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'0 <br />11 <br />5. Counseling in accessing available <br />local, regional and state services. <br />6. Temporary placement of the patient in <br />care providing facilities as <br />specified in location of services <br />below. <br />OCATION OF <br />SERVICE: Any of these: <br />1. Home of the patient (all funding <br />sources) <br />2. Offices or training location of the <br />service providing agency. (all <br />funding sources) <br />3. Adult day care facility (all funding <br />sources) <br />14. Domiciliary care facility'(SSBG, <br />Title III B and State Caregiver <br />Support Funds under Senate Bill 1559 <br />only) <br />5. Nursing home (Title"111 B and State <br />Caregiver Support funds under Senate <br />Bill 1559 only) <br />6. Hospital approved for respite beds <br />(Title III H and State.Caregiver <br />Support funds under Senate Bill 1559 <br />only) <br />Respite care services provided <br />in —home or in a day care center are <br />limited to a maximum of (48) hours of <br />service per month per caregiver. In <br />those instances where respite care <br />will be provided in a domiciliary <br />care facility, nursing home, or <br />hospital-the service is limited to 24 <br />days per year or 576 hours. Duration <br />of the service period shall be <br />unlimited for as long as the <br />caretaker continues to <br />qualify as a-caretaker as defined by <br />the service objective. <br />ASSESS TO SERVICE: Patient and /or caregiver may be referred <br />by self, physician,.family members, <br />friend or other service provider. <br />Referral accompanied by name, address, <br />and phone number, if available, of applicant. <br />DELIVERY <br />CHARACTERS: — 'The specific services to be provided <br />shall be determined by an appropriate <br />professional staff member (e.g., <br />registered nurse, social worker, home <br />economist, etc.) <br />— An appropriate in—home assessment <br />shall be made and documented within <br />ten (10) days of referrel. <br />— All contacts must be documented. <br />— An emergency contact person <br />identified and maintained on Panh <br />a <br />