For families in Nassau and Suffolk Counties caring for someone with dementia, the scholarship program provides respite opportunities, ranging from a period of a few hours to a few weeks in the home or out of the home, during the day, evenings or overnight. Families who qualify, may be eligible to receive up to $1,800, not to exceed 120 hours of paid respite care per year. To be eligible families must be enrolled in the Willing Hearts, Helpful Hands program and live in Nassau or Suffolk County. There are no income requirements for this program, however, this program is afforded limited funding and therefore eligible candidates may be subject to prioritization.
 
Acceptable paid respite services include:
  • Social Adult Day programs
  • Medical Adult Day Healthcare programs
  • In-home services
  • Assisted living facilities (for overnight or weekend stays)
  • Nursing homes (for overnight or weekend stays) 
Once eligibility has been determined by our staff, caregivers are able to select and arrange respite services through a licensed and accredited provider/agency of their choosing. 
 
Payments for these services will be issued by our organization directly to the care provider. Caregivers will no longer be required to pay for these services in advance and wait for reimbursement from Parker.

All of these services are free and are paid for (in part) by a grant from the New York State Department of Health.  Our staff are delighted to work with you to assist you and your loved one. 

If you have any questions, please call us at (516) 586-1507.

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* 1. Name of primary caregiver:

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* 2. Relationship to recipient:

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* 3. Address

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* 4. Telephone:

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* 5. Name of recipient:

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* 6. Recipient's Address:

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* 7. Phone:

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* 8. Recipient's Age:

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* 9. Recipient's DOB:

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* 10. People living in the household:

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* 11. Is the applicant currently receiving other services from the Caregiver Support Program?

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* 12. If answered yes to #11, what services are they receiving?

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* 13. What is the annual household income (all sources of income in household combined)?

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* 14. Does the person your caring for have Medicaid?

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* 15. Has the applicant received this grant before?  If yes, when?

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* 16. Agencies/individuals currently providing services, please list the agency/individual, telephone, number, type of service and how service is being paid for:

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* 17. Reason for respite:

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* 18. Type of respite requested and hours: Homecare, adult day care, in-patient respite, etc. (Example: adult day care, one day a week for 10 weeks):

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* 19. What licensed and bonded agency will you be using with the grant?  Please include name, location, and telephone number:

*To the professional who may be assisting the family with this application: It would be beneficial if you would complete this section.  We could certainly use your help to clarify any questions we may have.

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* 20. Name of Professional Assisting Family:

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