Respite Care Application

LMK Respite Care Voucher Program

The Laona M. Kitchen Foundation recognizes the importance of taking care of you, the caregiver. Through generous donations to the foundation, we offer a complimentary Respite Care Voucher that allows your loved one to receive respite care at the level needed by your loved one. Our voucher may be used for in-home care, adult day care or for a "short term respite" stay at an assisted living community. Anyone who does not have the means to provide this service for themselves is welcome to apply for this voucher. 

Criteria

  • A voucher will be issued in an amount of up to $500 which can be used for in-home care or adult day care or for a "short term respite" at an assisted living community. The voucher or any unused or unbilled balance will expire in 60 days from the date of issue.
  • The voucher will be issued to provide respite services from an agency or facility that is independently chosen by the caregiver.  Only agencies or facilities can be paid directly; private caregivers or individuals are not eligible for direct payment.
  • Applications for voucher or respite care services may only be made once in a twelve month period. 
  • Payment arrangements must be pre-approved by the Foundation.
  • The individual using the respite services must have a diagnosis of Alzheimer's/Dementia in order to qualify.
  • The Respite Care Voucher program is solely to provide financial assistance for respite care. The Laona M. Kitchen Foundation provides neither management nor direction of any respite care received by the individual. 

  • The Laona M. Kitchen Foundation does not exercise control or supervision of any facility where care is offered or provided. The Foundation does not sponsor or recommend any specific in-home care service company, adult day care center or assisted living facility.

  • Until the selection of a caregiver company, adult day care or an assisted living facility for the respite care is selected the voucher will not be approved.

The LMK Foundation provides respite care to give caregivers a break. Helping those families that financially otherwise could not afford such services is at the heart of those that give to our foundation. Please describe below why you need our assistance.

I understand that the role of the Respite Care Voucher Program is solely to provide financial assistance for Respite Care and that the Laona M. Kitchen Foundation provides neither management nor direction of any Respite Care received by me or by any member of my family. Accordingly, I release and indemnify the Laona M. Kitchen Foundation, Inc., its officers, director, employees and agents from any and all responsibility or liability for any care provided.

I understand the information included may be released to agencies/organizations providing funding or services to enable the best possible care.

Apply
Application for the Respite Voucher can be done one of three ways: Fill out the form below and Submit; Call (770) 779-0821 ext. 701; Or email [email protected].

*LMK Foundation will consider special circumstances that may cause deviation from the original processes.