out about available services. They also shared that they did worry(41.1%) about the safety of their loved ones when being cared for by someone else and expressed a lack of trust (35.1) in someone from the community to help in the caregiving process. Helpful Information Thirty-four percent (34%) of the caregivers stated that they would like to have information about the care recipient's condition and receive information from a medical professional and anther 30%would like to have a central source of information for caregivers to access and having information about applying for and paying for services were also very important. Approximately 25% of the caregivers expressed that it was important to have guidance on legal matters and to have help giving care recipients personal care. Caregiver Stress Being concerned about the care recipient's health was a serious issue for 38.8% of the caregivers. Other caregiver activities that caused stress included giving up their own activities, wishing that other relatives would do their fair share of caregiving assistance, taking care of the recipient when they do not feel well, their own emotional health and the care recipients' uncooperative or demanding attitude. -24- Job Stress Sixty-four percent of the caregivers reported having to rearrange their work schedule and almost— 25% stated that they had to take time off without pay because of their caregiving duties. Almost 50% of the caregivers work and they average about 36 hours per week and 15% indicated that they are working fewer hours due to their caregiving duties.. Approximately 23%of the caregivers indicated that they either are unable to look for work or had to quit their current job to provide caregiving services. Positive Aspects of Caregiving Over half(54.4%) of caregivers expressed that they felt useful and needed in their role as caregiver. Another 37.4% stated that they gain companionship from the care recipient and 34 % indicated that the care recipient is able to help the caregiver by buying needed items. When asked to summarize their caregiving experience in one word(which many found difficult to do), 27.5% chose `love" and 20% chose"rewarding". "Stressful"was reported by 12.7 caregivers. Rural and Urban Differences in Caregiving Rural caregivers were more likely than the urban caregiver to help with housework, pet care and transportation needs and they indicated a greater need for assistance with shopping. Urban caregivers were more likely to assist with Medicare and Medicaid or other types of government assistance. In addition, urban caregivers reported more overall care recipient behavior problems and expressed more negative stress outcomes than their rural counterparts. Urban caregivers also thought obtaining advice from mental health professionals and getting more information about the recipients's condition was important. Gender Differences in Caregiving Women caregivers were more likely to report higher levels of emotional and physical stress. It also appears that women caregivers are caring for older adults who report having several chronic conditions. When looking at what areas of support or information would be helpful to males and females, males indicated that help with housekeeping was an important issue. Women , on the other hand, stated that sitting services, having free time, needing caregiving skills training, getting advice from a medical professional and having a caregiver support were very important. Differences by Race of Caregivers Non-white caregivers were providing more caregiving activities and were more likely to report worrying about their love one's safety when someone else was caring for their loved one, reported being fearful of having people from the community help with their loved one and reported having a difficult time trusting others to care for their loved one. More non-white caregivers thought that getting more information about applying for or paying for services was -25- very important. Working and Non-working Caregivers Working caregivers indicated that obtaining information about paying for and applying for services and benefits was very important, along with help with shopping and getting information about the care recipient's medical condition. Part-time workers were interested in support groups, obtaining advice from mental health professionals and a central source of information for caregivers. Caregiver needs by Care Recipient Condition Caregivers caring for persons with Alzheimer's Disease reported greater emotional and physical stress, reported not knowing about community resources and had care recipients with more difficult behaviors. These caregivers also indicated less interest in using community services verses those caregivers who were caring for care recipients who did not have Alzheimer's Disease. They did however indicate that they wanted mental health and legal advice, a central source of information, more free time and assistance with medical care. Caregivers caring for persons with incontinence scored higher on emotional and physical stress than did caregivers not caring for some who was incontinent. These caregivers felt that help with home modification guidance on legal matters, having a central source of information for caregivers and help with personal care were very important services. Caregivers who were performing at least one Activity of Daily Living wanted help with sitting services giving personal care and obtaining medical equipment. They had higher rates of emotional had physical stress and had higher levels of fear, worry and trust when using others to assist in providing care. Recommendations The results of this confirm the idea that caregivers have different needs in the"caregiving cycle". At the start of their caregiving journey caregivers are interested in obtaining information and linkages. During the later stages in the cycle, when caregiving burdens increase, caregivers need more assistance in personal care needs, sitting services, respite and support groups. Below are the following recommendations for the caregiver assistance programs and services based on the data collected in this study: • Enhance and provide information and referral that gives caregivers information about medical conditions, mental health concerns, and programs and services (both private sector and government). Create a central source of information for caregivers at all stages to access. -26- • Need for Sophisticated Targeting of Programs and of Marketing Strategies: The varied needs if caregivers in this study require that programs target specific types of caregivers and use sophisticated marketing that targets specific caregiver and their needs. These unique needs are as follows: • Targeting support services to caregivers at the end of the cargiving cycle • Targeting beginning cycle caregivers with information and resources • Targeting information and resources to secondary family caregivers • Targeting the workplace where almost half are involved in some type of caregiving activity • Targeting by caregiving resources and services based on recipient conditions via health professionals • Targeting information and resources by ethnicity by networking with leader in the Hispanic community. -27- Section V: Public Input A public hearing was held in the Weld County Department of Human Services on February 13, 2003 at 10:30 a.m. The hearing was made public through a press release to the Greeley Tribune. A total of eleven (11)persons attended the meeting. The seven key community initiatives were presented. The initiatives were developed from information that the Area Agency on Aging obtained from the two needs surveys, feedback from the Area Agency on Aging Advisory Board and from individuals who attended the public hearings. The AAA Director also proposed that in order for the AAA to be effective in the development and coordination of new programs a small percentage Title III funds will be allocated to these activities over the next four years. The presentation was followed by a question and answer period. Minor corrections were made to the initiatives but no major changes were made. The initiatives were also presented to the members of the WELDCOs, an association of rural senior center coordinators on February 5, 2003 , the Area Agency on Aging staff on February 3, and the Senior Nutrition Advisory Committee February 19, 2003 No changes to the initiatives were requested. In order to obtain community input during the development of the community initiatives, four public hearings were held The first hearing was held on June 10, 2002 in the Ft. Lupton's Community Center (12 people attended). The second meeting on August 8, 2002 was held at the Pierce Senior Center, a small rural community (14 people attended).The third hearing was during the November 6, 2002 WELDCOs meeting, an association of Weld County rural senior center coordinators ( 22 people attended) . The last hearing was held on January 6, 2003 at the Weld County Long Term Care Committee's quarterly meeting(15 people attended). The Long Term Care Committee membership consists of many key long term care providers and other advocates from Weld County. The purpose of these hearings was to enlisted information from seniors, senior center coordinators, and community providers and other interested individual concerning the needs of seniors in Weld County. Overall, the participants of the hearings expressed positive comments concerning the availability of services in Weld County. However, several seniors and providers mentioned limitations surrounding transportation options in their communities. The towns/cities of Weld County outside Greeley/Evans do not have mass transportation systems. The Weld County Division of Human Services Mini Bus does provide county wide (outside the Greeley/Evans city limits) transportation but it is unable to meet all of the known transportation needs. To address this limitation in transportation services, several communities have purchased small vans through their local community centers to meet part of the transportation needs. Clearly not all of the communities have purchased vans. Therefore, transportation issues still exist. Other issues of concern were: • Affordable homemaker and personal care services -28- • Reinstatement of blood pressure and foot care clinics at the rural senior sites • Need for new and active volunteers in several of the rural senior centers — • Need to increase the awareness of service options in Weld County. • Increased education opportunities addressing medication issues such as: cost and availability and misuse of prescription medication and over-the -counter medications and supplements • A clearing house for caregivers -29- Section VI: AAA/State Joint Planning Initiative Colorado Department of Human Services, Division of Aging and Adult Services is currently in the process of developing new state initiatives. The new state initiatives will be included in the Weld County Area Agency's next one year plan. -30- Section VII: Community Initiatives The Weld County Area Agency on Aging has identified seven (7) community initiatives to focus on during the next four (4) years: These initiatives are intended to address several significant findings from a county-wide needs assessment conducted on a representative sample of Weld County elders 60 years of age and older in April 1998, the Caregiver Needs Assessment in Summer, 2002, and public input. (1) Emphasize facilitator, leadership, coordination, advocacy and resource development role. Issue: Area Agencies on Aging do not have and will not have the financial resources to address many of the unmet needs of older adults in our planning and service areas. Area Agencies do, however, have over twenty(20) years of experience in planning and organizational activities to help organizations and communities improve the quality of life of older adults and respond to the most serious unmet needs of the most frail and isolated elder. How Issues will be addressed: • increasing community-wide education/training, opportunities to the public on a wide variety of aging issues (i.e. medications, caregiving issues, senior empowerment etc) • partner with other community organizations to help address gaps in the long term care system • seek out best practice models and implement programs that are feasible • explore grant writing opportunities with both local and national finders • increase the visibility of the AAA by developing a media plan (2) Reduce the incidence of loneliness by seniors. Issues: The issue of loneliness was reported by 22 percent of older adults 60 plus as a significant problem. Despite the fact that most of Weld County's communities, including Greeley and 23 rural towns, support senior programs; there remain many(as many as 3,800 Weld seniors who are outside their community's social and helping network). Pervasive loneliness can be the root cause for depression and many physical health problems. How Issues will be addressed: • The Area Agency will continue to allocate a modest amount of resources to projects designed to find creative approaches for increasing connections between communities and lonely seniors. -31- (3) Increase and improve transportation resources for elders particularly low-income and minority. Issue: About 4.4% or potentially 850 to 900 seniors in Weld County experience times when they are unable to get transportation when they need it. This is three to four times more likely for 81 plus elders, elders of color, elderly widows 85 years and older and low- income elders. How Issues will be addressed: • Overall marketing of transportation options must be increased county- wide. The Area Agency on Aging will continue to work closely with the Weld County Transportation Department and support their efforts in seeking additional transportation funding from the Colorado Department of Transportation and other appropriate funding sources. • Work closely with rural senior centers and assist them in developing local community options. (4) Increase dental resources for low-income seniors. Issues: Weld seniors (7.2%) reported in the 1998 Needs Assessment that the most common health service they had difficulty procuring was dental care. The most common barrier to dental care is cost. Unresolved dental problems decrease the quality of life of an older adult by decreasing food choices and overall nutritional intake, decreasing socialization particularly when associated with eating activities and by increasing exposure to discomfort and pain. How Issue will be addressed: • The Area Agency will look for non-federal funding to provide funding sources for seniors who are unable to pay for their dental needs. • Will maintain current dental program (if funding remains available) (5) Improve access to Information and Assistance for Caregivers providing care to older Adults Issue: According to the 2002 Caregiver Needs Assessment, caregivers are in need of a central source of information easily obtain guidance and information about medical conditions, mental health concerns, senior programs and services. -32- How issue will be addressed: • Research clearing house models and choose a modti that can be reasonably replicated at the AAA • Develop a marketing plan that will be cost effective and reach a broad base of caregivers • Develop training workshops that will address the need for caregiving skill enhancements • Maintain the Respite Voucher Program to address the need of respite services • Maintain community based educational efforts that address the growing issues and needs of grandparents raising grandchildren (6). Improve seniors awareness of medication issues Issue: Seniors are experiencing many types of issues concerning medications. Some seniors are finding it difficult to obtain medications due to cost. Others are obtaining medications but are not using them as prescribed. Misuses are also occurring with supplements and other over the counter medications. How the issue will be addressed: • Advocate for Medication Assistance Programs at the Federal and State level • Provide access to information concerning discount medication programs • Provide community training on medication management and awareness of the dangers and usefulness of supplemental vitamins, herbs etc. • Promote senior participation in community wellness programs in order to avoid chronic illnesses resulting in the need for medication (7) Improving access to basic medical services Issue: Many senior centers are no longer receiving services such as blood pressure clinics and foot care clinics . Due to recent funding cuts at a state level agencies such as the local health department and home health care agencies are no longer able to provide these services at little or no cost to seniors. How the issue will be addressed: • Create a subcommittee that will explore this issue and seek creative local options and solutions • Explore other possible funding sources such as foundations and grants -33- Section VIII: Targeting Based on the Weld County 1998 Needs Assessment, Hispanic elders (Weld County's principal minority group) have the most difficulty obtaining transportation, completing instrumental activities of daily, and are consistently lower income than other groups. Weld County Hispanic elders represent about 14% of the 60 years old and older population (based on the 2001 population estimates). The greatest concentration of Hispanic elders are located in Greeley, Fort Lupton, Wattenburg, Milliken, Platteville, and Gilcrest. Approximately 30% of Weld County older adults 60 years and older are living in rural communities and 9% fall within the poverty guidelines. In addition, according to the 2000 U.S. Census Bureau 6,841 persons 65 years and older are disabled. The Area Agency on Aging will target services to these at risk elders using the following specific objectives: • Fund an Hispanic elderly outreach program capable of advocating for Hispanic elders through outreach and information and referral throughout Weld County. (Currently contracting with Catholic Charities Northern) • Designate a part time FTE bilingual outreach position within the AAA administrative office to provide bilingual support assistance to staff and information and assistance services to Hispanic elders seeking assistance directly through the Area Agency on Agency. (Currently a staff member is available to provide the above services) • Partner with Catholic Charities northern to find ways to better serve the transportation, and general isolation problems of Hispanic elders. (Currently contracting with Catholic Charities Northern to provide outreach services) • Maintain senior nutrition programs within Section 8 senior housing in Greeley and surrounding communities in Weld County(Currently providing senior meal programs in 5 senior housing units with a goal of increasing the number to 6 by 2004) • Maintain senior nutrition programs in rural communities that have a significant number of targeted seniors.(Currently providing senior meal program in 15 rural communities with the goal of increasing the number to 17 by 2005) • Maintain requirements in all provider contacts to outreach to the appropriate target populations. (Currently have updated all contracts to include targeting goals and will revise contracts on an annual bases) • Distribute posters and flyers in Spanish and English informing the public of the existence of the Area Agency on Aging and the services available. (With the help of the Area -34- Agency on Aging Advisory Board, Senior Site Coordinators and staff posters and flyers will be distributed every 6 months over the next 4 years) • Providing training and other educational opportunities such as the Legal Clinics for Grandparents raising Grandchildren at community centers such as The Rodarte Center and Ft. Lupton Community Center. (Legal workshops are currently being provided with the goal of increasing the quarterly workshops by one additional workshop by 2004 and one additional educational workshop by 2005) • Maintain Hispanic participation on the Area Agency on Aging Advisory Board.(Currently 20% of the advisory board members are minority with goal of increasing minority participation by 10% by 2004) • Maintain The Options for Long Term Care Program in-house to gain greater access to the frail and disabled seniors. (Will maintain the annual contract with Health Care Policy and Financing in order to maintain the Options program with the Area Agency on Aging) • Maintain the close working relationship between the AAA and the Northern Colorado Alzheimer's Association ,especially in regards to the Family Caregiver Program.(Will explore the possibility of having a Area Agency on Aging staff member become a member of the Alzheimer's Association's advisory board by 2005) -35- Section IX: Overview of Services: 2003-2007 Information and Assistance The Area Agency on Aging will ensure that all older persons within Weld County have reasonable and convenient access to information about services through the following means: • trained AAA staff and rural senior coordinators who are capable of providing accurate and appropriate information to callers and walk-ins who access information through the Area Agency on Aging office and nineteen (19) rural senior aide stations throughout Weld County. Based on the information obtained from the 1998 and 2002 needs assessments the community in is need of general and specific types of information related to older adults. Special attention will be paid to the needs of caregivers over the next 4 years. • disperse information through all forms of media including The Senior Marketplace News, the Senior Voice, the Weld Monthly Times, the Greeley Tribune, local rural weekly publications, an updated I & R Directory widely distributed throughout the aging service network and the public at large, specialty articles and interviews on issues of public interest, workshops, and public speaking. • increase elder to elder contact by promoting creative friendly visiting contacts through the support and leadership of senior centers, church community, current AAA service providers and other community volunteer organizations. • work collaboratively with other agencies such as Department of Social Services, United Way and other service agencies in the provision of information and assistance services Outreach Services The Area Agency on Aging will ensure that outreach efforts are conducted throughout Weld County to identify older persons and to inform them of the availability of services by: • designating a minimum of one trained, bilingual Area Agency staff person for one on one outreach and for Spanish interpretation services as needed and appropriate. • contracting for specific Hispanic Elderly Outreach component whose responsibility will be to identify Hispanic elders and provide information and assistance to such elders in accessing needed services throughout Weld County • training rural senior coordinators on outreach techniques and provide incentives for local communities under the leadership of their rural senior programs to identify and maintain continuous contact with all seniors with particular emphasis on the oldest, most frail, -36- minority and homebound. • providing technical assistance to wide range of community leaders including church leaders, service clubs, elected officials, and other volunteer organizations on the implications for health and well being of seniors who feel lonely and isolated. Transportation Services According to the 1998 Needs Assessment of Weld County 60 plus, 4.4% indicated that they currently experience times when they need to go somewhere but stay home because they have no means of transportation. This is particularly true for females, elders of color, those below poverty and the 81 plus. The transportation barrier was reported to affect the ability to see a doctor, go shopping, attend religious activities, and attend other activities such as a senior center or library. The Area Agency does not provide specific funding for transportation but does work closely with the Weld County Transportation. The needs of the above named at risk groups will be served by: • Increasing awareness of specific transportation options available to seniors and how to access the service— specifically demand-response service. • Coordinating more closely with other transportation systems, particularly the City of Greeley and neighboring counties' transportation programs. In-Home Services The Area Agency on Aging will provide for the availability of services to older persons in their homes in order to help them remain in their own homes with a maximum degree of independence by: • sponsoring the Colorado Options for Long Term Care Program or SEP (Single Point of Entry)which gives community based long term care options to persons qualifying for Medicaid and passing a medically needy screen. Maintaining the Options for Long Term Care within the Area Agency on Aging increases the likelihood that clients (many who are the most disabled, frail and low income in the community) are referred appropriately and quickly to the appropriate AAA program or service. • providing financial support for homemaker and personal care to individuals who have no other source of third party reimbursement for such services and who cannot afford the full cost of the service. The amount of funds allocated to this program clearly does not meet the full needs of the community but due to the expense of this service the AAA is only able to be one of several partner in the funding of this service. The AAA contract provider accesses additional funds from the community such as United Way funds to help fund this service to the community. The provider will be requested to maintain waiting list in order to help assess the unmet need. -37- • providing financial support for in-home, one on one peer counseling (seniors helping seniors) services to at risk seniors. Bring counseling services into the client's home has been very successful, far more successful than the traditional therapeutic approaches offered at the mental heath center. The AAA contract provider would be unable to provide this level of service without the assistance of the AAA. Legal Assistance Services The AAA will continue to maintain a paralegal on staff under the supervision (by contract) of a qualified attorney to provide advice and consultation to older adults with economic and social needs. Since the paralegal is a member of the AAA staff all seniors requesting legal assistance are either received directly by the paralegal or staff forward the appropriate calls to him. The paralegal consults with the supervising attorney on a regular bases (and as needed). Based on the 1998 Needs Assessment and the 2002 Caregiver Assessment seniors are requesting assistance regarding legal issues. Due to the cost of these services in the community, many seniors would be forced to go without this type of assistance if this services was reduced or eliminated. Ombudsman Services The Area Agency on Aging will maintain on staff of 2.16 FTE ombudsman. The Ombudsman will continue to report to the Area Agency on Aging Director and will have all the authority vested by the Federal Older Americans Act and State of Colorado Statutes to carry out the activities of a long term care ombudsman. Oversight will include six (6) Weld County nursing homes and sixteen (16) assisted living facilities. A team of approximately four(4) volunteers will be trained and supervised to assist the ombudsman. Current level of staffing allow the Ombudsman team to meet all the current requirements of the Ombudsman Program. In an effort to protect the rights of senior in long term care facilities and stretch limited resources, the Ombudsman program works closely with the Department of Social Services' Adult Protection team and other community groups by: • maintaining membership on the Weld County Adult Protection Networking Team • coordinating with TRIAD on elder abuse education activities • training staff and the aging network on referral procedures to adult protection • advocating for sufficient adult protection workers to respond in a timely manner to referrals • participating in community victim advocacy groups • maintaining funding from VALE -38- Disease Prevention and Health Promotion Services The AAA will participate in community efforts to promote disease prevention by: • educating the community on expressed health issues of elders as per needs assessment results • coordinating with North Colorado Medical Center and other key agencies to provide a Senior Health Fair in the fall of every year. • promoting, through technical assistance to Weld rural senior coordinators, health promotion activities as a central component of rural senior center programming. • provide educational opportunity to the community at large concerns issues related to medications needs,misuses, etc • support Wellspring Club, a community based wellness programs targeted to older adults Nutrition Services The AAA will make awards for congregate and home delivered meal services that will have the capability of serving all of Weld County by: JP • Maintaining a financial contract with a home delivered meals provider to serve hot meals Monday through Friday and frozen meals for reheating on weekends - available in Greeley and through two satellite sites in South Weld County. • Maintaining a financial contract with the University of Northern Colorado Food Service to prepare hot meals for delivery throughout Weld County to23 designated congregate meal sites. • Contracting with Weld County Transportation Program to deliver meals in bulk to congregate meal sites throughout Weld County. • Maintaining the in-house part time consultant to write menus and provide nutrition education and counseling to meal participants. • Supporting a part time AAA staff person to carry-out the contractual oversight needed to insure that the program meets the federal and state guidelines for an elderly meal program. • Advocate with local communities to increase support of the congregate meals program. Currently there are no waiting lists for these services but this may change if funding remains level or if funding cuts occur over the next four years. Advocacy, Coordination, and Program Development Emphasis will be placed on these activities with the clear intent of strengthening the AAA's leadership and technical assistance role to Weld communities. The AAA believes more time and resources must be directed to enabling and partnering activities that could result in creative community approaches for helping elders and their caregivers. Therefore the AAA will: -39- • redirect resources as available and appropriate to give greater support to advocacy, coordination, and program development activities. Other Optional Support Services • Eldergarden Adult Day Program - The Area Agency on Aging has supported the only adult day care program in Weld County for many years. Based on information from the needs surveys and public input this program continues to be a needed community service. As the number of frail seniors increases and working caregivers become overwhelmed by the needs of their loved ones, adult day care services will become a more vital service in the long term care continuum. Eldergarden is obtaining additional funding from other sources to supplement the funding that is provided by the AAA since the Older Americans Act funding does not meet all the existing need in the community. • Peer Counseling Program (see in-home section above) • The Area Agency will continue to sponsor the Options for Long Term Care Program serving approximately 500 frail, low-income, at-risk seniors and disabled providing case management and in-home services. Cost related to the sponsorship of the Options Program are covered by Medicaid. • The Area Agency on Aging will continue to support a .50 FTE rural senior center technical advisor using Community Service Block Grant funds (CSBG). This position plays a key role in providing education and technical assistance to all rural senior site coordinators National Family Caregiver Support Program The Area Agency on Aging will continue to support the in-house .60 FTE Family Caregiver position. The goal of the program will be to continue to provide information and assistance to caregivers, provide appropriate and needed caregiver training/workshops, and maintain the respite voucher program. In the 2002 Caregiver Needs Assessment, caregivers expressed a need for a central source of information for care caregivers at all stages to access. Over the next four years the AAA will work diligently to become that central information site for caregivers and the community at large. This will require additional in-house staff and resources and effective marketing strategies to reach a broad base of caregivers. Due the increase number of grandparents raising grandchildren in Weld County the AAA will continue to work with other key agencies in the community to provide educational opportunities such as legal clinics, resource fairs, support groups, newsletters, legal handbooks etc. Title VII Vulnerable Elder Rights Activities Program (see Ombudsman and Legal Assistance section for additional information and AAA staffing profile attachment) -40- For the last several years the Title VII funding has been used to enhance the in-house Ombudsman Program (Raegan Maldonado, lead ombudsman; Kathleen Alvarado, assistant ombudsman; and Marcia Jorgensen, assistant ombudsman). The dollars are used to help fund the Assistant Ombudsman positions and the Volunteer Ombudsman Program. In addition, the Ombudsman program is active in providing community education relating to elder abuse and exploitation. The Ombudsman team will continue to participate in the Adult Protection Networking Team , the Long Term Care Bio-Ethics Committee and the Long Term Care Committee. The Ombudsman team works closely with the in-house legal paralegal and the contract attorney concerning legal issues involving long term care residents. The Ombudsman also works closely with the Options for Long Term Care case managers in order to help long term care residents explore the opportunity of returning to independent living in the community. -41- Section X: Waivers Direct Service Provision Waivers The Weld County Area Agency on Agency is currently administering two programs that require waiver approval, the family caregiver program and the paralegal program. The Family Caregiver program is currently being administered by the Area Agency on Aging. A part-time Family Caregiver Coordinator is providing information and assistance and training to the general public and is coordinating a respite voucher program. In addition, programs for grandparents raising grandchild are being coordinated out of the Area Agency on Aging. The paralegal program has been administered out of the Area Agency on Aging for over fifteen (15) years. In order to meet the requirements of attorney oversight the Area Agency on Aging contracts with a local attorney. The program is highly successful and cost effective. The Area Agency does not believe that it continues to be necessary to seek a waiver for the congregate meals program as a direct service. We carry a vendor grant with the University of Northern Colorado to-prepare meals for the program, we contract with the Weld County Transportation Program to transport the meals to local sites, and we have non financial agreements with each of the local sites who agree to provide a setting for the meals and the necessary resources to administer the program at the site. We have no paid nutrition site staff. Administrative staff include a part time nutrition consultant to write the menus and monitor the sanitation at the sites and a part time FTE technical advisor to monitor the food service contract and the local site programs. We believe this does not constitute direct service provision under traditional definitions for direct service. Waivers of Title III Priority Services Access Historically the Area Agency on Aging has not met the 25% guideline under Access services because we opted not to fund the transportation program but rather support the county's efforts in locating other funding sources for senior transportation. Our transportation program is currently being supported by community service block grants and CDOT/FTA dollars. In addition, due to ongoing legal needs expressed by our senior community we have supported an in-house paralegal program and have purchased attorney services ,as needed from a local elder law attorney. This allows us to provide information regarding many legal issues that seniors are facing and giving us the opportunity to provide actual hands on assistance rather than just referral information. This program has been very cost effective and accessible to seniors through out the county. In addition, we are providing in-house information and assistance services and we -42- contract with Catholic Charities Northern for Hispanic Outreach services. In-Home Services The Area Agency on Aging is funding homemaker and personal care services through RVNA, a nonprofit home health care agency. Based on information obtained from focus groups, advisory board feedback and the 1998 needs survey, there continues to be a need for adult day care services (Eldergarden Adult Day Care) and the senior peer counseling program (North Range Behavioral Health). In order to funds these two needed services homemaker and personal care services are not being funded at the higher possible level. However, if additional funds become available homemaker and personal care services may receive additional dollars. -43- Section XI : Attachments -44- Area Agency on Aging Organizational Chart Board of County Commissioners — — — — Fiscal and _ _ _ Department of Human Services Personnel* Walter J. Speckman-Executive Director Area Agency on Aging Eva M. Jewell*-Director — — — - Advisory Board Dorothy Escamilla*-Assistant I � Community Services CareLink-OLTC Contract Services •Bev Reid*-Nutrition and •Sandra Hasch- Adult Day Care Home Health Care Senior Centers Technical Coordinator Peer Counseling Attorney Supervision Advisor Meals on Wheels Hispanic Outreach •9 Case Managers UNC Food Services •Joyce Johnson*-Nutrition •1 Registered Nurse* Consultant •Pete Archuleta*-Paralegal and Special Programs •Jerry Kearney*-Family Caregiver Coordinator •Dorothy Escamilla*- Outreach •Raegan Maldonado*- Ombudsman •2 Assistant Ombudsman* *Indicates full or part-time FTE (Older Americans Act) AAA Organizational Chart ATTACHMENT A -45- AREA AGENCY ON AGING STAFFING PROFILE Weld County Area Agency on Aging — 2B AAA Personnel Number #Of #Of Categories Of Minority FTEs FTEs FTEs Paid With OAA Funds 1.Agency Executive/ 1 1 Management Staff 3 .o t r + 5' n*�u.1 x'�:+ x}rg t r �'? s w f4=e k ,G e 2. Other Paid I:�`: �r "4d t (n p "r Professional Staff ��+i i ` s pp � t."I I t ' tI44 �riF li�I("I . (By Functional Responsibility) x,� . ff, ' �.4�'" � � FP��` , .F, .� �� 1 = etiil.,� A. Planning B. Development C.Administration D. Service Delivery 4.50 1 4.50 E.Access/Care Coordination 9.75 2 F. Clerical/Support Staff 1.45 1 1.45 3.Volunteers 400 4.Total AAA Staff 16.70 4 5.95 FUNCTIONAL RESPONSIBILITIES A. Planning--Includes needs assessment, plan development, budgeting/resource analysis, service inventories, standards development and policy analysis. B. Development--Includes public education, resource development, training and education, research and development and legislative activities. C. Administration--Includes bidding, contract negotiation, reporting, reimbursement, accounting, auditing, monitoring and quality assurance. D. Service Delivery--Includes those activities associated with the direct provision of a service which meets the needs of an individual older person and/or caregiver E. Access/Care Coordination--Includes outreach, screening, assessment, case management and l&R. F. Clerical/Support Staff—All paid personnel who provide support to the management and professional staff. SIP I : SIGNATURE: 2-/4-o 3 az rJ. 2-J 3 --O3 -AAA I": - DATE CHAIRPE ON. DATE AREA AG NCY ON AGING ADVISORY COUNCIL APPROVAL: AGING SERVICES UNIT MANAGER DATE AREA AGENCY ON AGING STAFFING PROFILE-ATTACHMENT B - 46 - • Request for Use of Part B Funds for Advocacy, Coordination, and/or Program Development Weld County Area Agency on Aging 2B Per amendments to the OAA of 2000, a statement of intent and justification for use of Part B funds for Advocacy, Coordination, and/or Program Development is required. SERVICE USAGE Note: Please indicate with brackets( )those PERCENTAGE percentages which are decreased. Part B Advocacy 70% Coordination 30% Program Development JUSTIFICATION FOR USE OF PART B FUNDS FOR ADVOCACY, COORDINATION,AND/OR PROGRAM DEVLEOPMENT: Coordination: Active participation in the Long Term Care Committee and the Coordination with the Options for Long Term Care System Advocacy: Represent the interest of seniors to County and State officials and pertinent agencies and organizations Conduct public hearings on senior issues Coordinate with agencies to promote new and expanded benefits for seniors SIG : SIGNATURE: �e L g--/1/--e3 (%) -13 q AAA C OR DATE Lad. ?fral DATE AREA AGENCY O AGING ADVISORY COUNCIL APPROVAL: AGING SERVICES UNIT MANAGER DATE REQ OF PART B FUNDS-ATTACHMENT C - 47 - DIRECT SERVICE WAIVER REQUEST Weld County Area Agency on Aging 2B Per, Direct Provision of Services, in accordance with Volume 10, Section 10.235 A through 10.240 C. 2. We hereby request approval of a Waiver to provide the direct services listed below. 1. Family Caregiver Coordinator 2. Legal Services-Paralegal (attorney services are contracted The Area Agency on Aging is responsible for insuring that all attachments covering the requirements in Volume 10, Section 10.235 A through 10.240 C. 2, are included with this Waiver Request. Additionally, please attach documents describing fully the direct service to be provided to include organizational structure and planned methods of program services delivery. Entitle these sheets as "Direct Service Program Description". PLEASE NOTE: If the Waiver Request is incomplete, this may result in a delay of the approval of the Annual Plan. SIGNATJIR ,: SIGNATURE: A DIRE DATE CHAIRP//EASON, DATE AREA AGENCY ON AGING ADVISORY COUNCIL SIGN 7 : SIGNATURE: L? IVE DIRECTOR OF JDA E AGING SERVICES UNIT DATE N EE MANAGER APPROVAL: AGING SERVICES UNIT MANAGER DATE DIRECT SERVICE WAIVER RED-ATTACHMENT D - 48 - WAIVER OF TITLE III-B PRIORITY SERVICES REQUEST Weld County Area Agency on Aging 2B Per, Restrictions On Use Of Funds, Volume 10, Section 10.413 B.3, we request approval of a Waiver for the following services to the indicated percentage(s): SERVICE PERCENT REQUESTED ACCESS 10.17% JUSTIFICATION FOR WAIVER: We are not meeting the 25% guideline because we opted many years ago not to fund the senior transportation program but rather support the county's efforts in locating other funding sources for senior transportation. Our transportation program is currently being supported by community service block grants and CDOT/FTA dollars. In addition, due to ongoing legal needs expressed by our senior community we have supported an in-house paralegal program and have purchased attorney services as needed from a local attomey. This allows us to provide information regarding many legal issues that seniors are facing and giving us the opportunity to provide actual hands on assistance rather than just referral information. This program has been very cost effective and accessible to seniors through out the county. In addition, we are providing in-house information and referral program and contract with Catholic Charities Northern for Hispanic senior outreach services.Therefore,we have opted to limit our funding for access services to 10.17%. IN-HOME SERVICES 9.58% JUSTIFICATION FOR WAIVER: We are currently funding homemaker and personal care services through RVNA Home Care Services. Based on focus group information, advisory board feedback and the 1998 needs survey we continue to have a clear need for adult day care services (Eldergarden Adult Day Care) and senior peer counseling program (North Range Behavioral Health). In order to meet these two significant needs we have opted to limit our funding for in—home services to 9.58%. LEGAL SERVICES JUSTIFICATION FOR WAIVER: WAIVER OF TITLE III-B PRIORITY SER REQ- ATTACHMENT E - 49 - SIGN 'SURE: SIGNATURE: 2/4-43 .d .{-?7,6O cq / 3 A05 AAA DATE CHAIRPE SON, DATE AREA AGENCY ON AGING ADVISORY COUNCIL APPROVAL: AGING SERVICES UNIT MANAGER DATE WAIVER OF TITLE III-B PRIORITY SER REQ-ATTACHMENT E _ 50 _ SENIOR CENTER FACILITIES/ACQUISITION Weld County Area Agency on Aging 2B Total Federal/ Local Local Other Budget State Cash In-Kind Resources 1. Acquisition 2. Construction 3. Renovation/ Alteration 4. Grand Total 5. Name and Address of the Grantee: 6. Name and Address DOES NOT APPLY of the Sr. Center: (if different from the grantee) 7. Date of Award (or anticipated date): 8. Area Agency Assurance of no suitable alternatives. In the case of acquisition or construction of a facility to serve as a Senior Center, provide a summary of efforts made to locate or lease a facility. 9. Grants in excess of $2,000 must comply with the requirements of the Davis-Bacon Act. Attach an explanation of how this requirement will be met. 10. Provide a demographic profile of the center participants (e.g., percent low- income minority). �SIG • SSIGNATURE: h P Z-/9-03 RdTr:1r _4 iJ c -I 3-03 A A DIA/ DATE CHAIRPFj12SON, DATE AREA AGENCY ON AGING ADVISORY COUNCIL APPROVAL: AGING SERVICES UNIT MANAGER DATE SENIOR CENTER FACILITIES ACQUISITION-ATTACHMENT F - 51 - PURCHASE OF EQUIPMENT REQUEST Weld County Area Agency-en Aging 2B Per, Restrictions On Proposed Purchase of Equipment, Volume 10, Section 10.455-457 and 10.475, we request approval of fixed assets and capital expenditures. (1) LIST ITEM TO BE PURCHASED: Nutrition Software (2)JUSTIFICATION OF ITEM PURCHASED: Necessary in order to analyze existing and future menus (3)LIST FUNDING SOURCE : Title III C-1 (4)INCLUDE YOUR PROCUREMENT PROCEDURE : See attachment L for details regarding the procurement procedure Documentation for proposed purchases should include,but not be limited to: 1. A list of the item(s)to be purchased; 2. Justification of need for the item --What will it be used for and where? Will it be replacing other equipment and why?Estimate life and depreciation of items requested?Etc. 3. The funding sources--Specify the total amount anticipated and the source of funds by Title III Part; include local funds, if any. 4. Procurement procedure—Discuss the process to solicit competitive bids and how the vendor was selected. If the lowest bid was not selected explain why. SIGNA • SSIGNATURE: aZ-iv-o 3 � .�1 j ..)3 A DI O DATE CHAT SON, DATE AREA AGENCY ON AGING ADVISORY COUNCIL APPROVAL: AGING SERVICES UNIT MANAGER DATE PURCHASE OF EQUIPMENT REQ-ATTACHMENT G - 52 - REGIONAL ADVISORY COUNCIL MEMBERSHIP JANUARY 1, 2003 TO DECEMBER 31, 2003 Weld County Area Agency on Aging 2B NAME ORGANIZATION AFFILIATION ` ADDRESS John Andrijeski Retired 26416 RangeView Dr. Kersey Co 80644 Don Beierbach Retired 4292 W 14th St Rd Greeley, CO 80634 Harold Chadwick Retired 2520 50th Ave Greeley, CO 80634 Mary Pat Eastwood Insurance 3609 Marigold St Evans, CO 80620 Don Feldhaus Greeley City Council 2038 27th Ave Ct. #4 Greeley, CO 80634 Ruth Gartrell Retired 20076 Southgate Ave LaSalle, CO 80645 Pat Graham University Professor 1638 27th Ave Greeley, CO 80634 Michelle Hernandez State Farm 3412 Trinidad St. Evans, Co 80620 Betty Jones Retired 1959 26th Ave Greeley, CO 80634 Mary Jones Retired 30887 Road 88 Ault, CO 80610 William Jerke County Commissioner Centennial Complex Greeley, CO 80631 Phyllis Rangel Retired 2235 46th Ave Ct#C Greeley, Co 80634 Josie Sanchez University of Northern CO P.O. Box 13 Pierce, CO 80631 Phil Shovar Retired 1809 19th Ave. Greeley Co 80631 Diane Warren City of Greeley/HR 1000 10th St Greeley CO 80631 - 53 - Please indicate on the chart below how many members are low income, minority, 60+ and disabled. — LOW MINORITY" 60+ DISABLED INCOME 0 3 9 1 SIGNATURE: SIGNATURE: ?---Z 4/-6 3 Al A D DATE CHAI ERS DATE AREA AGENCY ON AGING ADVISORY COUNCIL APPROVAL: AGING SERVICES UNIT MANAGER DATE REGIONAL ADVISORY COUNCIL MEMBERSHIP-ATTACHMENT H - 54 - COMMUNITY FOCAL POINTS AND SENIOR CENTERS Weld County Area Agency on Aging 2B LIST ALL FOCAL • .. ` 'CHECK`IF rCHECK IF l CHECK IF'. LOCATED. ': LOCATED FACILITY FACILITY IS FACILITYI IN AREA WITH A IN AREA WITH A POINTS AND SENIOR ."ISA :A IS A" • ^. HIGH •' 'x•`• HIGH" FOCAL SENIOR -' TITLE. ;CONCENTRATION CONCENTRATION CENTERS INCLUDING • POINT CENTER ,III-B OF LOW INCOME OF LOW,':. FUNDED ELDERLY ` ,INCOME` SR. ,MINORITY„ NUTRITION SITES IF A CENTER h ELDERLY: FOCAL POINT. PLEASE LIST: NAME ADDRESS,CITY,ZIP PHONE NUMBER NUMBER Ault Senior Center P.O. x x Box 1338 Ault, CO 80610 (970) 834-1325 Dacono Senior Center P.O. x x Box 99 Dacono 80610 (970) 834-1325 Erie P.O. Box 750 Erie Co x 80516 (303) 665-3298 Evans Community Center x 1100 37th St Evans (970) 339-5344 x 132 Ft. Lupton Community x Center 203 S Harrison Ave Ft .Lupton 80621 (970) 857-4200 Greeley Senior Center1010 x x 6`h St Greeley 80631 (970) 350-9440 Grover 211 Laramie Street x x Grover CO 80729 Hill N' Park 4205 x x x Yosemite Drive Greeley, CO 80634 (970) 330-8619 Johnstown Community x Center 101 W. Charlotte St Johnstown, CO 80534 - 55 - Kersey Senior Center P. O. x x Box 444 Kersey, Co 80644 LaSalle 326 3rd Ave x LaSalle 80645 284-0900 Lochbuie Senior Center x x x 331CherrySt#4 Lochbuie CO (303) 659-8262 Mead Community Center x 441 3`d St Mead CO 80542 (970)535-4477 Milliken Senior Center x x P.O. Box 354 Milliken, CO 80543 (970)587-2484 Nunn Senior Center P.O. x x Box Nunn, Co 80648 (790)897-2459 x x Pierce Senior Center P.O. Box 335 Pierce CO 80650 (970) 834-2655 Platteville Community x Center 400 Grand Ave Platteville, CO 80651 (970)785-6274 Wattenberg Community x x x Center 1917 Grace Ave Ft. Lupton, CO (303)637- 7608 Windsor Community x Center 301 Walnut St Windsor(970) 674-2414 SIGNATURE: SIGNATURE: 2-/1,-47.3 AN 41A C v l/� l/ r� lE -e3 DATE CHAIRPSON, DATE AREA A ENCY ON AGING ADVISORY COUNCIL APPROVAL: AGING SERVICES UNIT MANAGER DATE COMMUNITY FOCAL POINTS AND SR CTRS-ATTACHMENT I - 56 - • TITLE III MEAL SERVICE CHART* Weld County Area Agency on Aging 2B SITES LOCATED IN ';SITES WHICH TOTAL NUMBER SATES AREA IN WHICH AT SERVE MORE" OF DAYS PER SITE LEAST 20%OF 60+ ,!. THAN ONE WEEK MEALS POPULATIONS I WHICH ; COMPLETE ARE SERVED POVERTYLEV L SERVE 50% DA'PER NAME! OR MORE MINORITY ADDRESS CLIENTS X 3 Birchwood Apartments—Greeley X 2 Broadview-Greelev X 5 ElderGarden-Greeley X 3 Greeley Manor X 2 Greeley Senior Center X 2 Greeley Senior Housing X X 1 Rodarte Center X 1 Erie X 1 Evans X 1 Ft.Lupton X 1 Grover X 1 Hill N'Park X 1 Johnstown X 2 Kersey X 1 LaSalle X 1 Lochuie Mead X 1 Milliken X 2 - 57 - Nunn X I Pierce X I Platteville X I Wattenberg X X I Windsor X 2 * Each meal served must provide at least one-third of the current RDA, DRI and USDA Dietary Guidelines for the elderly. ** The second meal must provide at least one-third of the current RDA, DRI and USDA Dietary Guidelines for the elderly & must be served at another meal time. TITLE III MEAL SERVICE CHART-ATTACHMENT J - 58 - Year 1 Estimated Year 2 Estimated Year 3 Estimated Year 4 Estimated 4 YEAR TOTAL Total Available Total Total Available Total Total Available Total Total Available Total Total Available Total SERVICES Grant Funding Units Grant Funding Units Grant Funding Units Grant Funding Units Grant Funding Units Personal Care 4,535 700 4,535 686 4,535 672 4,535 659 4,535 646 Homemaker 17,840 1,100 17,840 1078 17,840 1056 17,840 1035 17,840 1014 Chore 0 0 0 0 0 0 0 0 0 0 Home Delivered Meals 77,223 24,00 77,223 23,520 77,223 23050 77,223 22589 77,223 22139 Adult Day Care 90,000 20,000 90,000 19,600 90,000 19208 90,000 18824 90,000 18448 Case Management 0 0 0 0 0 0 0 0 0 0 Congregate Meals 337,274 76,500 337,274 74,970 337,274 73471 337,274 72002 337,274 70562 Nutrition Counseling This will be addressed in the final 2003 budget Family Caregiver Program 55,276 1750 55,276 1715 55,276 1681 55,276 1647 55,276 1614 Transportation 0 0 0 0 0 0 0 0 0 0 Legal Assistance 57,736 1,100 57,736 1078 57,736 1056 57,736 1035 57,736 1014 Nutrition Education 10,019 69 10,019 68 10,019 67 10,019 66 10,019 65 Information&Assistance This will be addressed in the final 2003 budget Outreach 38,210 2,400 38,210 2352 38,210 2305 38,210 2259 38,210 2214 Counseling 33,000 2,000 33,000 1960 33,000 1921 33,000 1883 33,000 1845 Education 0 0 0 0 0 0 0 0 0 0 Health Promotion 11,768 2,00 11,768 2058 11,768 2017 11,768 1977 11,768 1937 Institutional Respite 0 0 0 0 0 0 0 0 0 0 Ombudsman Activities 48,578 1,130 48,578 1107 48,578 1085 48,578 1063 1042 48,578 Screening 0 0 0 0 0 0 0 0 0 0 Material Aid 0 0 0 0 0 0 0 0 0 0 Reassurance 0 0 0 0 0 0 0 0 0 0 TOTAL 0 0 0 0 0 0 0 0 0 0 Note: Due to potential flat federal funding and anticipated increase in unit cost, services were reduced by 2% each year. 'Four-Year Plan Fiscal Service and Project Income—Attachment K - 59 - I FOUR YEAR PLAN FISCAL SERVICE AND PROJECT INCOME PLAN i ESTIMATED Project Total Project Total Project Total Project Total Additional Project Total Additional Additional Additional Additional PROJECT INCOME Income Units Income Units Income Units Income Units Income Units Beginning Balance 8000 0 45,271 0 44,366 0 43,479 0 42,609 Total Earned 258,160 252,997 247,936 242,977 238,118 TOTAL AVAILABLE 266,160 0 0 0 0 0 0 0 0 0 Note: Units of services were estimated based on the average cost of services for each of the main programs that generate program income. • Four-Year Plan Fiscal Service and Project Income—Attachment K - 60 - MELD DIVISION OF HUNAN SERVICES COST PLAN BY MARILYN CARLINO FISCAL OFFICER REVISED FEB.2002 61 ATTACHMENT L CERTIFICATION OF COST ALLOCATION PLAN This is to certify that I have reviewed the cost allocation plan submitted herewith and to the best of my knowledge and belief: 1. All the costs covered by this proposal revised February 2002, to establish the cost allocation method for calendar year 2002 are allowable and in accordance with the requirements of OMB Circular A-87 and the requirements to the Federal awards to which they apply. 2. All costs covered by this proposal are properly allocable to the Federal awards on the basis of a beneficial or causal relationship between the expenses incurred and the awards to which they are allocated in accordance with the applicable requirements. Further, similar types of costs have been accounted for consistently. I declare that the foregoing is true and correct. State of Colorado County of Weld Division of Human Services Wa t l /'Speckman utiv6 Director, WCDHS 62 f . i I • WELD COUNTY DIVISION OF HUMAN SERVICES - ORGANIZATIONAL STRUCTURE BOARD OF WELD COUNTY COMMISSIONERS WELD COUNTY DIVI ION OF HUMAN SERVICES EXECUTIV DIRECTOR J AREA AGENCY FAMILY SERVICES EMPLOYMENT ADMINISTRATION ON AGING / EDUCATIONAL NETWORK OF WELD COUNTY Reception ��~ Community Developmentatiy-] . ~ Registration Fiscal appropriate practices Client Data ,_,j Services Food Stamp Job Search CDA Education Migrant/seasonal Farmvrorkers Nutrition Canters �.. Teacher Education TRAITAA Senior Canters Teacher Aid Education ..-- - .—.-- Outreach Curriculum Development Senior Employment w_ -_----- -! ,...-.y. --e-:.i....,, -___ - Senior Legal Services Job Referrals c....---.— ----- '�'�^� Employer . Job Placements Accounting Screenin ! Job Match ' Building and Care Link Assessmeal f Relations Job Listing Computer Evaluation Disabilities and marketing Special Job Solicitation • Maintenance Services for Mental Health Job Development Ombudsman Casa Managomenl children Summer Job Hunt M Veteran's Services , Health Screening a Veteran Veteran Service Coordination Personnel &Assessments Representative Veteran's Pieference Monitoring I r- Transportation Physicals Immunizations Health, Dental, Dental Exams and Nutrition a- ---ii..••-L•---s Dispatcher Denial Work GED Preparation Drivers Referrals - Remediai Education —� Assessments Secretarial Basic Word Processing .w---- — Learning Lab Basic Typing ss PBX Operator Recruienent Family Resume Development 1- i Contract Eli rb timy Employability Skills g . .,,..,,.,,�,,._ .. Casa Management Services I Services TAMP Program """""" ""�" JIPA Adult Programs Adult Day Care JTPA Youth Programs Peer Counseling ----- Special Summer Youth Program Meals on Wheels Policy Counci Programs Dislocated Workers Senior Clinics g Amerii orps Hispanic Outreach Parent Training Parent Volunteers Youth Crime Prevention and Intervention Home Health Care Parent Advocacy• Involvement Family Support Program Attorney Supervision Summer at Service WIC-Senor Meals IMIRILCDVIvIENJT SERVICES Or WELL) COuNJ 'T' ( One -Stop Career Center TYPES OF INFORMATION f WORKFORCE a — CUSTOMERS t ' Demographics : I Client Data * Labor Market Informaiion i * t TIER 1 Network * Training Information --I * Job Seekers# Employers I UI Rates * Major Employers ! * UI Recipients 1 * Economic Trends I * Youth • Career Information r....:�,..�,�. * Referrals Employer Relations 1 i i i ` • TYPES OF SERVICES • 1 •,1 w--- * Eligibility Determination * Job Orders I TIER 2 Network * Job Referrals (more specific information - - * Skills Assessment Veteran on needs) * Needs Assessment Representative -_-_- _ _ __ * Career Assessment ) * Job Placement I LID • Vocational Counseling a * Referrals ' Case Management i! (Less Intensive) # *Vouchers i 1 g 5 Learning Lab I. - . TYPES OF SPECIALIZED I TIER 3 Services SERVICES (more specific based " Training on eligibility)y) * Basic Skills • GED Special Programs -- -- * ESL ONE-STOP • Customized Training — CAREER _ * Case Management CENTER ( More Intensive) I EMPLOYMENT SER:\PCES OF WELD COUNTY Y ONE-STOP CAREER CENTER 1CORE SERVICES AVAILABLE TO AVAILABLE TO JOB SEEKERS i EMPLOYERS * Information about education and * Professional account managers training opportunities * Recruitment and referrals of * Resource Library skilled applicants * Access to the Internet, including * Regionalized labor market America's Job Bank, Colorado's information Job Bank, and other on-line * information about services for resources employers, including customized * Skills Assessment training, on-the-job training, and financial assistance programs * Employment-related resources • such as resume preparation tools * Access to the Internet, including America's•Job Bank, Colorado's * Job placement services Job Bank, and other on-line resources * Information and referrals to a variety of services, including * Layoff assistance veteran's benefits, programs for the employment of people with * Information about complying with disabilities, senior programs, employment-related laws such as apprenticeships/internships, and Workers Compensation and non- student financial assistance discrimination statutes * Intake and eligibility ; * Opportunities for employers to determination for programs become involved in workforce serving targeted populations development programs in their communities 65 C DENT FLOW CHART RECEPTION 11 Individual Expression of Need 3 V V ‘.../ • F Direct to Program if I Provide LMI Client requests to register or update with currently enrolled Job. Referral to individuals Job Service * JTPA registered with Job Service *TANF Provide employer applications 4/ * Dislocated Worker I Minimal client record updates 1 Individual given appointment * Learning Lab _______A for registration or seen on a walk-in basis * Y outh Programs NO * Food Stamp Job Search • * Other Programs V Individual Registration and Skills Screen for job YES interested referral completed and initial determination I in specific of potential eligibility for specific program NI, program or agency Individual referred for ` appointment for Transfer of all common data additional eligibility —> elements and acquire specific Determined eligible FNO_ documentation program elements for Program 1 YES Initial meeting with Assign to a • l • case manager. Client program case Initial assessment of identifies needs and - manager Reading and Math levels . barriers. Determination Additional Job Search assessment NO of Enrollment — YES Services Assistance required into the Provided Supportive Program Services I YES A provided as needed 4/ N0• jReferto ‘, — Learning Lab W for further Continue Job Services assessments Service for job Completed referrals _... 66 Area Agency on Aging Organization Chart Board of County Commissioners - --1 I I I Fiscal and Personnel Department of Human Services I • Marilyn Canino•. - — — Walter J. Specktnan" - Executive Director I I •Rhonda Homburg' I • Steve Kiburz• I I I • Susan Talmadge' Area Agency on Aging -- - -I Advisory Board I Linda Piper* - Director L J Dorothy Escamlila'- Assistant to Communit,t Set-vices Care Link- SEP Transportation • Rev Heidi- Coordinator • Eva Jewell' - Coordinator • Patsy Drewer- Coordinator Nutrition and Senior Centers. • Mindy Rickard'- Ombudsman • Dispatcher •Joyce Johnson' - Consultant • Sandy Hasch - Case Manager • Dispatcher • Pete Archuleta"1- Coordinator • Linda Hodge - Case Manager • Drivers (34) Employment • Dawn Riggenbach- Case Manager • Kalb!Miller- Case Manager • Dorothy Escamilla'- Outreach Contract Services Adult Day Care Home Health Care Peer Counseling Health Promotion • Part-time Older Americans Act Program Meals on Wheels Attorney Supervision co Respite Care Senior Nutrition tT Ail other funding: Job Training Partnership Act, Medicaid, Community Service Hispanic Outreach 07) Block Grant, Federal Transit Administration, Special Contracts OD FAMILY EDUCATIONAL NETWORK OF WELD COUNTY ORGANIZATIONAL CHART • Weld County Board of County Commissioners Division of Human Resources Services Executive Director Family Educational Network of Weld County PARENT POLICY COUNCIL • co UD Director - Site Manager %amily arent / \ Office Education Hea th Service Involvement CENTER Service Office Manager Specialist Specialist Specialist Specialist COMMITTEE Coordinators Technician Office Special Needs I Technician Technician Teachers Teac ier Lunch Aides Aides WELD COUNTY DIVISION OF HUMAN RESOURCES COST ALLOCATION PLAN PURPOSE The purpose of this cost allocation plan is to outline, in writing, the methods and procedures that Weld County Division of Human Services will use to allocate costs to its various programs, contracts and grants. BACKGROUND Weld County Division of Human Services (DHS) operates as an umbrella agency of Weld County Government. DES is the administrative entity for various federal and state programs, grants and contracts. These programs are grouped into four areas; Employment Services, Family Educational Network, Area Agency on Aging, and Other Human Service. Employment Services includes the following grants and contracts; Workforce Investment Act Grant programs, Wagner/Peyser programs, Summar Job Hunt, Employment First Food Stamp/Job Search Program, Workfare, TANF, Welfare to Work, Americorps, Tony Grampsas Youth Services, & the Educational Computer Lab. Family Educational Network consists of the following revenue sources and programs; Head Start, Migrant Head Start, Child Care Food Program, and State Preschool. Area Agency on Aging incorporates Older American Act funds into several Senior programs. It also relies on USDA funds for Senior nutrition programs, Community Service Block Grant Funds for coordinating the Senior volunteer program, Federal Transit Funds for Senior Minibus transportation, and Single Entry Point Funds and Private Contracts for Senior Case management. Other Human Service programs and funding include; Community Service Block grant, and the Commodity Supplemental Food Program. These grants require that DHS complies with OMB Circular A-102, Uniform Administrative Requirements for State and Local Governments and OMB Circular A- 87, Cost Principles for State and Local Governments. This Cost Allocation Plan is based on the definitions and requirements spelled out in OMB Circular A-87. GENERAL APPROACH The general approach of DHS in allocating costs to particular programs, grants and contract is as follows; A) All costs identifiable with a specific program, grants or contracts are charged directly to the benefitting program. 69 B) Unassigned direct coats are assigned to cost pools and are allocated monthly based on monthly time sheet distribution percentages of the personnel assigned to each particular cost pool. For example, the percentages taken against the Employment Services cost pool only come from Employment Services staff. ALLOCATION METHODOLOGY DHS uses five cost pools; 1) Transportation Cost Pool---This pool is used to accumulate all the joint costs associated with running DHS's Transportation Department which provides minibus transportation for several of our programs. This pool includes transportation staff salaries, fringe benefits, and all transportation operational costs. 2) Employment Services Cost Pool---This pool is used to accumulate all the joint costs associated with the operations of Employment Services including; Employment Services staff salaries, fringe benefits, and other costs which cannot be directly identified to a program. 3) Area Agency on Aging Cost Pool---This pool is used to accumulate all salary and fringe costs and joint costs associated with Area Agency on Aging employees and programs. 4) Administrative Cost Pool---This pool includes all administrative salaries, fringe, overhead and other joint costs associated with administering all DHS programs that cannot be directly identified to a grant or contract. 5) FENWC Cost Pool---This pool is used to accumulate all the joint costs associated with the operations of Family Educational Network of Weld County including; FENWC staff salaries and fringe, as well as other costs which cannot be directly identified to a specific program. TRANSPORTATION COST POOL The Transportation Department system tracks client miles and trips associated with each program served. These figures are accumulated into a monthly report. Monthly, percentages of miles per program are calculated for the period. The percentages are taken against the total transportation department costs for the month. The amounts are allocated from the pool to the program (fund) receiving benefit. 70 EMPLOYMENT SERVICES COST POOL Monthly time sheets are kept by all Employment Services employees noting their time per month per program served. Monthly, the time worked per program is entered into a spreadsheet which calculates total time (weighted by rates of pay) percentages per program. The time/rate percentages are taken against this pool of costs and are allocated to grants served accordingly. AREA AGENCY ON AGING SERVICES COST POOL Monthly time sheets are kept by all Area Agency on Aging employees noting their time per month per program served. Monthly, the time worked per program is entered into a spreadsheet which calculates total time percentages per programs weighted by rates of pay. The time/rate percentages are taken against this pool of costs and are allocated to grants served accordingly. ADMINISTRATIVE COST POOL Monthly time sheets are kept by all Administrative staff noting their time per month per program served. Monthly, the time worked per program is entered into a spreadsheet which calculates total time percentages per program weighted by rates of pay. The time/rate percentages are taken against this pool of costs and are allocated to grants served accordingly. FENWC COST POOL Monthly time sheets are kept by all FENWC staff noting their time per program served. The classroom staff allocates by percentage of children per program. Monthly, the percentages are calculated and taken against this pool of costs and allocated to grants and programs served accordingly. 71 GENERAL LEDGER ACCOUNTING Weld County uses a uniform classification of accounts for all general ledger departments. Each grant or program is its own general ledger department (fund) . All direct costs are charged directly to the particular department it served. All allocated costs are entered into the ledger by journal entry--from the pools to the grant departments. Each allocated line item is coded so it can be identified as to cost pool source. Each expense, whether direct or allocated, is also coded with a program code to charge it against the cost category defined by the grant. REPORTING Most grant programs are on monthly reporting. Each general ledger department is printed for the time period to report. The department carries the calendar year-to-date totals for each cost category of expenses. From the total for the grant cost category is subtracted what has been reported in prior periods of the same calendar year. The balance for the cost category is transferred to the report for the current period. The ledger report, is the documentation of costs and backup to reported expenditures. 72 - WELD COUNTY DIVISION OF HUMAN SERVICES (Regular Employees Benefit Time and FLSA) ACTIVITY SHEET NAME: _.. DEPT. NO. SOCIAL SECURITY# YEAR TOTKL 'TOTAL GRANT ADMIN- PAY PERIOD I - OVER SICK IVACA- PERS- 'FUN- LEAVE WORK OH.l- GRANTS HRS HRS I REG. TIME TIME TION ONAL ERAL W/O PA COMP DAY HEAD START 1HRS HRS HRS HRS HRS HRS HRS HRS HRS TOTAL PRESCHOOL __----_, 16 MIGRANT HEAD START -- 17 W/P WAGNER PEYSER 18 W/P SUMMER JOB HUNT • - 19 W/P RAPID RESPONSE _ 20 r W/P DISCRETIONARY (TTP) 21 _ EMPLOYMENT FIRST ___ ___ 22 WORKFARE .- 23 tTGYS 24• TANF 25 . TANF SUMMER PROGRAM _- I 26 WELFARE TO WORK 70% �. 27 WELFARE TO WORK 30% - 28 WIA ADMIN. 29 - ___ `WIAADULTPROGRAM _.- • 30 WIA IN-SCHOOL YOUTH PROGRAM ~ 31 WIA OUT OF SCHOOL YOUTH - 1 WIA DISLOCATED WORKER A_ _ 2� ___ I WIA STATEWIDE ACTIVITIES WIA DISPLACED HOMEMAKER 4 �'COMPUTER LAB 5 AMERICORP 6 , AAAADMIN. 7 AAA B-LEGAL _ 8 AAA B-OMSBUD. 9 AAA B-COORD. 10 AAA C-1 NUTRITION -� 11 AAA C-2 HOME DEL. 12 AAA D HEALTH SERVICES I 13 E AAA SPEC.OMSBUD. 14 AAA ELDER ABUSE 15 AAA ADMN.STATE PROGRAMS TOTAL MA DENTAL STATE PROGRAMS Total"GRANT HOURS"must be equal to the total of MA OMB.STATE PROGRAMS "REG HRS". Do not Include any leave in your total of Grant MA C.M.STATE PROGRAMS __ w____ MA O.R.STATE PROGRAMS SEP Hours. FCN Activity in program is defined in staff job description located in personnel file. VALE Included above is all time worked during this pay period. Included is ALL break and/or TRANSPORTATION _ meal time for which I was not completely relieved from duty. 1 certify that the above CSBG � '__-_.__—_, SUPP FOODS OTHER information is true and correct to the best of my knowledge. — TOTAL __4J Employee Signature Itttre _ 73 ' I r Weld County Area Agency on Aging y1✓N ` N V: `eXat I44/ J f \t<t .� y ti 7,4c F,Y. 4/ ki i,-2 t "� F .i ce ...i '` l ry 4tier;;?'. c. 44 „ .1.7.4\ .0,'1 r.C C k f n.4r r • Needs Assessment of Caregivers in Weld County 2002 Conducted by Robbyn R. Wacker, PhD University of Northern Colorado College of Health and Human Sciences L .t Needs Assessment Of Caregivers in Weld County Prepared for: Weld County Area Agency on Aging P. O. Box 1304 Greeley, CO 80632 970-353-3600 Prepared by: Robbyn R. Wacker, Ph.D. Associate Dean of the College of Health & Human Services Professor of Gerontology Program University of Northern Colorado 1000 Gunter Hall Greeley, CO 80639 970-351-1582 September 2002 2002 WCAAA Caregiver Assessment 3 Abstract Title: Needs Assessment of Caregivers in Weld Count Subject: A study to identify the needs of caregivers in Weld County who had previously cared for or were caring for persons age 60 and older. Date: September 2002 Abstract: A random-sample, statistically representative needs assessment of 224 Weld County residents who were caring for persons aged 60 and over was conducted via mail surveys. This report describes the findings of the survey, delineating the activities and needs of persons who had in the last 6 months cared for or were currently caring for persons aged 60 and older. 2002 WCAAA Caregiver Assessment 4 Acknowledgements Conducting a comprehensive needs assessment by contacting a representative sample of caregivers who reside in Colorado's Weld County required the assistance of numerous individuals. I wish to thank the individuals who worked behind the scenes to make this project a reality. First, I wish to acknowledge the input and insights of the initial instrument development committee. This committee consisted of community members who participated in three meetings during which the first layout of the questionnaire was drafted. These individuals include: Jerry Kearney Pat Graham Bonnie Wacker Crystal Day Eva Jewell Mary Pat Eastwood Corny Dietz Jose Sanchez Ruth Gartrell Don Beierbach Next, I could not have completed the research without the efforts of two research assistants, Sonja Rizzolo and Shirley Newsom-Gamez. Both Sonja and Shirley worked on the research team from the beginning, helping to identify randomly-selected respondents, fine-tuning the questionnaire, training and supervising interviewers, coding and entering the data, assisting with and generally being available when their assistance was needed. Finally, and perhaps most importantly, I want to thank the 224 Weld County caregivers who graciously consented to participate in the study by returning the completed mail survey. Without their input and responses, this project could not have been completed. All of these individuals contributed to the collection of invaluable data that will assist the Weld County Area Agency on Aging in developing programs and resources to help address the needs of Weld County caregivers. Dr. Robbyn R. Wacker Project Director 2002 WCAAA Caregiver Assessment 5 Table of Contents LIST OF TABLES 8 LIST OF FIGURES 9 EXECUTIVE SUMMARY 11 INTRODUCTION 11 METHODOLOGY 11 SURVEY FINDINGS 11 SOCIODEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS 11 CARE RECIPIENT CHARACTERISTICS 12 Age 12 Residence 12 Health Problems of Care Recipients 13 Behavior Problems of Care Recipients 13 CAREGIVING ACTIVITIES 13 Types of Assistance Provided 13 Frequency of Assistance Provided 13 Help with Caregiving Assistance 14 Use of Community Resources 14 HELPFUL INFORMATION 14 CAREGIVER STRESS 14 Job Stress 15 POSITIVE ASPECTS 15 RURAL AND URBAN DIFFERENCES IN CAREGIVING 15 GENDER DIFFERENCES IN CAREGIVING 15 DIFFERENCES BY RACE OF CAREGIVER 16 WORKING AND NON-WORKING CAREGIVERS 16 CAREGIVER NEEDS BY CARE RECIPIENT CONDITION 16 RECOMMENDATIONS 16 SECTION I - INTRODUCTION 18 BACKGROUND 18 OBJECTIVE 18 REPORT ORGANIZATION 18 SECTION II - METHODOLOGY 20 2002 WCAAA Caregiver Assessment 6 QUESTIONNAIRE DEVELOPMENT 20 SAMPLE 20 SURVEY PROCEDURES 21 CODING,DATA ENTRY,AND QUALITY CONTROL MEASURES 23 SECTION III - SURVEY FINDINGS 24 SOCIODEMOGRAPHIC CHARACTERISTICS OF CAREGIVERS 24 SEX 24 AGE 24 RACE/ETHNICITY 24 MARITAL STATUS 24 EDUCATION 24 HOUSEHOLD CHARACTERISTICS 24 RESPONDENT HOUSEHOLD LOCATION 25 CAREGIVER HEALTH 25 INCOME 25 CARE RECIPIENT CHARACTERISTICS 33 AGE 33 RESIDENCE OF CARE RECIPIENTS 33 HEALTH PROBLEMS OF CARE RECIPIENTS 34 BEHAVIOR PROBLEMS OF CARE RECIPIENT 36 CAREGIVING ACTIVITIES 38 Types of Assistance Provided 38 Frequency of Caregiving Assistance 40 HELP WITH CAREGIVING ACTIVITIES 42 Types of assistance provided by supplementary caregivers 43 Help provided to non-spousal caregivers 45 Help provided to spousal caregivers 45 USE OF COMMUNITY RESOURCES 46 Reasons for nonuse of community resources 47 Satisfaction with service use 52 TYPES OF ASSISTANCE,INFORMATION OR SUPPORT NEEDED BY CAREGIVERS 54 CAREGIVER'S ATTITUDE TOWARD USE OF COMMUNITY RESOURCES 58 WORK AND CAREGIVING 60 EMOTIONAL ASPECTS OF CAREGIVING 61 Help from care recipient 61 Problems or inconveniences experienced by caregivers 61 CAREGIVING DIFFERENCES BY LOCATION,GENDER, RACE, EMPLOYMENT STATUS,AND CARE RECIPIENT CHARACTERISTICS 64 RURAL AND URBAN CAREGIVERS 64 MALE AND FEMALE CAREGIVERS 65 DIFFERENCES BY RACE OF CAREGIVER 66 WORKING AND NON-WORKING CAREGIVERS - 66 CAREGIVER NEEDS BY CARE RECIPIENT CONDITION 66 SUMMARY AND RECOMMENDATIONS 67 2002 WCAAA Caregiver Assessment 7 RECOMMENDATIONS 68 APPENDIX _ 71 2002 WCAAA Caregiver Assessment 8 List of Tables Table 1. Telephone screening process 22 Table 2. Demographic characteristics of 224 survey respondents 26 Table 3. Demographic characteristics of 224 survey respondents (cont.) 27 Table 4. Relationship of supplemental helpers to primary caregiver 43 Table 5. Agreement/Disagreement with Attitudinal Statements Regarding Service Use* 59 Table 6. Feelings regarding caregiving activities 63 2002 WCAAA Caregiver Assessment 9 List of Figures Figure 1. Percentage of male and female caregivers (n=218) 28 _ Figure 2. Relationship of caregiver to care recipient (n=217) 28 Figure 3. Caregivers' race/ethnicity (n=206) 29 Figure 4. Caregivers' marital status (n=217) 29 Figure 5. Caregivers' educational level (n=221) 30 Figure 6. Number people living in household under age 18 (n=209) 30 Figure 7. Caregivers' Household income (n=206) 31 Figure 8. Comparative health status of caregivers (n=219) 31 Figure 9. Respondents' age groups (n=218) 32 Figure 10. Amount of time caregiving (n=217) 32 Figure 11. Care recipient's age (n=216) 33 Figure 12. Care recipient's residence (n=212) 34 Figure 13. Type of illnesses of care recipients 35 Figure 14. Number of conditions of care recipients 35 Figure 15. Percent of care recipients with selected behavior problems 36 Figure 16. Percent of care recipients with selected behavior problems (cont.) 36 Figure 17. Percent of care recipients with selected behavior problems (cont.) 37 Figure 18. Percent of care recipients with occasional or frequent behavior problems 37 Figure 19. Percent of caregivers who provide caregiving activities 39 Figure 20. Percent of caregivers who provide caregiving activities (cont.) 39 Figure 21. Percent of caregivers who provide caregiving activities (cont.) 40 Figure 22. Percent of caregivers who provide caregiving activities at all times or frequently 40 Figure 23. Percent of caregivers who provide caregiving activities at all times or frequently 41 Figure 24. Percent of caregivers who provide caregiving activities at all times or frequently (cont.) 41 Figure 25. Percent of caregivers who provide caregiving activities at all times or frequently (cont.) 42 Figure 26. Type of caregiving assistance provided by Helper A 43 Figure 27. Type of caregiving assistance provided by Helper B 44 Figure 28. Type of caregiving assistance provided by Helper C 45 Figure 29. Percent of caregivers who used selected community resources 47 Figure 30. Percent of caregivers indicating they did not know what the service could provide 48 Figure 31. Percent of caregivers who indicated that not needing the service was the reason for nonuse 49 Figure 32. Percent of caregivers who indicated that the reason for nonuse of selected community resources was because care recipient did not want to use the service 50 Figure 33. Percent of caregivers who indicated that cost of the service was the reason for nonuse 51 Figure 34. Satisfaction with use of community services 52 Figure 35. Satisfaction with use of community services (cont.) 53 Figure 36. Satisfaction with use of community services (cont.) 53 2002 WCAAA Caregiver Assessment 10 Figure 37. Satisfaction with use of community services (cont.) 54 Figure 38. Programs and services very or somewhat important to caregivers 56 Figure 39. Programs and services very or somewhat important to caregivers (cont.) 56 Figure 40. Programs and services very-or somewhat important to caregivers (cont.) 57 Figure 41. Programs and services very or somewhat important to caregivers (cont.) 57 Figure 42. Type of difficulties caregivers experience at the workplace 60 Figure 43. Problems or inconveniences experienced by caregivers 62 Figure 44. Problems or inconveniences experienced by caregivers (cont.) 62 Figure 45. Problems or inconveniences experienced by caregivers (cont.) 63 Figure 46. Differences in caregiver needs by location 65 2002 WCAAA Caregiver Assessment 11 Executive Summary Introduction As mandated by the Older Americans Act of 1965, the Weld County Area on Aging (WCAAA) is the coordinating entity serving the needs of persons age 60 and older residing in Weld County. Every four years, the State requires the 16 Colorado AAAs to develop a comprehensive plan addressing the needs of older adults in their respective regions. In addition, new dollars were allocated by the federal government to support caregiving activities. In order to determine what programs and services were needed by caregivers, the WCAAA decided that a statistically representative survey assessing the needs of caregivers of older adults would provide the data necessary to develop needed programs and services. The Caregivers of Weld County Survey was conducted by Dr. Robbyn R. Wacker from the University of Northern Colorado, College of Health and Human Sciences. The goal of the needs survey was to collect sufficient data through mail surveys to assess the needs of Weld County caregivers caring for persons age 60 and older. Methodology To identify caregivers, a list of households with a householder over the age of 40 was obtained. Households were randomly selected and called in order to identify any individuals who were currently caring for or had been caring for (in the last 6 months), an individual over the age of 60. Calls were made between July 1, 2002 and August 4, 2002. Some 8,831 households were contacted resulting in identifying 364 caregivers. Once identified by phone, caregivers were asked to participate in the study and if they agreed, they were mailed a survey, a postage paid return envelope, a Help Source Referral Guide, information about a Respite Program and a pill reminder box with the Area Agency on Aging's logo and phone number. To achieve a statistical reliability of +7.0% at the 95% confidence level, 220 respondents needed to be surveyed. By September 21, 2002, a total of 224 useable surveys were returned. Survey Findings Sociodemographic Characteristics of Respondents Of the 224 respondents completing the survey, 76.6% were females and 23.4% were males. Half of the respondents were the care recipient's daughters or daughter-in-laws (50.7%), 16.6% were sons or son-in-laws, 12.9% were spouses, 8.3% were non- relatives or friends and the remaining 11.5% were other family members (e.g., siblings, grandchildren). Twenty-two percent (22%) respondents were under the age of 50, 28.9% were between the ages of 50-60, 28.9% were between the ages of 61-70, 20.2% were over the age of 70. The mean age of respondents was 58.9. The majority of 2002 WCAAA Caregiver Assessment 12 respondents (51 .6%) indicated that their health was good compared to others their age, and 30.1% reported their comparative health as excellent. The vast majority of respondents (91.3%) were white; of the remaining 8.7%, 5.5% were Hispanic, with Asian Americans and persons of mixed race representing the remainder of the respondents. Slightly more than 75% were married (75.1%). Divorced and separated respondents represented the next largest group (10.6%), followed by widowed (8.3%), and never married (6.0%). The largest percentage (31.0%) of respondents reported their highest level of education as being high school graduates (or GED recipients). The rest reported their educational attainment (in descending frequency) as having some college (27.3%); a bachelor's degree (17.1%); a graduate degree (12.5%); an associate's degree (7.4%); and less than high school (4.6%). One-fifth (21.5%) reported having 1 or more persons under the age of 18 living in the household. One-hundred-fifty-five respondents (69.2%) resided in urban locations and 69 respondents (30.8%), in rural locations. Almost half (50.5%) reported that they were working. The average number of hours caregivers were working was 36 hours per week. Twelve percent of respondents (12.4%) reported annual household incomes of less than $15,000; 18.1%, $15,000-$24,999; 17.6%, $25,000-$34,999; 15.5%, $35,000- $44,999, 10.4%, $45,000-$54,999; 7.3% $55,000-$64,999; 7.8% $65,000-$74,999 and 10.9% $75,000 or more. Thirty-one respondents (13.8%) refused to divulge their annual household incomes. The number of years caregivers reported participating in caregiving activities ranged from 1 month to 53 years. The average length of time was 4.6 years. Sixteen percent of respondents had been caregiving less than 1 year; 22.1% one to two years; 24.4% three to four years; 15.2% five to six years; 5.1% seven to eight years, and 17.5% indicated nine or more years. Care Recipient Characteristics The age of the care recipients ranged from 60-101 years. The average age of care recipients was 82.6 years. Slightly more than 7% (7.4%) of caregivers cared for someone between the ages of 60-70; 31% of care recipients were between the ages of 71-80; 43.5% between the ages of 81-90 and 18.1% over the age of 90. Residence The majority of the care recipients lived in their own residence (53.8%). The remainder lived with the caregiver (27.8%), in a nursing home (9.4%), or in an assisted care facility (9.0%). Those care recipients who lived with non-spousal caregivers (n=29) have lived in the caregiver's home, on average for 7.0 years. Caregivers who did not reside with 2002 WCAAA Caregiver Assessment 13 the care recipient traveled on average, 21 minutes to where the caregiver resided. The amount of time it took to get to where the care recipient lived ranged from 1 minute to 8 hours. Health Problems of Care Recipients Care recipients had a variety of illnesses. The majority reported having mobility problems (59.6%), high blood pressure (40.8%), arthritis (38.1%), hearing loss (37.7%), and heart disease (32.3%). Other conditions included dementia or Alzheimer's Disease (27.4%), blindness or vision loss (22.9%), osteoporosis (22.8%), incontinence (21.1%), diabetes (17.5%), stroke (14.8%), lung disease (13%), and cancer (11.2%). Less than 10% had broken bones, mental or emotional illness, and neurological problems. Approximately 15% had other illnesses (14.8%). When asked what the recipient's main health illness was, 30.1% indicated mobility difficulties and 20.4% said dementia or Alzheimer's Disease. Behavior Problems of Care Recipients Almost 2/3rds of care recipients (62.5%) frequently or occasionally were awake in the night. Other behavior problems that occurred frequently or occasionally included being forgetful, confused or uncooperative (58.4%), unable to be left alone in the house, ;33.5%); becomes upset or yells (29%); embarrasses caregiver, (23.5%) and becomes violent (6.5%). Caregiving Activities When asked how many hours per week caregivers spent on caregiving activities, 43% reported spending 8 hours or less; 27.9% provide 9-20 hours, 11.1% spend 21-40 hours, and 17.8% report spending 41 hours or more per week. Types of Assistance Provided Almost all caregivers reported providing assistance in running errands (91.4%) and a similar percent indicated they helped with transportation needs (88.7%). Other types of assistance provided by more than half of the caregivers included meal preparation (60.6%), assistance with government programs, such as Medicare and Medicaid (60.2%), making telephone calls (57.7%), and help getting around with an assistive device (55.1%). Approximately a quarter of respondents provided care with personal needs such as dressing, bathing, toileting, and feeding. Frequency of Assistance Provided Over half of respondents indicated that they provided assistance at all times for running errands (57.3%), managing finances (54.2%), helping with government assistance programs (53.8%), making medical appointments (53.1%), helping with transportation needs (51.3%). Other assistance provided at all times by a high percent of caregivers included help bathing (48.2%), doing laundry (48.9%), preparing meals (46.2%), and running errands (42.6%). 2002 WCAAA Caregiver Assessment 14 Help with Careqivinq Assistance Slightly more than half (55.4%, n=108) of caregivers reported that they had assistance with caregiving activities from one other person. Twenty percent of these secondary caregivers were spouses and 38.7% were brothers or sisters. Most (59.8%) helped less than 5 hours per week. One third (n=75) reported having a second person helping with caregiving activities and 13.8% (n=31) had three people who helped. Use of Community Resources Slightly less than half (42.7%) of the respondents reported using home health services. Lifeline service, homemaker assistance, ombudsman services, and hospital care coordinators were used by less than one-fifth of caregivers. Those who used community resources reported high satisfaction with those services. Caregivers most often reported that the reason for nonuse of community services was that they didn't need the service. Only three services (case management with the Area Agency on Agency, Area Agency on Agency Referral and transportation services) had less than 50% report they did not need these services. For the latter two services, caregivers were more likely to report they did not know what these services could provide. In addition to not needing the service and not knowing what the service provided, caregivers most often reported that the reason for not using the service was due to the care recipient not wanting to use the service. Caregiver's also reported information about their attitudes toward community service use. Over 50% reported that they wished there was someone who could tell them more about services and 45.8% reported that did not know who to call to find services. Worrying about the safety of their loved one when being cared for by someone else was reported by 41.1% of caregivers and other 35.1°/0 reported it would hard to trust someone from the community to help care for their loved one. Helpful Information Over a third (34%) said that having information about the care recipient's condition and receiving advice from a medical professional was a very important need. Approximately another 30% told us that having a central source of information for caregivers to access and having information about applying for and paying for services were also very important. Almost a quarter of caregivers thought it was very important to have guidance on legal matters and to have help with giving care recipient personal care. Caregiver Stress Worrying about the care recipient's condition was a serious issue for 38.8% of caregivers. Other caregiving activities that caused caregivers stress included giving up their own activities (e.g., vacations and hobbies, 29.1%), wishing that other relatives would do their fair share of caregiving assistance (27.6%), taking care of the recipient when they don't feel well (24.9%), their own emotional health (20.9%) and the care recipient's uncooperative or demanding attitude (20.9%). 2002 WCAAA Caregiver Assessment 15 Job Stress Approximately half (n=109, 49.5%) of the caregivers reported that they were working and the average amount of hours worked in a week was 36 hours. Fifteen percent reported that they were working fewer hours than they would like because of their caregiving duties, 11.2% reported that caregiving activities kept them from looking for work and 12% told us they stopped working to take care of their loved one. In addition, some 64% of our caregivers told us that they had to rearrange their work schedule and almost one-quarter indicated that they had to take time off without pay because of their caregiving activities. Positive Aspects When asked how their loved one has been helpful to them, over half (54.4%) said they felt useful and needed. Keeping caregivers company and buying things for them was reported by another 37.4% and 34%, respectively. Twenty percent reported that the care recipient was unable to assist them in any way. When asked to summarize their caregiving experience in one word, 27.5% chose "love' and 20% chose "rewarding". "Stressful" was reported by 12.7% of caregivers. Rural and Urban Differences in Caregiving Rural and urban caregivers were providing very similar kinds of care with only four differences. Rural caregivers were more likely than their urban counterparts to help with housework, pet care, and transportation needs. Urban caregivers were more likely than rural caregivers to assist with Medicare or Medicaid or other types of government assistance. Urban caregivers reported more overall care recipient behavior problems than did rural caregivers. In addition, urban caregivers had more negative stress outcomes. More urban caregivers thought that getting advice from mental health professionals and getting more information about the recipient's condition was important. However, more rural caregivers reported needing help with shopping than did urban caregivers. Gender Differences in Caregiving Women caregivers are caring for persons with more chronic conditions, and they were more likely to report overall higher levels of emotional and physical stress. When examining what support and information services would be helpful to male and female caregivers, males indicated that help with housekeeping was a very or somewhat important issue. More female caregivers indicated that sitting services, having free time, needing caregiving skill training, getting advice from a medical professional, and having a caregiver support group were very important. 2002 WCAAA Caregiver Assessment 16 Differences by race of caregiver Non-white caregivers were providing more caregiving activities and were more likely to report worrying about their loved one's safety when someone else was caring for their loved one, report being fearful of having people from the community help with their loved one and report having a difficult time trusting others to care for their loved one. More non-white caregiver thought that getting more information about applying for or paying for services was very important. Working and non-working caregivers Working caregivers differed from non-working caregivers in that they reported that getting information about paying for and applying for services and benefits was very important, along with help with shopping, and getting information about the care recipient's condition. Part-time workers were interested in support groups with other caregivers, advice from mental health professionals, and a central source of information for caregivers. Caregiver needs by care recipient condition Caregivers caring for persons with AD had greatar levels of emotional and physical stress, reported not knowing about community resources, had care recipients with more difficult behaviors and who didn't want to use services compared to caregivers who were not caring for a person with AD. Caregivers caring for a person with AD wanted mental health and legal advice, a central source of information, more free time, and assistance with medical care. Caregivers caring for persons with incontinence scored higher on emotional and physical stress than did caregivers not caring for someone who was incontinent. These caregivers felt that help with home modifications, guidance on legal matters, having a central source of information for caregivers and help with personal care were very important services. Caregivers who were performing at least one Activity of Daily Living (help with toileting, dressing, bathing, eating, transferring, and getting around) wanted help with sitting services, giving personal care and obtaining medical equipment. They had higher rates of emotional and physical stress and had higher levels of fear, worry and trust when using others to assist in providing care. Recommendations The results of this study confirm the notion of"heterogeneity of need" among caregivers (Cantor, 1994). Caregivers have different needs in the "caregiving cycle". At the beginning of the caregiving cycle, caregivers are interested in obtaining information and linkages; at later stages in the cycle, when caregiving burdens increase, caregivers 2002 WCAAA Caregiver Assessment 17 need more assistance in personal care needs, sitting services, respite, and support groups. Thus the following recommendations for caregiver assistance programs and services are based on the data collected in this study: • Enhance and provide information and referral that gives caregivers information about medical conditions, mental health concerns, and programs and services (both private sector and government). Create a central source of information for caregivers at all stages to access. • Need for Sophisticated Targeting of Programs and of Marketing Strategies The varied needs of caregivers in this study require that programs target specific types of caregivers and use sophisticated marketing that targets specific caregivers and their needs. These unique needs are as follows: o Targeting supportive services to caregivers at the end of the caregiving cycle o Targeting beginning cycle caregivers with information and resources o Targeting information and resources to secondary family caregivers o Targeting the workplace where almost half are involved in some type of caregiving activity o Targeting by caregiving resources and services based on recipient conditions via health professionals o Targeting information and resources by ethnicity by networking with leaders in the Hispanic community. 2002 WCAAA Caregiver Assessment 18 Section I - Introduction Background As mandated by the Older Americans Act of 1965 (OAA), the Weld County Area on Aging (WCAAA) is the coordinating entity serving the needs of persons age 60 and older residing in Weld County. As such, WCAAA is responsible for: a) advocating for and protecting the rights of elders within the county; b) identifying service gaps; c) assisting service agencies and local governments in their planning and delivery of services for older persons; d) allocating Older Americans Act funds to providers to ensure service provision to elders, particularly those who are frail or disabled, of minority status, below poverty level, or living in rural areas; e) operating the long-term care ombudsman program; f) assessing the needs of seniors; and g) developing the area plan to provide a coordinated, comprehensive service continuum to meet the identified needs of Weld County residents age 60 and older. As a result of new directives under the OAA for serving caregivers, the WCAAA commissioned this study with the purpose of identifying caregiver activities, stresses and needs. This report represents a culmination of the research study beginning in July and ending in September of 2002. Objective The objective of the needs survey was to collect sufficient data through mail surveys to assess the needs of Weld County caregivers who were caring for persons age 60 and older. The results will be used to inform the creation of programs and services to support caregivers in Weld County. Report Organization The Executive Summary, located prior to this section, presents a synopsis of the report. This introductory section, Section I, provides some background regarding the origin of the needs assessment, delineates the objectives that the research project was designed to meet, and describes the layout of the report. Section II outlines the methods that were used to collect, analyze, and report the data. Section III offers the detailed findings derived from the quantitative portion of the needs survey. The Appendix contains a copy of the mail survey. Copies of other instruments, such as the telephone interviewer training guide (used to screen and identify caregivers), the coding key, or the call record), can be obtained by contacting Dr. 2002 WCAAA Caregiver Assessment 19 Wacker. All forms and data that would in any way jeopardize the confidentiality of the respondents will not be released. Section IG offers a series of recommendations to assist the WCAAA develop its plan to carry out the mandate of serving caregivers of elders age 60 and older. 2002 WCAAA Caregiver Assessment 20 Section II - Methodology Questionnaire Development Initial Committee Input: During the first phase of questionnaire development, Director Eva Jewell called together members of the WCAAA Advisory Board along with Dr. Wacker, to form a questionnaire development committee. These individuals participated in three meetings during which the first layout of the questionnaire was drafted. Questionnaire Refinement: After the first draft of the questionnaire was developed with committee input, Dr. Wacker continued to refine the questionnaire. Dr. Wacker pulled questions from various published research surveys and incorporated many of them into . the questionnaire. Questions from the national caregiver studies were also included. This questionnaire was reviewed and approved by Ms. Jewel and her board. Questionnaire Format: Dr. Wacker formatted the questionnaire to make the layout easy for mail respondents to complete (a copy of the survey is located in the Appendix). Two questionnaires were developed, one for caregivers who were currently providing care and one with the same questions written in past tense for caregivers who were not currently performing caregiving activities, but had done so in the last 6 months. Questionnaire Piloting: Dr. Wacker pretested the survey with caregivers who were solicited from local agencies (e.g., Eldergarden, local support groups, and the Area Agency on Aging). Feedback obtained from these pretest subjects was incorporated into the questionnaires to improve their comprehensibility, logic, and flow. Finalized Questionnaires: After the questionnaire had been thoroughly piloted and refined, the actual collection of data began. The first telephone calls to local caregivers began on July 1, 2002 and finished August 30, 2002. Sample Sampling Frame: To obtain a representative sample of eligible respondents, Dr. Wacker procured a database of persons age 40 and older residing in Weld County from Qwest. Qwest randomly selected approximately half of those households. The list indicated each householder's name and the mailing address of each potential respondent, and the telephone number for every household. The entire list contained 6,609 names. In order to oversample for elderly caregivers, a list of persons age 60 and over from Qwest was also used. This list contained 7,471 names. Sample's Statistical Reliability: To achieve a statistical reliability of +7.0% at the 95% confidence level, 220 respondents needed to be surveyed. Therefore, this study 2002 WCAAA Caregiver Assessment 21 t ensures that the findings are statistically reliable at±7.0%. This means that if 65% of the respondents answered "yes" to a question, that if the entire population of Weld County caregivers had been asked, anywhere from 58-72% would have answered "yes" to the question 19 out of 20 times. Sample Selection: There are no firm numbers of how many persons are caregivers in Weld County, however, by randomly sampling the general population, we can be more certain that the results we obtain are reflective of all caregivers in the County. To achieve the desired sample of 220 respondents, every ninth name on the 40+ and 60+ age household Qwest list of households was selected for inclusion in the study and this continued until the desired number of caregivers were identified and agreed to participate. Survey Procedures Time Period: Training for the callers who were to identify and invite caregivers to participate in the study was conducted on June 27, 2002. Calling commenced on July 1 , 2002 and callers worked Monday through Thursday from 3pm to 7 pm and ended August 30, 2002. The first survey was mailed out on July 15, 2002. Follow up reminder calls to those caregivers who had agreed to participate in the study, but had not yet returned the survey were made the 2nd week in September. The final survey was returned September 25, 2002. Staff: Dr. Wacker was the principle investigator in charge of the study. The two supervisors, Sonja Rizzolo and Shirley Newson-Gamez, assisted her throughout the telephone survey process. Individuals who called households to identify caregivers were hired and trained by Dr. Wacker. Training of Supervisors and Telephone Screeners: Dr. Wacker spent 10 hours training the supervisors and callers using the "Interviewer Training Manual" she had created. The Telephone Screeners were taught the specific screening protocols to ensure standardization when screening for caregivers and soliciting their participation. Call Record: Call records were developed to provide a list of households contacted, and identification of eligible respondents as identified in the random sample selection process explained above. The call record listed the respondent name, city, and telephone number. Interviewers were instructed to record their individual interviewer identification code, the date, and time of the first contact with a respondent. At the end of the contact, possible disposition codes would be recorded. If the interviewer encountered a non-eligible (e.g., a noncaregiver or caregiver of someone under age 60) s/he would record the appropriate code on the call record and no further attempts to call that individual would be made. If the respondent was unavailable (e.g., answering machine message or the phone was busy) the interviewer would mark this as the first attempt and leave a message when possible. After two attempts to reach a respondent, no further call backs were made. 2002 WCAAA Caregiver Assessment 22 Random Sample With Replacement: To achieve the designated number of respondents, the project used the "random sample with replacement" method. When respondents were ineligible, refused, or could not be reached after two attempts, a replacement was selected from the sampling frame. These replacement respondents were selected from the Qwest sampling frame list by taking the name of the household immediately following the name of the potential respondent who had been eliminated from the study. Supervision of Telephone Interviewers: The Supervisors took turns supervising the telephone screeners. Their role was to listen to the screeners to ensure proper etiquette and to achieve strict adherence with protocol. Respondent Incentive to Participate: In an effort to increase respondent participation, all received a pill reminder box with the AAA logo and number, a Help Source resource guide from the AAA and a flyer about a respite program available through the AAA. All caregivers who agreed to participate in the study received a letter that briefly explained the project, promised the respondent confidentiality, the survey and a stamped self return envelope to use to return the survey. The letter was produced on UNC letterhead and was hand-signed by Dr. Wacker. Telephone Screening and Sample Selection By analyzing the call records, the outcome of all the phone attempts to identify caregivers could be calculated (Table 1). Table 1. Telephone screening process Number of households contacted 8,831 Number of phone calls made to identify 11 ,541 caregivers 541 Number of caregivers identified 177* Number of caregivers refusing to participate 364 Number of caregivers agreeing to participate 67% As °/.3 of total caregiver contacts 224 Number of completed surveys 61% As % of caregivers agreeing to participate * estimate As Table 1 indicates, to achieve the 220 completed telephone surveys, a total of 8,831 households were contacted. Some 11,541 calls were made to households in order to identify caregivers. The most common reason for failure to participate in the study was that respondents were not caregivers. The second most common reason for failure to participate in the study was among the households where potential respondents could not be reached after two attempts had been made. We estimate that 541 households reported having a caregiver, but 177 refused to participate in the study. The number 2002 WCAAA Caregiver Assessment 23 refusing to participate is an approximate number as many contacts chose to hang up before more information could be gathered to determine if these self-identified caregivers met our criteria for inclusion in the study. To achieve the 220 completed mail surveys, a total of 364 households initially were sent a survey packet. One-hundred- ninety-seven (197) received a follow-up post card reminder, and 25 of those eligible to participate received another mail survey packet. Phone calls were made the remaining caregivers (n=100) who had not returned their surveys. The acceptance rate (the number returned [224] divided by the total number of eligible households randomly selected for the mail survey [364 eligible]) was 61%. Mail Survey Packet: Each of the mail surveys mailed to the sampled respondents contained the following: • a cover letter explaining the purpose of the survey, promising respondent confidentiality, and requesting participation. Each letter was printed on UNC letterhead and was hand-signed by Dr. Wacker • a postage-paid return envelop for respondents to send back their completed surveys • the mail survey, which was coded on the back with an identification number so that Dr. Wacker could track which respondents had returned a completed survey and which respondents would need a follow-up mailing • incentives for participating, that included a pill box with the WCAAA logo on it, a Help Source Guide, and a flyer about a respite program from the WCAAA (See Appendix) Coding, Data Entry, and Quality Control Measures Dr. Wacker supervised and assisted in the creation of the coding key and trained the two supervisors on how to code the surveys for data entry. The 32-question on the surveys resulted in a total of 390 variables. The coding key clarified how each variable would be coded. The two supervisors coded the surveys using the same coding key so that all data would be coded exactly the same. Dr. Wacker next trained the two supervisors how to enter the coded surveys into the SPSS PC statistical software package. They again followed strict protocol so that every survey would be entered in the same way to ensure standardization of data. For the final stage of data quality control measures, Dr. Wacker checked the accuracy of the data by comparing data runs with viable response ranges. In this way, the data set was thoroughly reviewed and revised to eliminate any data entry errors, thus assuring that the data being analyzed were accurate. 2002 WCAAA Caregiver Assessment 24 Section III - Survey Findings Results from the data derived from the survey are presented in this section. The following is based on the analysis of a total of 224 completed surveys. The report and the charts/graphs are based on the "valid percentage" in which the base number includes only the respondents for whom a factual (i.e., "valid") response is available, thus excluding missing data. Sociodemographic Characteristics of Caregivers The sociodemographic characteristics of the caregivers are presented in Tables 2-3. Figures 1-10 graphically illustrate the various sociodemographic characteristics of respondents. Sex Of the 224 respondents completing the survey, 76.6% were females, 23.4% were males. Age The ages of the caregivers ranged from 19 to 86. The average age was 58.9. Twenty- two percent were under the age of 50, 28.9% were between the ages of 51-60 and 61- 70, and another 20% were over the age of 71. Race/Ethnicity The vast majority of respondents (91.3%) were white whereas 5.5% were of Hispanic origin; 1 .4%, Asian American; and 1.9% classified themselves as being of mixed race. Marital Status Three quarters of the survey respondents were married (75.1%). Divorced/separated were the next largest group (10.6%), followed by widows and widowers (8.3%), and never married (6.0%). Education The largest percentage (31%) of respondents reported their highest level of education as being high school graduates (or GED recipients). The rest reported their educational attainment (in descending frequency) as having some college (27.3%); a bachelor's degree (17.1%); a graduate degree (12.5%); an associate's degree (7.4%) or less than high school (4.6%). Household Characteristics Seventy nine percent indicated that no one under age 18 lived in their household; 17.2% had 1-2 persons under 18 living in the household and 4.4% had 3 or more persons under age 18 living in the household. 2002 WCAAA Caregiver Assessment 25 Respondent Household Location Sixty-nine percent (n=155) of respondents lived in Greeley/Evans; the remainder in rural areas in Weld County. Caregiver Health More than three quarters (81.7%) reported their health as either good or excellent. Sixteen percent felt their health was fair and 1.8% poor. Income Respondents were asked to identify the income category into which their household annual income fell. Breaking down income by category, 18.1% had incomes between $15,000-$24,999; 17.6% had incomes between $25,000-$34,999; 15.5% had incomes between $35,000-$44,999; 12.4% less than $14,999; 10.9% with incomes above $75,000; 10.4% with incomes between $45,000-$54,999; 7.8% between $65,000- $74,999; and 7.3% with incomes between $55,000-$64,999. Thirty-one respondents refused to divulge their annual household incomes. 2002 WCAAA Caregiver Assessment 26 Table 2. Demographic characteristics of 224 survey respondents Sex Number Percent Male 51 23.4 Female 167 76.6 Age <50 48 22.0 X=58.9 51-60 63 28.9 61-70 63 28.9 71+ 44 20.2 Race/Ethnicity White 200 91.3 Hispanic 12 5.5 Asian American 3 1.4 Mixed Race 4 1.8 Marital Status Married 163 75.1 Widowed 18 8.3 Never married 13 6.0 Divorced/separated 23 10.6 Education Less than HS 10 4.6 High school/GED 67 31 .0 Some college 59 27.3 AA degree 16 7.4 College graduate 37 17.1 Graduate degree 27 12.5 2002 WCAAA Caregiver Assessment 27 Table 3. Demographic characteristics of 224 survey respondents (cont.) Household Members Under 18 Number Percent None 164 78.5 1-2 persons 36 17.2 3 or more persons 9 4.4 Residence in Weld County Number Percent Greeley/Evans 155 69.2 Rural 69 30.8 Length of Time Caregiving <1 year 34 15.7 1-2 years 48 22.1 3-4 years 53 24.2 5-6 years 33 15.2 7-8 years 11 5.1 9+ years 38 17.5 Comparative Health Status of Caregiver Excellent 66 30.1 Good 113 51.6 Fair 36 16.4 Poor 4 1.8 2002 WCAAA Caregiver Assessment 28 Figure 1. Percentage of male and female caregivers (n=218) Male 23.4% F ! l ......----- Female 76.6% Figure 2. Relationship of caregiver to care recipient (n=217) Other Family Nonrelatives or 9.8% Friends 10.8% { , Daughters/ P� / Daughters-in- Spouse . , =- law 13.1% - G, .W-.,✓.�-- ' 50.0% Sons/Son-in- laws 16.3% 2002 WCAAA Caregiver Assessment 29 Figure 3. Caregivers' race/ethnicity (n=206) Asian American Hispanic 1.3% Mixed Race 5.4% 1\ 1.8% 3 v J rr White 91.5% Figure 4. Caregivers' marital status (n=217) Never Married Divorced 6.0% Separated 10.6% Widowed --__..._. :..,, 8.3% f. s Married 75.1% 2002 WCAAA Caregiver Assessment 30 Figure 5. Caregivers' educational level (n=221) Graduate Degree <HS 12.5% 4.6% Mi Bachelors'441 ` ik HS Degree 31.0% 17.1% Y Assoc Degree 7.4% Some College 27.3% Figure 6. Number people living in household under age 18 (n=209) 3+ Persons 4% 1-2 Persons 17.2% None 78.4% 2002 WCAAA Caregiver Assessment 31 Figure 7. Caregivers' Household income (n=206) 18.1% 17.6% 15.8% 12.4% 10.4% 10.9% 7.3% 7.8% I <$14,999 $15- $25- $35- $45- $55- $65- $75,000 24,999 34,999 44,999 54,999 64,999 74,999 Figure 8. Comparative health status of caregivers (n=219) Poor Fair 2% 16%4141111 Excellent `c 31% Good 51% 2002 WCAAA Caregiver Assessment 32 Figure 9. Respondents' age groups (n=218) _ 71+ <50 20.2% 22.0% s z 1 r 61-70 51-60 28.9% 28.9% Figure 10. Amount of time caregiving (n=217) 24.4% 22.2% 17.5% 16/0 15.2% = ,t 5.1% I 1 I 1 1 1 <1 year 1-2 years 3-4 years 5-6 years 7-8 years 9+ years 2002 WCAAA Caregiver Assessment 33 Care Recipient Characteristics Age — The age of the care recipients ranged from 60 to 101 years. The average age of the care recipients was 82.6 years. As shown in Figure 11, slightly more than 7% (7.4%) cared for someone between the ages of 60 - 70; 31% of care recipients were between the ages of 71-80; 43% between the ages of 81-90 and 18.1% over the age of 90. Figure 11. Care recipient's age (n=216) 60-70 years 91 years 18% 7/o \ AID 71-80 years ` _ . 31% 81-90 years 44% Residence of Care Recipients The majority of caregivers were caring for a care recipient who was living in their own residence (see Figure 12). Over half (53.8%) of care recipients were living in their own homes and over a quarter (n=59, 27.8%) lived with the caregiver. The remainder of the care recipients lived in a nursing home (9.4%) or an assisted care facility (9.0%). Those care recipients who lived with a non-spousal caregiver have lived, on average, in the caregiver's home for 7 years. Caregivers who traveled to the care recipient to provide care, traveled an average of 21 minutes. The amount of travel time ranged from 1 minute to 8 hours. 2002 WCAAA Caregiver Assessment 34 Figure 12. Care recipient's residence (n=212) Live in Asst Living Live in NH 9.0% 9.4% Live in own ti residence Live with e 53.8% caregiver 27.8% Health Problems of Care Recipients Caregivers identified the types of health problems their loved one had as well as identified the recipient's main health problem. Most of the care recipients had difficulty with some chronic condition or conditions including mobility (59.6%) followed by high blood pressure (40.8%), arthritis (38.1%) and heart disease (32.3%). Over one quarter of the care recipients reported having some type of dementia or Alzheimer's Disease (27.4%), while slightly less had trouble with vision (22.9%), osteoporosis (22.8%), and incontinence (21.1%). As shown in Figure 13, fewer care recipients had problems with diabetes, stroke, lung disease, cancer, broken bones, mental or emotional problems, and neurological problems. Forty percent of care recipients had 3-4 health problems, 24.8% had 1-2 health problems, and 34.9% had 5 or more health problems (see Figure 14). 2002 WCAAA Caregiver Assessment 35 Figure 13. Type of illnesses of care recipients Neuro Mental BrBones Cancer Lung Other Stroke Diab Incont Osteo Vision Dementia HD Hearing Arthrit HBP Mobility 0 10 20 30 40 50 60 70 Figure 14. Number of conditions of care recipients 1-2 Conditions 5 or more 25% conditions 3-4 conditions 40% 2002 WCAAA Caregiver Assessment 36 Behavior Problems of Care Recipient Caregivers were asked to identify how frequently care recipients exhibited various behavioral problems such as not being able to beleft alone in the house, was awake in the night, was confused or refuses to cooperate, or engaged in embarrassing, upsetting or violent behavior. Almost 2/3rds of care recipients (62.5%) frequently or occasionally were awake in the night (see Figures 15-17). Other behavior problems that occurred frequently or occasionally included being forgetful, confused or uncooperative (58.4%), unable to be left alone in the house, (33.5%); becomes upset or yells (29%); embarrasses caregiver, (23.5%) and becomes violent (6.5%). Figure 15. Percent of care recipients with selected behavior problems 40% 30% 20% 1 10% ! { 0% 1 ( ` ■ k,anss.ua Awake in night Confused or Refuses to Cooperate ■Freq ®Occass O Seldom ■Never Figure 16. Percent of care recipients with selected behavior problems (cont.) 50% 40% 30% 20% 10% e,. I 0% Can't be left alone Becomes upset or yells ■Freq ■Occass OSeldom ■Never 2002 WCAAA Caregiver Assessment 37 Figure 17. Percent of care recipients with selected behavior problems (cont.) 80% 60% 40% 20% 0% Embarrasses me or others Becomes violent ■Freq ■0ccass O Seldom ■Never Figure 18 shows the behaviors that were a frequent or occasional concern to caregivers. Over 50% of caregivers indicated that the care recipient was frequently or occasionally awake in the night and was confused, forgetful or refused to cooperate; over 30% of caregivers reported that they frequently or occasionally couldn't leave their loved one alone. Figure 18. Percent of care recipients with occasional or frequent behavior problems 35 30 I asig 25 1 4n -is 20 kas r a 15 ' x , ` . y 101 I ■ I ■ 7 4 ■0 I Awake in Forgets Can't leave Upset Embarr Violent Night alone ■Occassionally O Frequently 2002 WCAAA Caregiver Assessment 38 Caregiving Activities Caregivers were asked about the types of caregiving activities they provided, how frequently they provided such assistance, if they had any help from family members, _ and if they used a variety of community resources. Types of Assistance Provided Caregivers reported whether they provided assistance in 20 different types of activities of daily living, including personal care (ADLs) and instrumental activities (IADLs). These activities were as follows: • Get around using an assistive device • Get in and out of bed • Get dressed • Bathe • Toileting • Feeding • Give shots • Give medications • Housework • Pet care • Laundry • Meal preparation • Manage finances • Make telephone calls • Write notes, cards or letters • Make medical appointments • Help with Medicaid, Medicare or other government assistance • Grocery shopping • Run errands • Provide transportation Figures 19-21 show the percentage of caregivers who reported that they provided various kinds of caregiving assistance. The activities for which the majority of caregivers were assisting with were in the areas of providing instrumental activities of daily living (IADLs) — running errands (91.4%), providing transportation (88.7%), going grocery shopping (75.5%), making medical appointments (73.%), doing housework (72.2%), helping with finances (69.1%) and doing laundry (62.8%). Activities of daily living (ADLs), which included personal care activities such as bathing and dressing, were provided by approximately 25% of caregivers. For example, 30.8% helped the care recipient get dressed, 25.8% bathe, 23% get in and out of bed, 22.1% feeding and 20.1% assisted with toileting. 2002 WCAAA Caregiver Assessment 39 Figure 19. Percent of caregivers who provide caregiving activities 91.4% 88.7% 75.5% 0 73/0 71.4% 69.1% • 62.8% 1 i i � 3 K Run Provide Groc Make med Help w/ Asst w/ Laundry errands transp shopping Apps hswrk finances Figure 20. Percent of caregivers who provide caregiving activities (cont.) 60.6% 60.2% 57.7% 55.1% 46.8% 0 462/0 I 4 I 30.8% 1 { J I i{ I ? 1 1 I Meal Prep Help w/ Make Help get Write notesGive meds Help get gov asst telecalls around or cards dressed progs 2002 WCAAA Caregiver Assessment 40 Figure 21. Percent of caregivers who provide caregiving activities (cont.) 25.6% 23% 22.1% 21.3% 20.1% 5 i § 1 ,l 6.3% l Help bathe Help in/out Asst w/ Help w/ Asst w/ Give shots Bed petcare feeding toileting Frequency of Caregivinq Assistance If caregivers reported that they provided a caregiving activity, they indicated how frequently they provided that activity— rarely, occasionally, frequently, or at all times. Over 50% of caregivers were always responsible for grocery shopping (57.3%), managing finances (54.2%), helping with government assistance (53.8%), making medical appointments (53.1%), and helping with transportation (51.3%). Figure 22. Percent of caregivers who provide caregiving activities at all times or frequently 60 50 . 40 c 2 30 20 10 � 0 Groc Shp Finances Gov Asst Med Appts Bathe ■At all times O Frequently 2002 WCAAA Caregiver Assessment 41 Over 70% of caregivers either frequently or always provide seven activities — grocery shopping, managing finances, helping with government programs, making medical appointments, bathing, providing transportation and doing laundry. Figure 23. Percent of caregivers who provide caregiving activities at all times or frequently 60 50 40a) C 2 30 a`) 20 10 - 0 Trans Laundry Meal Prep Errands Meds M At all times O Frequently Figure 24. Percent of caregivers who provide caregiving activities at all times or frequently (cont.) 60 50 40 - •C a) 2 30 cL 20 10 Cards Hswrk Pet Care Feeding Shots ■At all times ❑ Frequently 2002 WCAAA Caregiver Assessment 42 Figure 25. Percent of caregivers who provide caregiving activities at all times or frequently (cont.) 60 50 40 2 30 0_ 20 10 " 0 Tele Calls In-out Bed Toilet Dressed Get around ■At all times ❑ Frequently Help with Care giving Activities Caregivers were asked to indicate if they had any help from up to three family members or friends in providing caregiving assistance. They indicated the secondary helper's relationship to them, what task(s) they helped with and on average, how many hours per week they helped (see Table 4). Over half (n=124, 55.4%) of the caregivers in this study reported that they had assistance from one person (Helper A) in providing care to the care recipient. Thirty three percent had help from a second person (Helper B) and 13.8% had help from a third person (Helper C). Of the 124 people who assisted the caregivers, 38% were either brothers or sisters, 20.2% were spouses and 10.5% were daughters or daughter-in-laws and mothers or fathers. Helper B was most often a brother or sister (33.8%), however, these helpers included a brother-in-law or sister-in- law or daughter/daughter-in-law (14.1%), and other family (11.3%). Helper C was almost most often another "secondary" family member (27.6%, e.g., aunt or granddaughter), or a primary family member (a sibling or spouse, 20.7%; or son 13.8%). 2002 WCAAA Caregiver Assessment 43 Table 4. Relationship of supplemental helpers to primary caregiver n=124 n=71 n=29 Relationship to caregiver Helper A Helper B Helper C n % n % n % Brother or sister 48 38.7 24 33.8 6 20.7 Spouse 25 20.2 7 9.9 6 20.7 Daughter or Daughter-in- 13 10.5 10 14.1 2 6.9 law Mother or Father 13 10.5 1 1.4 0 Son 7 5.6 6 8.5 4 13.8 Other non-relative 7 5.6 5 7.0 1 3.4 Other Family 6 4.8 8 11.3 8 27.6 Brother-in-law or sister-in- 5 4.0 10 14.1 2 6.9 law Types of assistance provided by supplementary caregivers Caregivers who indicated that they had one person (Helper A) to help with caregiving activities told us what types help they provided. As shown in Figure 26, 27.6% of these supplemental caregivers helped with transportation and 24.8% assisted with housework and kept the care recipient company. Twenty percent helped run errands, 18.1% helped with finances and 15.2% assisted with meals. The average number of hours of caregiving assistance provided by Helper A was 10.1. The majority (75%) spent 8 hours or less a week helping. Figure 26. Type of caregiving assistance provided by Helper A 27.6% 24.8% 24.8% 20% 18.1% 15.20/0 15.2% 14.3% 11.4% it I 1 I 1 I I I Prov Housewrk Keep care Run Asst w/ Asst w/ Asst w/ Asst w/ Asst w/ transp recp errands finances Meals Meds groc shp laund company 2002 WCAAA Caregiver Assessment 44 Those who had a second person (Helper B, n=75) helping with caregiving reported they most often kept the care recipient company (31.8%), did housework (25.8%), provided transportation (19.7%), assisted with meals (13.6%), ran errands (12.1%) and did shopping (12.1%, see Figure 27). The average number of hours of caregiving assistance provided Helper B was 7.4. The majority (75%) spent 8 hours or less a week helping. Figure 27. Type of caregiving assistance provided by Helper B 31.8% 25.8% .tto rf,: TM,c'`0Ik r 19.7% A 13.6% 12.1% 10.6% Keep care recp Housewrk Prov transp Asst w/ Meals Run errands Shopping company Those who were identified as Helper C (n=31) most often kept the care recipient company (29.6%), provided transportation (21.4%), did housework (17.9%) assisted with yard work (14.3%), provided emotional support (10.7%) and visited with the care recipient (10.7%; see Figure 28). The average number of hours of caregiving assistance provided by Helper C was 4.7. The majority (68%) spent 3 hours or less a week helping. 2002 WCAAA Caregiver Assessment 45 Figure 28. Type of caregiving assistance provided by Helper C 29.6% .P' 21.4% I } ^IJ 17.9% 14.3% 'x= 10.7% 10.7% 10.7% ,4h4. , Keep care Prov transp Housewrk Yardwork Help w/ Prov Visits occass recp phone calls emotional company support Help provided to non-spousal caregivers Almost 60% (n=108) of non-spousal caregivers had one helper, 34% (n=65) had a second helper and 16% (n=30) had a third helper. Two-thirds of non-spousal caregivers had assistance from Helper A who was either the caregiver's spouse/partner (21.3%) or a sibling (42.6%). Thirty percent assisted caregivers with transportation (30.1%), 25.8% with housework, 23.7% kept care recipient company, 20.4% helped finances and 18.3% helped with errands. Helper B was most often a sibling (37%), a sister-in-law (10.8%) or a spouse/partner (9.2%) or son (9.2%). Helper B helped by keeping the care recipient company, helped with housekeeping (27.6%), transportation (20.7%), and preparing meals (13.8%). Most (66%) provided 6 hours or less a week in assistance. Helper C was a spouse/partner (20%), aunt or sister (13.3%) and son (10%) and 32% provided the care recipient company, 23% assisted with transportation needs, 19% helped with housework, and 15.4% with yard work. The majority of these helpers (66%) assisted 3 hours or less per week. Help provided to spousal caregivers Forty-three percent (n=12) of spousal caregivers had one helper, 32% (n=9) had a second helper and 3% (n=1) had a third helper. Of those spousal caregivers who told us they had one person helping (Helper A), 66.6% of these helpers were a son or daughter. These helpers provided company to the care recipient (40%), ran errands (30%), did housework (20%), and provided emotional support (20%). The majority 2002 WCAAA Caregiver Assessment 46 helped 4 hours or less a week. Helper B was most often a daughter (77.8%). These second helpers provided shopping assistance (42.9%), emotional support (42.9%), ran errands (28.6%) and helped with outings, meals, laundry, and keeping the care recipient company (all 14.3%). The majority of these second helpers provided 4 hours or less a week. Only 1 spousal caregiver had a third person who helped — a son who provided emotional support, made phone calls and visited occasionally. Thus spousal caregivers had fewer secondary helpers than did non-spousal caregivers. Use of Community Resources Caregivers were asked to identify the programs and services they used to assist them in providing care to their loved one. The 19 services they could choose from were: • Senior Legal aid • Home health care services • Homemaker services • Eldergarden Adult Day Program • Peer counseling • Senior group meals • Meals on Wheels • Long Term Care Ombudsman • Food bank • Grocery/prescription shopping service • In-home companion service • Area Agency on Aging (as a referral source) • Support group • Hospital Community Care Coordinator • Area Agency on Aging Case Manager • Nursing home respite services • Life Line Response System • MedVan, the Bus or MiniBus • United Way Help Line If caregivers used the program, they were asked to indicate if the service fully, partially, or did not meet their needs. If caregivers did not use the service, they were asked to indicate why they did not. Reasons for not using the service included not knowing what the service could provide, haven't needed the service, couldn't afford it, the care recipient didn't want to use the service, the hours were not convenient, or another reason. As shown in Figure 29, home health care services were used by 42.1% of caregivers and 18.1% reported using Life Line response system. Other frequently used services included homemaker services (17.9%), hospital community care coordinators (16.7%), long term care ombudsman (17.2%) and meals on wheels (14.6%).Finally, less than 10% of caregivers reported using nine of the services listed in Figure 29. 2002 WCAAA Caregiver Assessment 47 Figure 29. Percent of caregivers who used selected community resources Home Health --- " 142.1 Life Line °EM 0-,H18.1 Homemaker , 1 17.9 Ombuds aa r4 . I 17.2 O Use of community resources Hosp CCC .,.,-,,. {4. _ `I 16.7 MOW „,orx ,., 114.6 Transp -=113.6 NH Resp 110.8 AAA Ref 110.7 Group Meals 110 AAA Case Man 19.3 Shop Sery 17.9 Food Bnk 17.9 Supp Grp 15.6 In-Home Comp 15.6 Peer Coun 15.2 Eldergard 14.2 Legal i 4.2 Uway Ref 2.8 0 10 20 30 40 50 Percent Reasons for nonuse of community resources When caregivers indicated they did not use a particular community resource or service, they identified the reasons for nonuse. Over 40% of caregivers indicated that they did not know what three services, Area Agency on Aging referral (49.7%), case management under the AAA (44.2%), and United Way Help Line (40.4%) could provide them (see Figure 30). More than 20% of caregivers didn't know about hospital care coordinators, Life Life, legal assistance, peer counseling and in home services. 2002 WCAAA Caregiver Assessment 48 Figure 30. Percent of caregivers indicating they did not know what the service could provide AM 49.7% Case AAA 44.2% Uway 40.4% Hos CCC 35.6% II Don't Know What Life Line 30.5% Service Could Provide Legal 29.3% Peer Coun -_.0 a. 27.2% In-Home Comp 22.9% Transp 19.6% Supp Grp 19.2% Group Meals `. 18.4% NH Resp 17.3% Groc Shp . 17.3% Home Hlth 16.5% Eldergnd 16.1% Food Bnk 15.8% Ombuds 15.6% Hmaker 12.4% MOW ® 9.7% 0 20 40 60 Figure 31 shows the percent of caregivers who indicated that they hadn't needed various services. Over 50% of caregivers reported not needing 17 of the 19 community resources listed. Food bank, support groups, home health, grocery shopping, ombudsman, nursing home respite and legal aid were not perceived as needed by over 60% of caregivers. 2002 WCAAA Caregiver Assessment 49 Figure 31. Percent of caregivers who indicated that not needing the service was the reason for nonuse. Food Bnk 70.3% Sprt Grps 70.1% Hhealth 68% • Haven't Needed Service Groc Shp 67.3% Ombuds 65.6% NH Resp 64.8% Legal Aid 60.9% Trans 59.5% Life Line 58.3% • Peer Coun 56.8% MOW 56.5% Hosp CC 55.4% In-Home Comp 55.4% Uway 55.1% Homemkr 54.8% Eldergnd 53.4% Grp Meals - 51.3% AAA Csm 48.5% AAA 44.8% 0 20 40 60 80 Figure 32 shows the percent of caregivers who reported that the reason for not using a selected program or service was because the care recipient did not want to use the service. Two of the meal programs, group senior meals and the Meals on Wheels program had the highest percent of care recipients (29.4% and 28.6%, respectively) 2002 WCAAA Caregiver Assessment 50 who did not want to use the service. Other personal care services and respite services, including Eldergarden (25.3%), home health care (23.7%), homemaker (23.3%), and in- home companion (21.1%) were programs that approximately one-quarter of care recipient's did not want to use. Figure 32. Percent of caregivers who indicated that the reason for nonuse of selected community resources was because care recipient did not want to use the service Grp Meals „ : 29A% MOW 28.6% Eldergrdn 25.3% HHCare " ' ' - 23.7% ®Care Recp Doesn't Homemkr ` r : 23.3% Want to Use In-Home Comp `"' -Ts_ ` 21.1% Ombuds "" ° u' r 20.1% Peer Coun ' 17.8% Transp J 15.8% NH Respite .": 15.4% Groc Shop _ ._< ` r 13.7% Life Line 11.5% Food Bnk 11.3% Legal 10% AAA Csm 9.7% Supp Grp x<:,=; 9.6% Hos CCC M 8.1% MA 7.9% UWAY ® 5.6% 0 10 20 30 40 2002 WCAAA Caregiver Assessment 51 Figure 33 illustrates the percent of caregivers who said that cost was the reason for non-use of services. Although a smaller percent of caregivers indicated that cost was a reason for non-use of services compared to other reasons, some of the personal care services were most often not used because of cost. For example, 11% did not use homemaker services, 7.2% home health care and 5.1% did not use in-home companion services because of cost. Interestingly, although the Ombudsman service, legal aid, peer counseling, United Way Help Line, hospital care coordinators, AAA services, and support groups do not charge a fee, some caregivers mistakenly believed these services charged a fee. Figure 33. Percent of caregivers who indicated that cost of the service was the reason for nonuse. Homemkr 111% HHCare 17.2% MOW 15.8% Ombuds* 15.2% ❑ Did not use service due In-Home Comp 15.1% to cost NH Respite 14.3% Life Line 14% Groc Shop 13.6% Eldergrdn • 13.4% Legal* 13.4% Grp Meals 12.5% Transp 12.5% Peer Coun* • 12.4% UWAY* 12.2% Hos CCC* ' '•: 12% AAA* u= ° ' 11 .8% Food Bnk* 11.2% AAA Csm 0.6% Supp Grp* 0.6% 0 2 4 6 8 10 12 * This service does not charge a fee. 2002 WCAAA Caregiver Assessment 52 Satisfaction with service use Those who used services were asked to indicate if the service met their needs (see Figures 34-37). Very few caregivers reported that the service they used did not meet their needs. However, certain services had more caregivers reporting that their needs were fully met. For example, the following services had more than 50% of caregivers indicating that their needs were fully met: hospital care coordinators, senior legal aid, in- home companions, AAA case management , homemaker, home health, senior group meals, AAA referral service, Ombudsman, Meals on Wheels, Life Line, transportation and nursing home respite. Four services had more caregivers indicate that their needs were partially met than fully met - peer counseling, United Way Help Line, the food bank and Eldergarden. Figure 34. Satisfaction with use of community services 80 60 - 40 20 1 0 , r , NH Resp (n=24) Transp (n=25) Life Line (n=37) MOW (n=30) ■Fully Met ®Partially Met O Did not meet 2002 WCAAA Caregiver Assessment 53 Figure 35. Satisfaction with use of community services (cont.) 80 60 C ` 40 a a 20 Fa I t Ombuds AAA (n=23) Grp Meals Home Health Homemker (n=38) (n=20) (n=88) (n=35) ■ Fully Met ®Partially Met O Did not meet Figure 36. Satisfaction with use of community services (cont.) 80 60 c ,_ e 40 20 1 . { , Shop Sery Hosp CCC Legal Aid In-home Comp AAA Case (n=17) (n=39) (n=11) (n=11) (n=19) ■Fully Met ■Partially Met O Did not meet 2002 WCAAA Caregiver Assessment 54 Figure 37. Satisfaction with use of community services (cont.) 80 60 40 a 20 t + ■ ` . t : N i , Peer Coun UWAY (n=5) Food Bnk Eldergdn (n=9) Support Grp (n=11) (n=17) (n=11) ■Fully Met ■Partially Met O Did not meet Types of Assistance, Information or Support Needed by Caregivers Caregivers were asked to indicate how important (very, somewhat or not important) 20 different types of information, assistance or support would be to them. These items were: • Help with housekeeping • Extra money/financial support • Information about applying for or paying for services or benefits • Someone to talk with • Sitting services or someone to check on care recipient • Help with giving care recipient personal care • Help with shopping • Help with medical care or medications • Information about care recipient's condition • Free time for myself • Central source of information for caregivers to access • Guidance on legal matters • Transportation for appointments and other essential trips • Special medical equipment for assistance with daily activities • Information about intimacy issues 2002 WCAAA Caregiver Assessment 55 • Home modification to improve safety or access • Training to improve skills as a caregiver • Advice from a medical professional (e.g., nurse, physical therapist, doctor) • Advice from a mental health professional • A support group to talk with other caregivers Figures 38 —41 show that the information or service most needed by caregivers had to do with being able to get more information. Specifically, they wanted advice from a medical professional, wanted information about the care recipient's condition, wanted a central source of information for caregivers, and information about applying for or paying for services or benefits. Over 50% thought it was very important or somewhat important to have more free time and guidance on legal matters. Over 40% thought it important to have help with providing personal care, having extra money or financial support, having sitting services or someone to check on the care recipient, help with medical care or medications, training to improve caregiver skills, and getting advice from a mental health professional. 2002 WCAAA Caregiver Assessment 56 Figure 38. Programs and services very or somewhat important to caregivers 40 °'a30 t _ a)20 � a0 1 . t , t Medical Advice Info Recip Central Source Info Sery and Free Time Cond Info Bene El Very Important O Somewhat Important Figure 39. Programs and services very or somewhat important to caregivers (cont.) 40 30 c _ L 20 ' T ` F F T 10 y "r�.." i` '� re "" eti ry � . t 1 Legal Adv Personal Care Extra Money Sitting Sery Adv MH Prof •Very Important 0Somewhat Important 2002 WCAAA Caregiver Assessment 57 Figure 40. Programs and services very or somewhat important to caregivers (cont.) 40 30 .. U 20 ..,t. 10 ors;• Improve care Transp Houskp Help w Med Med Equip skills Care ■Very Important O Somewhat Important Figure 41. Programs and services very or somewhat important to caregivers (cont.) 40 30 •c 20 do- us.'s i> k. 10 soli' 0 i I 1 1 1 Someone to Home Modif Crgver Sup Grp Shopping Intimacy Issues talk wl Assistance ■Very Important 0 Somewhat Import 2002 WCAAA Caregiver Assessment 58 Caregiver's attitude toward use of community resources In an effort to identify attitudes that might be related to caregiver's unwillingness to use community services, caregivers were asked to indicate if they agreed or disagreed with a serious of attitudinal questions listed in Table 5. A high percentage of caregivers indicated in four separate questions in that they did not know who or where to find services. As shown in questions 2, 3, 4 and 6 in Table 5, over 40% indicated that they wished there was someone who could tell them more about services, that they did not know who to call to find services, that no one told them about services, and they did not know how to find more services. In addition, approximately 30% of caregivers agreed that they didn't have the energy or time to find services (questions 10 and 11) and another 26% said they had been meaning to look around for services, but they hadn't gotten around to it (question 12). A second barrier to service use was identified in three questions that reflected a desire to provide care without help from outside agencies. Sixty-nine percent agreed that they had a sense of pride about taking care of their loved one without help from community services (question 1). Forty percent agreed with the statement that they should care for their loved one without help from community services (question 7), and other 31% agreed that families should care for their loved one and not ask for outside help (question 9). Three questions (questions 5, 8, 13) measured caregivers' worry or fear of trusting others to care for their loved one. Over 40% (41 .1%) of caregivers agreed that they worried about their loved one's safety when they were with others, 35.6% agreed that it was hard to trust someone from community services to help provide care and 16.2% said they were fearful of having outside assistance. Finally, the last five questions measured caregiver's reluctance to use community services due to family disapproval, other people's disapproval and not wanting to have others know about their loved one's condition (questions 14-18). These attitudes did not appear to be salient to these caregivers as less than 10% agreed that they felt familial or social pressure against using community resources. 2002 WCAAA Caregiver Assessment 59 Table 5. Agreement/Disagreement with Attitudinal Statements Regarding Service Use* Strongly Agree Disagree Strongly Agree Disagree I am proud of being able to care for my 1 loved one with little help from community 16.6 52.3 24.4 6.7 services. I wish there was someone who could tell 2 me more about services for my loved one. 11.4 46.7 29.3 12.5 I know who to call to find services for my 3 loved one. 8.3 37.5 47.4 6.8 No one has told me what services are 4 available for my loved one. 9.8 35.2 36.3 18.7 I worry about my loved one's safety when 5 someone else is taking care of him or her. 13.0 28.1 41.1 17.7 6 I do not know how to find more services. 7.4 33.7 37.4 21.6 I think that I should care for my loved one 7 without help from community services. 9.7 30.8 42.1 17.4 It is hard to trust someone from community 8 services to help with care for my loved one. 10.5 25.1 53.9 10.5 I believe in the idea that families should 9 care for their own and not ask for outside 7.4 24.1 48.7 19.5 help I do not have the energy to look for 10 community services. 3.7 23.3 49.7 23.3 I do not have time to find community _ 11 services. 4.3 24.9 45.8 24.9 I have been meaning to look for services 12 but have not gotten around to it 2.2 24.5 49.5 23.9 13 I am fearful of having people from community help with my loved one. 4.2 12.0 53.6 30.2 14 My family prevents me from using community services for my loved one. 3.7 5.3 45.8 45.3 People outside my family would think less 15 of me if I used community services. 3.6 5.2 56.0 35.2 My family would think less of me if I used 16 community services for my loved one's 1.0 5.2 55.2 38.5 care. 17 I do not want others to know my loved one has the condition they do. 1.1 3.7 46.0 49.2 18 Families should not use community services. 3.2 50.0 46.3 2002 WCAAA Caregiver Assessment 60 Work and Caregiving Half (49.5%) of the caregivers surveyed indicated that they worked for pay at a job or business. Working caregivers worked, on average, 36.3 hours per week. The number of hours caregivers worked per week ranged from 2 to 80 hours. Twelve percent (n=13) indicated that they stopped working primarily to take care of their loved one and 11.2% (n=12) said that being a caregiver kept them from looking for a job. In addition, 15.5% (n= 17) reported that they were working fewer hours than they would like because of caregiving activities. We asked working caregivers if they had experienced a variety of difficulties at work because of caregiving activities. As shown in Figure 42, rearranging their work schedule was the most frequent workplace issue (64.2%) caused by caregiving duties. Almost one-quarter of working caregivers indicated that they had taken time off without pay to perform caregiving duties. A small percent (8.3%) experienced conflict with coworkers as a result of caregiving activities. Figure 42. Type of difficulties caregivers experience at the workplace 64.2% c m u m a 24.8% 10.1% 8.3% 0 2.8/0 1.8% 0.9% PIENISE Rearranged Took Time Other Conflict with Lost promo Took early Lost job schedule off w/o pay cowrkrs ret bene 2002 WCAAA Caregiver Assessment 61 Emotional Aspects of Caregiving Caregivers were asked to identify if and how the care recipient was helpful to them, how serious of an issue various emotional and physical problems were to them and finally, to select one feeling that best described their overall caregiving experience. Help from care recipient Caregivers indicated if the person they cared for could help with household chores, babysitting, buying things or giving the caregiver money, keeping them company, making them feel useful, or was helpful in another way. Over half (54%) said that the person they cared for made them feel useful and needed, 37.4% said that the care recipient kept them company and 34% said the care recipient bought things or gave the caregiver money. One quarter stated that the care recipient helped with household chores. Few care recipients, 7.3%, provided babysitting assistance and 8.7% provided other emotional or tangible things to caregivers. One fifth of caregivers indicated that the care recipient was unable to assist them in any way. Problems or inconveniences experienced by caregivers Caregivers can experience a variety of emotional, social, financial or physical problems or inconveniences as a result of their caregiving activities. Caregivers were asked to tell us whether the following statements were a very serious issue, a serious issue, moderately serious issue, a somewhat serious issue, or not a serious issue. • I don't have much privacy. • Giving up my vacations, hobbies or own activities. • Caregiving has taken a toll on my physical health. • Caregiving has taken a toll on my emotional health. • Financially caregiving has cost me more than I can afford. • Caregiving has created family conflict. • I wish other relatives would do their fair share of assistance. • Being so upset that I did something to the care recipient that I now regret. • Taking care of the care recipient even when I don't feel well. • The care recipient has medical care needs that I can't provide. • Watching or worrying about the care recipient's deteriorating condition. • • The care recipient's uncooperative or demanding attitude. • Problem with distance to the care recipient's location. Reported in Figures 43-45 are the percentage of caregivers who reported that the various issues were either moderately serious, serious or very serious issue. Worrying about the care recipient's condition was a serious concern for 38.8% of caregivers. Giving up vacations, hobbies or their own activities concerned 29.1% and wishing that other relatives would do their fair share of caregiving concerned 27.6%. Two other issues — caregiver's emotional health and the care recipient's uncooperative or 2002 WCAAA Caregiver Assessment 62 demanding attitude was a serious concern by 20.9%. Only 1% reported that doing something they regretted was a serious issue. Figure 43. Problems or inconveniences experienced by caregivers 20 15 C a . o 10 a 5 0 Worry about Wish other rel Give up hobbies Care recp Caregiver's recp cond would assist or vac demand attitude emotional hlth •Very Serious 0Serious ■Moderately Figure 44. Problems or inconveniences experienced by caregivers (cont.) 20 15 2 0 10 0 a 5 0 Care rep has med Distance from care Don't have much Taken a toll on my needs I can't provide recp privacy physical health •Very Serious 0Serious ■Moderately 2002 WCAAA Caregiver Assessment 63 Figure 45. Problems or inconveniences experienced by caregivers (cont.) 20 15 Y 2 10 a 0MEI Cost of caregiving Caregiving has Having to provide I did something I created family care when sick regret conflict II Very Serious OSerious ■Moderately Caregivers were asked to select just one feeling that best described their caregiving experience. As shown in Table 7, over one quarter (27.5%) selected "love" as their answer followed by 20.1% (n=41) who said "rewarding". Interestingly, 13.2% (n=27) selected "ok" and 12.7% (n=26) selected "stressful". No caregiver selected "anger" or "happiness". Thus over half (54%) selected a positive feeling, 32.8% selected a negative feeling and 13% selected a neutral feeling — "ok". Twenty caregivers did not select a feeling... most of these indicated they just couldn't select one feeling to represent their experience. Table 6. Feelings regarding caregiving activities Feeling n0/0 Love 56 27.5 Rewarding 41 20.1 OK 27 13.2 Stressful 26 12.7 Obligation/Duty 19 9.3 Enjoyable 13 6.4 Burden 8 3.9 Tired 7 3.4 Sadness/Fear 5 2.5 Lonely 2 1.0 Anger 0 Happiness 0 2002 WCAAA Caregiver Assessment 64 Caregiving differences by location, gender, race, employment status, and care recipient characteristics In order to understand any differences among different types of caregivers with regard to information needs and support, community service use, and caregiver stress separate analyses were conducted. Caregiver differences were examined for rural and urban caregivers, male and female caregivers, non-white and white caregivers, working and non-working caregivers, and caregivers who were caring for persons with certain health conditions. Only statistically significant differences are reported unless otherwise noted. Rural and Urban Caregivers As mentioned previously, caregivers living in Greeley/Evans were classified as urban caregivers (n=155) and those living elsewhere in Weld County were classified as rural caregivers (n=69). There was no difference in type of conditions the rural or urban care recipient was suffering from — except in two areas. Rural care recipients were more likely to be recovering from broken bones and urban care recipients were more likely to have heart disease than their rural counterparts. Rural and urban caregivers were providing very similar kinds of care with only four differences. Rural caregivers were more likely than their urban counterparts to help with housework, pet care, and transportation needs. Urban caregivers were more likely than rural caregivers to assist with Medicare or Medicaid or other types of government assistance. Urban caregivers reported more overall care recipient behavior problems than did rural caregivers. In addition, urban caregivers had more negative stress outcomes in two areas. Urban caregivers were more likely than rural caregivers to indicate that their care recipient frequently embarrassed them in public and sometimes forgot things, or was confused or refused to cooperate. Urban caregivers also reported more overall emotional and physical stress than did rural caregivers. In two areas, not having much privacy, and giving up vacations or hobbies were reported by urban rather than rural caregivers to be very serious issues. Interestingly, rural caregivers were more likely to report having one and two additional people to assist them in caregiving activities than were urban caregivers. Urban and rural caregivers were interested in the same types of support services and information, except for needing advice from mental health professionals, information about the care recipient's condition, and help with shopping. More urban caregivers thought that getting advice from mental health professionals was somewhat or very important as well as getting more information about the recipient's condition. However, more rural caregivers reported needing help with shopping than did urban caregivers. 2002 WCAAA Caregiver Assessment 65 Figure 46. Differences in caregiver needs by location 40 ■Very Important 30 i. '�'j ■Somewhat Important v 1 . a I 20 F I 10 • n h HAn ! Rur,4vice from n4fi4tliP Wti1Q4mation abdtf$an Rlfalwith shoppMUDan health prof Male and Female Caregivers There were 166 female and 51 male caregivers in our study. Women cared for individuals with more chronic conditions than did male caregivers (M=4.6 vs. 3.0). Women were more likely than men to care for individuals with cancer, arthritis, hearing loss, incontinence, and stroke. Women were also more likely than men to assist with laundry, make telephone calls, write cards or letters, assist with government benefits, and run errands. Those persons female caregivers were assisting were more likely to be awake in the night and to embarrass them. With regard to caregiver stress, women were more likely to report overall higher levels of emotional and physical stress. Specifically, women reported that giving up hobbies or vacations, and the emotional and physical demands of caregiving were either serious or very serious issues. In contrast, male caregivers indicated that a serious issue for them was that the care recipient had medical needs that they couldn't provide for. When examining what support and information services would be helpful to male and female caregivers, males indicated that help with housekeeping was a very or somewhat important issue. More female caregivers indicated that sitting services, having free time, and needing caregiving skill training and having a caregiver support group were very important. Although more women indicated that getting advice from a 2002 WCAAA Caregiver Assessment 66 medical professional was very important, more men indicated this was somewhat important. Differences by race of caregiver Differences in caregiver's activities and needs were analyzed by race (non-white vs. white). Non-white caregivers were providing more caregiving activities (13.7 vs. 9.6). Although not statistically significantly difference, non-white care recipients had slightly more illnesses/conditions (4.2 vs. 3.9) and used fewer community services (1.7 vs. 2.2). Non-white caregivers were more likely to report worrying about their loved one's safety when someone else was caring for their loved one, being fearful of having people from the community help with their loved one and having a difficult time trusting others to care for their loved one. Non-white caregivers reported only one difference in caregiver needs from their white counterpart. More non-white caregivers thought that getting more information about applying for or paying for services was very important. Working and non-working caregivers Working caregivers differed from non-working caregivers in that they reported getting information about paying for and applying for services and benefits to be very important, along with help with shopping, and getting information about the care recipient's condition. Among part-time and full-time working caregivers, part-time workers (those working less than 40 hours per week) reported that the following information or services were very important: support groups with other caregivers, advice from mental health professionals, and a central source of information for caregivers. Caregiver needs by care recipient condition The circumstances of caregivers who were caring for persons with AD and incontinence were examined. Caregivers caring for persons with AD had greater levels of emotional and physical stress, reported not knowing about community resources, had care recipients with more difficult behaviors and who didn't want to use services compared to caregivers who were not caring for a person with AD. These caregivers, however, used an average of 2.7 community services compared to an average of 1.8 services used by caregivers who were not caring for a person with AD. Caregivers caring for a person with AD felt the following services or information were very important (compared to caregivers not caring for a person with AD): • advice from mental health professional • help with medical care or medications • free time for themselves • central source for caregivers to access • guidance on legal matters Caregivers caring for persons with incontinence scored higher on emotional and physical stress than did caregivers not caring for someone who was incontinent. These 2002 WCAAA Caregiver Assessment 67 caregivers also had higher levels of not knowing what community services could provide and were more likely to find it hard to trust someone else in caring for their loved one and to worry about their loved one's safety when they-are cared for by others. Persons with incontinence also had more health conditions and negative behaviors than persons who did not suffer from incontinence. These caregivers felt that help with home modifications, guidance on legal matters, having a central source of information for caregivers and help with personal care were very important services. The number of conditions that a care recipient suffered from caused caregivers to require different services. Caregivers that were caring for a person with 4 or more conditions were more likely to indicate that they felt the following was very important: • help with providing personal care, • help with medical care or medications, • getting advice from mental health professionals, • getting information about applying for or paying for services, • sitting services Caregivers who were performing at least one Activity of Daily Living (help with toileting, dressing, bathing, eating, transferring, and getting around) were different from caregivers who were not performing these activities. ADL caregivers indicated that sitting services, help with giving personal care and needing medical equipment were very important issues for them compared to non-ADL caregivers. In addition, ADL caregivers were providing more types of assistance, had care recipients who engaged in stressful behaviors, and had higher rates of emotional and physical stress than did non-ADL caregivers. ADL caregivers also reported using more community resources than did non-ADL caregivers (2.6 vs. 1.0) but they had higher levels of fear, worry and trust when using others to assist in providing care. Interestingly, non-ADL caregivers believed more strongly that families should care for their loved one without help from community services than did ADL caregivers. Summary and Recommendations Care recipients in this study had an average age of 82 years, were living in their own homes, and had approximately 4 illnesses or health conditions —with approximately 60% having mobility problems. Over half were occasionally or frequently awake in the night, or were forgetful, confused or uncooperative. Although many care recipients helped the caregiver with household chores, assisted with buying things or made the caregiver feel useful, 1/4 of care recipients were unable to assist the caregiver in any way. The majority of caregivers were daughters or daughter-in-laws, although sons and son- in-laws comprised 16% of caregivers. Caregivers were, on average, 59 years old, in good health, married, and had a high school degree or better. The majority had been caregiving for 4 years or less. Most of the caregivers performed instrumental activities of daily living (IADLs) such as running errands, grocery shopping, assisting with housework, laundry and transportation needs. Half of the caregivers had at least one 2002 WCAAA Caregiver Assessment 68 person who assisted them with caregiving activities — primarily in instrumental activities such as providing transportation, helping with housework, and keeping the care recipi&nt company. Home health service was used by most of the caregivers, but overall community resource use was low. Reasons for non-use of community resources for many of the caregivers were that they reported not needing the service or they did not know what the service provided. Care recipients did want to use services that related to meals or personal care such as Eldergarden, home health care, homemaker, or in-home companion services. Overall, those who did use community services were satisfied with those services. By far the most important item that caregivers wanted was access to information. Caregivers wanted access to medical advice, information about the care recipient's condition, wanted a central source of information for caregivers to access, and information about services and benefits. Although caregivers were spending most of their time assisting with IADLs, services that assisted them with these items (transportation, housekeeping, and shopping assistance) were only seen as somewhat important. Thus indicating that they were still able to provide these types of services without needing assistance. Three areas of caregiver stress emerged for caregivers in this study. Caregivers reported worrying about their loved one's condition, they wanted more help from relatives and they were having to give up hobbies or vacation time. Thirty eight percent of caregivers either stopped working to take care of their loved one, weren't looking for work because of caregiving activities, or they were working fewer hours than they would like due to their caregiving responsibilities. The majority of working caregivers reported having to rearrange their work schedule or having to take time off without pay because of caregiving activities. Over half reported that their feelings regarding caregiving activities were positive (e.g., love, rewarding, enjoyable) whereas a third reported a negative reaction (e.g., stressful, obligation/duty, burden, tired, sad or lonely) and the remainder had a neutral reaction- "ok". Perhaps most importantly, there were important differences in caregiver experiences for women, for caregivers caring for persons with AD and incontinence and those providing assistance with ADLs. Recommendations The results of this study confirm the notion of"heterogeneity of need" among caregivers (Cantor, 1994). Caregivers have different needs in the "caregiving cycle". At the beginning of the caregiving cycle, caregivers are interested in obtaining information and linkages; at later stages in the cycle, when caregiving burdens increase, caregivers 2002 WCAAA Caregiver Assessment 69 need more assistance in personal care needs, sitting services, respite, and support groups. Thus the following recommendations for caregiver assistance programs and services are based on the data collected in this study: — • Information and Referral- In this study, all caregivers wanted more information — about their loved one's condition, about community resources, about applying for government assistance programs, and they wanted medial advice as well as a central source to find caregiving information. For example, one caregiver stated, "There is assistance for people out there, but it needs to be more widely known. The way things are now you really don't know about them until you really need them, then is not the time to start having to look for assistance." • Need for Sophisticated Targeting of Programs and of Marketing Strategies The varied needs of caregivers in this study require that programs target specific types of caregivers and use sophisticated marketing that targets specific caregivers and their needs. These unique needs are as follows: o Targeting Supportive Services to Caregivers at the End of the Caregiving Cycle — Supportive services, such as help with medical care, help providing personal care, and sitting services are needed by about 1/3'd of caregivers. These caregivers must be made aware of the services available, must have help in making their need for services made apparent, and must have some assistance in gaining cooperation from the care recipient to accept these services. Here's what one caregiver had to say about their information and support needs, "1. Support groups. 2. CPR training. 3. OT info or training sessions for correct ways to help with mobility and safe transfers and transports. 4. Workshops with info to better understand dementia. 5. Info on how to encourage independence and self-esteem for person receiving care." Another told us, "Providing agencies and help varies. Many of us caregivers can do housekeeping, cooking, transportation, shopping, etc.-it's the stress of always needing to re-arrange schedules to meet the recipients demands ... Somehow, we need more education before these times hit us! Many of us caregivers would like either time away or get the recipient away for a time period!" Another mentioned the reluctance of the care recipient to accept services. "A number of services could be helpful. However in my case, my mother does not allow "strangers" in her home-only nurses, aid, therapists, as ordered by her doctor. She will not even allow a pastor in her home because she no longer knows them personally. I am usually at her house 12 hours, Monday through Friday and sometimes help out on the weekends. My sister, my nephew, and I happen to be all the help there is from a very large family. My mother said she "raised us and we are supposed to take care of her". This is a 2002 WCAAA Caregiver Assessment 70 nightmare experience. She is cruel, suspicious, accusing, and says things that aren't true. But she only mistreats her three caregivers." o Targeting Beginning Cycle Caregivers - These caregivers were primarily engaged in providing IADL. They are looking for information and they not as open to using community services at this point. However, marketing approaches can begin to increase of awareness of community resources for when they may need such services. o Targeting the Family— Over half of caregivers reported having assistance with caregiving activities. Thus marketing strategies need not just focus on "finding the caregiver" but can expand marketing efforts to nontraditional locations, such as the workplace or grocery store, to reach other family members. o Targeting the workplace — Half of the caregivers were working. Fulltime working caregivers appeared to be at the beginning stages of the caregiving cycle and were in need of information and referral. Part-time workers wanted support group assistance and advice from mental health professionals, and appeared to be in need of assistance with providing personal care services. One caregiver noted, "I am fortunate that Mom is able to help me out financially so I can stay home to care for her. However, I am aware another of my co-workers may have to leave work to care for her father at home. She'll be a great loss to the office, but to pay someone to come in during the day to care for her father would cost her more than what she is making. " o Targeting by conditions— Clearly those caregivers who were caring for persons with AD or incontinence had different needs. For example, caregivers caring for someone with AD needed free time, advice from mental health professional and legal advice. Those caring for persons with incontinence seemed to be more isolated, stress and more worried • about using community resources. One caregiver of a person with Alzheimer's stated, "My children are still in denial after their father was diagnosed with Alzheimer's...More programs to get parents/children to see caregivers need help. If you do have meetings make certain there is a place recipient can go. Afternoon meetings are very convenient for elderly caregivers. Alzheimer's patients are hard to get moving. I don't like to drive after dark. Money is a big problem when you don't have money to hire it done. I feel so overwhelmed! o Targeting by ethnicity- although non-white caregivers were not much different from their white counterparts, they did report a heightened sense of worry, fear and mistrust of using services to assist in caring for their loved one. 2002 WCAAA Caregiver Assessment 71 Appendix Caregiving in Weld County y q\k (0, 4_ 41, A Understanding the Needs of People Who Care for Loved Ones Survey conducted by the University of Northern Colorado College of Health and Human Sciences On behalf of the Weld County Area Agency on Aging aaa- Assfslance.Advocacy.Ansuvrs on Aging. Section I. First, we would like to ask you some general questions about the person you care for. 1. What is your relationship to the person you care for? a. Spouse/partner b. Brother c. Sister d. Daughter e. Daughter-in-law f. Son g. Son-in-law h. Grandchild i. Other relative j. Non-relative/friend 2. How long have you been providing caregiving assistance to this person? months or years 3. Where does this person reside? a. With me how long has this person lived with you? (skip to Question 5) b. In their own home or apartment c. In an assisted living facility d. In a nursing home 4. If the person you care for does not live with you, how long does it take you to get to where they live? minutes or hour(s) 5. What is their age? 6. What illnesses does the care recipient have? Please circle all that apply. a. Mobility problems j. Hearing loss b. Dementia or Alzheimer's Disease k. Incontinence • c. Heart disease or condition I. Mental or emotional illness d. Cancer m. Broken bones e. Stroke n. Osteoporosis f Arthritis o. Neurological problems g. Diabetes p. High blood pressure h. Lung Disease q. Other (Specify): i. Blindness or vision loss 7. Of those you've circled above, which would you say is the main problem you deal with as a caregiver? (Select 1) (letter of the above item) Section II Questions in this next section help us understand what kinds of assistance you provide as a caregiver. S. Please tell us if you help with the activities we have listed below and how much help you provide. Do you... On the days that you help, how much assistance, on an a. help the person you care for get average day do you help with getting around? (please around with a wheelchair or other circle the number) assistive device? 1. Yes Ifyes, D. 1. rarely provide assistance 2. No 2. occasionally provide assistance 3. frequently provide assistance 4. provide assistance at all times for this activity b. help... get in and out of bed? On the days that you help,how much assistance, on an 1. Yes If yes, ? ► average day do you help with getting out of bed? 2. No (please circle the number) 1. rarely provide assistance 2, occasionally provide assistance 3. frequently provide assistance 4. provide assistance at all times for this activity c. help...get dressed? On the days that you help, how much assistance, on an 1. Yes If yes, ► average day do you help with getting dressed? 2. No (please circle the number) 1. rarely provide assistance 2. occasionally provide assistance 3. frequently provide assistance 4. provide assistance at all times for this activity d. give ...shots? On the days that you help,how much assistance, on an 1. Yes If yes D. average day do you help with giving shots? 2. No (please circle the number) • • 1:rarely provide assistance 2. occasionally provide assistance 3. frequently provide assistance 4,provide assistance at all times for this activity e. give ...medications or pills? On the days that you help, how much assistance, on an 1. Yes If yes, ► average day do you help with giving medication? 2. No (please circle the number) 1. rarely provide assistance 2. occasionally provide assistance 3. frequently provide assistance 4. provide assistance at all times for this activity f help ...bathe? On the days that you help,how much assistance, on an 1. Yes If yes, ► average day do you help with bathing? 2. No (please circle the number) 1. rarely provide assistance 2. occasionally provide assistance 3. frequently provide assistance 4. provide assistance at all times for this activity g. help...with toileting? On the days that you help, how much assistance, on an 1. Yes If yes, ► average day do you help with toileting? 2. No (please circle the number) 1. rarely provide assistance 2. occasionally provide assistance 3. frequently provide assistance 4. provide assistance at all times for this activity h. help...with feeding? On the,days that you help,how much assistance, on an 1. Yes If yes I. average day do you help with feeding? 2. No (please circle the number) 1. rarely provide assistance 2. occasionally provide assistance 3. frequently provide assistance 4. provide assistance at all times for this activity i. help...with housework? On the days that you help, how much assistance, on an 1. Yes If yes, ► average day do you help with housework? 2. No (please circle the number) 1. rarely provide assistance 2. occasionally provide assistance 3. frequently provide assistance 4. provide assistance at all times for this activity j. help ...with pet care? On the days that you help, how much assistance, on an 1. Yes If yes, A. average day do you help with pet care? 2. No (please circle the number) _„ .1. rarely provide assistance 2. occasionally provide assistance 3. frequently provide assistance • 4. provide assistance at all times for this activity k. help...do laundry? On the days that you help, how much assistance, on an 1. Yes Ifyes, s. average day do you help with laundry? 2. No (please circle the number) 1. rarely provide assistance 2. occasionally provide assistance 3. frequently provide assistance 4. provide assistance at all times for this activity 1. help...with meal preparation? , On the days that you help, how much assistance, on an I. Yes Ifyes, D. ! average day do you help with meal preparation? 2. No (please circle the number) 1. rarely provide assistance 2. occasionally provide assistance 3. frequently provide assistance 4. provide assistance at all times for this activity m. help...manage finances and/or pay On the days that you help, how much assistance, on an bills? average day do you help with managing finances? 1. Yes Ifyes, ► (please circle the number) 2. No 1. rarely provide assistance 2. occasionally provide assistance 3. frequently provide assistance 4. provide assistance at all times for this activity n. help... make telephone calls? On the days that you help, how much assistance, on an 1. Yes Ifyes, ► average day do you help with making phone calls? 2. No (please circle the number) 1. rarely provide assistance t 2. occasionally provide assistance 3. frequently provide assistance 4. provide assistance at all times for this activity o. help...write notes, cards, or letters? On the days that you help, how much assistance, on an 1. Yes If yes, D. average day do you help with writing correspondence? 2. No (please circle the number) 1. rarely provide assistance 2. occasionally provide assistance 3. frequently provide assistance 4. provide assistance at all times for this activity p. help...make medical appointments? On the days that you help,how much assistance, on an 1. Yes If yes, i average day do you help with making medical 2. No appointments? (please circle the number) 1.rarely provide assistance 2. occasionally provide assistance 3. frequently provide assistance 4. provide assistance at all times for this activity q. help...with Medicare, Medicaid or On the days that you help, how much assistance, on an other types of government assistance? average day do you help with Medicare, Medicaid or 1. Yes Ifyes, ► other types of assistance? (please circle the number) 2. No 1. rarely provide assistance 2. occasionally provide assistance 3. frequently provide assistance 4. provide assistance at all times for this activity r. help...with grocery shopping? On the days that you help, how much assistance, on an 1. Yes If yes, D. average day do you help with grocery shopping? 2. No (please circle the number) 1. rarely provide assistance 2. occasionally provide assistance 3. frequently provide assistance 4. provide assistance at all times for this activity s. help...run other errands? On the days that you help, how much assistance, on an 1. Yes Ifyes, ► average day do you help with other errands? 2. No (please circle the number) 1. rarely provide assistance 2. occasionally provide assistance 3. frequently provide assistance 4. provide assistance at all times for this activity t. help... with transportation needs? On the days that you help,how much`assistance, on an 1. Yes If yes, DD. average day do you help with transportation needs? 2. No (please circle the number) 1.}rarely provide assistance 2:occasionally provide assistance 3. frequently provide assistance 4.provide assistance at all times for this activity 9. About how many hours per week, on average, do you provide caregiving assistance? a. 0 - 8 hours b. 9 —20 hours c. 21 —40 hours d. 41 or more hours, or constant care 10. How frequently do the following problems occur with the person you care for? Please place a check/ in the column that best represents your answer. Frequently Occasionally Seldom Never He/she can't be left alone in the house Is awake in the night Sometimes forgets things, or is confused or refuses to cooperate Embarrasses me or others Becomes upset and/or yells Becomes violent 11. Listed below are statements that describe some problems or inconveniences that many people have when they are caregivers. Please tell me how serious of a concern these issues are for you by placing a check/ in the column that best represents your answer. Very Moderately Somewhat Not a Serious Serious Serious Serious Serious Issue Issue Issue Issue Issue I don't have much privacy. Giving up my vacations, hobbies or own activities. Caregiving has taken a toll on my physical health. Caregiving has taken a toll on my emotional health. Financially caregiving has cost me more than I can afford. Caregiving has created family conflict` I wish other relatives would do their fair share of assistance. Being so upset that I did something to the care recipient that I now regret: Taking care of the care recipient even when I don't feel well. The care recipient has medical care needs that I can't provide. - Watching or worrying about the care recipient's deteriorating condition. The care recipient's uncooperative or demanding attitude. Problem with distance to the care recipient's location. 12. Please tell us about other family members or friends who are assisting you in providing caregiving activities. If no other family member or friend assists you, please leave this question blank and go to the next question. How many hours What is their relationship to What caregiving task(s) do per week, on you? they help you with? average, do they help you? Person A Person B Person C 13. Often, a person you take care of can be helpful to you. Please indicate which of the following ways your loved one has been helpful to you? Please circle all that apply. a. Helping with household chores b. Helping with babysitting c. Buying things for me or giving me money d. Keeping me company e. Making me feel useful and needed f. Other way? Please specify: g. He/she is unable to assist me in any way. Section III. Next, we are interested in understanding whether you have used the following community services to assist you in your caregiving activities. 14. If you have not used the service, place a ✓ in the no column and please tell us why you have not used the service. If you have used the service, place a ✓ in the yes column and tell us if the service met your needs. No, I Yes, I If you used this service, how haven't Please tell us why you have not have used well did this service meet your Program or used this used this service (circle all that or am needs? (circle the letter that best Service service apply) using this represents your answer) service a. I do not know what this service lc Senior legal aid could provide for me a. Fully met my needs b. I haven't needed this service b. Partially met my needs c. Can't afford it c. Did not meet my needs d. Care recipient doesn't want to„ use this service e. Hours didn't match my needs f. Other reason? a. I do not know what this service Home health could provide for me a. Fully met my needs care services b. I haven't needed this service b. Partially met my needs (e.g.,nursing, c. Can't afford it c. Did not meet my needs therapy, d. Care recipient doesn't want to personal care) use this service e. Hours didn't match my needs f. Other reason? a. I do not know what this service Homemaker could provide for me Fully met my needs services(e.g., b. I haven't needed this service b. Partially met my needs housekeeping, c. Can't afford it c. Did not meet my needs meal d. Care recipient doesn't want to preparation) use this service= e. Fours didn't match my needs £ Other reason? No, I Yes,I If you used this service, how haven't Please tell us why you have not have used well did this service meet your Program or used this used this service(circle all that or am needs? (circle the letter that best Service service apply) using this represents your answer) service Eldergarden a. I do not know what this service Adult Day could provide for me a. Fully met my needs Services b. I haven't needed this service b: Partially met my needs c. Can't afford it c. Did not meet my needs d. Care recipient doesn't want to use this service e. Hours didn't match my needs f. Other reason? a. I do not know what this service Peer counseling could provide for me a. Fully met my needs (in-home b. I haven't needed this service b. Partially met my needs counseling) c. Can't afford it c. Did not meet my needs d. Care recipient doesn't want to use this service e. Hours didn't match my needs f. Other reason? a.I do not know what this service Senior group could provide for me a. Fully met my needs meals b. I haven't needed this service b. Partially met my needs c. Can't afford it c. Did not meet my needs d. Care recipient doesn't want to use this service e. Hours didn't match my needs f. Other reason? a. I do not know what this service Meals on could provide for me a. Fully met my needs Wheels b. I haven't needed this service b. Partially met my needs c. Can't afford it c. Did not meet my needs d. Care recipient doesn't want to use this service e. Hours didn't match my needs f. Other reason? No, I Yes, I If you used this service, how haven't Please tell us why you have not have used well did this service meet your Program or used this used this service(circle all that or am needs? (circle the letter that best Service service apply) using this represents your answer) service Long Term Care a. I do not know what this service Ombudsman could provide for me a. Fully met my needs (e.g.,nursing b. I haven't needed this service b. Partially met my needs home and c. Can't afford it c. Did hot meet my needs assisted living d. Care recipient doesn't want to resident use this service advocate) e. Hours didn't match my needs ' f. Other reason? .`. . Food Bank a. I do not know what this service Program could provide for me a. Fully met my needs • b. I haven't needed this service b. Partially met my needs c. Can't afford it c. Did not meet my needs d. Care recipient doesn't want to use this service e. Hours didn't match my needs f. Other reason? Grocery/ a. I do not know what this service prescription could provide for me a. Fully met my needs shopping service b. I haven't needed this service b. Partially met my needs c. Can't afford it` c. Did not meet my needs d. Care recipient doesn't want to use this service e. Hours didn't match my needs f. Other reason? In-home a. I do not know what this service companion could provide for me a. Fully met my needs service b. I haven't needed this service b. Partially met my needs c. Can't afford it c. Did not meet my needs d. Care recipient doesn't want to use this service e. Hours didn't match my needs • f. Other reason? No, I Yes,I If you used this service,how haven't Please tell us why you have not have used well did this service meet your Program or used this used 11215 service (circle all that or am needs? (circle the letter that best Service service apply) using this represents your answer) service Area Agency on a.I do not know what this service Aging(Referral - ' could provide for me a....Tully met my needs.,' Source) b. I haven't needed this service b. Partially met my needs c. Can't afford it ' Did not meet my needs ` c. d. Care recipient doesn't want to use this service? . "` e. Hours didn't match my needs `.' . f. Other reason? -; Support group a. I do not know what this service (e.g., could provide for me a. Fully met my needs Alzheimer's, b. I haven't needed this service b. Partially met my needs Parkinson's, c. Can't afford it c. Did not meet my needs etc.) d. Care recipient doesn't want to use this service e. Hours didn't match my needs f. Other reason? Hospital a. I do not know what this service Community could provide for me ' a. Fully met my needs Care b. I haven't needed this service b. Partially met my needs Coordinators c. Can't afford it c. Did not meet my needs d. Care recipient doesn't want to use this service e. Hours didn't match my needs f. Other reason? Case Manager a. I do not know what this service with Area could provide for me a. Fully met my needs Agency on b. I haven't needed this service b. Partially met my needs Aging c. Can't afford it c. Did not meet my needs d. Care recipient doesn't want to use this service e. Hours didn't match my needs f. Other reason? Nursing home a. I do not know what this service respite;services could provide for me Pr a Ful(ymet my needs i' b. I haven't needed this service b " Partially met my needs. c. Can't afford it " c.' 'Did not meet my needs', d. Care recipient doesn't want to use'this service e. Hours didn't match my needs FY No, I Yes, I If you used this service, how haven't Please tell us why you have not have used well did this service meet your Program or used this used this service (circle all that or am needs? (circle the letter that best Service service apply) using this represents your answer) service Life Line a.I do not know what this service Response could provide for me a. Fully met my needs System b. I haven't needed this service b. Partially met my needs e. Can't afford it c. Did not meet my needs d. Care recipient doesn't want to use this service - e. Hours didn't match my needs f. Other reason?:, MedVan, The a. I do not know what this service Bus or Mini Bus could provide for me a. Fully met my needs b. I haven't needed this service b. Partially met my needs c. Can't afford it c. Did not meet my needs d. Care recipient doesn't want to use this service e. Hours didn't match my needs f. Other reason? United Way a. I do not know what this service Help Line could provide for me a. Fully met my needs (Referral b. I haven't needed this service b. Partially met my needs Source) c. Can't afford it c. Did not meet my needs d. Care recipient doesn't want to use this service e. Hours didn't match my needs f. Other reason? 15. Which of the following kinds of help, information or support are important to you? Please indicate by using a 1, 2, or 3 to indicate how important the types of assistance listed below are to you. 1 = Very Important 2 = Somewhat Important 3 = Not Important a. Help with housekeeping b. Extra money/financial support c. Information about applying for or paying for services or benefits d. Someone to talk with e. Sitting services or someone to check on care recipient f. Help with giving care recipient personal care g. Help with shopping h. Help with medical care or medications i. Information about care recipient's condition j. Free time for myself k. Central source of information for caregivers to access 1. Guidance on legal matters m. Transportation for appointments and other essential trips n. Special medical equipment for assistance with daily activities o. Information about intimacy issues p. Home modification to improve safety or access q. Training to improve my skills as a caregiver r. Advice from a medical professional (e.g., nurse, physical therapist, doctor) s. Advice from a mental health professional t. A support group to talk with other caregivers Next, we want to ask you your opinion about using community services. Listed below are various opinions, both negative and positive that we have heard about using community services. 16. Please tell us if strongly agree, agree, disagree or strongly disagree with the following statements. Place an ✓ in the column that best represents your answer. Strongly Agree Disagree Strongly Agree Disagree It is hard to trust someone from community services 3 :'f to help with care'for my loved one. •` My family prevents me from using community services for my loved one. I do not have time to find community services ` I worry about my loved one's safety when someone else is taking care of him or her. I think that I should care for my loved one without - ` ' help from community services. I am proud of being able to care for my loved one with little help from community services. I do not know how to find more services. I believe in the idea that families should care for their own and not ask for outside help People outside my family would think less of me if L. used community services. ; No one has told me what services are available for my loved one. ner to look for community Idonothavethee se rvices. I have been meaning to look for services but have not gotten around to it I do ;:� .: know my loved one has the-'• ``` ` - - notwant others to .. :�':''�.:'` � �= �� condition they do " : ,: , : F L ; k. . I am fearful of having people from community help with my loved one. My family would think less of me if I used 1A . r.y; :ra, �ti,. , *; k' :.r . community services for my loved one's care. -',' . .. :sue :, . • • Families should not use community services. I know who to call to find services for my loved one. I wish there was someone who could tell me more about services for my loved one. Sedhon IV. Another important purpose of this study is to understand what employment issues caregivers may face. So next, we would like to ask you aboutyoio•employment status. 17. Are you currently working for pay at ajob or business? a. Yes b. No If no, please skip to Question 21 18. How many hours per week do you usually work? hours 19. Which of the following ever occurred at work because of your caregiving activities? (circle all that apply). a. Rearranged your work schedule (come in late or leave early, take time off during the week) b. Took time off without pay c. Turned down or lost a promotion d. Chose early retirement e. Lost any job benefits f. Conflict with coworkers g. Other (Please specify): h. None of the above happened as a result of my caregiving duties 20. Are you working fewer hours than you would like to because of your caregiving activities? a. Yes b. No Please skip to Section V below 21. If you are not now working, did you stop working primarily to take care of your loved one? a. Yes b. No 22. Has being a caregiver kept you from looking for a job? a. Yes b. No Section V. Thank you for taking the time to help us understand the issues of concern for caregivers. We have just a few more questions about yourself for statistical purposes. 23. What is your age? 24. Compared to other people your age, would you say your health, in general is a. Excellent b. Good c. Fair d. Poor 25. Do you have any physical limitations that sometimes can make it hard to be a caregiver? a. Yes b. No 26. What is your race/ethnicity? a. Hispanic b. Asian c. White d. Black e. Native American Indian f. Mixed race 27. What is your total household income? a. <14,999 b. 15,000-24,999 c. 25,000-34,999 d. 35,000-44, 999 e. 45,000-54,999 f. 55,000-64,999 g. 65,000-74,999 h. 75,000 or above 28. How many people under 18 live in your household? 29. What is your marital status? a. Currently married or with a partner b. Currently never married c. Currently divorced or separated d. Currently widowed 30. What is your gender? a. Female b. Male 31. What is your highest educational experience? a. less than high school graduate b. HS graduate c. Some college d. Associates degree e. Bachelors degree f. Graduate degree 32. We have just one final question about your caregiving role. Please tell us what one feeling best describes your overall caregiving experience. (Select 1) a. Rewarding b. Enjoyable c. Tired d. Lonely e. Stressful f. OK g. Anger h. Sadness/Fear i. Burden j. Obligation/Duty k. Love 1. Happiness Is there anything else you would like to tell us that might help us understand the kinds of programs or services that might be of assistance to caregivers? • Thank you ! If you would like a summary of the results, please V this box. ❑ �r �,. . aaa . . ap Assistance.Advocacy Answers on Aging. I F Weld County Agency on Aging fr-s\fr 3 a pS ource for Seniors Ease Management Education CareLink Case Management 970-353-3800 x3325 Aims Senior Education Program 970-330-8008 x469 Lifetime Wellness Center 970-350-6633 Consumerflffairs/Legal North Colorado Therapy 970-339-2444 Area Agency on Aging 970-353-3800 x3330 AARP 1-800-424-3410 Elder Abuse - Colorado Rural Legal Services 970-353-7554 Elder Abuse Education 970-353-3800 x3331 Credit Counseling i 1-800-424-2277 Elder Abuse Reporting 970-352-1551 x6211"& 6214 Consumer Fraud 970-356-4000 Income Tax Counseling 970-351-2588 Employment Medicare Counseling 970-351-2588 Green Thumb (local) 1-800-584-9161 TRIAD/Senior Safety 970-356-2627 Food, Eounseliny and Support Groups Colorado Food Share 1-800-933-7427 American Cancer Society 970-356-9727 Food Stamps 970-356-3850 Alzheimer's Support 970-392-9202 Grocery Shopping & Delivery 970-351-2588 Connections for Independent Living 970-352-8682 Meals on Wheels 970-353-9738 Friendly Visitor Program 970-353-6433 Fort Lupton Office 303-857-6460 Grief/Loss Support 970-352-8487 Tri-Town Office 303-833-3021 Hispanic Elderly Outreach 970-353-6433 Senior Nutrition Meals 970-353-3800 x3323 Fort Lupton Office 303-857-0521 Weld Food Bank 970-356-2199 Peer Counseling 970-346-8849 (North Range Behavioral Health) General Assistance ' Parkinson's Support Group 970-339-2444 Low Income Energy Assistance 970-352-1551 x6390 Pro Bono Mental Health 970-353-3686 UNC Speech & Language Clinic 970-351-2012 House Call Hair Care 970-352-3667 Durable'Ifledical Equipment Weatherization 970-867-9409 Apria Health Care 970-353-5355 Helpline 970-353-8808 Don Paul Respiratory 970-356-0210 - health tare Interwest Home Medical 970-506-1111 Salad Clinic 303-857-2771 Lincare 970-356-1506 North Colorado Medical Center 970-352-4121 Banner Home Medical Equipment 970-506-6420 Sunrise Health Center 970-353-9403 Physician's Choice Medical 1-800-429-7301 Community Outreach Clinic 970-304-6420 La Pharmacia 970-395-0052 RCC 970-356-9078 Rocky Mountain Home Care 1-800-772-2201 \X/'neelc hair House 1-800-466-7015 N . 'Health los.oranre: - `. 'Houlin4(lubiidizedR6ral Weld County)-(on't Medicaid Hotline 1-800-221-3943 Keenesburg -Timberwood 303-732-4221 Medicaid (Greeley) 970-352-1551 Kersey- Latham Manor 970-352-8394 Medicaid (Fort Lupton) 303-857-4052 Windsor - Century III 970-686-5576 Medicare - Claims 1-800-332-6681 Windsor - Governor's Farm 970-686-9650 Medicare Counseling 970-351-2588 Health Insurance Counseling 1-800-544-9181 Housing(Seniors Only-lion Subsidized) Greeley Place 970-351-0683 Rome Health(are and management , Bonell Good Samaritan Center 970-352-6082 Argus Front Range Home Care 1-800-288-3961 Banner Home Care 970-506-6800 Housing(Assisted Living) Caring Hearts 970-378-1409 (State and/or County Licensed) Complete Home Care 720-652-0292 Alladin (Keenesburg) 303-732-4856 Good Samaritan Home Health 303-449-6796 Beehive Homes (Evans) 970-351-0091 Heartland Home Health Ilt Hospice 970-346-0035 Beehive Homes (Fort Lupton) 303-857-1921 Home Instead 970-302-5106 Beehive Homes (Windsor) 970-674-1446 Hospice & Palliative Care Bonell Good Samaritan/The Manor 970-352-6082 of Northern Colorado 970-352-8487 Garden Square of Greeley 970-396-2969 Interim Health Care 970-226-3008 Garden Square at Westlake 970-396-2969 Maxim Home Health 1-888-655-5520 Graycara East (Keenesburg) 303-732-4424 Mountain Home Care 970-352-4124 Graycara West 970-330-5133 North Colorado Therapy Center 970-339-2444 Two Rivers B & C Home 970-352-5376 Preferred Mobile Home Care 970-356-5317 The Bridge 970-339-0022 RVNA Home Health Care 970-330-5655 The Villa 970-353-9263 TLC Adult Care 970-284-7902 Sterling House 970-330-9500 Housing(General Information) The Willows (Windsor) 970-686-2258 Greeley/Weld Housing Authority 970-352-1551 x6541 Long Term Care Ombudsman 970-353-3800 x3324 Housing(Subsidized in City of Greeley) (General Information and Advocacy for Residents) Birchwood Apartments 970-330-6206 Broadview Apartments 970-352-9305 Income Supplements_- Greeley Manor 970-356-5489 OAP - Old Age Pension 970-352-1551 Greeley Senior Housing 970-395-0822 Social Security 1-800-772-1213 Immaculata Plaza 970-356-0610 Social Security (Local) 970-353-2192 Island Grove Village 970-356-2808 Joe P. Martinez 970-352-6082 Information and.Referral - La Casa Rosa 970-353-7437 Meeker Commons 303-863-8651 Area Agency on Aging 970-353-3800 x3323 University Plaza 970-353-9275 Eldercare Locator (National) 1-800-677-1116 Housing(Subsidized Rural Weld County) Grandparents Raising Ault - Villa Fourteen 970-834-1570 Grandchildren Task Force 970-353-3800 x3323 Dacono - Senior Apts. 970-346-7660 ext. 6550 `RursingHomes Eaton - Benjamin Square 970-454-3338 Bonell Good Samaritan Center 970-352-6082 Erie - Victor E Smith 303-665-9244 ext. 11 Centennial Health Care 970-396-2969 Evans - Centennial Housing 970-330-1160 Fort Lupton -Adams Park 303-857-4056 Fairacres Manor 970-353-3370 Fort Lupton - Columbine Court . 303-857-4400 Kenton Manor 970-396-2969 Fort Lupton - Crane Court 303-857-4400 Life Care Center 970-330-6400 Grover - Prairie Village 970-656-3626 Windsor Health Care 970-686-7473 Hudson - Prairie View 303-536-4501 Long Term Care Ombudsman 970-353-3800 x3324 Johnstown - Columbine 970-587-2600 Wilk - - Personal Alert Systems ` Senior(enters/Recreation -Con't Argus (Life Line) 1-800-288-3961 Hill N' Park 970-330-8619 Banner Safety Call 970-506-6823 Johnstown 970-587-5251 CLR 970-686-1145 Kersey 970-352-8394 Patients Choice (AN/LAC) 970-461-1558 LaSalle 970-284-6931 TeleCare (Lifeline) 1-888-669-2273 Lochbuie 303-659-8262 Mead 970-535-4477 ,, Respite Care(Day), Milliken 970-587-2484 Eldergarden Adult Day Care 970-353-5003 Nunn 970-897-2459 Pierce 970-834-2655 Respite Care(Overnight) Platteville 970-785-6274 See Nursing Homes or Assisted Living Windsor 970-686-7476 Overnight Respite Options See Nursing Homes or Assisted Living - Transportation MedVan 970-330-6340 - Senior Centers/Recreation Shamrock Taxi 970-686-5555 Ault 970-834-1325 Weld County Transportation 970-356-4000 Tri Town 303-833-4300 The Bus (Greeley Paratransit) 970-350-9290 Eaton 970-454-2937 Erie 303-926-2717 Volunteer Opportunities Evans 970-339-5344 AARP 1-800-424-3410 Fort Lupton 303-857-4080 Senior Volunteer/Friendly Visitor 970-353-6433 Greeley 970-350-9440 Retired and Senior Volunteer Program 970-351-2588 Grover 970-895-2346 fenior iervices Outside of Weld County . Region 8 Area Agency on Aging 719-589-4511 Region 1 Area Agency on Aging 970-867-9409 (Alamora,.Conejor, Castilla, Mineral, (Logan, Morgan, Phillips, Sedgwick, Rio Grande, Saguache Counties) Washington, Yuma Counties) Region 9 Area Agency on Aging 970-259-1967 Region 2A Area Agency on Aging 970-498-6800 (Archuleta, Dolores, LaPlata, (Larimer County) Montezuma, San Juan Counties) Region 3 Area Agency on Aging 303-455-1000 Region 10 Area Agency on Aging 970-249-2436 (Adams,Arapahoe, Clear Creek, Denver, (Delta, Gunnison, Hinsdale, Douglas, Glipin,Jefferson Counties) Montrose, Ouray, San Miguel Counties) Region 3B Area Agency on Aging 303-441-3570 Region 11 Area Agency on Aging 970-248-2717 (Boulder County) (Garfield, Moffitt, Rio Blanco, Mesa Counties) Region 4 Area Agency on Aging 719-471-2096 (El Paso, Park, Teller Counties) Region 12 Area Agency on Aging 303-468-0295 (Eagle, Grand,Jackson, Pitkin, Region 5 Area Agency on Aging 800-825-0208 Route, Summit Counties) (Cheyenne, Elbert, Kit Carson, Lincoln Counties) Region 13 Area Agency on Aging 719-539-3341 Region 6 Area Agency on Aging 719-384-8166 (Chaffee, Custer, Fremont, Lake Counties) (Baca, Bent, Crowley, Kiowa, Otero, Prowers Counties) Region 14 Area Agency on Aging 719-846-4401 (Huerfano, Las Animas Counties) Region 7 Area Agency on Aging 719-583-6611 (Pueblo) C BADO Weld County Senior Centers and Programs Ault 970-834-1325 Kersey 970-352-8394 Tri Town 303-833-4300 LaSalle 970-284-6931 Eaton 970-454-2937 Lochbuie 303-659-8262 Erie 303-926-2717 Mead 970-535-4477 Evans 970-339-5344 Milliken 970-587-2484 Ft. Lupton 303-857-4080 Nunn 970-897-2459 Greeley 970-353-9440 Pierce 970-834-2655 Grover 970-895-2346 Platteville 970-785-6274 Hill N' Park 970-330-8619 Wattenberg 303-659-4948 Johnstown 970-587-5251 Windsor 970-686-7476 for more information call 910-353-3800 X3323 Disclaimer: This list of services is not intended to be inclusive of the wide range of services that are available for older adults. This list is intended to present the most common numbers that are requested by older adults and their families. For more information please call the Area Agency on Aging at 353-3800, ext. 3323 or consult the Yellow Pages of your phone book for other offerings. Weld County Area Agency on Aging is released from any liability and claims no responsibility for any services rendered by the listed agencies. Rev. 7/2001 72.7. v . 'P a" .t+ „'"y asn3' ^c^�r.& " i ii L4.'f' y, sa':X.v— y f k �U� 'f7 ' �a'�f; � w w'+ x4h `;t �3 � d�� Akt CAREGIVER RESPITE PROGRAM Serving caregiver needs for respite in Weld County The caregiver respite program is designed to provide support for individuals involved in an on-going caregiving relationship. The person receiving care must be 60 years or older and be in need of sufficient daily care and support to remain in his/her home despite physical or cog- nitive impairment. The assistance is intended to enhance the quality of care provided by giv- ing relief for the caregiver and by delaying the need for alternative placement for the care re- cipient. Respite services are defined as "temporary, substitute support for older adults in order to pro- vide relief for family members and other caregivers."These services can be re- ceived in the client's home, at an Adult Day program or in an assisted living or nursing facility. Respite assistance is not based on income guidelines; however, preference will be given to persons with low income, minority, homebound, isolated, disabled or functionally Clouted. APPLICATION GUIDELINES: * All requests for respite assistance will be directed to and approved by the AAA Family Care- giver coordinator. * The initial interview with the caregiver and the care recipient will take place in the home at a time convenient for them. *• Caregiver will complete a "Stress Interview" questionnaire. * Care recipient will be screened to determine needed assistance in activities of daily living: * Respite care can be provided by a family member, friend, or service provider. * All services and dollar amount must be preauthorized prior to being performed. A certificate voucher and authorization number will be issued at that time. • Services are to be paid for by the caregiver who in turn will invoice the Area Agency on Ag- ing for reimbursement. Provider agencies such as Adult Day care, home health care agencies, assisted living and nursing home facilities can bill the Area Agency on Aging directly with the approval of the AAA Family Caregiver coordinator and client. * A total amount of S1,000 will be awarded to each eligible caregiver per this funded year and must be used by year's end, Dec. 31,2002. Referrals and inquiries can be made by calling the AAA Family Caregiver .coordinator at the Weld County Area Agency on Aging' T9,70-3,S3-4,800, Ext 3368:j' ... ..♦... ..,.1„.,ala:f ,.....i.r... 1- a......,u'...we v c, ...;: ...x.._r ,+;...nv.sY,..a.l....-+ .,rtr&..a...i_nlu._..i t 1:b.YwLY.stm.Y r-st‘je-H- MEMORANDUM DATE: February 19, 2003 TO: David E. Long, Chair, Weld County Board of Wig �. Commissioners COLORADO FROM: Walter Speckman, Executive Director, Division of Human Services �� SUBJECT: Weld County Area Agency on Aging's Four (4) Year Plan Enclosed for Board approval is the Weld County Area Agency on Aging's Four(4) Year Plan. This plan outlines the programs that are being funded by the Older Americans Act and local priorities and initiatives that have been identified by seniors, community professionals, needs surveys, and the Weld County Area Agency on Aging Advisory Board. This plan is reviewed on a annual bases and revisions ?re made as needed. If you have atoiti Dna! questions, please contact Eva Jewell, Director of the Weld County Area Agen,.,' on k, r.g at 3,;3-3800, extension 3331. 2003-0515 Hello