Lifespan Respite
Technical Assistance Center

State Performance Measurement and Data Tools

For more on Performance Measurement,
 visit here.

For more sample measurement toolsvisit here.

Data Elements

South Carolina

Data Elements for Lifespan Respite Reporting



HEARTS Pre and Retrospective Post Test Form 


         Financial Assistance Evaluation Form 

Respite Care I&R Evaluation Form  

DE RespiteOnline Referral Service Evaluation Form 

DE Financial Assistance Survey Results 


Nebraska Lifespan Respite Network: Producing Positive Outcomes for Families 2015-2017 Evaluation Final Report, UNMC-MMI and DHHS. The evaluation demonstrated respite services resulted in a range of family caregiver outcomes, including fewer health symptoms reported by family caregivers and less relationship strain with the care recipient.

FY 2017 Lifespan Respite Services Program Report highlights the accomplishments of the Nebraska Lifespan Respite Services Program over the past year to meet the requirements of the state statute authorizing the program (Neb. Rev. Stat. §68-1520 through §1528).

2017 NE Lifespan Respite Family Caregiver Survey for caregivers receiving NE Lifespan Respite Subsidy families, with supplemental questions.

The supplemental questions are used by the local Respite Network Coordinators for all initial and renewal clients at the time of eligibility determination notification. Calling the family caregiver is done by the Respite Coordinator when receiving notice from the Lifespan Respite Subsidy Social Services Worker (SSW) that eligibility has been completed. This interaction provides an opportunity to begin building (or enhance an existing) relationship with the family caregiver. Goal is to enable families to have confidence in contacting the local respite network if there are concerns or questions.

Nebraska Lifespan Respite Subsidy 2015 Evaluation Report, September 2015


NV Pre and Post Respite Caregiver Surveys

Nevada Lifespan Respite Care Program Data on Caregivers 2012, Final Report 

New Hampshire

NH LRC Coalition Logic Model 

New York

New York’s Lifespan Respite Evaluation Plan for the 2014-2017 grant award

North Carolina

NC Pre  and Post  Caregiver Respite Surveys

Mini-Grant Tools and Reports

Setting Goals to Maximize Your Respite Time Tool
Mini-grant Summary Tables
Mini-grant Summary Report, March 2012-May 2013
Caregiver Survey  Results  


Caregiver Survey 



DE Choice of Respite Care Provider by 2010 Financial Assistance Recipients 

DE Demographics of Respite Recipients 

PPT of Yearly Summary of DE Demographic Descriptors 


NE Annual Report of Activities, Outcomes and Individuals Served 

North Carolina

NC Lifespan Respite Mini-Grantee Quarterly Reporting Form 


TN Volunteer Report 



Lifespan Respite

Technical Assistance Center

ARCH National Respite Network and Resource Center

4016 Oxford Street

Annandale, VA 22003

(703) 256-2084

This project is supported, in part by grant number 90LT0002, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.


The ARCH National Respite Network and Resource Center is a division of the Chapel Hill Training-Outreach Project, Inc. | 800 Eastowne Drive, Chapel Hill, NC, 27514 |



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