HomeMy WebLinkAboutNYS Office for the Aging - Social Adult Day ServicesGeorge E. Pataki
Governor
Walter G. Hoefer
Director
New York
(JFFICEfor *
Two Empire State Plaza
Albany, New York
12223-1251
NYSOFA@o fa.state.ny, us
January 11, 2001
Jean W. Cochran, Supervisor
Town of Southold
Southold Town Hall
P.O. Box 1169
Main Road
Southold, NY 11971
Dear Ms. Cochran:
We are pleased to enclose the official fully executed contract between our Office and Town of
Southold under the Social Adult Day Services (SADS) program. The program period begins January
1, 2001. Shbrtly, we will be sending you additional information regarding your 25% advance
payment, vouchering procedures and budget modification procedures.
If you have any fiscal questions, please contact me at (518) 486-2725. If you have any programmatic
questions, please contact Andrea Hoffman at (518) 474-0484.
We convey our best wishes for a successful program.
Sincerely,
Stephen Francis
Senior Accountant
Enclosures
cc: Andrea Hoffman
PROMOTING INDEPENDENCE AND QUALITY OF LIFE FOR OLDER NEW YORKERS
An Equal OppOrtttni~Employer
STATE AGENCY (Name & Address)
NEW YORK STATE OFFICE FOR THE AGING
2 Empire State Plaza
Albany, NY 12223-1251
CONTRACTOR (Name & Address)
Town of Southold
750 Pacific Street
Box 85
Mattituck, NY 11952
CHARITIES REGISTRATION NUMBER:
FEDERAL TAX IDENTIFICATION NUMBER:
MUNICIPALITY NO.: (if applicable)
470379000-000
STATUS
CONTRACTOR IS ( ) IS NOT (x) A
SECTARIAN ENTITY
CONTRACTOR IS ( ) IS NOT (~ A NOT FOR
PROFIT ORGANIZATION
NYS COMPTROLLER'S NUMBER
C002905
ORIGINATING AGENCY CODE
01370
TYPE OF PROGRAM(S/:
Social Adult Day Services Program
INITIAL CONTRACT PERIOD
FROM: 1/1/2001
TO: 12/31/2001
FUNDING AMOUNT FOR INITIAL PERIOD:
$20,000
MULTI-YEAR TERM
(if applicable)
FROM:
N/A
TO:
APPENDICES ATTACHED AND PART OF THIS AGREEMENT:
_X APPENDIX A Standard Clauses as required by the Attorney General for ail State contracts,
X APPENDIX A1 Agency-specific Clauses
X APPENDIX B Budget
X APPENDIX C Payment and Reporting Schedule
X APPENDIX D Program Workplan
_X APPENDIX X Modification Agreement Form (to accompany modified appendices for changes
in term or consideration on an existing period or for renewal periods)
__ OTHER (Identify)
__ OTHER (identify)
__ OTHER (identify)
__ OTHER (Identify)
IN WITNESS THEREOF, the parties hereto have executed or approved this
AGREEMENT on the dates below their signatures.
Contract No: c002905
CONTRACTOR STATE AGENCY
Town of Southold New York State Office for the Aqinq
Printed
Name
Jean W. Cochran Title: Director
Printed Name
Title: Southold Town Supervisor
Date: 12/5/00 Date:
State Agency Certification
"In addition to the acoeptance of this contract, I also certify that original copies of this
signature page will be attached to all other exact copies of this contract."
STATE OF NEW YORK )
) SS.:
County of Suffolk )
On the 5th day of December ,2000 before me personally appeared
Jean W. Cochran , to me known, who being by me duly sworn,
did depose and say thatx¥~/she resides at 270 Boisseau Avenue, Southold, NY
, thatxJ~she is the Supervisor of the
Town of Southold , the corporation described herein which
executed the foregoing instrument; and that,/she signed ~ii~/her name thereto by
order of the b~ard of directors of said corporation. MELANIE DO~OSKI
NOTARY m~UC, Sram ~ NY
ATTORNEY GENERAL'S SIGNATURE STATE COMPTROLLER'S SIGNATURE
APPROVED
Date:,, Da~ ;: DEC 1 9 2000
STATE OF NE~ YORK
&GREEMENT
This AGREEMENT is hereby made by and between the State of
New York agency (STATE) and the public or private agency
(CONTRACTOR) identified on the face page hereof.
NITNESSETH:
WHEREAS, the STATE has the authority to regulate and provide
funding for the establishment and operation of program services
and desires to contract with skilled parties possessing the
necessary resources to provide such services; and
WHEREAS, the CONTRACTOR is ready, willing and able to
provide such program services and possesses or can make available
all necessary qualified personnel, licenses, facilities and
expertise to perform or have performed the services required
pursuant to the terms of this AGREEMENT;
NOW THEREFORE, in consideration of the promises,
responsibilities and covenants herein, the STATE and the
CONTRACTOR agree as follows:
I. Conditions of AGreement
A. This AGREEMENT may consist of successive periods
(PERIOD) as specified within the AGREEMENT or within a
subsequent Modification Agreement(s) (Appendix X). Each
additional or superseding PERIOD shall be on the forms
specified by the particular State agency, and shall be
incorporated into this AGREEMENT.
B. Funding for the first PERIOD shall not exceed the
funding amount specified on the face page hereof. Funding
for each subsequent PERIOD, if any, shall not exceed the
amount specified in the appropriate appendix for that
PERIOD.
C. This AGREEMENT incorporates the face pages attached and
all of the marked appendices identified on the face page
hereof.
D. For each succeeding PERIOD of this AGREEMENT, the
parties shall prepare new appendices, to the extent that any
require modification, and a Modification Agreement (The
attached Appendix X is the blank form to be used). Any
terms of this AGREEMENT not modified shall remain in effect
for each PERIOD of the AGREEMENT.
To modify the AGREEMENT within an existing PERIOD, the
parties shall revise or complete the appropriate appendix
form(s). Any change in the amount of consideration to be
paid, or change in the term, is subject to the approval of
the office of the State Comptroller. Any other
modifications shall be processed in accordance with agency
guidelines as stated in Appendix Al.
E. The CONTRACTOR shall perform all services to the
satisfaction of the STATE. The CONTRACTOR shall provide
services and meet the program objectives summarized in the
Program Workplan (Appendix D) in accordance with:
provisions of the AGREEMENT; relevant laws, rules and
regulations, administrative and fiscal guidelines; and where
applicable, operating certificates for facilities or
licenses for an activity or program.
F. If the CONTRACTOR enters into subcontracts for the
performance of 'work pursuant to this AGREEMENT, the
CONTRACTOR shall take full responsibility for the acts and
omissions of its subcontractors. Nothing in the subcontract
shall impair the rights of the STATE under this AGREEMENT.
No contractual relationship shall be deemed to exist between
the subcontractor and the STATE.
G. Appendix A (Standard Clauses as required by the Attorney
General for all State contracts) takes precedence over all
other parts of the AGREEMENT.
II. Payment and ReDortin~
A. The CONTRACTOR, to be eligible for payment, shall submit
to the STATE's designated payment office (identified in
Appendix C) any appropriate documentation as required by the
Payment and Reporting Schedule (Appendix C) and by agency
fiscal guidelines, in a manner acceptable to the STATE.
B. The STATE shall make payments and any reconciliations in
accordance with the Payment and Reporting Schedule (Appendix
C). The STATE shall pay the CONTRACTOR, in consideration of
contract services for a given PERIOD, a sum not to exceed
the amount noted on the face page hereof or in the
respective Appendix designating the payment amount for that
given PERIOD. This sum shall not duplicate reimbursement
from other sources for CONTRACTOR costs and services
provided pursuant to this AGREEMENT.
C. The CONTRACTOR shall meet the audit requirements
specified by the STATE.
2
III. Terminations
A. This AGREEMENT may be terminated at any time upon mutual
written consent of the STATE and the CONTRACTOR.
B. The STATE may terminate the AGREEMENT immediately, upon
written notice of termination to the CONTRACTOR, if the
CONTRACTOR fails to comply with the terms and conditions of
this AGREEMENT and/or with any laws, rules, regulations,
policies or procedures affecting this AGREEMENT.
C. The STATE may also terminate this AGREEMENT for any
reason in accordance with provisions set forth in Appendix
Al.
D. Written notice of termination, where required, shall be
sent by personal messenger service or by certified mail,
return receipt requested. The termination shall be
effective in accordance with the terms of the notice.
E. Upon receipt of notice of termination, the CONTRACTOR
agrees to cancel, prior to the effective date of any
prospective termination, as many outstanding obligations as
possible, and agrees not to incur any new obligations after
receipt of the notice without approval by the STATE.
F. The STATE shall be responsible for payment on claims
Pursuant to services provided and costs incurred pursuant to
terms of the AGREEMENT. In no event shall the STATE be
liable for expenses and obligations arising from the
program(s) in this AGREEMENT after the termination date.
IV. Indemnification
A. The CONTRACTOR shall be solely responsible and
answerable in damages for any and all accidents and/or
injuries to persons (including death) or property arising
out of or related to the services to be rendered by the
CONTRACTOR or its subcontractors pursuant to this AGREEMENT.
The CONTRACTOR shall indemnify and hold harmless the STATE
and its officers and employees from claims, suits, actions,
damages and costs of every nature arising out of the
provision of services pursuant to this AGREEMENT.
B. The CONTRACTOR is an independent contractor and may
neither hold itself out nor claim to be an officer, employee
or subdivision of the STATE nor make any claim, demand or
application to or for any right based upon any different
status.
Property
Any equipment, furniture, supplies or other property
purchased pursuant to this AGREEMENT is deemed to be the
property of the STATE except as may otherwise be governed by
Federal or State laws, rules or regulations, or as stated in
Appendix Al.
VI. Safeguards for Services and Confidentiality
A. Services performed pursuant to this AGREEMENT are
secular in nature and shall be performed in a manner that
does not discriminate on the basis of religious belief, or
promote or discourage adherence to religion in general or
particular religious beliefs.
B. Funds provided pursuant to this AGREEMENT shall not be
used for any partisan political activity, or for activities
that may influence legislation or the election or defeat of
any candidate for public office.
C. Information relating to individuals who may receive
services pursuant to this AGREEMENT shall be maintained and
used only for the purposes intended under the contract and
in conformity with applicable provisions of laws and
regulations, or specified in Appendix Al.
APPENDIX A
STANDARD CLAUSES FOR ALL NEW YORK STATE CONTRACTS
The parties to the attached con ract, cerise, lease, amendment or other agreement of an,/kind Coereinafter, "the contract" or
"this contract") agree to be bound by the following clauses which are hereby made a pa~t of the contract (the word
omrac or herein relers to any party other than the State, whether a contractor, licenser, licensee, lessor, lessee or any
other party):
l. EXECUTORY CLAUSE. In accordance with Section 41 of the State Finance Law, the State shall have no liability under
this contract to the Contraclnr or to anyone else beyond funds appropriated and available for this contract.
2. NON~ASSIGNMEblT CLAUSE In accordance with Section 138 of the State Finahce Law, this contract may not be
assigned by the Contractor or its tight, title or interest therein ~ssigned, transferred couveyed, sublet or otherwise disposed
of without the previous consent, in writing, of the State and any attempts to assign the contract without the State's written
consent are mdl and void rlh~ Con factor may, however, assign its right to receive payment without the State's prior written
consent unless this contract concerns Certificates of Participation pursuant to Article 5-A of the State Finance law.
· COMPTROLLER S APPROVAL th accordance with Section 112 of the State Finance Law (or, if this contract is with the
State University or City University of New York, Section 355 or Section 621 g of the Education Law), if this contract
exceeds $15,000 (or the ~rdnimum tlxresholds agreed to by the Office of the State Comptroller for certain S.U.N.Y. and
C. U.N.Y. contracts), or if this is an amendment for any amount to a contract which, as so amended, exceeds said statutory
amoun, or if, by this contract, the State agrees to give'something other than money when the value or reasonably estimated
value of such consideration exceeds $15,00{), it shall not be valid, effec ye or binding upon the Slate until it has been
approved by the State Comptroller and filed in his office.
4.WORKERS" COMPENSATION BENEFITS. In accordance with Section 142 of the State Finance Law, this contract
shall be void and of no force and effect unless the Contractor shall provide and maintain coverage during the life of this
cmltract for the benefit of such employees as are required to be covered by the provisions of tile Workers' Compensatthn
Law.
5. NON-DISCRIMINATION REQUIREMENTS. In ancordance with Article 15 of the Executive Law (also known as the
Human Rights Law) and all other State and Federal statutory and constitutional non-discrinfination provisions, [tie
Contractor will not discriminate against any em, ployee or applicant for employmant because of race, creed, color, sex,
n~.tioanl origin, age, disability or marital status. Furthermore, in accordance with Section 220-e of tile Labor Law, if this is a
contract for the construction, aheratthn or repair of any public building or public work or for the manufacture, sale or
distribution of materials, equipment or supplies, and to the extent that thts coutract shall be performed within the State of
New York, Contractor agrees that neither it nor its subcontractors shall, by reason of race, creed, color, disability, sex, or
national origin: (a) discriminate in hiring against any New York State citizen who is qualified m~d available to perform the
work; or Co) discriminate against or intimidate any employee hired for the performance of work under this contract. If this is
a building service contract as defined in Sectthn 230 of the Labor Law, then, m accordance with Section 239 thereof,
Contractor agrees that neither it nor its subcontractors shall be reason of race, creed, color~ national origin, age, sex, or
disability: (al discriminate in ttinng against any New York State citizen who is qualified and available to perform the work;
or Co) discmninate aga/nst or intimidate m~y employee hired IBr the pe~a%rmance of work under this contract. Contractor is
subject to fines of $50.00 per person per day for any violatmn of Section 220~e or Section 239 as well as possible
termination of this contract and forfeiture of all moneys due bereander for a second or subsequent violation.
6. WAGE AND HOURS PROVISIONS· If this is a public work contract covered by Article 8 of the Labor Law or a
building service contract covered by Article 9 thereof; neither Contractor's employees nor the employees of its
subcontractors may be required or permitted to work more than the number of hours or days stated in said statutes, except as
otherwise provided in the Labor law and as set forth in prevailing wage m~d supplement schedules issued by the State Labor
Department. Furthermore, Contractor and its subcontractors tnust pay at least the prevailing wage rate and pay or provide
the prevailing supplements, including the premmin rates for overtime pay, as determined by/he State Labor Deparlment in
accordance with the Labor Law.
7. _NON-COLLUSIVE BIDDING REQI. flREMENT. In accordance with Section 139-d of the State Finance Law, if this
contract was awmrded based upon the submission of bids, Contractor warrants, nnder penalty of perjuu, that its bid was
arrived at thdependently and without collusion aimed at restricting competition. Contractor further warrants that, at the time
Contractor submitted its bid, an authorized and responsible person executed and delivered to the State a non-collusive
bidding certification on Contraclor's behalf.
8. INTERNATIONAL BOYCOT'F PROHIBITION. In accordance with Section 220-f of the Labor Law and Section 139-h
of the State Fthance Law, if this contract exceeds $5.000, the Contractor agrees, as a material condition of the contract, that
neither the Contractor nor any substantially owned or affiliated person, firm, partnership or corporation has participated, is
participating, or shall participate in an intematiunal boycott in violation of the federal Export Administration Act of 1979
(50 USC App. Sections 2401 et seq.) or regulations thereunder. If such Contractor, or any of fire aforesaid affiliates of
Contractor, is convicted or is otherwise found to have violated said laws or regulations upon the final determination of the
United States Commerce Department or any other appropriate agency of the United States subsequent to the contractors
execution, such contract, amendment or modification thereto shall be rendered forfeit and void. The Contractor shall so
notify the State Comptroller within five (5) business days ut' such conviction, determination or disposition of appeal
(2NYCRR 105.4).
9. SET-OFF RIGHTS. The State shall have all of ils commoll law, equitable and statutory rights of set-offi These rights
shall include, but not be limited to, the State's option to withhold for the purposes of set-off any moneys due to the
Contractor under this contract up to any ammmts due and owing to the State with regard to this contract, any other contract
with any State department or agency, including a~y contract for a term conunencing prior to the term of this contract, plus
any amounts due and owing to the State for any other reason including, without limi. tfition, tax delinquencies, fee
delinquencies or monetary penalties relative thereto. The State shall exercise its set-off fights in accordance with nurnml
State practices including, in cases of set-off pursuant to an audit, the finalization of such an~t by the State agency, its
representatives, or the State Comptroller.
10. RECORDS, The Contractor shall establish and maintain complete and accurate books, records, documents, accounts and
other evidence direedy pertinent to performance under this contract (hereinafter, collectively, "the Records"). The Records
must be kept for the balance of the cglandar year in wlfich they were made and for six (6) additional years thereafier. The
State Comptroller, the Attorney General and any other person or entity authorized to conduct an exaWanation, as well as the
agency or agencies involved in this contract, shall have access to the Records during normal business hours at an office of
the Contractor within the State of New York or, if no such office is available, at a mutually agreeable and reasonable venue
within the State, for the term specified above for the purposes of inspection, auditing and copying. The State shall take
reasonable steps to protect from public disclosure any of the Records widch are exempt from disclosure under Section 87 of
the Public Officers Law (the "Statute") provided that: (i) the Contractor shall timely inform an app~-opriate State official, in
writing, that said records should not be disclosed; and (ii) said records shall be sufficiently identified; and (iii) designation
of said records as exempt under the Statute is reasonable. Nothing contained herein shall diminish, or in any way adversely
affect, the State's right to discovery in any pending or future litigation.
11. IDENTIFYING INFORMATION AND PRIVACY NOTIFICATION.
(A) FEDERAL EMPLOYER IDENTIFICATION NI[1MBER and/ur FEDERAL SOCIAL SECURITY NUMBER.
All invoices or New York State standard vouchers submitted for payment for the sale of goods or services or the
lease of real or pexsonal property to a New York State agency must include the payee's identification number, i.e.,
the seller's or lessor's identification number. The number is either the payee's Federal employer identification
number or Federal social security number, or both such numbers when the payee has both such numbers. Failure
to include this number or numbers max, delay payment. Where the payee does not have such number or numbers,
the payee, on its invoice or New York State standard voucher, must give the remqon or reasons why the payee does
not have such number or numbers.
(B) PRIVACY NOTIFICATION. (1) The authority to request the above personal information from a seller of
goods or services or a lessor of real or personal property, and the authority to maintain such information, is found
in Section 5 of the State Tax Law. Disclosure of tlris information by the seller or lessor to the State is mandatory.
'Die principal purpose for which the information is collected is to enable the State to identify individuals,
businesses and others who have been delinquent in filing tax returns or may have understated their tax liabilities
and to generally identify persons affected by the taxes admiinstered by the Commissioner of Taxation and
Finance. The information will be used for tax administration purpose and for any other purpose authorized by law.
(2) The persona/information is requested by the purchasing unit of the agency contracting m purchase the goods
or services or lease the real or personal property covered by tiffs contract or lease. The information is maintained
in New York State's Central Accounting System by the Director of Aanountirtg Operations, Office of the State
Comptroller, AESOB, Albany, New York 12236.
12. EQUAL EMPLOYMENT OPPORTUNITIES FOR MINORITIES AND WOMEN. In accordance with Section 312 of
the Executive law, if this contract is: (i) a written agreement or pumhase order instrument, providing for a total expenditure
in excess of $25,000.00, whereby a contracting agency is comnfitted to expend or does expend funds in return for labor,
services, supplies, equipment, materials or any combination of the foregoing, to be performed for, or rendered or furnished
to the contracting agency; or (ii) a written agreement in excess of $100,000.00 whereby a contracting agency is committed
to expend or does expend funds for the acquisitior~, construction, demolition, replacement, major repair or renovation of real
property and improvements thereon; or (iii) a written agreement in excess of $100,000.00 whereby die owner of a State
assisted housing project is committed to expend or does expend funds for the acquisition, construction, demolition,
replacement, major repair or renovation of real property and improvements thereon for such project, then: (a) The
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Cgn!ractor will not discriminate against employees or applicants for employmem because of ~ ace, creed, color, national
origin, sea, age, disability or marital stalus, and will undertake or continue existing programs of affirmative action to ensure
that minority group members and women are afforded equal employment opportunities without discrimination. Affilrmative
action shall mean recruitment, mt~ployment, lob assignment, promotinn, upgradings, demotion, transfer, layoff, or
termination and rates of pay or other Inrn~s ol: compensmion; (b) at the reqnest of the contracting agency, the Contraclor
shall request each employment agency, labor uninu, or authorized representative of workers with which it has a collective
bargaining or other agreement or understanding, to himish s written statement that such emphiyment agency, labor union or
representative will not discrimiffate on the basis of race, creed, color, national origin, sex, age, disability m- marital atoms
and that such union or repmsemative will affirmatively cooperate in the implementation of the contractor's obligations
herein; and (c) die Contractor shall state, iii all solicitations or advertisements for employees, that, in the performm~ce of the
State contract, all qualified applicants will be afforded equal employment opportunhies without discrimination because of
race, creed, color, national origin, sex, age, disability or marital status.
Contractor will include the provisions of "a, "b", and "c" above, in every subcontract over $25,000.00 for the construction,
demolition, replacement, major repair, renovatinn, planning or design of real property~and improvements thereon (the Work)
except where the Work is for the beneficial use of the Contractor. Section 312 does not apply to: (i) work, goods or services
unrelated to this contract; or (ii) employment outside New York State; or (iii) banking services, insurance policies or the
sale of securities. The State shall consider compliartce by a contractor or subcontractor with the requirements of any federal
law concerding equal emphiS, ment opportunity which effectuates the purpose of this section. The contracting agency shall
determine whether the imposition of the ]requirements of the provisions hereof duplicate or conflict with any such federal
law and if such duplication or conflict exists, the contracting agency shall waive the applicability of Section 312 to the
extent of such duplicanon or conflict. Contractor will comply with all duly promalgated and lawful rilles and regulations of
the Division of Minority and Women's Business Development pertaining hereto.
13. CONFLICTING TERMS. In the event of a conflict between the terms of the contract (including any and all attachments
thereto and amendments thereof) and the terms of tiffs Appendix A, the terms of this Appendix A shall control.
14. GOVERNING LAW. This contract shall be governed by the laws of the State of New York except where the Federal
supremacy clause requires otherwise
15. LATE PAYMENT. Timeliness of payment and any interest to be paid to Contractor for late paymeni shall be governed
by Article XI-A of the State Finance Law to the extent required by law.
16. NO ARBITRATION. Disputes involving this contract, including the breach or alleged breach thereof, may not be
submitted to binding arbitration (except where statatorily andmrized), but must, instead, be beard in a court of competent
jurisdiction of the State of New York.
17. SERVICE OF PROCESS. In addition to the methods of service allowed by the State Civil Practice Law & Rules
("CPLR "), Contractor hereby consents to service of process upon it by registered or certified mall, return receipt requested.
Service hereundar shall be complete upon Contractor's actual receipt of process or upon the State's receipt of the return
thereof by the United States Postal Service as refl~sed or undeliverable. Contractor must promptly notify the State, in
writing, of each and evew change of address to which service of process can be made. Service by the State to the last known
address shall be sufficient. Contractor will have thiriy (30) calendar days after service hm-eunder is complete in which to
respond.
18. PROHIBITION ON PURCHASE OF TROPICAL HARDWOODS._The Contractor certifies and warrants that all wood
products to be used under this contract award will be in accordance with, but not limited to, the specifications and
provisions of State Finance Law § 165. (Use of Tropical Hardwoods) which prohibits purchase and use of tropical
hardwoods, unless specifically exempted, by the Slate or any governmental agency or political subdivision or public benefit
corporation. Qualification for an exemption under this law will be the responsibility of the contraclor to establish to meet
with the approval of the State. In addition, when any portion of this contract involving the use of woods, whether supply or
installation, is to be performed by any subcontractor, the prime Contractor will indicate and certify in the submitted bid
proposal that the subcontractor has been informed and is in complitmce with specifications m~d provisions regarding use of
tropical hardwoods as detailed in §165 State Finmme Law. Any such use must meet with the approval of the State,
otherwise, the bid may not be considered responsive. Under bidder certifications, proof of qualification for exemption will
be the responsibility of the Contractor m meet with the approval of the State.
19. MACBRfl~E FAIR EMPLOYMENT PRINCIPLES. In accordance with the MacBride Fair Employment Principles
(Chapter 807 of the Laws of 1992), the Contractor hereby stipulates that the Contractor eidier (a) has no business operations
in Northern tm/and, or ~) shall take lawfid steps in good faith to condoct any business operations in Northern lrelm~d in
accordance with the MacBfide Fair Employment Principles (as desefibed in Section 165 of the New York State Finfince
Law), m~d shall permit independent moiuioring of compliance with such principles.
20. OMNIBUS PROCUREMENT ACT OF 1992 It is the policy of New Ym-k State to maximize opportunities for the
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participation of New York State business enterprises, including minority and women-owned business enterprises as bidders,
subconh~actors and suppliers on its procurement cootrants.
Information on the availability of New York State subcontractors and suppliers is available from:
Department of Economic Development
Division for Small Business
30 South Pearl Street
Albany, New York 12245
Tel. 518-292-5220
A directory of certified minority and women°owned business enterprises is available from:
Department of Economic Development
Minority and Women's Business Development Division
30 South Pearl Street
Albany. New York 12245
www.empire, stale.ny.us
The Onmibus Procurement Act of t992 requires that by signing this bid proposal or contract, as applicable, Contractors
certify that whenever the total bid amount is greater than $1 milfion:
(a) The Contractor has made reasonable efforts to encourage the participation of New York State Business
Enterprises as suppliers and subcontractors~ including certified minority and women-owned business enterprises,
on this project, and has retained the documentation of these efforts to be provided upon request to the State;
(b) The Contractor has complied with the Federal Equal Opportunity Act of 1972 (P.L. 92~261), as amended:
(c) The Contractor agrees to make reasonable efforts to provide notification to New York State residents of
employment opportnnifies on this project through listing any such positions with the Job Service Division of the
New York State Department of Labor, or providing such notification in such manner as is consistent with existing
collective bargaining contracts or agreements. The Contractor agrees to document these efforts and to provide said
documentation to the State upon request: m~d
(d) The Contractor acknowledges notice that the State may seek to obtain offset credits from foreign countries as a
result of this contract and agrees to cooperate with the State in these efforts.
21. RECIPROCITY AND SANCTIONS PROVISIONS. Bidders are hereby notified that if their principal place of business
is located in a state that penalizes New York State vendors, and if the goods or services they offer will be substantially
produced or performed outside New York State, the Omnibus Procurement Act 1994 amendments (Chapter 684, Laws of
1994) require that they be denied contracts which they would otherwise obtain. Contact the Department of Economic
Development, Division for Small Business. 30 South Pearl Street; Albany New York 12245, for a current list of states
subject to this provision.
(Revised August, 2000)
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APPENDIX A-1
AGENCY SPECIFIC CLAUSES
SOCIAL ADULT DAY SERVICES PROGRAM
(Please note that the order in which each part of this Appendix A-1 is set forth,
corresponds directly to that of the State of New York Agreement {boilerplate}.)
I. Conditions of Agreement
The Contractor shall comply with all applicable State Laws, including Section
541a of Article 19-J of the Executive Law, and the State Finance Law of New
York State, and with all applicable rules and regulations of the State and the
New York State Office of the State Comptroller that are in effect or become
effective during the term of this Agreement.
The Contractor shall comply with Section 6654.20 of Title 9 of the New York
Codes, Rules and Regulations and MDS requirement as established in NYSOFA
Program Instruction ~97-PI-01.
The Contractor shall comply with the registration and reporting provisions
required of charitable organizations by Article 7-A of the New York State
Executive Law.
The Contractor shall comply with Titles VI and VII of the Civil Rights Act of
1964 (Public Law 38-352), and any amendment thereto, and all rules and
regulations pertaining thereto promulgated by the United States Department of
Health and Human Services that are in effect or become effective during the
term of this Agreement. In addition to the above protections the Contractor
shall comply with Titles I, II, and III of the Americans with Disabilities Act
of 1990, and any amendment thereto, which protects qualified individuals with
disabilities from discrimination in employment and provides access to public
services. Reasonable accommodations must be made for any person with a
disability desiring to participate in services funded under this agreement, no
fees can be charged to the participant for such accommodation.
The Contractor shall comply with the program management and assessment
requirements of the State, including but not limited to announced and
unannounced on-site visits by State staff, disclosure of all program files and
related fiscal records and development of a corrective action plan if required
by ~he State in a program assessment report.
The Request for Proposals package issued by the State and the proposal
submitted by the Contractor in response to the Request for Proposals are a part
of this Agreement. The Program Workplan (Appendix D) shall not be modified
without approval from the Sta~e. If modification to the Program Workplan is
necessary, the Contractor must submit a written request to the State and await
State approval before implementing such changes.
The Contractor shall make expenditures only for authorized items of expense
contained in the Budget (Appendix B). Cost overruns of up to $200 or 10%
(whichever is greater) for an individual budget category for authorized items
of expense will be allowed as long as the total costs do not exceed the total
amount of the contract. If expenditures for other than authorized items become
necessary, the Contractor shall submit a written request for approval from the
State and await State approval before incurring such expenditures. Also, if
costs for an individual budget category will exceed the budgeted amount by more
than $200 or 10%, whichever is greater, a budget modification must be approved
in writing by the State before these costs will be reimbursed. Budget
modifications shall not result in an increase in the amount made available
under this Agreement unless the State gives its express written consent.
II.
A.
III .
A.
IV.
A.
Unless a waiver is requested and granted as provided for in legislation, the
Contractor agrees and understands that any funds provided under this program
shall not exceed 75% of the Total Budget Amount.
The Contractor agrees that the Social Adult Day Services funding shall not
supplant any existing public or ~rivate f~nding for social adult day services
programs.
The Contractor agrees that the Social Adult Day Services funding shall not be
used for services provided to el~/erly persons who are eligible for or receiving
comparable services pursuant to 7~itles XVIII, XIX or XX of the federal Social
Security Act or any other government program.
The Contractor may enter into subcontracts for the provision of some aspects of
the program as described in the Program Workplan. All such subcontracts shall
be written according to State and local standards and a copy of each executed
subcontract shall be forwarded to the State prior to payment by the State for
any expenditures incurred under such subcontract.
The Contractor agrees that any public information materials or other printed or
published materials will give due recognition to the fact that the program is
supported with State Funds and such recognition will be in a form prescribed by
the State.
The Contractor shall work cooperatively with and consult with the area agencies
on aging in the region to be served by this Agreement.
The Contractor shall work cooperatively with public and private agencies,
institutions, organizations, and associations within New York State and, where
appropriate, with national organizations in the development of activities under
this Agreement.
Payment and Reporting
The Contractor agrees that in the absence of new legislative authorization for
the use of these State funds for the purpose described in this Agreement, the
State may only be authorized to reimburse vouchered claims for payment for
approved expenses incurred during the 2000-01 State Fiscal Year up to and
including March 31, 2001.
In the event that new legislative authorization permits the use of these State
funds in subsequent State fiscal year(s), the State ,is authorized to reimburse
vouchered claims for payment for approved expenses incurred by the ending date
of the fiscal year for which authorization is received.
The Contractor understands and agrees that all payments to be made hereunder,
are subject to the availability of State funds and, the State shall have no
liability to the Contractor beyond the amounts made available under the 2000-01
State Budget.
Terminations
The Contractor shall make a full and final accounting of all funds received
under this Agreement within 60 days of receipt or issuance of a notice of
termination.
Indemnification
The Contractor shall assume responsibility for recruitment, retention, and/or
dismissal of all personnel to be employed in the conduct of this Agreement.
The Contractor shall ensure that the personnel hired are qualified to carry out
the activities outlined in this Agreement.
VI.
A.
Property
The Contractor agrees that all rights and title to any materials (manuals,
tests, guides, audio or visual materials or devices) developed with funds under
this Agreement shall become the property of the State. Reproduction,
distribution, sale, release or other use of such material by the Contractor
must be specifically requested in writing by the Contractor and must receive
prior approval by the State.
Safeguards for Services and Confidentiality
The Contractor shall utilize these State funds to serve those aged (i.e.,
persons age 60 and older) individuals possessing functional impairments,
whether due to physical or cognitive impairments, regardless of their
membership status subject to the availability of funding.
The Contractor shall serve any aged individual possessing functional
impairments, whether due to physical or cognitive impairments, and assure equal
access for participation, services, activities and informational and outreach
sessions without regard to race, color, religion, sex, national origin,
partisan affiliation or sexual orientation.
The Contractor shall prevent the use of official authority, influence or
coercion to interfere with or affect elections or nominations for public
office.
The Contractor shall assure there is neither coercion nor advice to other
persons to contribute anything of value to a party, committee, organization,
agency, or person for political purposes, nor engage in any other partisan
activities.
The Contractor shall use all cost sharing and participant contributions
received for services funded under this Agreement to expand services under this
Agreement and to incorporate them into the budget accordingly.
The Contractor agrees to maintain the confidentiality of all personal
information pertaining to senior citizens served under this Agreement,
including contributions; disclosure of such information may be made only when
necessary to the provision of services, unless the senior citizen or his/her,
authorized representative gives his/her consent to disclose such information,
disclosure is required by court order, or such information is provided in
summary, statistical, or other form, which does not identify particular
individuals.
3
Appendix B
Budget Sununary
ProDosing Organization Town of So'~lthold
Contract Period:January 1, 2001 - ]0ecember 31, 2001
Budget Category Budget Amount
1. Personnel $ 19,581
2. Fringe Benefits 2,086
3. Maintenance and Operations 333
4. Other Expenses 0
5. Subcontractors and/or Consultants * 0
6. Total Budget 22,000
7. Less Program Income 2,000
8, Net Budget Expenses 20,000
9. Matching Funds 0
10. State Funds Requested ** $ 20,000
* For each anticipated subcontractor or consultant,
Subcontractor/Consultant Budget must be completed and submitted.
** State Funds Requested must be a minimum of $20,000 and a maximum of
$75,000.
~ame, ~cle ~oca~on tif hourly ra~e ~
~loyme, cal=. Weeks
HeMth, ,Aide ~
~,38o 52
Sr. Adult Day Care
Bruce Berger
Massage Therapist ~o,6~ 52
Sr. Adu1t Day Care
Lauren Como ~~
100%
Prograph
7380.
10,641.
1,560.
19,581.
Soczal Securi:y $2¢98.
ae:~r~m~n~
Hmalch I~surance
S9__8.
Disability
196.
2,086.
3. Maintenance and Operations:
Rent/Utilities (if multiple locations, please attach additional copies):
Location: O~er:
Monthly Rental:S__ X %Chargeable X _ _ mos. = $
Utilities: $ Janitorial Services: $
Maintenance-in-lieu of rent: $
Briefly Describe Each Expense:
Telephone: $.
Postage:
Supplies: Art supplies, paints, paper)large paper pads, $-- 333
massage gels, towels, cassettes, record books ma ic markersL etc.
Printing/Photocopying:
Equipment maintenance and repair: (describe equipment and list amount)
$_
Meals: $--
4. Other Expenses:
ITEM:
TOTAL
List each item and its cost for all Other Expenses.
$ AMOUNT
$333
TOTAL S 0
Subcontractors/Consultants: List each organization's name, tlrpe of service and
amount below. Include a budget for each subcontractor/consultant.
Organization/Type of Service
Program Income: List total amount anticipated:
Participant Contributions:
Cost Sharing:
Other Income (specify source):
TOTAL
Amount
O00
$ 0
9. Local Matching Cash: List sources and
amounts of Local Matching Cash.
Source:
(/) if
in-kind
TOTAL 000
Amount
$
$
0
$ 20,000
APPENDIX C
PAYMENT AND REPORTING SCHEDULE
SOCIAL ADULT DAY SERVICES PROGRAM
The Contractor shall submit appropriate State Vouchers for reimbursement
of expenses incurred in the conduct of this Agreement on a monthly or
quarterly basis in such form as required by the State and with the
necessary documentation as specified in the Social Adult Day Services
Program Vouchering Procedure. The Contractor may request an advance not
to exceed 25% of the State funds awarded. The Contractor shall submit
the final voucher for expenses incurred under this Agreement to the
State within 90 days after the ending date of the Agreement (by March
31, 2002). State Vouchers must be submitted to:
New York State Office for the Aging
Attention: Bureau of Fiscal Operations
2 Empire State Plaza
Albany, NY 12223-1251
If the Contractor is a not-for-profit organization, then subject to the
submission of a properly completed advance voucher, the advance will be
paid within 30 days of the starting date of this Agreement. If it is
necessary for the State to suspend the Prompt Contracting Law time
frames, under the circumstances provided for in that statute, this
payment date will be adjusted accordingly.
The Contractor shall submit to the State an interim program progress
report as prescribed by the State. This report is due by July 30, 2001
for the period ending June 30, 2001. A final program progress report
must be submitted no later than 30 days after the end of the contract
period (by January 31, 2002). Program progress reports must be
submitted to:
Andrea Hoffman
Division of Local Program Operations
New York State Office for the Aging
2 Empire State Plaza
Albany, NY 12223-1251
Program Workpl~n
Appendix D
Proposing Organization Southold Town~ Human Services
Subpart I: F-~nsion of Existing Social Adult Day Sa=vices Program
Section A.
1. Operating schedule and location(s)
a. Current hours and days of operation and location(s)
5 days a week - Monday through Friday
9 a.m. - 4 p.m.
Located at the Human Resource Center
750 Pacific St. (P.O. Box 85)
Mattituck, NY 11952
Describe any anticipated changes in this program area if funds
are awarded. Identify major benchmarks to be achieved and time
frame for overall completion.
If funds are available for our one year pilot program, we will expand Our
catchment area to include Shelter Island Shelter Island has
no Day Care at al! . a
We have ca]is to utilize our Day Care
Program, but we cannot accept them as we need another part time staff person
in order to supervise, monitor, provide personal care, maintenance and the
daily Iiving skills of the additional clients.
The funds would allow us to utilize specialized aIternative approaches to
enhance the environment and utilize ail the senses of our clients to instill
a genera! sense of well being in the hope that through the techniques of
massage therapy and music therapy we can calm our A]zheimer's clients so
they can re]ax more, decrease pacing and wandering, promote more focus and
lessen combativeness. We wi]! monitor the effects of the various methods
on their behavior. It is our hope that utilizing these methods would en-
able us to increase our ability to manage their behavior better and extend
their time at home and in our program, thus deterring premature institution-
alization.
-cont. on next page-
b. continued
Many of our frail elderly c]ients suffer from depression. It is our hope that the
touching techniques in combination with moving to music, and doing activities to
music will stimulate more positive responses to the world around them, that they
wi1! feel more empowered and part of a very special group of caring people. We
want to produce overal! physical, mental and emotional benefits from this indiv-
idualized two-pronged approach to enriching the lives of our participants.
Hospitals are utilizing massage therapy to calm and relax pre-operative patients
as we]] as post-operative massage to promote healing. Examples of some of the
overall benefits of massage are:
1. Increases nourishment to muscles and organs.
2. Increases efficiency and performance of muscle cells.
3. Improves cardio-vascular system where the number of circulating red blood
cells is increased leading to greater oxygen capacity being carried to
the blood.
4. Stimulates the body's parasympathetic nervous system which helps to ]ower
blood pressure.
5. Breathing becomes slower and fuller and thus more efficient due to greater
pulmonary ventilation.
6. Skin will have increased secretions because of more blood flow to it which
will cause more regeneration of new skin cells through mitosis (replication).
7. Stimulates and tonifies digestive organs.
8. Improves digestion and the absorption of more usable nutrition.
9. Causes the release of special pain killing neurotransmitters known as
endorphins where an euphoric feeling can be felt.
10. Increase basal metabolic rate where every cel! does more than what it did
before, burning more calories in the process.
11. Increases the elimination of toxins and waste products from the body ceils.
12. Aids the body's feeling of tactile sensation where there is numbness or
tingling.
Our goal is to utilize massage techniques, comparable with our clientele, as
well as music therapy to improve the health and behavior of both the frail
elderly and dementia clients. Our goal is to enrich their quality of life,
improve wandering and/or pacing and combative behavior among some dementia and
A]zheimer clients to enable them to utilize our program longer, make it easier
for caregivers to manage their behavior at home thus deterring premature insti-
tutionalization.
Although we have sufficient staff, they have many duties. They must implement
the individual care plans, attend to the client's personaI care, provide the
individual help required for nutrition, supervision and monitoring. They are
very busy with their overall duties. The two consultants would only plan and
implement their specialties. Each one would provide a rich, unique array of
activities, presented to our clients on a regular scheduled basis, an en-
richment of the senses of each participant at the level of their ability to
accept it.
- cont. on next page -
b. continued
These are the special enhancements our budget cannot provide, but things that may
increase the ability of our clients to enjoy more meaningful days. This one year
pilot project wouId determine if this is possible.
Major benchmarks would be recorded monthly as the program progressed. We would
have a base line for each client and at the end of six months we would chart
changes in behavior, such as depression, combativeness, wandering, pacing,
anxiety levels and length of stay in Day Care. A limited day may be able to
be expanded. There may be increased participation in activities, less care-
giving stress for families, an increase in the general well-being of the client
to allow them to remain at home and in our program and not be prematurely
institutionalized..
3
Program WorkDl=n
Appendix D
Southold Tow~, Human .Se~ri~
2. Program participants:
· Average % of participants/day KO n.
· Unduplicated % of participants/month~O
· Unduplicated % of participants in calendar year 1999 50
· A description of the program participants including the types
and degree of their impairments
1. Cannot ambulate alone, grossiy'dnsteady, cane; possible
hallucinations at home.
2. No problems with early dismissal.
3. No problems; needs assist due to blindness.
4. No problems here; can easily feel slighted and becomes angr
5. Less participation; no exercises; on list at Westhampton NH
6. Cannot ambulate alone; very unsteady; walker; forgetful.
7. Episode on 8/17; ? comonary involvement; to Urist on Friday
blood work on Monday 8/21. Staff knows to observe closely.
8. Extremely rigid; has been on Exelon for one week (aricept
discontinued)Exelon stopped on Friday 8/18; no med over the
weekend and'to start Aricept on monday. Her behavior has
become worse in most areas on the exeon. Husband to see
Ickes on 8/30 and Valiicourt on 9/6. Difficult behavior at
home. Appetite poor; Donna Z. to assist with diet. We en-
courage or feed her; offer supplements and fluids; home at
1:30. (Alzheimer's Disease) continued next page
b. Describe any anticipated changes in this program area if funds are
awarded. Identify major benchmarks to be achieved and time frame
for overall completion.
An%ic~Dated changes iD Dr0gram area if fuuos are awarded would be to enhance
and improve the behavioral management of clients, %o improve their physical,
emotional and social well-being; to increase their ability to utilize our
Day Care Program longer and to deter premature institutionalization.
We would supervise and monitor clients as they participated in our enhanced
program and noting any changes in behavior, length of daily attendance in
program, caregivers opinions from interviews to determine change in behavior
at home, and any n~ticeable physical, emotiona! and/or socia! ~mprovement.
It is ~mportant that each client be prov!ded with the services and activities
that are commensurate with their ability to participate with maximum benefit
to their general well being - to reach out to al! their senses in order to
)rovide meaningful opportunities to enjoy music, movement, touch and artistic
expression to the highest personal level they can attain; to make joyful con-
tact with the world around them.
- cont. on next page -
4
a. continued
10.
11.
12.
13.
14.
15.
16
17.
18.
19.
Slow to respond but doing well
husband is trying to regulate.
12:30.
on Exelon; constipation problem that
We encourage extra fluids. °ere until
Comes M-W-F; likes to help other clients; no problems
Comes M-W-F, becoming more frail and unsteady ambulation when weather
is humid; uses cane.
Short of breath on exertion; extremely unsteady ambulation and needs
one assit; uses walker; post stroke client.
Becoming more frail;
needs encouragement
(Dementia)
uses cane and cannot ambulate alone; unsteady;
to eat; we give supplements and extra fluids.
Quiet as usual; family away until next month and Jack is living with
Nancy Lillis; right hand swollen; he declines to exercise with that
arm; occasionally cough becomes loose and Nancy adds one more nebulizer
treatment.
No problems; needs guidance 'with ambulation; daughter concerned she
will fall.
No problems here; needs to walk more; wife overwhelmed at home with
his ability to get "into everything". (Alzheimer's Disease)
Started Jb Exelon Jn conjunction with Aricept on 8/15; already improve-
ment noted in word retrieval thought processes. Needs to walk more;
cannot sit too long or her feet and legs hurt. (Alzheimer's Dsease)
Nicely managed at home and here on Seraquel.
is coming M-W-F and staff knows to let Doris
cannot find him. (Alzheimer's Disease)
Needs to walk; husband
color after lunch so she
Becoming more incontinent at home. No problems here. Leaves at 1:30
(Alzheimer;s Disease)
5
b. continued
Each client's chart would have a baseline of impairments, physical, mental and
emotional. Changes would be noted each month. At the six month mark a chart
of each client would be made showing progress, or no or little progress, in
each area noted. This would be done each month with the final individual
progress reports charted in December.
6
Proposing Organization: ~] ~
Program WorkDl~n
A~Dsndix D
Human Services
3. Staffing:
List staff positions with their responsibilities, indicating whether
paid or volunteer, indicating those with direct contact with
participants and the nature of the contact and hours worked. For
full time staff whose responsibilities are providing assistance to
participants or supervising participant activities, list relevant
training and experience. Complete a Biographical Sketch for the
program director
(Please be advised that the regulations include requirements in this
Director: The Director of the Day Care Program is also the Director of Human
Services for the Town of Southold. The Director has the authority, working
with the Suffolk County Office for Aging and the Supervisor and Town Board
of Southold Town to hire personnel, be responsible for policies and proced-
ures, has the basic responsibility to manage and implement the program and to
ensure that activities and services are provided appropriately and in accord-
ance with participant's needs. This is a full time paid position.
Adult Day Care Supervisor: This is a full time paid position. The Adult
Day Care Supervisor directly implements compliance and conformity standards
with local, State and Federal laws and regulations. The Day Care Super-
visor submits program reports, does initial assessments, completes the PDS
assessments, writes the individual care plans and implements them, provides
at least six hours of in-service training annually to develop, review and
expand skills and knowledge, provides annual training in the use of fire
extinguishers, written procedures regarding evacuation and emergency sit-
uations, emergency phone numbers, keeps open communications with famiIies of
participants. Al] trainings are documented.
- cont. on next page -
b. Describe any anticipated changes in the program area if funds are
awarded. Identify major benchmarks to be achieved and timeframe
for overall completion.
If funds are awarded 3 people will be added to the staff, a massage
therapist, a music therapist and an aide who will do record keeping,
assist the therapists, track client progress, carry out therapists
assignments throughout the week. A data base will be established and
precise tracking of progress will be essential to the project.
The therapists will have to have job descriptions prepared, permission
from the Supervisor a,d Town Board to establish the positions and all
positions must be advertised. This process takes about 6-8 weeks. Staff
are expe~ed to be on board by February 1.
7
a. continued
Day Care Aide: This is a full time paid position. The current staff person in
this position has been with the Day Care Program since its inception in 1985.
She received a special 40 hour home heatth aide course through the Suffolk County
Department of Health, specifically for the implementation of the new Day Care
Program. She has received training from Dr. Lori Bright-Long and Dr. Alan
Steinberg, co-founders of the Long Island A1zheimer's Assistance Center at Stony
Brook Hospital. They are both Geriatric Psychiatrists who provided training for
us in the initial years of our program. Dr. Jay Slotkin, a loca! Geriatrician,
also has provided our aides with training. The Day Care Aide of course, takes
part in all in-service trainings here at the Human Resource Center where our
Day Care Program is located. Al! staff members have had ppd (Mantoux) skin
tests as well as the Hepatitus A injection. All service staff members are
certified home health aides, have had at least six hours of in-service train-
ing annually, trained in the use of equipment, such as fire extinguishers,
location of emergency numbers.
Day Care Aide: This is a fulI time paid position. The current staff member
has worked in our program since 1988 and is a certified home health aide. He
has participated in all in-service trainings, has had his ppd skin test and
Hepatitus A injection. As all our aides, he facilitates socialization through
games, reorientation activities, while supervising and monitoring the behavior
and personal needs of the participants. He leads exercise programs, field
trips, does gardening with them, takes clients for walks, helps them with
cutting food when necessary, serves snacks. He also conducts short quizzes
with mind alert questions. All the aides are trained to help those who are
functionally or mentally impaired to achieve as much as they are able to
socially, intellectually, educationally and physically.
Three Part Time Aides: These are ali paid positions. All are certified home
health aides, all have had the ppd skin test and the Hepatitus A injection.
All have participated in our in-service trainings. These aides add an extra
feature of each leading a group of Day Care participants in activities
appropriate to their leve! of ability, letting all participants use their
individuaI abilities to the fullest. All service staff is responsible for
carrying out the individual service plans for participants.
Social Worker: This is a full time paid position with Southold Town Human
Services, however, part of her time is utiIized for our Day Care Program.
She is part of our admission and discharge committee, meets with our care-
givers group and meets individually with families to do case management.
Volunteer: Our volunteer is a retired psychiatrist who volunteers every Mon-
day morning to do a variety of activities with our Day Care participants.
She, too, has met all the requirements in regard to health status. If re-
quired, this volunteer is ab!e to perform tasks related to the health, safety
or welfare of the participants.
Proposin~ Or~an{zation:
Progr~mWor~)lan
Appendix D
Southold Town, Human Services
4. Relationship(s) With Other Organization(s):
If the program is sponsored by or is part of another organization
(e.g., a program within a YMCA or Senior Housing Complex),
describe that organization, its involvement in serving the
individuals in the con~nunity, especially older adults and its
relationship with the program.
Describe the program's relationship with other community
organizations providing other services and supports that may be
needed by program participants, e.g., referral mechanisms, case
conferencing.
In 1982 Dr. Jay Slotkin and I co-founded the Southold Town Geriatric Network.
It has since been replicated throughout the county. Each month a group of
health professionals from many disciplines meet on the last Wednesday of
each month at 9:30 a.m. at the Human Resource Center. We have physicians,
hospital discharge planners, nursing home social workers, home health care
supervisors, community advocates from the Suffolk County Office for Aging,
Assisted Living owners, Respite Care, Hospice, North Fork Counseling social
workers and many others over' the years. We discuss overall health care
changes, changes in health care on the east end of Long Island; we refer
clients to other agencies, do case counseling and discuss many other issues.
This meeting keeps us aware of other services that are available and our
services receive support from the other agencies throughout Suffolk County.
We have a long and outstanding relationship with other organizations in our
area and throughout Suffolk County.
Describe any anticipated changes in this program area if funds
are awarded. Identify major benchraarks to be achieved and time
frame for overall completion.
No changes are anticipated.
9
Proposing Organization:
Pro~ramWorkpl~n
A~pendix D
Southold Town Human Services
Assessments and Care Planning:
Describe the current process for conducting client assessments
and developing participant care plans. Include a description of
the instrument(s) used, the frequency for conducting assessments
and developing care plans, where assessments are conducted and the
staff who perform these functions.
(Please be advised that there are program requirements for this
area.)
Upon admission into our Day Care Program the Supervisor of Day Care
visits the home of the participant and completes a PDS assessment. There
is an initial assessment and an individualized care plan is developed.
There is a six month reassessment and after six months another annual.
There are also episodic PDS assessments after a participant suffers a
stroke or other serious illness and another care plan is developed.
Describe any anticipated changes in this program,area if funds
are awarded. Identify major benchmarks to be achieved and time
frame for overall completion.
There will be no changes in this policy.
10
Proposing Organization:
Program Wor~lan
A~pen~ix D
Southold Town Human Services
6. Program Services and Activities:
Describe the services and activities of the prograph. Include a
schedule/calendar of a tYpical day/week for the program (the
times and types of activities). Describe the level of assistance
that is provided to participants, e.g., if needed by a participant
the program provides supervision and cueing, as well as hands-on
assistance ~uch as cutting food, opening containers and actual
feeding.
{Please be advised that the regulations include requirements in
this area ~!
If any aspect of the program is provided by an entity under a
subcontract, please describe the entity and what it provides to
the program.
The Southold Town Day Care Program is a structured, comprehensive program
which provides functionally impaired individuals with socialization, supervisl(
and monitoring, personal care and nutrition. Monday through Friday, 9:00 a.m.
to 4:00 p.m. We also offer additional services such as enhancement of daily
living skills, transportation, caregiver assistance and case coordination and
assistance. Clients are assisted as needed in such areas as eating, toileting
transfer, and ambulation. Juice and snacks are served to all participants at
appropriate times. All meals comply with the standards set forth for a nutrit2
program for the elderly site and as established by the New York Office for
Aging and the Suffolk County Office for Aging. We also provide cueing,
cutting food, opening containers and actual feeding. See Attachment #1
Describe any anticipated changes in this program area if funds
are awarded. Identify major benchmarks to be achieved and time
frame for overall com~letion. If any changes include
subcontractors, it is recommended that letters of support from
these entities be included.
These standards will remain the same.
11
Proposing O~ga~£sa~£on:
Program Workplan
Appendix D
Southold Town Human Services
7. Program Site:
a. Describe the physical attributes of the sitels) where the program
is located, including its (their) location in the community, the
building(s) and room(s) where program activities take place,
services are provided and that participants use, and any space
shared with .other programs or services.
In 1993 the Town of Southold purchased a bank mortgage center to utiliz~
as our Human Resource Center. They built an addition comprised of a large
kitchen and two handicapped bathrooms. The building is located in the hamle~
of Mattituck in Southold Town.
The Day Care Program occupies three rooms - an office for the superviso~
Day Care, a conference room and a large 30' x 50' room where program
activites take place. Adjacent to this room is a 28' x 25' deck that was
constructed for us as an Eagle Scout project and where clients can enjoy an
outdoor picnic, games and refreshments under an umbrella. We do not share
space with any other programs.
bo
Describe any anticipated ch~ges in this program area if funds
are awarded. Identify benctunarks to be achieved and time frame
for overall completion.
No changes will be made in the building or Day Care area.
of
12
Proposin~ Organization:
Program Work Plan
Appendix D
Southold Town Human Services
8. Participant Cost Sharing:
a. Is there a standard practice of requiring participants to pay for
some/all of the cost of the program? If yes, describe how cost
sharing determinations are made, what is considered for making a
determination and how much a participant is required to pay. If a
slidinu scale is used please include it. Also, please describe
what happens if a person is unable to pay the cost share.
Participants are given a brochure upon application to our program which
states our policy of voluntary and anonymous contributions. The suggested
voluntary contribution is $ 12.00 per day for the program and lunch, if a
person utilizes our round trip bus services it is an additional voluntary
and anonymous contribution of $2.00. Service will not be denied if a person
is unable or unwilling to contribute.
Describe any anticipated changes in this program area if funds
are awarded.
There will be no change in this policy if funds are awarded.
13
Proposing Orga~za~on~
Pro.ram Work Pls~n
Appe~Lix D
Southold Town ~uman Services
Participant Contributions:
ao
Is there a standard process for providing participants with a
voluntary opportunity to contribute toward the cost of the
program? If yes, describe the process,, including how individuals
are informed of this opportunity and the frequency. If there is a
suggested contribution amount or a sliding scale please provide
that information.
Yes, we have a standard process for providing participants with a
voluntary opportunity to contribute toward the cost of the program.
Upon admission to our program participants and their families are given
our brochure which states our policy. We also have an
informational letter which informs families of the opportunity to
contribute. This letter is sent monthly.
ho
Describe any anticipated changes in this program area if funds
are awarded.
There will be no change in this policy if funding is awarded.
14
Program Work, lan
Appendix D
Proposing Organization: Southold Town Human Services
Section B. Rationale ama Justification for Program Cha~ges
Sunm~arize the program expansion that will take place because ;of the
additional funding and provide a rationale and justification for the
expansion of =he existing program and an explanation of unme~ need that will
be addressed.
We serve approximately 20 participants daily in our Day Care Program. A]
are functionally impaired. Six of our clients have been diagnosed with
Alzheimer's Disease. Although we have a full day program for our Day Care
members and provide many activities to maintain their abilities, we can do
Our clients who have Alzheimer's Disease pace and wander. Some are combatant,
while others find it difficult to stay the full day. This causes more stress
on the caregivers, who truly need every moment of respite they can get from
our program. Many of our frail elderly clients are depressed. They realize
health changes that have occurred in their lives. Some have left their own
homes to move in with family members. Others feel set aside from life and ne
to be reassured that they are still important to those around them. It is
difficult for our aides to devote the individual time needed to address these
issues in a concentrated, comprehensive way.
In order to address these issues positively and, as our regulations sugge
to maintain the highest practicable physical, mental and psychosocial well-bei
of the participant including independence and self care, w~ propose to hire as
consultants a certified massage therapist and a music therapist. With these
techniques we will encourage the clients to use their existing..capacities,
develop new capacities and interests and compensate for existing or developing
impairments in capacity.
Through the use of massage and touch, concentrated weekly for one year,
and with moving, painting, singing and listening to music we will encourage
focus, calming, a general feeling of well-being, less anxiety and a decrease
depression. This may contribute to a decrease in pacing, wandering, combativ.
ness and lengthen the hours they can remain in our program each day. Improve-
ment in managing the behavior o~ clients will releave stress at home and allo~
the caregivers to enjoy the full day of respite deterring premature
institutionalization for our clients.
We want to implement this one year pilot project and form an initial base
line, monitor any changes in behavior of our clients on a monthly basis and at
the end of six months we will chart the changes for each client to see if they
benefitted from the program and identify those areas. A final report would be
charted at the end of the project to see the results of our project.
We would hope that, as stated in our regulations, we would encourage and
stimulate the participant to interact with others and seek to establish,
maintain or improve the client's sense of usefulness to self and others, the
desire to use his or her physical and mental capabilities to the ~ullest
extent, and his or her sense of self respect.
The second goal of our proposal is to expand our catchment area to includ
the Town of Shelter Island. Shelter Island has no Day Care Program and we get
many requests for Shelter Island residents to utilize our Program. Although
we have accepted some Shelter Island clients in the past, we don't have enough
staff to meet the need. Therefore, I would like to add one part-time aide to
our staff in order to include residents of Shelter Island in our program.
15
Program workplan
Appendix D
Proposin~ Org~nlsation: Southold Town Human Services
Section C: Continuation of Program Expamsion
Funding available under this grant was appropriatedon a one-time basis.
Please explain how the program expansion described in this proposal will be
continued when funds under this grant are no longer available.
If our one year pilot project meets our expected goals I would want to
continue it. When funds are no longer available we must first try to
increase our budget through Town of Southold funding. Our second effort
will be voluntary contributions for the service, although service will not
be denies to anyone because of their inability or unwillingness to pay.
Also, we will utilize our general voluntary contributions for the Day Care
Program toward this program. Our estimated yearly and anonymous
contributions are estimated at $ 25,000.00 per year. It is usually more
than this estimate.
Program Workplan
Appendix 1)
Proposing Organization Southold Town Human Services
ATTACHMENTS
VENETIA McKEIGHAN
DIRECTOR
Adult Day Care Schedule of Activities
Daily schedule as follows :
8:30 9:30 a.m.
9:30 - 10:O0.a.m.
10:00- 10:30 a.m.
10:30 -11:00 a.m.
11:00-11:15 a.m.
11:15-11:45 a.m.
11:45 -1Z:15 p.m.
12:30- 1:30 p.m.
1:30- 2:00p.m.
2:00- 3:00 p.m.
3:00- 3:15 p.m.
3:15- 3:45 p.m.
3:45- 4:00 p.m.
4:00 p.m.
Arrival by van or caregiver
Breakfast
Reality orientation; "Keep Mind Alert"
Exercises, Range of Motion to music
Juice or soup as appropriate
Target game, Large motor activity, parachute, ball
Dinner; all clients assisted and transfered
Rest period, Video movie, table games, cards
Ambulate as needed
Table games, crafts, target games, word games
Afternoon snack; all clients assisted
Bingo or similar game
Clients prepared for departure
Dismissal; clients home by van or caregiver
All clients are assisted as needed with feeding, toileting, ambulation
In good weather, w~e walk outdoors and use our deck for snacks
We maintain the window sill garden
The men play pool 'or the ladies have manicures
Music is a big part.of our day, singing, dancing, instruments, games
A time for Reminisce/(i~"planned i~to each day.
Families participate in holiday parties or programs
Craft projects are done according to the various abilities
Monthly blood pressures and weights are taken
Family imput is always appreciated
Agency Code 01370
SAMPLE FORM - DO NOT COMPLETE
APPENDIX X
Contract No.
Period
Funding Amount for Period
This is an AGREEMENT between THE STATE OF NEW YORK, acting by and through the NEW YORK
STATE OFFICE FOR THE AGING, having its principal office at 2 Empire State Praza, Albany, New York 12223-
1251 (hereinafter referred to as the STATE), and
(hereinafter referred to as the CONTRACTOR), for modification of Contract Number C to extend the
term of the Agreement through
All other provisions of said AGREEMENT shall remain in full force and effect.
IN WITNESS WblEREOF, the parties hereto have executed this AGREEMENT as of the dates
appearing under their signatures.
State Aqency Certification
"in addition to the acceptance of this contract, I also certify that original copies of this signature page will be
attached to all other exact copies of this contract."
CONTRACTOR SIGNATURE
STATE AGENCY SIGNATURE
By: By:
Printed Name
Walter G. Hoefer
Title:
Title: Director
Date: Date:
STATE OF NEW YORK )
Countyof .) ) SS.:
On the day of ,20 , before me personally appeared. , to
me known, who being by me duly sworn, did depose and say that he/she resides at
, that he/she is the of the
, the corporation described herein which executed the foregoing
instrument; and that he/she signed his/her name thereto by order of the board of directors of. said corporation.
(Notary)
STATE COMPTROLLER'S SIGNATURE
Title:
Date: