2018-441-E Finance - Charles House Association outside agency agreement

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DocuSign Envelope ID: C5305795- 2DF5- 4A04- B090- 9F458AA520CB EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Work Statement o) Complete the Work Statement Chart to describe the work to be performed. This chart is used to document program activities, program goals, performance measures, and actual results. (Add more rows as needed) If this is a new program, you will only document the projected information. Every program is required to have AT LEAST 1 Program Activity, which should be SMART (,2pecific, Measurable, Achievable, Relevant, and _Time-bound. Click on SMART Goals to learn more. • Program Activities should outline major activities the agency implements to accomplish its program goals. (i.e. Deliver meals to elderly /disabled residents.) • Program Goal should explain what the program is trying to achieve /accomplish. Goals are statements about what the program should accomplish. (i.e. Deliver 100 meals per day, Monday- Friday.) • Performance Measures describe how you will evaluate the degree in which you achieved the stated goals. (i.e. Will track the number of meals delivered each day.) • Actual Program Results use program results to indicate the actual measurable achievement of goals. If goals were not met, please explain. (i.e. Delivered an average of 105 meals per day.) Work Statement Chart for Program Charles House Daytime Eldercare Program 1. Program Activity Name Family Caregiver Support: The Charles House Daytime Program supports family caregivers by offering respite from the ongoing concerns of caring for a loved one and by supporting the best functioning of their loved ones through participation in the therapeutic program Program Goal Enrollment in the program allows caregiving families to continue their care giving as they wish. Performance Measures 50% of enrolled families (projected 120) in the funding year will have the capacity to continue providing care in the home and not require, or delay, residential care placement for their participant/enrolled family member. Previous Year Program Results At the end of the 16 -17FY, 60% of the 62 families enrolled at the beginning of the FY were still engaged in caring for their loved ones. Current Year Estimated Results Estimating 65% of the 70 enrolled families at the beginning of the grant year will continue family care giving throughout the year. Next Year Projected Results Projecting 65% of the projected 77 enrolled families at the beginning of the rant year will continue family care giving throughout the year. 2. Program Activity Name Enriching the lives of elders, enhancing well -being and supporting functioning: The relationship Charles House maintains with enrolled families is the basis for the collaboration in caring. The daytime program works to support a variety of functioning abilities for participants: including self - esteem, gross and fine motor skills, social skills, verbal skills, ambulation, memory and reminiscence, activities of daily living. Program Goal The Charles House program thrives to enhance the functioning and quality of life for participants. Performance Measures Over 75% of families (projected to be 55 responding families) will report in the annual evaluation survey satisfaction with the Charles House program and will report positive effects of the program for their enrolled family members, such as improvement in their participant /enrollee's behavior, emotional status, physical and /or cognitive functioning Previous Year Program Results The 2016 Caregiver Survey showed 100% of 38 reporting families observing improvements in their family member's functioning. PROGRAM INFORMATION 2/12/2018 10:47:30 AM I -, o