CLIENT'S RIGHTS AND RESPONSIBILITIES

PREAMBLE:

The Visiting Nurse Association of Wallingford, Inc. is dedicated to assisting individuals and/or families remain in their own residences functioning at their optimal level during periods of physical, emotional, mental and/or social crisis. Clients admitted to the Home Care Department of the Agency are assured that they will receive care of the highest quality in compliance with stated Agency policies. Service will be provided in a timely manner in accordance with physician's orders that will define an individualized Plan of Care specifying the type, frequency, and duration of service(s) to be provided.

The Visiting Nurse Association of Wallingford, Inc. respects the following Client's Rights and Responsibilities. A list of these rights and responsibilities will be provided to each client orally and in writing prior to the start of care.

RIGHTS:

You and/or your guardian have the right:

1. To treatment with respect and dignity and to the assurance that your property will be treated with respect by all Agency personnel who serve you.
   

2. To receive service regardless of race, creed, gender, age, handicap, sexual orientation, veteran status or lifestyle.
   

3. To freedom from mental or physical abuse, neglect or exploitation by Agency staff.
   

4. To privacy and to the assurance that all information about you and your care and treatment will remain confidential and will not be released to anyone who is not legally authorized to receive it without you/your guardian's written consent as stated in the Agency's policies concerning the access and disclosure of clinical information.
   

5. To formulate Advance Directives and to receive care whether or not Directives are executed. You have the right to be informed, in writing, of the Agency's policies and procedures for implementing these Directives and have the assurance that Agency personnel will comply with your Directives in accordance with state law.
   

6. To request written copies of the Agency's Admission and Discharge Policies which are used in determining the service(s) for which you are eligible.
   

7. To services, products and equipment available directly or by contract that are ordered by your physician for the provision of your care.
   

8. To be fully informed about your health condition in a manner that is understandable to you, unless contraindicated by your physician.
   

9. To make informed decisions regarding your care and treatment.
   

10. To participate in the development of your Plan of Care and/or any change(s) in your Plan of Care before it is implemented.
    

11. To receive a written copy of your Plan of Care including ongoing service(s) and discharge planning, the levels of personnel who will provide your care, the frequency of the visits that are proposed, and the emergency procedures to be followed in the absence of Agency personnel.
    

12. To the name, professional qualifications, and disciplines of each staff member who is responsible for and/or is providing your care and whom to call if these caretakers are not available.
    

13. To refuse treatment and to be informed of potential results and/or risks of such refusal.
    

14. To accept, refuse, or discontinue service(s) and/or to request a change in caregivers without the fear of reprisal or recrimination. The Agency and/or your physician MAY refer you to another source of care if your refusal to comply with the Plan of Care threatens or compromises the Agency's ability to provide quality care to you.
    

15. To have your pain issues evaluated and addressed by Agency home care staff.
    

16. To a complete explanation of any proposed experimental treatment, to the assurance that no experimental treatment will be provided without your specific agreement to and full understanding of such treatment, and to refusal and/or termination of such treatment at any time.
    

17. To receive written and verbal education, instructions, and requirements for continuing care after the Agency's service is terminated.
    

18. To be referred to another provider organization if the Agency is unable to meet your needs or if you are not satisfied with the care you are receiving.
    

19. To advanced notification of options regarding treatments or transfers including the date and reason for discontinuation of care.
    

20. To participate in the selection of options for alternative levels of care or referral to other organizations as indicated by your need for continuing care.
    

21. To inspect the written record of care and treatment which were provided to you by Agency personnel. A written request and two working days notice are required for such inspection that will take place at the Agency office.
    

22. To information regarding the Agency's billing policies and payment procedures including its policy regarding uncompensated care.

23. To receive written and verbal notification, prior to the start of each service, regarding the full charge for each service, the payment source(s) to be billed, the charges for which you will or may be liable, and your eligibility for sliding fee consideration. As soon as possible, but no later than 15 working days from the date the Agency is notified, you and/or your guardian will be given verbal and written notification of any change in your established charge/payment arrangement.
    

24. To contact the billing office at (203) 269-1475 regarding your bill and to request copies of all bills for service which you have received, regardless of payment source.
    

25. To receive disclosure information regarding any beneficial relationships the Agency has that may result in profit for the referring organization.
    

26. To request and obtain information regarding the Agency's liability insurance.
    

27. To file grievances or complaints verbally or in writing, without reprisal or recrimination, regarding treatment, care, or respect for person or property that were or fail to be furnished by any representative of the Agency. Grievances and complaints should be directed to the Executive Director of the Agency at (203)269-1475 from 9:00am to 5:00pm. You will receive either a written or oral response from the Agency regarding the investigation and resolution of the issue. All grievances and resolutions are documented in the Agency's Complaint Log and are presented to its Professional Advisory Committee.
    

28. If a complaint or grievance, including implementation of your Advance Directives, is not resolved to your satisfaction or if you have a question regarding this Agency or any other home care agency in the state, you may call the toll-free Medicare Hot Line at (800) 828-9769 Monday through Friday from 8:30am to 4:30 pm. You may call this number 24 hours a day, seven days a week and leave a message if you call at times other than regular workdays. The purpose of the hot line is to receive complaints or questions about local home care agencies.

29. You may call the Commissioner of Health Services of the Connecticut Department of Public Health, 410 Capitol Avenue, Hartford, CT 06106 at (860) 509-7400, Monday through Friday, 8:30am to 4:30pm with complaints or questions.
    
    

RESPONSIBILITIES:

You and/or your guardian have the responsibility:

1. To participate in the formulation of your Plan of Care and in the determination of all changes made to the Plan including discontinuation of service.

2. To follow the established Plan of Care and to carry out mutually agreed upon responsibilities and activities.
   

3. To notify the Agency of changes in reportable symptoms or other changes in your condition which may require hospitalization or other modification to your Plan of Care.
   

4. To notify the Agency of any change in insurance coverage and/or payer responsibility prior to the effective date of the change.
   

5. To inform the Agency of the existence of, and any change to, your Advance Directives.
   

6. To notify the Agency when visit schedules need to be changed.

7. To maintain a safe environment in which care can be provided.