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Jane Mahoney

on 10 April 2018

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Transcript of AFCSP 101

One of Jack's responsibilities is to oversee the Alzheimer's Family Caregiver Support Program, frequently called AFCSP.
The AFCSP program was created in 1985 and is a state funded program.
It was created to make available a large array of community services for people with Alzheimer's disease and their caregivers.
Services provided through the AFCSP program are aimed at three things.
So exactly how does Jack help people with Alzheimer's and their caregivers in Cheddar County?
Some ideas came to Jack's mind...
Alzheimer's Family Caregiver Support Program
Meet Jack. He's the newest staff at the ADRC of Cheddar County, in charge of the Caregiving Program.
Jack wonders what this AFCSP program is and what is involved in coordinating it.
Enhancing quality of life
Providing assistance to caregivers
Respite care
Support groups
Recreation activities/supplies
Adaptive equipment
Meals and nutrition
Jack looked in the policy and sure enough, he was right!
All of those things are ways AFCSP can offer support,
and there's even more ways he can help.
But wait. If this is a government program, there certainly are some financial guidelines that need to be met.
Jack was right again. There are eligibility requirements that must be met.
1.) The person must have a diagnosis of Alzheimer's disease or a related dementia.
of course...
4.) Preference is given to someone living in a home setting.
2.) Annual income of person and spouse must be $48,000 or less. No limit for assets.
or delaying institutionalization
In-home services
3.) The person must not be receiving or eligible to receive Family Care
adult day care, overnight respite, in-home respite, short-term facility stay
educational classes, counseling, public presentations, caregiver conferences
help with bathing,personal cares, cleaning, cooking, therapies
bed alarms, door locks, adaptive clothing, assistive technology, weighted silverware
medical appointments, day programing social outings, escort services, specialized transportation
Jack is feeling pretty good about understanding his new job, and just in time - here comes a couple looking for help.
Meet Mr. and Mrs. Green. George has Lewy Body Dementia and Helen is looking for help caring for him.
Eligibility Requirements
Helen is feeling stressed by George's constant questioning and occasional hallucinations. He has also wandered off while she was working in the garden. Helen has tried to do it alone but finally recognizes the need for some help.
Jack tells Helen about ways she might get some relief. He told her about the caregiver support group on Thursday morning, a caregiver class coming up, the Adult Day Program at the Senior Center, in-home services, transportation, door alarms and other adaptive equipment that Helen might find helpful.
Helen's eyes light up at the possibility of having some time to herself and she had never thought of a door alarm. But her eyebrows furrow as she wonders how much it will cost.
Jack tells Helen about the funds available through the AFCSP program that can cover all of these things if they qualify for the program. Helen is ready for help and asks what she needs to do next.
Jack gives Helen a list of things she will need to bring so they can complete the paperwork for the program.
(for both Helen and George)
Social Security
Phone number
Powers of Attorney
Food Stamps
Homestead Credit Claim
Community Options Program
incurred to care for George, related to his dementia, such as:
Medical co-pays
Medical equipment
Transportation to access health care
Respite or home care
Physician signed diagnosis of dementia
Helen arrives the next day with papers in hand. Jack has gathered all he needs to tackle The Worksheets!
General Information form
Financial Eligibility Screen-Worksheet 1
Financial Eligibility Determination-Worksheet 2
Maximum Annual Payment Schedule
Determining Eligibility
On to Worksheet 1,
Financial Eligibility Screen
Jack uses the information Mrs. Green brought to complete worksheet 2. Since Helen listed their income as monthly amounts, Jack uses his calculator to figure out the annual amount for the worksheet, then fills in the answers.
$305 x 12=$3660
$285 x 12=$3420
$1542 x 12=$18,504
$971 x 12 =$11,652
Jack asked his supervisor about the maximum annual service payment. Jack learns that Cheddar County has a maximum payment of $2000, allowing them to serve more families.
Jack talks with Helen about the various options of support; day program, in home respite, homemaker services, transportation, door locks and other adaptive equipment, etc.
books, games, cards, YMCA membership
home delivered and congregate meals, nutritional supplements and counseling
Jack gives Helen the details about the support group and day program along with contact information. They pick out the door alarm and Jack orders it for her. Jack gives Helen information on caregiver stress and a caregiving book. He also promises to give her a call in a couple weeks to make sure she is doing okay.
Helen thanks Jack and goes home happy. Jack feels good about helping Helen.
Other allowable uses of funds:
contract with service providers to develop new programs or expand services
outreach to find people in need of support by the program
provide activities/education to enhance public awareness of Alzheimer's/dementia
pay for program administration - up to 10% of allocation
Jack starts with the
General Information Form
. This is just basic information so it is very simple to complete.
Helen said George is not on any of the programs listed, so on to Worksheet 2.
Worksheet 1 is a quick check to see if the person is already qualified based on their eligibility in other programs. If they are, worksheet 2 does not have to be completed.
Worksheet 2 has three parts. Part 1 and 2 determine if the person qualifies for the program financially by looking at income and then deducting Alzheimer's related expenses.
General Information
Income Amounts
Medical and other expenses
Other Programs George is on
Jack enters $1,884 on line 2, then uses his calculator to figure out the household's "Net Service Need" and enters that on line 3.
Jack completes the rest of the worksheet and finds he can offer the Greens $1,971, almost the entire $2,000 maximum!
Hee Haw!
Jack works with his fiscal department to figure out the details of who will make the payments to the day program and for the door locks. The county can choose to pay directly to the provider or have the Greens pay and then reimburse them. Fiscal offers to pay directly which makes it easier for the Greens and also avoids the need for a 1099 tax form.
Helen has decided that she would like to have George go to the day program once a week and also to install door locks.
...and door locks...
The next day Jack meets Brett, a 33 year old man caring for his mom Florence, who was diagnosed with dementia at age 52. Brett would like his mom, who lives alone in her own house, to participate in a day program so she isn't alone so much.
Jack thinks he's got the whole AFCSP thing down, but this situation is a little different... Florence isn't even 60 years old, and she still lives alone. Brett just helps her out with some things, like transportation, paying her bills, cooking and cleaning for her, etc.
Plus, Florence was still working earlier this year, leaving her with an income higher than the maximum $48,000 required for the program. Jack needs to figure this out.
According to the policy, AFCSP can serve people who have a dementia diagnosis no matter what their age. There is also no requirement that the caregiver needs to be living with the care recipient.
And Jack remembers Part 2 of Worksheet 2 lets you subtract dementia related caregiving expenses to reduce your income.
Jack enters income and expenses on Worksheet 2, Parts 1 & 2.
Wait a minute. Can Long Term Care Insurance, Medical Insurance and house cleaning count as a dementia related expense?
Yes! Health insurance premiums for the care recipient are allowable expenses. And if the house cleaning is part of the plan to keep Florence in the community it also counts as a dementia related expense.
Next, Jack and Brett talk about the day program Brett heard about - the days, times, costs, etc. Brett would like his mom to go there three times/week and she will need transportation since the hours don't coincide with his work schedule.
Line 6 indicates that Jack is able to give Brett the full $2000, however this amount will not come close to covering the cost of the day program for the entire year. But at least it will give them a start.
Jack likes his new job. He sees that the AFCSP program can really help people in a lot of different ways. Next week he will talk to his supervisor about doing some outreach and public education about Alzheimer's Disease and the AFCSP program. For now, he turns off his light and goes home.
For help with your AFCSP program, contact:

Jane Mahoney

Lynn Gall
Wisconsin Office on Aging

You can find the AFCSP Policy, worksheets and other necessary enrollment documents at GWAAR.org; For Professionals; Family Caregiver Support; AFCSP
AFCSP is a very flexible program! It is important to offer a large array of services in order to meet the individual needs of each person or family.

Scenario #1
Determining Eligibility
Scenario #2
$65 x 12 = $780
$104.90 x 12 = $1259
$147.50 x 12 = $1770
$36.20 x 12 = $434
annual total = $3463
The Greens qualify based on their income before subtracting expenses, but Jack includes the expenses in order to reduce any potential cost share which is determined in Part 3.
Jack writes down Helen's requests for adult day care and door locks. Then he does a little research on prices and enters the cost of both items. He adds up the total cost and enters it on line 1.
Part 3 is where the needed goods and services are listed and where the actual county payment is calculated. Jack will need some things to complete this section:
needs assessment
maximum annual payment schedule
maximum annual service pament for Cheddar County
To comlete line 4, Jack needs to know what Cheddar County's Maximum Annual Service Payment is. AFCSP policy says each household can receive no more than $4,000 each year, but counties can choose to offer a lower maximum.
only George's medical expenses can be deducted...
calculate the premiums for Medicare, George's Supplement and Part D plan for the entire year
medications for the year
$45 x 12 = $540
$85 x 12 = $1020
$450 x 12 = $5400
$20 x 12 = $240
$35 x 12 = $420
combine doctor visit total with medicine total:
420 + 240 = $660
Jack enters the needed services and associated costs in the first section of Part 3
$30 x 12 = $360
Brett's Information about Florence...
Jack asks Brett for the needed information to complete the worksheets, paying particular attention to how much money is spent to care for his mom
in relation to her dementia
and keeping her in the community.
Jack starts by using a needs assessment and good listening skills to help create a plan that meets the Green's needs. He is careful to explain the full array of services that can be accessed using AFCSP funds, rather than pushing Helen to just receive respite.
Next, Jack uses the income from line 29 and the Maximum Annual Payment Schedule to determine the household's ability to pay.

Then he uses the Maximum Annual Payment Schedule to determine Florence's Cost Share and completes the rest of Part 3.
combine medical insurance with long term care insurance premiums:
1020 + 5400 = $6,420
Full transcript