The care recipient (patient) must
• Be 60 years of age or older or, if below 60 years of age, have a diagnosis of Alzheimer's or any forms of dementia
• Live in the Pulaski, Saline, Monroe, Prairie, Lonoke or Faulkner county
• Have a diagnosis of any chronic illness that requires a caregiver
• Not receive like-services funded by other sources (including, but not limited to: private insurance, Medicaid, Medicare, ARChoices, Independent Choices, Supplemental Security Income or Hospice)
To request an application, call 501-224-0021 or email [email protected]. All fields on the application must be completed, signed and include the doctor’s certification on the professional’s stationary or prescription pad or it will be denied and returned delaying approval. It can take up to 10 business days to process the application.
Applications can be mailed to Alzheimer’s Arkansas, 201 Markham Center Drive, Little Rock, AR 72205, emailed to [email protected] or faxed to 501-227-6303.
All information on the application must be completed, the 2nd page must be signed and dated, and the submission must include a diagnosis on an official letterhead or prescription pad (per the instructions under ELIGIBILITY). It may take up to 10 business days to process your application. Applications can be sent via mail, email, or fax (information below). The grant will not be effective until after you receive an approval letter from Alzheimer’s Arkansas. After the grant is approved, you will have 3 months or until June 15th, 2024 (whichever comes first) to use the funds. Applications will be accepted until April 15, 2024; if funds are still available.
This grant does not pay the caregiver to take care of the care recipient (patient). The caregiver must hire a care provider, an individual over 18 years old and does not live with the patient or an agency that will provide the care or services for the patient. The date of service cannot be before your approval date, located on your approval letter.
A Respite Service Log is mailed along with the approval letter to use if you hire an individual. Use the log to record the date, number of hours and the hourly rate that is agreed upon by the caregiver and care provider. Please complete a separate service log for each care provider. All information must be filled out and signed by the caregiver and care provider and include a copy of the care provider’s driver’s license or state-issued ID. If you hire an agency, they can submit an invoice for payment. Make sure the “Make Check Payable To” has the information on who is to receive payment, whether the caregiver is being reimbursed or the care provider is being paid directly.
Service Logs and Invoices can be mailed to Alzheimer’s Arkansas, 201 Markham Center Drive, Little Rock, AR 72205, emailed to [email protected] or faxed to 501-227-6303. Payment or reimbursement may take up to 15 business day to process.
"*" indicates required fields
