SENIOR CITIZENS' SERVICES FUND BOARD
HOME CARE YEAR-END PERFORMANCE TO BUDGET REPORT
EXHIBIT B: YEAR END REPORT: YEAR:
Org. Name:
Contact Email:
Performance of Proposed Service
Indicate the total number of units of service provided in Camden County and the number of units funded by county funds for each expense item. Indicate the dollar amount county funds expended.
Performance from Jan. 1 - Dec. 31 $
THIS FORM IS DUE ON OR BEFORE JAN 15 FOLLOWING THE CONTRACT PERIOD
Expense
Item		 Units Senior
Units
Only		 Units
funded
by Co. fds		 County
Funds
Expended
Advanced Personal Care 15 min.
Advanced Personal Care - RCF/ALF 15 min.
Authorized Nurse Visits 1 visit
Authorized Nurse Visits - RCF/ALF 1 visit
Basic Personal Care - Agency Model 15 min.
Basic Personal Care - RCF/ALF 15 min.
Personal Care Assistant - Consumer 15 min.
Aged and Disabled Waiver Services
Adult Day Care 15 min.
Homemaker/Chore 15 min.
Home Delivered Meals 15 min.
Respite - Basic 15 min.
Respite - Advanced 15 min.
Respite - Advanced (block) 6-8 hrs
Respite - Advanced (daily) 17-24 hrs
Respite - Nurse 1-1 visit
Respite - Basic (block) 9-12 hrs
Independent Living Waiver Services
Personal Care Assistance 15 min.
Other Services (list and provide associated units and fund
Total Funds expended:
Unexpended Camden County Funds as of Dec. 31