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Alzheimers Respite

Applications

Below is the Caregiver application available for download.

[all applications are in pdf format which requires Adobe Acrobat Reader. Download Adobe Reader from the link below if you do not have this software.]


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The Need for Respite:

Respite care is a SHORT-TERM option designed to provide a break, or a time of caregiver relief, from the constant physical and emotional stress of caring for a person with Alzheimer’s disease or a related disorder. Family caregivers generally find that the task of caring for a person with dementia is overwhelming. An occasional break from caregiving enables an exhausted caregiver to regroup, both physically and emotionally.

Description of this Program:

The Respite Care Program is funded by the State Department of Social Services and is operated in partnership with the Alzheimer’s Association of Connecticut Chapter and the Connecticut Area Agencies on Aging.
The program offers an opportunity to purchase respite services from an approved community services provider for the individual with Alzheimer’s, or the option of receiving an assessment of services needed and the development of a short-term care plan. The program offers funding for respite services that include, but are not limited to: Adult Day Care, Home Health Aide, Homemaker, Companion, Skilled Nursing Care or short term nursing home care. Funds may be used for daytime or overnight respite. The individual with Alzheimer’s or dementia must meet financial eligibility requirements to participate in this program. In addition, a 20% co-payment of the cost of the service is required.

Eligibility for this program:

Health Status:
The Applicant or authorized agent must provide a completed “Physician Statement” form (blank is attached to this application) from a physician stating that the patient has a diagnosis of irreversible and deteriorating dementia of the Alzheimer’s type. Dementias may include but are not limited to: Multi-infarct dementia, Parkinson's Disease, Lewy Body Dementia, Huntington's Disease, Normal Pressure Hydrocephalus, or Pick's Disease.

Income:
The individual with dementia cannot be covered by Medicaid (Title 19), the Connecticut Homecare Program for Elders, have an income of more than $30,000 a year, or have liquid assets of more than $80,000.

The following are considered income:
Social Security, Supplemental Security, Railroad Retirement income; pensions; wages; interest; dividends; net rental income; veteran’s benefits; and any other payments received on a one-time or recurring basis. If accounts are jointly owned with a spouse, 50% of the total interest income in the account will be counted as applicant income. Proof must be provided of all income of the applicant. The following are considered liquid assets:
Checking accounts, savings accounts, individual retirement accounts, certificates of deposits, stocks, or bonds that can be converted into cash within 20 working days. If an asset is jointly owned with a spouse, 50% of the total asset value will be counted as the applicant’s asset. Proof must be provided of all assets of the applicant.In addition, if there is an individual authorized to act on behalf of the individual with dementia (such as a Conservator or Power of Attorney), please provide documentation of this designation.