Connecticut National Family Caregiver Support Program - Respite and or Supplemental Services - Grandparent/Relative Caregiver Application

Sep 19, 2026

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Connecticut National Family Caregiver Support Program provides respite care and supplemental services for grandparents and relative caregivers. Services support a care recipient age 18 or younger referred through an approved community provider, including short-term caregiver relief and one-time health-related items. Eligibility defines a legal, primary caregiver relationship for ages 55+ and priority is based on social and economic need. Costs use a sliding fee scale, federal poverty level may qualify for priority, and donations may be accepted where applicable. The application form collects caregiver demographics, income-related guidance, and child information.

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Respite Care and Supplemental Services Application

Eligibility to Receive Respite and/or Supplemental Services

Grandparent/Relative Caregiver Application Form

# Connecticut National Family Caregiver Support Program Respite Care and Supplemental Services Application GRANDPARENT/RELATIVE CAREGIVER APPLICATION SENIOR RESOURCES—AGENCY ON AGING Connecticut National Family Caregiver Support Program is funded by Title III E funds under anamendment to the Federal Older Americans Act. It is operated in partnership with the ConnecticutState Department on Aging and the Connecticut Area Agencies on Aging. The program offers an opportunity for grandparents or relative caregivers to receive respite and/orsupplemental services from an approved community services provider for a child who is 18 years ofage or younger, who is referred to as the care recipient. Respite care services include, but are not limited to camperships and day care. Funds may be used for daytime or overnight respite. *The need for Respite and Supplemental Services: Respite care is a SHORT-TERM option designed to provide a break, or a time of caregiver relief, fromthe constant physical and emotional stress of an older person caring for a child, especially childrenwith skilled needs. An occasional break from caregiving enables the exhausted caregiver toregroup both physically and emotionally from his/her caregiver responsibilities. Supplemental services are one time health-related items or service options designed to help “fill thegap”when there is a need or there are no other ways to obtain the service. Supplemental serviceswill help improve the quality of life for the care recipient and help to alleviate the strain on oldercaregivers that care for children. Supplemental services include, but are not limited to receivinghome safety/modifications and medical equipment. A sliding fee scale is utilized to determine the recommended cost sharing for respite andsupplemental services based on the grandparent/relative caregiver’s monthly income. For thosewith income below federal poverty level, donations are accepted. Direct payment to a caregiverregardless of licensure is prohibited. Please talk with the Caregiver Program Coordinator for moredetails. If you are: A family caregiver for an older adult who is 60 years of age or older A grandparent/relative caregiver age 55 or more raising a child age 19 to 59 and disabled Please complete Senior Resources “Services for Caregivers”Application Rev 8.14.2018 Eligibility to receive Respite and/or Supplemental Services: Definition: The term “Grandparent” or “Relative Caregiver”means a grandparent,step-grandparent, or a relative of a child by blood or marriage who is 55 years of age orolder and 1) Lives with the child, 2) Is the primary caregiver of the child (18 years of age or younger) because the biologicalor adoptive parents are unable or unwilling to serve as primary caregiver of the child,and 3) Has a legal relationship to the child, as such legal custody or guardianship, or is raisingthe child informally. Priority will be given to older individuals with greatest social and economic need, withparticular attention to low-income older individuals and older individuals providing careand support to persons with intellectual disabilities and related developmental disabilities. Income: Income will be self-declared (proof of income will not be required) . If the grandparent orrelative caregiver has income at or below federal poverty level, he or she will beconsidered a priority for receiving services. The following are considered income: Social Security, Supplemental Security, Railroad Retirement income, pensions, wages,interest, dividends, net rental income, Veteran’s benefits, and any other payments receivedon a one-time or recurring basis. If accounts are jointly owned between the grandparent/relative caregiver and a spouse, 50% of the total interest income in the account will becounted as the grandparent’s/relative caregiver’s income. PLEASE NOTE: Any income received for the child, for example child support, social securitysurvivor’s benefi

FAQs

Who is eligible to apply as a grandparent/relative caregiver?

Applicants must be 55 years of age or older, be the primary caregiver of the child (18 or younger) due to the biological or adoptive parents being unable or unwilling, and have a legal relationship such as custody/guardianship or be raising the child informally.

What types of respite and supplemental services are available?

Respite care is short-term relief and may include day care or camperships, including daytime or overnight respite. Supplemental services are one-time health-related items or service options such as home safety/modifications and medical equipment.

How is the cost sharing for services determined?

A sliding fee scale determines recommended cost sharing based on the caregiver’s monthly income. Income at or below the federal poverty level qualifies the caregiver as a priority, and donations are accepted where applicable.

Sep 19, 2026

Upload by McQueen