Hope Hospice and Health Services > Services > Dementia Support > Family Caregiver Respite Program

Family Caregiver Respite Program

Hope Hospice runs the Family Caregiver Respite Program to help local families care for a loved one living with dementia. This program provides award recipients with 16 hours of complimentary care in your home from a participating agency. It’s not required that the patient be on our hospice service.

Why is Respite Care Important?

The stress that family caregivers experience as their loved one declines can be staggering. Whether you have help from other family members and friends, or you’re forging alone, you likely feel overwhelmed and exhausted most of the time. It’s imperative for your own well-being to carve out time for self-care. Simply put, self-care is time away from your caregiving responsibilities at home; you might use the time for a social outing, attending church or a book club, a massage, or exercise.

Respite care is a term to describe short-term relief for the family caregiver by providing a qualified individual to watch over your loved one while you take time for personal appointments or any sort of self-care. Consistent respite care will help you lower your stress level and fuel the other areas of your life.

Hope Hospice created the Family Caregiver Respite Program to help low- and middle-income individuals experience the benefits of respite care. This program is supported by grants and donations and is available as long as it remains funded. At this time, the initial grantor has outlined the following qualifying criteria.

Applicant Qualifications

You are the primary family caregiver for a loved one living with dementia diagnosed by a physician.
You and the patient reside in San Ramon, Dublin, Pleasanton, or Livermore.
Your household income does not exceed 400 percent of the current federal poverty guidelines for your household size. You may direct questions to our Dementia Services Department at (925) 829-8770 or [email protected].

Level of Care

This service is intended to pair families with a professional caregiver trained in dementia care to watch over your loved one while you enjoy time off for personal appointments and self-care. However, please note the following limitations on service.

Care providers cannot, for example:

Lift over 25 pounds (e.g., bedridden patients).
Administer medication (reminders to take meds are okay).

Care providers can, for example:

Read to your loved one.
Assist with personal care.
Serve a simple meal.

An award is valid for 16 total hours of care, to be used within 30 days of receiving your voucher. Each appointment must be for a minimum of 4 hours. Discuss level-of-care needs with your selected agency during your initial consultation.

You may reapply for this program monthly, though new applicants are given priority consideration.

Family Caregiver Respite Program Application

Applicant (Family Caregiver) Information

Name

Relationship to care recipient

Do you live together?
YesNo

Home address

Phone Number

State your gross annual household income (e.g., social security, pension).

Document Upload
Before an award of respite care is granted, income verification will be required. To expedite the review of your application, please attach a copy of your recent tax return summary page, a paycheck statement, or annual income report from the Social Security Administration.

Is the care recipient receiving other financial support for care services at this time? If yes, please explain.

Care Recipient Details

Name

Age

Gender

Date of dementia diagnosis, Physician’s name, and medical office location

Situational Explanation

Who participates in the at-home care of this patient? For example, explain which family members/friends or professional caregivers regularly contribute, what services they provide, and the frequency.

Explain your need for respite care at this time.

By checking this box, you indicate that you understand that homecare providers cannot perform medical care, such as administering medication, catheter changes, or wound care.

Signature
By signing, you certify that the information you have presented is true.

Date