CLIENT/CONSUMER and AGENCY RESPONSIBILITIES


Client Name 
Client Address
Client's Telephone Number                          
Email


If applicable,

Client’s Representative  
Relationship to Client
Address of Client’s Representative  
Client Representative’s Telephone Number 
Email


As a client of Compassionate Homecare of South Florida, LLC, the above-named client has rights and responsibilities including, but not limited to, those outlined below:

Client’s Responsibilities:

The client has a responsibility to:

  1. provide complete information about matters relating to their health and abilities when it could influence the care they are being given;
  2. know their medical history and have details on any medications being taken;
  3. accept the consequences of their own decisions;
  4. report unexpected changes in their condition, such as having suffered a mild stroke;
  5. request information about anything that they do not understand;
  6. contact the Agency with any concerns or problems regarding services;
  7. follow service plans and/or express any concerns about the service plan;
  8. accept the consequences, if the Care Plan /Service plan is not followed;
  9. follow the terms and conditions of the Service Agreement;
  10. notify the Agency, in advance, of any changes to the work schedule;
  11. inform the Agency of the existence of, and any changes to, advance directives;
  12. report any potential risks that might exist to the Home Care Worker such as the possibility that a client/family member might have a contagious illness or condition;
  13. be considerate of property belonging to the Agency and/or Home Care Worker;
  14. ensure that Home Care Workers are free from any actions that could be interpreted as being abusive such as intimidation, physical/sexual/verbal/mental/emotional/material/ financial abuse; and
  15. respect the dignity and privacy of the Home Care Worker;
  16. avoid asking the Agency staff to act outside the law, in the delivery of service;
  17. notify the Agency of any changes being made to their contact information such as address or phone number;
  18. advise the Agency of any changes being made to their health care professionals, g.: physician, physiotherapist, occupational therapist, dietician, registered nurse, etc.
  19. be responsible for payment for charges that are not covered by other parties such as Medicare & Medicaid;
  20. notify the Agency of any changes in insurance coverage for home care services;
  21. pay bills per agreed upon rates and timeframes;
  22. assume financial responsibility for all materials, supplies and equipment required for their care, which are not covered by other parties;
  23. provide a safe environment for care and services to be delivered;
  24. exercise a reasonable level of discretion and confidentiality in regards to service/treatment records that are kept in the home;
  25. give reasonable notice, when possible, if service is going to be cancelled;
  26. keep all weapons in the home away from the work area during visits made by the Home Care Workers;
  27. secure aggressive or menacing pets before the Home Care Worker enters the home;
  28. provide a smoke free environment when Home Care Worker is present;
  29. review and sign the employee time sheet, upon completion of shift; and,
  30. carry out the defined responsibilities.

 

Agency’s Responsibilities

 

The Agency has a responsibility to:

  1. ensure that Home Care Workers meet the state’s competency requirements;
  2. review Home Care Workers’ competency at least annually and more often, if indicated;
  3. document face-to-face interviews with all home care workers and independent contractors;
  4. provide ongoing, competent and appropriate supervision of Home Care Workers.
  5. carry bonding for Agency staff;
  6. carry general liability, professional liability (if appropriate) and other insurances as necessary;
  7. meet the standards of Worker’s Compensation;
  8. conduct criminal background checks and child abuse clearances, if applicable, on all staff; and maintain documentation confirming these clearances have been done;
  9. advise clients whether Home Care Worker is an employee of the Agency or is an independent contractor;
  10. ensure home care service delivery standards are met;
  11. ensure federal, state, county & municipal legalities are researched and applied;
  12. adhere to labor regulations;
  13. develop contingency plans;
  14. make deductions for social security, Medicare and other taxes;
  15. conduct needs assessments, with client’s/family’s input;
  16. develop service plans with client’s/family’s input;
  17. consult with relative professionals regarding the service plan (as required);
  18. be part of, or coordinate, a health care team to provide for the client’s needs, as indicated;
  19. establish goals with client/client’s representative’s input and strive to meet these goals;
  20. provide clients with written documentation of:
  21. the services that will be provided;
  22. names of the Home Care Workers assigned to deliver service;
  23. hours when services will be provided; and,
  1.  fees for services and total costs;
  1. maintain the client’s/family’s confidentiality, privacy and dignity;
  2. maintain professionalism and a code of ethics;
  3. avoid inflicting its personal values and standards onto clients;
  4. be alert for and report signs of elder abuse;
  5. obtain immunizations (such as flu shots) when required unless such an act is contrary to personal beliefs and/or medical conditions;
  6. ensure staff and Independent Contractors, exposed to clients, undergo screening tests to ensure they do not have an infectious disease such as Tuberculosis and/or Hepatitis;
  7. be aware of the cost portion that other parties (e.g. Medicare & Medicaid) will be responsible for, when clients receive third party financial assistance; and, know what charges they will not cover;
  8. when requested, ensure clients have access to all service invoices pertaining to their service, regardless of whether the bills are paid out-of-pocket or by another party.
  9. provide clients with the Department of Health’s telephone number for registering complaints;
  10. ensure that staff do not assume Power of Attorney or Guardianship over any client, who is receiving services from the Agency;
  11. ensure that it doesn’t accept endorsed checks from the clients;
  12. establish and monitor appropriate professional boundaries; and
  13. abide by its own policies, procedures and best practices.

 

This Client & Agency Responsibilities form has been reviewed with, and a copy given to, the named client/client’s representative.

   
 Signature of Client/Client Representative         

      
 Signature of Agency Representative                           

Date
Position of Agency Representative  

 

 

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Document name: CLIENT/CONSUMER and AGENCY RESPONSIBILITIES
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December 18, 2023 4:36 pm GMTCLIENT/CONSUMER and AGENCY RESPONSIBILITIES Uploaded by John Smith - smitch@chsfl.co IP 202.47.33.79
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