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


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

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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