Senator Tomassoni Caregiver Support Program

Senator Tomassoni Caregiver Support Program is sponsored by The ALS Association (Minnesota families). This program provides funds for home care support for caregivers of persons with ALS in Minnesota, and offers ALS-specific trainings for caregivers and professional home care providers.

The ALS Association is pleased to announce a new funding opportunity for Minnesota families impacted by ALS. Caregivers of persons with ALS in Minnesota may apply for funds to help with home care support for caregivers. These funds are available because of the tremendous efforts of late Senator David Tomassoni who championed for caregiver support funds.

Caregivers who need extra support to care for their loved one may apply. In addition to the home care support for caregivers, ALS-specific trainings will be offered to caregivers (virtually and in-person) as well as training specifically designed for professional home care providers to increase knowledge of ALS and the caregiving needs of persons with ALS, so they will be more knowledgeable about issues individuals with ALS may face.

In our commitment to equity, transparency, and accountability, we thank you in advance for providing demographic information as part of the application process. Once submitted, please allow up to two weeks for a care services staff member to be in touch to further discuss your needs and the options available through these State of Minnesota funds. The person who provides the most care for the person with ALS in Minnesota.

Usually, this is the caregiver who lives with the person with ALS or spends the most time assisting the person with their care needs. The person living with ALS must reside in Minnesota. A person with ALS who resides in a skilled nursing facility is not eligible for this program.

Veterans receiving service-connected benefits are not eligible to participate in this program. A person living with ALS who qualifies for Medicaid or a Minnesota home and community-based waiver program is not eligible to participate in this program. A person living with ALS who has a long-term care insurance policy is not eligible to participate in this program.

Families may apply once per year (one applicant per family). Caregiver applying for this award must be at least 18 years old. A caregiver assessment will be required.

Please answer the following questions to confirm your eligibility for this program: Does the person with ALS live in Minnesota? Does the person with ALS live in a skilled nursing facility? Is the person with ALS eligible for service-connected Veterans benefits?

Does the person with ALS qualify for Medicaid or a Minnesota home and community-based waiver program? Does the person with ALS have a long term care insurance policy that is currently paying for in home care? I have reviewed my answers above and all information is correct.

Please complete the following section for the person you are caregiving for (the care recipient). Does the person living with ALS have the same address as the caregiver (you)? Does the person living with ALS have the same email as the caregiver (you)?

Does the person living with ALS have the same phone number as the caregiver (you)? If you selected ‘Other’ for your language preference, please let us know which language you prefer. What is their race/ethnicity?

American Indian/Alaskan Native Is the person with ALS a veteran? Does the person with ALS have a diagnosis of FTD (Frontotemporal Degeneration)? No Frontotemporal degeneration or frontotemporal dementia (FTD) refers to a group of disorders that causes progressive damage to the temporal and frontal lobes of the brain associated with personality, behavior, and language.

While FTD with ALS is rare, current research suggests that up to 50% of people with ALS might experience some degree in change in thinking and behavior. I have reviewed my answers above and all information is correct. Please complete the following section about you - the person providing caregiving to the person living with ALS.

What is your race/ethnicity? American Indian/Alaskan Native If you selected ‘Other’ for your language preference, please let us know which language you prefer. What is your relationship to the person living with ALS?

_____________________________________________ Please Select the choice(s) that best reflect your caregiving role. How long have you been caregiving for the person with ALS? Less than one year 1- 5 years 6 - 10 years More than 10 years Are you providing care to more than one person (i.e. children, grandchildren, and/or other adults?)

I provide assistance with the following activities of daily living (select all that apply): Eating Bathing Grooming Dressing Mobility Toileting Transferring None of the above I provide assistance with the following Instrumental Activities of daily living (select all that apply): Shopping Meal Preparation Housework Transportation Managing appointments Managing finances and/or paperwork None of the above Frequency of care (select only one): Provides care daily Provides care weekly Provides care monthly Currently does not provide assistance but will has an increasing concerns about person with ALS's ability to manage things without help How much time do you spend each week providing care?

(select only one): 5 hours per week or less 6 to 20 hours per week 21 to 40 hours per week More than 40 hours per week Currently does not provide an assistance How often has the person with ALS been hospitalized in the last 6 months (select only one): How often has the person with ALS fallen in the last 6 months (select only one): CAREGIVER SELF-ASSESSMENT QUESTIONNAIRE The following assessment must be completed by the caregiver.

On a scale of 1-5, in the past month, to what extent did you experience the following: Are you having feelings of being overwhelmed, overworked, and/or overburdened? 1 Never 2 Rarely 3 Sometimes 4 Often 5 Always Has there been an increase in tension in your relationship with the care recipient? 1 Never 2 Rarely 3 Sometimes 4 Often 5 Always Have you noticed any changes in your social life?

1 Never 2 Rarely 3 Sometimes 4 Often 5 Always Has your health suffered because of your caregiving? 1 Never 2 Rarely 3 Sometimes 4 Often 5 Always Are you having any conflicts with your previous daily commitments? 1 Never 2 Rarely 3 Sometimes 4 Often 5 Always Do you have feelings of being confined or trapped by the responsibilities or demands of caregiving?

1 Never 2 Rarely 3 Sometimes 4 Often 5 Always Do you ever have feelings related to a lack of confidence in your ability to provide care? 1 Never 2 Rarely 3 Sometimes 4 Often 5 Always Do you have concerns regarding the future care needs of the care recipient? 1 Never 2 Rarely 3 Sometimes 4 Often 5 Always To what extent are you having any conflicts with your family over care decisions?

1 Never 2 Rarely 3 Sometimes 4 Often 5 Always Are you having any conflicts within your family over the amount of support you are receiving in providing care? 1 Never 2 Rarely 3 Sometimes 4 Often 5 Always To what extent are you having any financial difficulties associated with caregiving?

1 Never 2 Rarely 3 Sometimes 4 Often 5 Always On a scale of 1 to 10, with 1 being “not stressed” to 10 being “extremely stressed,” please rate your current level of stress. Please specify at least two activities you are no longer able to participate in since you became a caregiver. I have reviewed my answers above and all information is correct.

Ineligible: Person with ALS does not reside in the Minnesota. We are sorry. Due to state requirements in which the person with ALS must reside in Minnesota , you are not eligible for this program.

Please contact The ALS Association ( als. org ) in the state where the person with ALS resides for ALS-related information and resources. Ineligible: Long-Term Care Insurance Notice Thank you for your interest.

Individuals living with ALS who have a long-term care insurance policy are not eligible to participate in this program. If you have a Long Term Care Policy, please contact your carrier for information on benefits available. Ineligible: Veterans receiving service-connected benefits Notice Thank you for your interest.

V eterans receiving service-connected benefits are not eligible to participate in this program . If you are a veteran, please contact your benefits administrator for information on respite support. Ineligible: Person with ALS does not reside in the Community.

We are sorry. The program requires that the person with ALS must reside in the community. If you are a caregiver seeking caregiver support, please contact The ALS Association ( als.

org ) in the state where the person with ALS resides for ALS-related information and resources. Ineligible: Qualifies for Medicaid or Minnesota Home Notice Thank you for your interest. Individuals living with ALS who qualify for Medicaid or a Minnesota home and community-based waiver program are not eligible to participate in this program.

If you participate in a county assistance program, please contact your county case manager for information on respite support By providing your electronic signature below, you are agreeing to the following: I hereby authorize The ALS Association to release pertinent information to any home care agency or Fiscal Management Service billing The ALS Association for services rendered.

The ALS Association, and its employees, directors, contractors and agents are released from any and all claims, asserted liability, or actual liability related to or associated with care funded by The ALS Association for my family, including, without limitation, any caregiver training provided by The ALS Association and all determinations of need or other determinations of qualification for the Tomassoni Caregiver Support Program.

Name of Person with ALS (Type Full Name) Name of Caregiver (Type Full Name) Tomassoni Caregiver Support Program Information If you have questions or wish to provide feedback about The Senator Tomassoni Caregiver Support Program, please email: Tomassoni-MN@als. org or call 888-672-0484 . The person living with ALS must reside in Minnesota.

A person with ALS who resides in a skilled nursing facility is not eligible for this program. Veterans receiving service-connected benefits are not eligible to participate in this program. A person living with ALS who qualifies for Medicaid or a Minnesota home and community-based waiver program is not eligible to participate in this program.

A person living with ALS who has a long-term care insurance policy is not eligible to participate in this program. Families may apply once per year (one applicant per family). Caregiver applying for this award must be at least 18 years old.

A caregiver assessment will be required.