Resident Agreement
C.
IN THE EVENT THE MONTHLY SUM REFERENCED ABOVE IS NOT PAID ON OR BEFORE
THE 10TH DAY OF ANY MONTH, THE RESIDENT WILL BE ASSESSED WITH A LATE FEE
OF $100.00. THE FAILURE TO ASSESS THE LATE FEE WILL NOT CONSTITUTE A
WAIVER OF THE RIGHT TO ASSESS FUTURE LATE FEES.
D.
Person to Person Care Center reserves the right to increase the rates stated above by giving thirty
(30) day written notice to the Resident.
E.
Person to Person Care Center is responsible for arranging for social and leisure activities, local
transportation, arranging appointments for medical, dental, nursing or medical health services,
24-hour staff, food preparation and dietary standards are required by F.S. 400.413 (3).
Transportation to medical, dental, or health services will be the responsibility of the Resident
unless the facility agrees.
F.
The Resident shall give Person to Person Care Center a thirty (30) day written notice prior to
terminating their Contract. In case of death or discharge due to medical reasons, the notice of
termination requirement will be waived and a prorated refund shall be given. Should the Resident
be requested to relocate from Person to Person Care Center by Person to Person Care Center, a
forty-five (45) day written notice will be given
G.
A prorated refund based on the daily rate for any used portion of payment beyond the termination
date will be given to the Resident. Person to Person Care Center will send an itemized written
H.
L
deductions
list of any costs
for such
actually
costs
incurred and/or damages to the premises as well as any refunds due after
and/or to the
or damages, within forty-five (45) days to your last known address
calendar days
address
of
of your responsible party. You will respond in writing, within fourteen (14)
This provision is
notification,
applicable
to contest any of the damages included on the written itemized list.
reasons, transfers
when a Resident terminates or vacates the facility because of medical
termination date is
to
the
a
nursing
date
home, death, facility closure or transfer of ownership. The
facility may clear
the unit will be vacated and cleared of all personal belongings. The
items at a rate equal
the
unit and charge the Resident or his or her estate for moving and storing the
unit. Person to Person
to
Care
the actual costs to the facility, not to exceed 20% of the regular rate for the
clear, move and store belongings
Center will provide 14 days advance written notice of its intent to
claimed within forty-five
prior to charging Resident. If the Resident's possessions are not (45) days after notification, the facility may dispose of them.
H.
nation,
The refund to
or
the Resident shall be made forty-five (45) days subsequent to written notice of
the unit is vacated
in the case of death or discharge due to medical reasons, forty-five (45) days after
facility intends to make
and cleared of all personal belongings. If after a Contract is terminated the
Resident
a claim against a refund due the Resident, the facility shall notify the
reasonable
or
time
responsible party, in writing, of the claim and shall provide said party with a
period of no less than fourteen (14) calendar days to respond.
I.
Funds due to the Resident and all property held by the Person to Person Care Center shall be until such time as the funds and property are disbursed to the Personal
appointed
Representative of the Resident's Estate, spouse or adult next of kin. In the event there is no duly Personal Representative,
Person Care
the person receiving funds or property will hold Person to
(2) years
Center harmless from claims and third parties. Funds not disbursed within the two will be deposited in the Aging& Adult Service Trust Fund.
J.
daily
In case
rate
a
Resident
must be paid
has to
to
be
reserve
admitted to a hospital, nursing home or other health care facility, the
gives
the Resident's bed unless the Resident or Responsible Party notice of the Resident's non return and all Resident property is removed from the unit. Until such notice is received, the agreed upon rate may be charged by Person to Person Care Center
K.
discontinuance
If the facility discontinues
shall be refunded
operation, any advance payments for services beyond the date of
closure, whether
to the Resident or as provided herein within seven (7) days of or not such refund is requested.
L.
provide
Person to
24-hour
Person Training Center is not affiliated with a religious organization and does not nursing care or 24-hour nursing supervision.
M.
for
Person
Residents
to Person Care Center respects the rights of the Resident as outlined in the Bill of Rights of Adult Assisted Living Facilities.
N.
The Resident
respect the
agrees to abide by all facility rules, policies and procedures, pay the monthly rate on property and privacy of others, and not leave the facility without signing the sign out log.
O.
ADMISSION, RETENTION & DISCHARGE POLICY: Medical and personal information will
ASSESSMENT
to the facility upon admission. Medical information must be on the HEALTH FOR ASSISTED LIVING FACILITIES FORM #1823
- There is no rate progression based on levels of care.
-
Person to Person Care Center will accept for admission any paying adult who does not need more than supervision or assistance taking medications, ambulation, dressing, eating, toileting and bathing. They must also.
- Be free from communicable disease
- Be able to participate in social and leisure activities
- Be able to communicate their needs
- Be able to evacuate the facility with assistance in an emergency
- Not need nursing or convalescent care for more than seven days
- Not be a threat or danger to themselves or others
-
A Resident may remain at Person to Person Care Center so long as they continue to meet their financial obligations and the above admission criteria.
-
Upon determination by the Administrator or Health Care Provider that the Resident needs services beyond those that the facility is licensed to provide, the Resident, or resident’s representative, or agency acting on the Resident’s behalf, shall be notified in writing that the Resident must make arrangements for transfer to a care setting that has services needed by the Resident. In the event the Resident has no person to represent him/her, the facility shall refer the Resident to the Social Service Agency for the placement, provisions as outlined in F.S. Section 429.26 shall be effective.
P.
Person to Person Care Center will not charge for any supplies, services or accommodations that it has agreed by this Contract to provide as part of the monthly rate. The Resident or representative will be furnished, in advance, an itemized written statement setting forth additional charges for any services, supplies or accommodations available to the Resident not covered under the Contract. An Addendum will be added to this Contract to reflect the additional services, supplies or accommodations not provided hereunder. Such Addendum must be dated and signed by Person to Person Care Center and the Resident or Resident’s legal representative and a copy given to the Resident or Resident’s representative.I have read and received a copy of the Admissions Package which contains the following:
- Resident Contract
- Copy of the Resident Bill of Rights
- The Ombudsman Brochure
- House policies and procedures
- Admissions Retention and Discharge Policy
- Agreement to Arbitrate
I understand that all notices in this contract will be in writing.
Do Not Resuscitate Order & Advanced Directives Policy:
Purpose: To establish the guidelines of addressing DNROs
Definition: A Do Not Resuscitate Order (DNRO) is a form or patient identification device
developed by the Department of Health to identify people who do not wish to be resuscitated in
the event of respiratory or cardiac arrest.
Procedure:
a. Person to Person Care Center, LLC will provide residents with a copy of Form SCHS-4-
2006- Health Care Advance Directives-The Patient's Right to Decide April 2006, regarding
advance directives for patient or patient's responsible party to read.
b. Person to Person Care Center, LLC does not provide residents with a DNRO. However,
information about how a DNRO, if a resident or guardian decide, can be found at:
http://www.doh.state.fl.us/demo/trauma/DNRO/Form1896.pdf or your health care provider
c. Each resident of Person to Person Care Center will have documentation in their record
indicating whether or not he or she has executed a DNRO. If a DNRO has been executed, a
copy of a resident's DNRO must be in the resident's file on the authorized yellow form and
with 2 physician signatures to be valid. This form will be readily available in the event of an
emergency and will be sent to the hospital with the patient if the patient requires
hospitalization.
e. In the event a resident is receiving hospice services and experiences cardiopulmonary arrest,
facility staff must immediately contact the hospice provider. The hospice procedures shall take
precedence over those of the assisted living facility.
Staff:
Person to Person Care Center, LLC staff WILL NOT administer chest compressions or provide
respiratory assistance to any resident that has a DNRO.
Person to Person Care Center, LLC staff will administer chest compressions (CPR) to residents
who do not have a DNRO.
