HomeMy WebLinkAboutAgenda - 06-21-2016-11-b - Adult Care Home Community Advisory Committee - Appointments 1
ORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: June 21 , 2016
Action Agenda
Item No. 11-b
SUBJECT: Adult Care Home Community Advisory Committee — Appointments
DEPARTMENT: Board of Commissioners
ATTACHMENT(S): INFORMATION CONTACT:
Membership Roster Donna Baker, Clerk to the Board
Recommendations 919-245-2130
Applications for Persons Recommended
Attendance Records
Applicant Interest List
Applications of Persons on the Interest
List
PURPOSE: To consider making appointments to the Adult Care Home Community Advisory
Committee.
BACKGROUND: The following information is for Board consideration:
• Appointment to a one (1) year training term (Position #1) "At-Large" representative for
Christine Cresha Cianciolo expiring 06/21/2017.
• Appointment to a second full term (Position #3) "At-Large" representative for Deborah
Rider expiring 06/30/2019.
• Appointment to a second full term (Position #10) "At-Large" representative for Dr. Beverly
Foster expiring 06/30/2019.
POSITION NAME SPECIAL REPRESENTATIVE EXPIRATION DATE
NO.
1 Christine Cresha Cianciolo One Year Training Term 06/21/2017
At-Large
3 Deborah Rider At-Large 06/30/2019
10 Dr. Beverly Foster At-Large 06/30/2019
NOTE - If the individuals listed above are appointed, the following vacancies remain:
• None
• All positions require a one year training period from date of
appointment.
FINANCIAL IMPACT: None
2
SOCIAL JUSTICE IMPACT: Enable Full Civic Participation. Ensure that Orange County
residents are able to engage government through voting and volunteering by eliminating
disparities in participation and barriers to participation.
RECOMMENDATION(S): The Manager recommends that the Board consider making
appointments to the Adult Care Home Community Advisory Committee.
3
Board and Commission Members
And Vacant Positions
Adult Care Home Community Advisory Committee
Meeting Times: 3:30 pm-5:00 pm Bi-monthly Terms: 3 Contact Person: Carmelita Karhoff
Meeting Place: Positions: 12 Length:2 years Contact Phone: 919-558-2714
Description: Members are appointed by the Board of Commissioners to at-large positions. There is an initial one-year training term with subsequent eligibility for three additional two-year
terms.This committee works to maintain the intent of the Adult Care Home Residents`Bill of Rights for those residing in licensed adult care homes. The members of this
committee also promote community involvement and cooperation with these homes to ensure quality care for the elderly and disabled adults.
VACANT Day Phone: Sex: First Appointed:
1 Evening Phone: Race: Current Appointment:
FAX: Township: Expiration: 03/31/2017
E-mail: Resid/Spec Req: At-Large Number of Terms:
Special Repr:
Mr. Daniel Hatley Day Phone:919-200-0822 Sex: Male First Appointed: 08/17/2010
2 Evening Phone:309-252-1169 Race:Caucasian Current Appointment: 10/06/2015
1308 Leclair St. FAX: 888-514-4878 Township: Chapel Hill Expiration: 10/31/2017
Chapel Hill NC 27517 E-mail:dan@hatleylawoffice.com Resid/Spec Req: At-Large Number of Terms: 3
Special Repr: DD/MR
Deborah Rider Day Phone:919-818-6489 Sex: Female First Appointed: 06/19/2012
3 Evening Phone:919-732-9476 Race:Caucasian Current Appointment: 09/17/2013
2314 Red Oak CT. FAX: Township: Hillsborough Expiration: 06/30/2016
Hillsborough NC 27278 E-mail:driderl736 @gmail.com Resid/Spec Req: At-Large Number of Terms: 1
Special Repr:
Mr. Max Mason Day Phone:919-649-7937 Sex: Male First Appointed: 06/07/2011
4 Chair Evening Phone: Race:Caucasian Current Appointment: 10/06/2015
821 Tinkerbell Rd. FAX: Township: Chapel Hill Expiration: 06/30/2017
Chapel Hill NC 27517 E-mail:maxomason@yahoo.com Resid/Spec Req: At-Large Number of Terms: 2
Special Repr:
Dr. Anthony John Vogt Day Phone:919-929-8646 Sex: Male First Appointed: 10/16/2012
5 Evening Phone:919-929-8646 Race:Caucasian Current Appointment: 10/06/2015
713 W.Barbee Chapel Road FAX: Township: Chapel Hill Expiration: 10/31/2017
Chapel Hill NC 27517 E-mail:ajvogt@earthIink.net Resid/Spec Req: At-Large Number of Terms: 2
Special Repr:
Friday,May 20,2016 Page 1
4
Board and Commission Members
And Vacant Positions
Adult Care Home Community Advisory Committee
Meeting Times: 3:30 pm-5:00 pm Bi-monthly Terms: 3 Contact Person: Carmelita Karhoff
Meeting Place: Positions: 12 Length:2 years Contact Phone: 919-558-2714
Description: Members are appointed by the Board of Commissioners to at-large positions. There is an initial one-year training term with subsequent eligibility for three additional two-year
terms.This committee works to maintain the intent of the Adult Care Home Residents`Bill of Rights for those residing in licensed adult care homes. The members of this
committee also promote community involvement and cooperation with these homes to ensure quality care for the elderly and disabled adults.
Mrs Suzanne Haff Day Phone:919-933-9329 Sex: Female First Appointed: 12/09/2014
6 Evening Phone:919-933-9329 Race:Caucasian Current Appointment: 12/15/2015
107 Hunter Hill Road FAX: Township: Chapel Hill Expiration: 10/31/2017
Chapel Hill NC 27516 E-mail:suzhaff@gmail.com Resid/Spec Req: At-Large Number of Terms: 1
Special Repr:
A Yvonne Mendenhall Day Phone:919-968-7874 Sex: Female First Appointed: 12/09/2014
7 Evening Phone:919-968-7874 Race:Caucasian Current Appointment: 12/15/2015
304 W Barbee Chapel Rd FAX: Township: Chapel Hill Expiration: 10/31/2017
Chapel Hill NC 27517 E-mail:menholiday@aol.com Resid/Spec Req: At-Large Number of Terms: 1
Special Repr:
Mrs. Gloria Brown MSW Day Phone:919 537-7485 Sex: Female First Appointed: 12/15/2015
8 Evening Phone:919 245-1025 Race:African American Current Appointment: 12/15/2015
2200 Old Forest Drive FAX: Township: Hillsborough Expiration: 12/15/2016
Hillsborough NC 27278 E-mail:browng @piedmonthealth.org Resid/Spec Req: At-Large Number of Terms:
Special Repr:
Mr William Zang Day Phone:2022151131 Sex: Male First Appointed: 01/21/2016
g Training Evening Phone:2022151131 Race:Caucasian Current Appointment: 01/21/2016
106 Hayes Street FAX: Township: Hillsborough Expiration: 01/21/2017
Hillsborough NC 27278 E-mail:wglangl9540dgmail.com Resid/Spec Req: At-Large Number of Terms:
Special Repr:
Dr. Beverly Foster Day Phone:919 966-4995 Sex: Female First Appointed: 06/18/2013
10 Evening Phone:919 967-2930 Race:Caucasian Current Appointment: 06/17/2014
2454 Springview Trail FAX: 919 843-6212 Township: Chapel Hill Expiration: 06/30/2016
Chapel Hill NC 27514 E-mail: Bev_Foster@unc.edu Resid/Spec Req: At-Large Number of Terms: 1
Special Repr:
Friday,May 20,2016 Page 2
5
Board and Commission Members
And Vacant Positions
Adult Care Home Community Advisory Committee
Meeting Times: 3:30 pm-5:00 pm Bi-monthly Terms: 3 Contact Person: Carmelita Karhoff
Meeting Place: Positions: 12 Length:2 years Contact Phone: 919-558-2714
Description: Members are appointed by the Board of Commissioners to at-large positions. There is an initial one-year training term with subsequent eligibility for three additional two-year
terms.This committee works to maintain the intent of the Adult Care Home Residents`Bill of Rights for those residing in licensed adult care homes. The members of this
committee also promote community involvement and cooperation with these homes to ensure quality care for the elderly and disabled adults.
Mr James Bartow Day Phone:919 932-2682 Sex: Male First Appointed: 02/18/2014
11 Evening Phone:919 932-2682 Race:Caucasian Current Appointment: 10/21/2014
118 Collums Rd FAX: Township: Chapel Hill Expiration: 10/31/2017
Chapel Hill NC 27514 E-mail:jmsbartow@gmail.com Resid/Spec Req: At-Large Number of Terms: 1
Special Repr:
Deborah Stewart Day Phone:919-210-4857 Sex: Female First Appointed: 12/09/2014
12 Evening Phone:919-210-4857 Race:Caucasian Current Appointment: 12/09/2014
1405 Buckhorn Rd. FAX: Township: Cheeks Expiration: 10/30/2017
Mebane NC 27302 E-mail:deb.k.stewart@gmail.com Resid/Spec Req: At-Large Number of Terms:
Special Repr:
Friday,May 20,2016 Page 3
6
From:Max Mason
To:Thom Freeman;Donna Baker;Carmelita Karhoff; Mary Fraser
Subject:Adult Care Home Community Advisory Committee Appointment
Date:Friday,May 20,2016 3:18:39 PM
Mr. Freeman, Ms. Baker,
Good afternoon. I hope you are both well. I am the chairman of the Orange County Adult Care Home
Community Advisory Committee. We have one vacancy currently, and another likely to occur in the
very near future. Conveniently, we have two applicants with whom I've spoken and am very confident
they would fit excellently on the committee. Yesterday at our regular business meeting we discussed
whether we could request that the Commissioners appoint at least one of the candidates to our
committee as soon as possible. To that end, I would request that Ms. Christine (Cresha)Cianciolo be
appointed at the Commissioners' earliest convenience. I have spoken with Ms. Cianciolo today and
confirmed that she is still very interested in serving. The other applicant, Ms. Katy Stewart, I am not as
certain about, but since we do not have an official vacancy yet, I think that appointment is less urgent.
Thank you for letting me know what options we have in this regard.
Take care,
Max
7
From:Carmelita Karhoff
To:Thom Freeman
Cc: Max Mason
Subject:Adult Care Home Community Advisory Committee(ACHCAC)Recommendations for Reappointment
Date:Thursday,June 09,2016 5:07:16 PM
Attachments:Copy of Adult Care Home Community Advisory Committee Attendance Rider and Foster.xlsx
Importance: High
Good afternoon, Thom —
It is with pleasure that we are recommending the re-appointments of both Deborah Rider
and
Beverly Foster to the Orange County Adult Care Home Community Advisory Committee.
A review of the ACH CAC meeting minutes showed both members to have met their
requirements of
adult care homes visitations and committee meeting attendance and participation in their
advocacy
roles..
Their meeting attendance record is attached.
Thank you, please let me know if you have any questions or need additional information.
All the best,
Carmelita
Carmelita Karhoff, MSHA
Regional Long Term Care Ombudsman
Triangle J Council of Governments, Area Agency on Aging
4307 Emperor Blvd., Suite 110, Durham, NC 27703
(0) 919'558'2714 (fox)919'998'8101
ckarhoff@tjcog.org/vvww.tjnog.org/vvw^w.tj000.org'
8
Page 1 of 2 Cresha (Christine) Cianciolo
Volunteer Application
Orange County Advisory Boards and Commissions
Name: Mrs Cresha (Christine) Cianciolo
Name Called:
Home Address: 7704 Amesbury Drive
Chapel Hill NC 27514
Phone (Day): 919-489-8539
Phone (Evening): 919-489-8539
Phone (Cell): 919-260-0353
Email: c.a.cianciolo @gmail.com
Place of Employment: Retired
Job Title: Volunteer
Year of OC Residence: 1989
Township of Residence: Chapel Hill
Zone of Residence: Chapel Hill Township within C.H. city limits
Sex: Female
Ethnic Background: Caucasian
Community Activities/Organizational Memberships:
Board of Directors Community Home Trust
Board of Directors Friends of the Chapel Hill Public Library
Co-manager Friends Book Store (Chapel Hill Public Library)
Volunteer Duke HomeCare and Hospice
Volunteer Music and Memory Program at Carol Woods
Member Henry Clark Society Habitat of Humanity
Past Service on Orange County Advisory Boards:
None
Boards/Commissions applied for:
Adult Care Home Community Advisory Committee
Background, education and experience relevant to this board:
As a Registered Nurse, I was privileged to serve in several arenas. The first decade of my
career was in Critical Care, working in the Emergency Room, Surgical Intensive Care and
Coronary Care units. I later became a Study Coordinator recruiting patients for research studies
at large University Medical Centers. The remaining two decades were spent as a Clinical Trials
Coordinator, training and monitoring physicians and nurses conducting clinical trials to ensure
they were complying with the CFR(Code of Federal Regulations, specifically 21 CRF50). These
provisions provide for the protection of human rights in subjects participating in research
studies. It is clear to me that these guidelines can apply to any human in a vulnerable position.
Although this work was demanding and challenging, it has enhanced my ethical standards, of
which I am proud. It has also required me to be organized and detailed.
After retiring three years ago, I have volunteered with Duke HomeCare and Hospice to provide
support and comfort to those at the end of life and their families. This effort has provided me
access to several extended care facilities in the area, observing firsthand the treatment and
management of the residents (good and bad).
I am also involved with the Music and Memory program at Carol Woods. There I partner with
9
Page 2 of 2 Cresha (Christine)
elders suffering with either physical or cognitive challenges to develop a music playlist to meet
their individual tastes. This effort has provided me the satisfaction of witnessing the healing
powers of music. The adventure of providing a personalized music playlist for patients with
limitations is both challenging and humbling.
I have been on the Board of the Community Home Trust since 2010. This has allowed me to
further my desire to ensure that affordable housing is available for those who serve our
community(teachers, UNC housekeepers, policemen, firemen)as well as single parents or the
elderly. I am also on the Board of the Friends of the Chapel Hill Public Library(and co-manage
the Friends Book Store),where I help to raise funds that support the library in providing
programs for both adults and children. I am dedicated to both these Boards and enjoy being
part of teams, working together to further our missions.
Reasons for wanting to serve on this board:
I would be interested in serving on this board as I am passionate about the welfare and needs of
the elderly. As a nurse, I have seen the need for patient advocates to guide and educate the
patient in their course of treatment and care. I have seen weekly changes in clients in extended
care facilities that often go a€°'unseena€TM by staff who see and attend to them daily. Often,
there is no interested family member available to assist in making life changing decisions or in
determining if a resident s needs are being met. I feel that with my background, I am able to
assess and plan for a population that is often a€°'under-serveda€TM. I would be honored to be
considered for this role.
Conflict of Interest:
I am married to a Chapel Hill government official.
Supplemental Questions:
Other Comments:
This application was current on: 1/18/2016 4:16:04 PM Date Printed: 1/19/2016
10
Page 1 of 2 Deborah Rider
Volunteer Application
Orange County Advisory Boards and Commissions
Name: Deborah Rider
Name Called:
Home Address: 2314 Red Oak CT.
Hillsborough NC 27278
Phone (Day): 919-818-6489
Phone (Evening): 919-732-9476
Phone (Cell):
Email: drider1736 @gmail.corn
Place of Employment: Affordable Family Care
Job Title: Care Giver
Year of OC Residence: 2005
Township of Residence: Hillsborough
Zone of Residence: Hillsborough Town Limits
Sex: Female
Ethnic Background: Caucasian
Community Activities/Organizational Memberships:
Past Service on Orange County Advisory Boards:
Boards/Commissions applied for:
Advisory Board on Aging
Background, education and experience relevant to this board:
Reasons for wanting to serve on this board:
Conflict of Interest:
Board of Social Services
Background, education and experience relevant to this board:
Reasons for wanting to serve on this board:
Conflict of Interest:
Supplemental Questions:
Work Experience: 30+ years with the state of Maryland from social services to policy
analyzing, I did it all.
Volunteer Experience: I have volunteered at various k-12 school functions for my
daughter. Avid animal lover. Cared for my parents until their deaths in 2000 and 2011.
Education: Dundalk High School 1967-1970 High School Diploma; University of Maryland
Baltimore County 1970-1974 Bachelors in Social Work/Sociology; University of Maryland
School of Social Work 1981-1983 Masters in Social Work and Community Planning
11
Page 2 of 2 Deborah Rider
Other Comments:
STAFF COMMENTS: Applied 04/26/2012 for Advisory Board on Aging, Board of Social
Services, Adult Care Home Community Advisory Committee. ADDRESS
VERIFICATION: 2314 Red Oak Ct. is Hillsborough Township, Hillsborough Town Limits.
This application was current on: 5/31/2016 Date Printed: 5/31/2016
12
Page 1 of 2 Beverly Foster
Volunteer Application
Orange County Advisory Boards and Commissions
Name: Dr. Beverly Foster
Name Called:
Home Address: 2454 Springview Trail
Chapel Hill NC 27514
Phone (Day): 919 966-4995
Phone (Evening): 919 967-2930
Phone (Cell):
Email: Bev_Foster @unc.edu
Place of Employment: UNC-Chapel Hill School of Nursing
Job Title: Faculty and Undergraduate Program Director
Year of OC Residence: 1981
Township of Residence: Chapel Hill
Zone of Residence: Does not apply
Sex: Female
Ethnic Background: Caucasian
Community Activities/Organizational Memberships:
Past Service on Orange County Advisory Boards:
Boards/Commissions applied for:
Supplemental Questions:
Work Experience: Preparation of undergraduate baccalaureate students for nursing
licensure and practice; program administration and teaching. Direct patient care in the
areas of adult acute care and maternal child.
Volunteer Experience: Orange County Board of Health, member and chair.
Senior Center Wellness Advisory Board, member and chair.
North Carolina Board of Nursing, member and chair.
Governor's Task Force for Healthy Carolinians (current).
Foundation for Nursing Excellence, member and chair (current)
Program accreditor for nursing (CCNE) (current)
Education: BSN (1964), Syracuse University
MSN (1976), UCLA
MPH,(1981), University of Hawaii
PhD,(1993), UNC-Chapel Hill
Other Comments:
I have not recently been involved in local community service and wish to again become
active locally. My mother was rather briefly in two skilled nursing facilities in Orange
County prior to her death a few years ago, and I became aware of the needs for
13
Page 2 of 2 Beverly Foster
monitoring and service improvement in this area. At my age I realize I may be a user of
these services myself! I believe my background in nursing education, accreditation and
regulation may be of use to the committee. STAFF COMMENTS: Originally applied for
Nursing Home Community Advisory Committee 2-10-2011. ADDRESS JURISDICTION:
2454 Springview Trail, CH, is in CH Township and CH Jurisdiction.
This application was current on: 2/10/2011 7:20:17 AM Date Printed: 6/10/2016
14
BOCC Attendance Report For Advisory Boards
Adult Care Home Community Advisory Committee May/2015 — May/2016
Member Appointed May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May
Beverly Foster 06/18/2013 x x x E x x x
Deborah Rider 06/19/2012 x E x x x x x
X: Attended E: Excused U: Unexcused BM: Business Meeting
Current through-05/31/2016
15
Applicant Interest Listing by Board Name and by Applicant Name
Contact Person: Carmelita Karhoff
Adult Care Home Community Advisory Committee
Contact Phone: 919-558-2714
Mrs Judith Causey Day Phone: 9192604249 Sex: Female
2621 Beavertail Dr Evening Phone: 9192604249 Race: Caucasian
Hillsborough NC 27278 Cell Phone: 9192604249 Township: Hillsborough
E-mail: judithcausey@hotmail.com Res.Eligibility:
Date Applied: 01/25/2016
Skills: Also Serves On:
Mrs Cresha(Christine) Cianciolo Day Phone: 919-489-8539 Sex: Female
7704 Amesbury Drive Evening Phone: 919-489-8539 Race: Caucasian
Chapel Hill NC 27514 Cell Phone: 919-260-0353 Township: Chapel Hill
E-mail: c.a.cianciolo @gmail.com Res.Eligibility: Chapel Hill Township
Date Applied: 01/18/2016
Skills: Also Serves On:
Jacqulyn Podger Day Phone: 919-740-8814 Sex: Female
719 New Hope Church Rd. Evening Phone: 919-240-7633 Race: Caucasian
Chapel Hill NC 27516 Cell Phone: 919-740-8814 Township: Chapel Hill
E-mail: jacannpod @gmail.com Res.Eligibility: County
Date Applied: 05/23/2016
Skills: Also Serves On:
Katy Stewart Day Phone: 9196915555 Sex: Female
8407 NC 57 Evening Phone: 9196915555 Race: Caucasian
Rougemont NC 27572 Cell Phone: 9196915555 Township: Hillsborough
E-mail: katystewl @gmail.com Res.Eligibility:
Date Applied: 01/15/2016
Skills: Also Serves On:
Monday,May 23,2016 Page 1 of 1
16
Page 1 of 2 Judith Causey
Volunteer Application
Orange County Advisory Boards and Commissions
Name: Mrs Judith Causey
Name Called:
Home Address: 2621 Beavertail Dr
Hillsborough NC 27278
Phone (Day): 9192604249
Phone (Evening): 9192604249
Phone (Cell): 9192604249
Email: judithcausey @hotmail.corn
Place of Employment: Retired. UNC
Job Title: RN Center For Excellence
Year of OC Residence: 1999
Township of Residence: Hillsborough
Zone of Residence:
Sex: Female
Ethnic Background: Caucasian
Community Activities/Organizational Memberships:
Active RN License
PHRC
MADD
Past Service on Orange County Advisory Boards:
None
Boards/Commissions applied for:
Nursing Home Community Advisory Committee
Background, education and experience relevant to this board:
I am 77. I have interacted with and nursed many geriatric patients. I have. Visited many long
term care facilities. I have placed patients into long term care facilities &continued to supervise
care &services on site
Reasons for wanting to serve on this board:
Serve in some capacity to help Orange County to be first class in services offered our citizens.
Conflict of Interest:
Adult Care Home Community Advisory Committee
Background, education and experience relevant to this board:
Interacted with & nursed many seniors. I am a senior in good health
Reasons for wanting to serve on this board:
I have an interest in helping our citizens to age in their own homes
Conflict of Interest:
Supplemental Questions:
17
Page 2 of 2 Judith Causey
Other Comments:
This application was current on: 1/25/2016 11:39:33 PM Date Printed: 2/1/2016
18
Page 1 of 2 Jacqulyn Podger
Volunteer Application
Orange County Advisory Boards and Commissions
Name: Jacqulyn Podger
Name Called:
Home Address: 719 New Hope Church Rd.
Chapel Hill NC 27516
Phone (Day): 919-740-8814
Phone (Evening): 919-240-7633
Phone (Cell): 919-740-8814
Email: jacannpod @gmail.com
Place of Employment: retired
Job Title: former Duke employee 14 years
Year of OC Residence: 2008
Township of Residence: Chapel Hill
Zone of Residence: County
Sex: Female
Ethnic Background: Caucasian
Community Activities/Organizational Memberships:
1. Senior Health Insurance Information Program Counselor
2. A Helping Hand Volunteer and Pro Bono Hero
3. Board Member Junior Leadership of Durham
Past Service on Orange County Advisory Boards:
Former Adult Home Advisory Committee for Durham County
Boards/Commissions applied for:
Adult Care Home Community Advisory Committee
Background, education and experience relevant to this board:
Previous experience with the Adult Care Home Advisory Committee in Durham County along
with current commitment to SHIIP and A Helping Hand. Both commitments are volunteer and I
work with seniors in Orange County and am aware of the problems facing an aging population. I
believe I can offer a perspective unique to my experience in providing front line services.
Reasons for wanting to serve on this board:
I have a passion for working with seniors and would like to contribute in a way that can influence
decision making at a county and state level.
Conflict of Interest:
19
Page 2 of 2 Jacqulyn Podger
Advisory Board on Aging
Background, education and experience relevant to this board:
Durham County along with current commitment to SHIIP and A Helping Hand. Both
commitments are volunteer and I work with seniors in Orange County and am aware of the
problems facing an aging population. I believe I can offer a perspective unique to my experience
in providing front line services.
Reasons for wanting to serve on this board:
I have a passion for working with seniors and would like to contribute in a way that can influence
decision making at a county and state level.
Conflict of Interest:
Nursing Home Community Advisory Committee
Background, education and experience relevant to this board:
Durham County along with current commitment to SHIIP and A Helping Hand. Both
commitments are volunteer and I work with seniors in Orange County and am aware of the
problems facing an aging population. I believe I can offer a perspective unique to my experience
in providing front line services.
Reasons for wanting to serve on this board:
I have a passion for working with seniors and would like to contribute in a way that can influence
decision making at a county and state level.
Conflict of Interest:
Supplemental Questions:
Other Comments:
This application was current on: 5/23/2016 12:37:29 PM Date Printed: 5/23/2016
20
Page 1 of 2 Katy Stewart
Volunteer Application
Orange County Advisory Boards and Commissions
Name: Katy Stewart
Name Called:
Home Address: 8407 NC 57
Rougemont NC 27572
Phone (Day): 9196915555
Phone (Evening): 9196915555
Phone (Cell): 9196915555
Email: katystew1@gmail.com
Place of Employment: Self employed
Job Title: RN
Year of OC Residence: 1997
Township of Residence: Hillsborough
Zone of Residence:
Sex: Female
Ethnic Background: Caucasian
Community Activities/Organizational Memberships:
I am currently exploring ways to get involved with my community and advocate for the
clientele that I have been caring for my whole career. I have been a nurse for 25 years. I
have worked with the geriatric community during those years with 22 years spent in
hospice care. I have recently decided to work for myself and care for those as I can. I am
researching housing for the elderly and terminally ill. I want to provide a safe caring
environment for this population. I believe I have many years of experience to offer.
Past Service on Orange County Advisory Boards:
None
Boards/Commissions applied for:
Adult Care Home Community Advisory Committee
Background, education and experience relevant to this board:
25 years in nursing of the elderly. Head of hospice care during most of my career.As well as
home health care, visiting most of all care homes in the 25 mile radius.
Reasons for wanting to serve on this board:
I would like to offer my knowledge that I have have gained in this field in a constructive, helpful
way. I want to be a patient advocate, speak for a population I know very well.
Conflict of Interest:
21
Page 2 of 2 Katy Stewart
Advisory Board on Aging
Background, education and experience relevant to this board:
As I stated above, 25 years in nursing of the elderly. Head of hospice care during most of my
career. As well as home health care, visiting most of all care homes in the 25 mile radius. I want
to be a patient advocate, speak for a population I know very well.
Reasons for wanting to serve on this board:
I want to offer any knowledge I have gained to speak for this population.
Conflict of Interest:
Board of Health
Background, education and experience relevant to this board:
As I stated above, 25 years in nursing of the elderly. Head of hospice care during most of my
career. As well as home health care, visiting most of all care homes in the 25 mile radius. I want
to be a patient advocate, speak for a population I know very well.
Reasons for wanting to serve on this board:
I want to be a patient advocate, speak for a population I know very well.
Conflict of Interest:
Supplemental Questions:
Other Comments:
This application was current on: 1/15/2016 10:39:15 AM Date Printed: 5/4/2016