Lifespan Respite Care Grant Respite Care Service 650-25-75

(Revised 08/10/2025 ML #3939)

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Purpose:

 

The purpose of the Lifespan Respite Care Grant Respite Care Service is to offer funding to support unpaid caregivers of children with special medical, emotional, or behavioral needs or unpaid caregivers of adults who need ongoing care to meet their basic daily needs. Additionally, the caregiver must have a short-term need for planned or emergent respite care which cannot be provided by other public funding sources.

 

The need for respite care services may result from but is not limited to the following circumstances:

  1. Caregiver illness (physical, mental, emotional);

  2. Caregiver medical appointments;

  3. Caregiver hospitalization;

  4. Caregiver death;

  5. Illness of a loved one;

  6. Emergencies;

  7. Funeral, wedding, graduation, vacation, or other events the care recipient is unable to attend;

  8. Waiting for approval for other respite funding sources;

  9. Substance use disorder;

  10. Fire/weather damage to caregiver/care recipients’ home;

  11. Caregiver/care recipient conflict;

  12. Abuse/neglect prevention;

  13. Risk of loss of employment;

  14. Day or overnight camps;

  15. Retreats;

  16. Other needs as identified and approved by the Program Administrator.

 

Definitions:

 

Caregiver: Individuals over age 18, including family members, psychological caregivers, foster parents, or other caregivers as approved by the Program Administrator providing unpaid care to adults regardless of age or type of disability who need the care to meet basic daily needs, or to children with special medical, emotional, or behavioral needs who require care or supervision beyond that required to meet their basic needs.

 

Care Recipient: An adult regardless of age or type of disability who needs care or supervision to meet basic daily needs, or a child with special medical, emotional, or behavioral needs who require care or supervision beyond that required to meet their basic needs.

 

Respite Care: Temporary relief for the caregiver who is providing unpaid care for an individual of any age.

 

Respite Provider: An individual who is age 18 and older, facility, or organization which provides respite care services. The provider may be a family member who does not reside with the care recipient, a friend or a neighbor as chosen by the caregiver/care recipient/legal representative. In special situations and with prior approval from the Program Administrator, the provider may reside in the same household as the care recipient.

 

Emergency: Unplanned or unforeseen event or crisis which results in the immediate and unavoidable absence of the caregiver or the risk of institutional or higher-level placement of the care recipient if respite services are not provided.

 

Eligibility Criteria:

 

To be eligible for Lifespan Respite Care Grant Respite Care Services the individual:

  1. Meets the definition of a primary caregiver (does not have assistance from another caregiver living in the same home) and resides in the state of North Dakota.

  2. Demonstrates a short-term planned or emergent respite need which is not able to be met through other respite funding sources.

  3. Must not intend to use this service as a long-term respite solution.

  4. Lives with the care recipient or if the primary caregiver does not live with the care recipient, they must be providing frequent on-site visits throughout the day which are essential to assuring the care recipient’s health and safety. For example, the care recipient would not be able to get out of bed, prepare a meal, etc., in the absence of the caregiver.

 

Allowable Service Activities:

 

If the provider is a licensed respite provider or a Qualified Service Provider, the respite provider may only provide services that are within their licensing capacity or service standards. If the respite provider is a facility, they must make available evidence that the care staff meets the requirements of their licensing entity upon request.

 

If the physical, mental, and social well-being and safety of the care recipient can be assured, approved activities while providing respite care are those indicated in the “Individual Qualified Service Provider Handbook” as set forth by Adult and Aging Services and may include:

  1. Providing supervision and companionship

  2. Bathing

  3. Dressing/undressing

  4. Feeding/eating

  5. Toileting and/or incontinence cares

  6. Assisting with mobility

  7. Transferring/turning/positioning

  8. Light housework

  9. Laundry

  10. Meal preparation

  11. Provide verbal medication reminders

 

Limits: Lifespan Respite Care Grant Respite Care Service Funding:

 

  1. Respite funds are available once per caregiver/family each grant year (July 1-June 30). The maximum amount available each grant year is determined by the Program Administrator.

  2. The lifetime voucher limit is two (2) vouchers or $5,000, whichever is met first.

  3. Providers must charge their usual and customary rates.

  4. Non-institutional respite care is capped at the daily swing-bed rate regardless of whether an overnight stay is included. Current Swing Bed Rate.

  5. Adult and Aging Services may grant approval for Lifespan Respite Care Grant Respite Care Services to address special, unusual, or unique caregiver respite situations, including the amount of respite authorized, the number of applications allowed per grant year, and retroactive application approvals.

 

Application Process:

 

The agency/referring professional requesting respite services shall submit the following application materials to carechoice@nd.gov or lifespanrespite@nd.gov:

 

  1. Lifespan Respite Care Grant Respite Care Application (SFN 548).

    1. Request for services will only be accepted from agencies working with caregivers and care recipients. Referrals will not be accepted directly from individuals, i.e., caregivers, care recipients, family, etc.

      1. The agency/referring professional must be different than the intended provider specified on the SFN 548.

    2. Assure required signatures are on the application.

    3. Electronic signatures are allowed.

  2. Lifespan Respite Care Grant Respite Provider Agreement (SFN 559) for each provider.

    1. More than one (1) respite provider is allowable, however, the caregiver then has the full responsibility to track voucher funding remaining between the two (or more) providers.

  3. A Substitute IRS Form W-9 (SFN 53656) for each provider.

    1. A voided check or signed bank statement should also be submitted if the provider desires to setup ACH (automatic payments); if these items are not sent, the provider will be mailed a paper check.

Authorization Process:

 

Respite services must not be initiated until the authorization has been approved by Adult and Aging Services.

 

When respite is approved:

  1. Adult and Aging Services shall notify the referring professional as well as the provider that the request is approved and provide a copy of each of the following:

    1. The Lifespan Respite Care Grant Respite Care Authorization (SFN 548)

    2. The Lifespan Respite Care Grant Respite Provider Agreement (SFN 559)

    3. The Lifespan Respite Care Grant Respite Care Provider Service Log (SFN 546)

    4. The Lifespan Respite Care Grant Respite Care Service Standards

  2. The referring professional/agency shall:

    1. Notify the caregiver that the application was approved (include copy of SFN 548) and provide the caregiver with a copy of The Lifespan Respite Care Grant Respite Care Service Standards

  3. Provide the sample journal/worksheet to the provider

 

When respite is denied:

 

  1. Adult and Aging Services shall notify the referring professional and provider that the request is denied and provide a reason for the denial.

  2. The referring professional/agency shall notify the caregiver that the application was denied and assist the caregiver/care recipient in seeking other respite care.

 

Application Revisions:

Application revisions or requests for additional respite may be submitted on the original Lifespan Respite Care Grant Application form (SFN 548) in the “Revision” section on Page 1 of the application. The date, reason, amount requested, change in provider (if applicable) and other relevant information should be included.

 

Respite Cancellations:

If the caregiver’s circumstances change and the service is no longer needed, the requesting individual shall inform the Program Administrator of the reason and the date of the cancellation.

 

Provider Records:

The provider must keep records for each respite care visit. Providers are required to keep their records for 75 months following the last date of service. A sample journal/worksheet is available. The record must include the following:

 

  1. Name of the caregiver/care recipient;

  2. Start and end time of the visit (including a.m. and p.m.);

  3. Date of service;

  4. Amount of service (hours/days etc.);

  5. Brief description of task performed i.e. personal care, supervision, socialization, etc.

 

Provider Billing:

  1. Providers will be reimbursed in a form and manner as defined by the Department.

  2. All requests for reimbursement shall be received within 60 days from the first day of service.

  3. All requests for reimbursement must be submitted on the Lifespan Respite Care Grant Provider Service Log (SFN 546).

  4. Electronic signatures are allowed.

 

Electronic Signatures:

Electronic signatures are allowed. By signing electronically there is agreement that the electronic signature is the legal equivalent of a manual/handwritten signature and will have the same validity and enforceability as a handwritten signature.

 

Grievances:

A recipient of Lifespan Respite Care Grant funds/services may file a grievance in writing to the Director of Adult and Aging Services Section:

 

Director, Adult & Aging Services Section

1237 W. Divide Ave., Suite 6

Bismarck, ND 58501

 

The grievance statement must list the facts related to the grievance, the nature of the grievance, and any request for resolution. The grievance should be made in writing within thirty (30) days of the action. A response to the grievance will be made within five (5) working days of receipt of the grievance.