Your Rights as a Client

As a personal assistance provider, we have an obligation to protect the rights of our clients and explain these rights to you before treatment begins. Your family or your designee may exercise these rights for you in the event that you are not competent or able to exercise them for yourself.

As a client, you have the right to:

• Competent, individualized health care without regard to race, color, creed, sex, age, national origin, handicap, ethical/political beliefs, ancestry, religion, or sexual orientation or whether or not an advance directive has been executed.
• Receive appropriate care without discrimination.
• Exercise your rights as the direct client of this agency or, if appropriate, as the client representative with legal authority to make health care decisions on behalf of the client.
• Be treated with consideration, respect, and full recognition of the client’s human dignity and individuality, including privacy in treatment and care for personal needs.
• Receive treatment, care, and services that are adequate, appropriate, and in compliance with relevant state, local, and federal laws and regulations.
• Participate, either yourself or your designated representative, in the consideration of ethical issues that arise in your care.
• Have your property treated with respect.
• Be free from mental, verbal, sexual, and physical abuse, neglect, involuntary seclusion, and exploitation, including humiliation, intimidation, or punishment.
• Be admitted for service only if the agency has the ability to provide safe, professional care at the level of intensity needed.
• Expect all personnel caring for you will be current in knowledge and have completed a training –program or competency evaluation regarding his/her respective areas of employment.
• Be informed that you may participate in the development of the client’s service plan and medical treatment, the periodic review and update, discharge plans, appropriate instruction and education in the service plan, and be informed of all services the agency is to provide, the staff to provide care and the frequency of visits/shifts to be furnished and to be advised of any change in the service plan before the change is made.
• Know when and how each service will be provided and coordinated, the agency ownership, name and functions of any person and affiliated agency personnel providing services.
• Choose service providers, communicate with those providers, and to reasonable continuity of care.
• Be fully informed, orally and in writing, at the time of admission and in advance of services provided, a statement of services available by the agency and related charges. This must include those items and services for which you may be responsible for reimbursement. The agency will advise you of changes orally and in writing as soon as possible, but no later than five (5) calendar days from the date that the agency becomes aware of a change.
• Be informed of any financial benefits.
• Be taught and have your family members taught the service plan so that you can, to the extent possible, assist yourself and your family or other designated party can also understand and assist you.
• Request information regarding the services including alternatives to care risk(s) involved. This information will be given in a language or format so that you and your family members can readily interpret and understand so that informed consent may be given.
• Refuse service after the possible consequences of refusing services have been fully explained. The agency shall allow a client, or client representative with legal authority to make decisions, to accept or reject, at the client’s or client representative’s discretion without fear of retaliation from the agency, any employee, independent contractor, or contractual employee that is referred by the agency.
• A cognitively capable adult client or a client representative with legal authority to make decisions, to refuse any portion of planned service or other portions of the service plan.
• Review all of your records during normal business hours.
• Assistance in locating appropriate community resources before you run out of funds. However, in keeping with proper fiscal responsibility, uncompensated care may not be provided.
• Be informed of anticipated outcomes of services and of any barriers in outcome achievement.
• Privacy, including confidentiality of all record communications, personal information, and transfer to a health care facility, as required by law or third-party contracts. You shall be informed of the policy and procedure regarding disclosure of your records.
• Receive the care necessary to assist you in attaining optimal levels of health, and if necessary, cope with death. To know that a client does not receive experimental treatment or participate in research unless he/she gives documented voluntary informed consent.
• Provided information about advance directives and the right to have an advance directive and this agency requests information regarding the client’s advance directives to determine whether the advance directive information has an impact on care provided.
• Be informed in writing of policies and procedures for implementing advance directives, including any limitations if the provider cannot implement an advance directive based on such as living wills or the designation of a surrogate decision-maker, are respected to the extent provided by law.
• Know that Do–Not–Resuscitate orders shall not constitute a directive to withhold or withdraw medical treatment other than CPR. Withdrawal of life-sustaining treatment is done only after the physician has ordered it and the family/significant other/POA/MPOA is notified.
• Be informed of the procedures for submitting complaints with respect to client care that is or fails to be furnished or regarding the lack of respect for property by anyone who is furnishing services on behalf of the agency with suggested changes in services without coercion, discrimination, reprisal or unreasonable interruption of services.
• To be informed (as the consumer or authorized representative) of the consumer’s rights through an effective means of communication. Additionally, the client has the right to be informed about:
  • The individuals providing services.
  • The full name, staff position and employer of all persons with whom the consumer has contact and who is supplying, staffing or supervising care or services.
  • The right to be served by agency staff that is properly trained and competent to perform their duties, including the ability to identify visiting staff through proper identification. This agency shall disclose of any sub-contractual relationship with any individual or agency to be assigned or referred to provide care to the client.

The telephone number where a client or the client representative can contact the agency 24 hours a day, 7 days a week regarding care is 682-203-4126.

• Live free from involuntary confinement and be free from physical or chemical restraints.
• Be provided with updates and state amendments on individual rights to make decisions concerning medical care within 90 days from the effective date of changes to state law.
• To receive information about the scope of services that the organization will provide and specific limitations on those services.
• Be informed of the procedure for submitting a written complaint/grievance to the home health agency. All complaints/grievances may be given to any agency member. If not satisfied with the response or any step in the chain of command, continue to the next person. Contact Lone Star Visiting Caregivers and ask to speak to the following:
  PAS Supervisor

2. Administrator

• Receive a prompt response, through an established complaint or grievance procedure, to any complaints, suggestions, or grievances the participant may have. The administrator or designee documents and investigates the grievance/complaint within 10 calendar days of receipt of the complaint. The Administrator or designee must complete the investigation and documentation within 30 calendar days after the Agency receives the complaint unless the Agency has and documents reasonable cause for delay. You may appeal the administrator findings to the Governing Board by submitting a written complaint to:

Attention Owner

Lone Star Visiting Caregivers

7460 Warren Parkway #166

Frisco, TX 75034

• Be informed of your state’s hotline and the agency's contact information make suggestions or complaints, or present grievances on behalf of the client to the agency, government agencies, or other persons without the threat or fear of retaliation.
•  

Texas Department of Family and Protective Services

1-800-252-5400.

Your Responsibilities as a Client

Client Responsibilities:

• To ask questions of the staff about anything they do not understand concerning their treatment or services provided.
• To provide complete and accurate information concerning their present health, medication, allergies, etc.
• To inform staff of their health history, including past hospitalization, illnesses, injuries.
• To involve themselves and/or Caregiver, as needed and as able, in developing, carrying out, and modifying their service plan.
• To review the Agency’s information on maintaining a safe and accessible home environment in their residence.
• To request additional assistance or information on any phase of their service plan they do not fully understand.
• To inform the staff when a health condition or medication change has occurred.
• To notify the Agency when they will not be home for a scheduled home care visit.
• To notify the Agency prior to changing their place of residence or telephone.
• To notify the Agency when encountering any problem with equipment or services.
• To notify the Agency if they are to be hospitalized or if a physician modifies or ceases their prescription.
• To make a conscious effort to comply with all aspects of the service plan.
• To notify the Agency when payment source changes.
• To notify the Agency of any changes in or the execution of any advanced directives.

Agency Responsibilities

Before the care is initiated, the agency must inform a client orally and in writing of the following:

• The extent to which payment may be expected from third-party payers;
• The charges for services that will not be covered by third-party payers;
• Services to be billed to third-party payers;
• The method of billing and payment for services;
• The charges that the client may have to pay;
• A schedule of fees and charges for services;
• The nature and frequency of services to be delivered and the purpose of the service;
• Any anticipated effects of treatment, as applicable; The agency must inform a client orally and in writing of any changes in these charges as soon as possible, but no later than five (5) days from the date the home health agency provider becomes aware of the change; If an agency is implementing a scheduled rate increase to all clients, the agency shall provide a written notice to each affected consumer at least 30 days before implementation;
• The requirements of notice for cancellation or reduction in services by the organization and the client;
• The refund policies of the organization; and
• The agency shall not assume power of attorney or guardianship over a consumer utilizing the services of the agency, require a consumer to endorse checks over to the agency, or require a consumer to execute or assign a loan, advance, financial interest, mortgage, or other property in exchange for future services.

Complaints and Grievances

You may report a complaint or grievance at any time without reprisal or disruption of services.

Any staff member may receive a complaint or grievance about services or care that is or is not furnished or about the lack of respect for the consumer's person or property by anyone furnishing services on behalf of the personal care agency.

Complaints and Grievances Procedure:

1. Client or client representative reports a complaint/grievance to any staff member.
2. Staff members receiving complaints or grievances report them to the Administrator or designee.
3. Administrator or designee documents the complaint and investigates the grievance/complaint within 5 business days of receipt of the complaint. The
4. Administrator or designee must complete the investigation and documentation within 30 calendar days after the Agency receives the complaint unless the Agency has and documents reasonable cause for delay.
5. If the Administrator or designee is unable to resolve the complaint/grievance, the Owner is notified and takes action toward resolution.
6. Notify the client when appropriate action has been taken or that the problem has been resolved.
7. Document the action taken and resolution on the Complaint Form.

You may appeal the administrator’s findings to the Owner by submitting a written complaint to:

Attention Owner

Lone Star Visiting Caregivers.

7460 Warren Parkway #166

Frisco, TX 75034    

Additionally, the client may contact at any time without reprisal or disruption in services the:

Department of Aging and Disability Services,

DADS' Consumer Rights and Services Division,

P.O. Box 149030,

Austin, Texas 78714-9030

Toll Free 1-800-458-9858  

Rights of the Elderly

This Agency advises you of the following rights:

Definitions:

1. "Convalescent and nursing home" means an institution for onsite, ongoing skilled care.
2. "Personal Assistance Services (PAS)” means routine ongoing care or services required by an individual in a residence or independent living environment that enable the individual to engage in the activities of daily living or to perform the physical functions required for independent living, including respite services. The term includes:
3. "Alternate care" means services provided within an elderly individual’s own home, neighborhood, or community, including:
   Day care,
   B. Foster care,
        C. Alternative living plans, including personal care services.
        D. Supportive living services, including attendant care, residential repair, or emergency response services.
4. "Person providing services" means an individual, corporation, association, partnership, or other private or public entity providing convalescent and nursing home services, personal assistance services, or alternate care services.
5. "Elderly individual" means an individual 60 years of age or older.

Prohibition:

1. A person providing services to the elderly may not deny an elderly individual a right guaranteed by this chapter.
2. Each agency that licenses, registers, or certifies a person providing services shall require the person to implement and enforce this chapter. A violation of this chapter is grounds for suspension or revocation of the license, registration, or certification of a person providing services.

Rights of the Elderly:

1. An elderly individual has all the rights, benefits, responsibilities, and privileges granted by the constitution and laws of this state and the United States, except where lawfully restricted. The elderly individual has the right to be free of interference, coercion, discrimination, and reprisal in exercising these civil rights.
2. An elderly individual has the right to be treated with dignity and respect for the personal integrity of the individual, without regard to race, religion, national origin, sex, age, disability, marital status, or source of payment. This means that the elderly individual:
   Has the right to make the individual's own choices regarding the individual's personal affairs, care, benefits, and
   services;
        B. Has the right to be free from abuse, neglect, and exploitation, and
        C. If protective measures are required, has the right to designate a guardian or representative to ensure the right to
            quality stewardship of the individual's affairs.
3. An elderly individual has the right to be free from physical and mental abuse, including corporal punishment or physical or chemical restraints that are administered for discipline or convenience and are not required to treat the individual's medical symptoms. A person providing services may use physical or chemical restraints only if the use is authorized in writing by a physician or if the use is necessary in an emergency to protect the elderly individual or others from injury. A physician's written authorization for the use of restraints must specify the circumstances under which the restraints may be used and the duration for which the restraints may be used. Except in an emergency, restraints may only be administered by qualified medical personnel.
4. A mentally retarded elderly individual with a court-appointed guardian of the person may participate in a behavior modification program involving the use of restraints or adverse stimuli only with the informed consent of the guardian.
5. An elderly individual may not be prohibited from communicating in the individual's native language with other individuals or employees to acquire or provide any type of treatment, care, or services.
6. An elderly individual may complain about the individual’s care or treatment. The complaint may be made anonymously or communicated by a person designated by the elderly individual. The person providing the service shall promptly respond to resolve the complaint. The person providing services may not discriminate or take other punitive action against an elderly individual who makes a complaint.
7. An elderly individual is entitled to privacy while attending to personal needs and a private place for receiving visitors or associating with other individuals unless providing privacy would infringe on the rights of other individuals. This right applies to medical treatment, written communications, telephone conversations, meetings with family, and access to resident councils. An elderly person may send and receive unopened mail, and the person providing services shall ensure that the individual's mail is sent and delivered promptly. If an elderly individual is married and the spouse is receiving similar services, the couple may share a room.
8. An elderly individual may participate in activities of social, religious, or community groups unless the participation interferes with the rights of other persons.
9. An elderly individual may manage the individual's personal financial affairs. The elderly individual may authorize in writing another person to manage the individual's money. The elderly individual may choose how the individual's money is managed, including a money management program, a representative payee program, a financial power of attorney, a trust, or a similar method, and the individual may choose the least restrictive of these methods. A person designated to manage an elderly individual's money shall do so by each applicable program policy, law, or rule. On request of the elderly individual or the individual's representative, the person designated to manage the elderly individual's money shall make available the related financial records and provide an accounting of the money. An elderly individual's designation of another person to manage the individual's money does not affect the individual's ability to exercise another right described by this chapter. If an elderly individual is unable to designate another person to manage the individual's affairs and a guardian is designated by a court, the guardian shall manage the individual's money by the Probate Code and other applicable laws.
10. An elderly individual is entitled to access to the individual's personal and client records. These records are confidential and may not be released without the elderly individual's consent, except the records may be released:
    To another person providing services at the time the elderly individual is transferred; or
    B. If the release is required by another law.
    
11. A person providing services shall fully inform an elderly individual, in language that the individual can understand, of the individual's total medical condition and shall notify the individual whenever there is a significant change in the person's medical condition.
12. An elderly individual may choose and retain a personnel physician and is entitled to be fully informed in advance about treatment or care that may affect the individual's well-being.
13. An elderly individual may participate in an individual plan of care that describes the individual's medical, nursing, and psychosocial needs and how the needs will be met.
14. An elderly individual may refuse medical treatment after the elderly individual:
    Is advised by the person providing the services of the possible consequences of refusing treatment; and
    B. Acknowledges that the individual clearly understands the consequences of refusing treatment.
15. An elderly individual may retain and use personal possessions, including clothing and furnishings, as space permits. The number of personal possessions may be limited for the health and safety of other individuals.
16. An elderly individual may refuse to perform services for the person providing services.
17. Not later than the 30th day after the date the elderly individual is admitted for service, a person providing services shall inform the individual;
    Whether the individual is entitled to benefits under Medicare or Medicaid; and
    B. Which items and services are covered by these benefits, including items or services for which the elderly individual
             may not be charged.
18. A person providing services may not transfer or discharge an elderly individual unless:
    The transfer is for the elderly individual's welfare, and the individual's needs cannot be met by the person providing
    services;
         B. The elderly individual's health is improved sufficiently so that services are no longer needed;
         C. The elderly individual's health and safety or the health and safety of another individual would be endangered if the
             transfer or discharge was not made;
         D. The person providing services ceases to operate or to participate in the program that reimburses the person
             providing services for the elderly individual's treatment or care; or
         E. The elderly individual fails, after reasonable and appropriate notices, to pay for services.
19. Except in an emergency, a person providing services may not transfer or discharge an elderly individual from a residential facility until the 30th day after the date the person providing services provides written notice to the elderly individual, the individual's legal representative, or a member of the individual's family stating:
    That me person providing services intends to transfer or discharge the individual;
    B. The reason for the transfer or discharge listed in Subsection(R);
         C. The effective date of the transfer or discharge;
         D. If the individual is to be transferred, the location to which the individual will be transferred; and E. The individual's
             right to appeal the action and the person to whom the appeal should be directed.

20. An elderly individual may:
    Make a living will by executing a directive under the Natural Death Act;
    B. Execute a durable power of attorney for health care; or
         C. Designate a guardian in advance of the need to make decisions regarding the individual's health care should the individual become incapacitated.

List of Rights:

1. A person providing services shall provide each elderly individual with a written list of the individual's rights and responsibilities, before providing services or as soon after providing services as possible and shall post the list in a conspicuous location.
2. A person providing services must inform an elderly individual of changes or revisions in the list.

Rights are Cumulative:

The rights described in this chapter are cumulative of other rights or remedies to which an elderly individual may be entitled under the law.

HIPAA Notice of Privacy Practices

In compliance with HIPAA - The Health Insurance Portability and Accountability Act of 1996

If you are a client of Lone Star Visiting Caregivers, this notice describes how your medical information may be used and disclosed and how you can get access to this information. Please review this notice carefully.

1. USES AND DISCLOSURES

The Agency will not disclose your health information without your authorization, except as described in this notice.

Plan of Care. The Agency will use your health information for the plan of care; for example, information obtained by the admitting staff member will be recorded in your record and used to determine the course of care. The staff will communicate with one another personally and through the case record to coordinate the care provided.

Payment. The Agency will use your health information for payment for services rendered. For example, the Agency may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or the Agency. The Agency may also need to obtain prior approval from your insurer and may need to explain to the insurer your need for personal assistance services and the services that will be provided to you.

Health Care Operations. The Agency will use your health information for personal assistance services operations. For example, Agency field staff, supervisors and support staff may use information in your case record to assess the care and outcomes of your case and others like it. This information will then be used to continually improve the quality and effectiveness of the services we provide. Regulatory and accrediting organizations may review your case record to ensure compliance with their requirements.

Notification. In an emergency, the Agency may use or disclose health information to notify or assist in notifying a family member, personal representative, or another person responsible for the care of your location and general condition.

Public Health. As required by federal and state law, the Agency may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Law Enforcement. As required by federal and state law, the Agency will notify authorities of alleged abuse/neglect; and risk or threat of harm to self or others. We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

Charges against the Agency. In the event you should file suit against the Agency, the Agency may disclose health information necessary to defend such action.

Duty to Warn. When a client communicates to the Agency a serious threat of physical violence against himself, herself, or a reasonably identifiable victim or victims, the Agency will notify either the threatened person(s) and/or law enforcement.

The Agency may also contact you about appointment reminders, treatment alternatives, or public relations activities.

In any other situation, the Agency will request your written authorization before using or disclosing any identifiable health information about you. If you choose to sign such authorization to disclose information, you can revoke that authorization to stop any future uses and disclosures.

1. INDIVIDUAL RIGHTS

You have the following rights concerning your protected health information:

1. You may request in writing that the Agency not use or disclose your information for treatment, payment, or administration purposes or to persons involved in your care except when specifically authorized by you when required by law, or in emergencies. The Agency will consider your request; however, the Agency is not legally required to accept it. You have the right to request that your health information be communicated to you in a confidential manner such as by sending mail to an address other than your home.
2. Within the limits of the statutes and regulations, you have the right to inspect and copy your protected health information. If you request copies, the Agency will charge you a reasonable amount, as allowed by statute.
3. If you believe that information in your record is incorrect or if important information is missing, you have the right to submit a request to the Agency to amend your protected health information by correcting the existing information or adding the missing information.
4. You have the right to receive an accounting of disclosures of your protected health information made by the Agency for certain reasons, including reasons related to public purposes authorized by law and certain research. The request for an accounting must be made in writing to the Privacy Officer. The request should specify the time period for the accounting starting on or after April 14, 2003. Accounting requests may not be made for periods in excess of six (6) years. The Agency would provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee.
5. If this notice was sent to you electronically, you may obtain a paper copy of the notice upon request to the Agency.
6. AGENCY´S DUTIES
7. The Agency is required by law to maintain the privacy of protected health information and to provide individuals with notice of its legal duties and privacy practices with respect to protected health information.

2. The Agency is required to abide by the terms of this Notice of its duties and privacy practices. The Agency is required to abide by the terms of this Notice as may be amended from time to time.
3. The Agency reserves the right to change the terms of this Notice and to make the new Notice provisions effective for all protected health information that it maintains. Prior to making any significant changes in our policies, the Agency will change its Notice and provide you with a copy. You can also request a copy of our Notice at any time. For more information about our privacy practices, please contact the office at 682-203-4126.
4. This agency must notify the patient of a breach of their protected health information. This agency will notify the patient within 15 business days of discovery of any breach in the patient’s protected health information. Notification will occur regardless of whether the breach was accidental or if a business associate was the cause. A “breach” of PHI is any unauthorized access, use, or disclosure of unsecured PHI unless a risk assessment is performed that indicates there is a low probability that the PHI has been compromised. The risk assessment must be performed after both improper uses and disclosures and include the nature and extent of the PHI involved, a list of unauthorized persons who used or received the PHI, if the PHI was, in fact, acquired or viewed, and the degree of mitigation. This agency and if any business associate was involved must consider all the following factors in assessing the probability of a breach:

• the nature and extent of the protected health information involved, including the types of identifiers and the likelihood of re-identification;
• the unauthorized person who used the protected health information or to whom the disclosure was made;
• whether the protected health information was actually acquired or viewed; and
• the extent to which the risk to the protected health information has been mitigated.
•  

“Unsecured” protected health information means protected health information that is not rendered unusable, unreadable, or indecipherable to unauthorized individuals through the use of a technology or methodology.

5. If the breach is determined to have no or low probability of risk to the patient then the patient will not be notified. Any other risk factor requires the agency to notify the patient in writing within 15 business days of the conclusion of the determination.
6. COMPLAINTS

If you are concerned that the Agency has violated your privacy rights, or you disagree with a decision the Agency made about access to your records, you may contact the office at 683-203-4126. You may also send a written complaint to the Federal Department of Health and Human Services. The Lone Star Visiting Caregivers office staff can provide you with the appropriate address upon request. Under no circumstances will you be retaliated against for filing a complaint.

1. CONTACT INFORMATION

The Agency is required by law to protect the privacy of your information, provide this Notice about our information practices, and follow the information practices that are described in this Notice.

If you have any questions or complaints, please contact: Agency Administrator

You may contact this person at:

Lone Star Visiting Caregivers

7460 Warren Parkway #166

Frisco, TX 75034

1. P) 682-203-4126

Complaints may also be directed to the Texas Department of Disability and Aging without fear of retaliation.

Department of Aging and Disability Services,

DADS' Consumer Rights and Services Division,

P.O. Box 149030,

Austin, Texas 78714-9030

Toll Free 1-800-458-9858  

Medicaid Fraud Reporting

If you have reason to believe that, someone is defrauding the Medicaid program please report it to the appropriate agency listed below.

Abuse, Neglect, Exploitation Policy & Drug Testing Policy

Agency employees and independent contractors shall report all actual or suspected cases of abuse, neglect, or exploitation of a client/child to an agency supervisor and the appropriate state agency. If agency personnel detect any signs of family violence, the information required by law is given to the victim, and suspected family violence is reported to the employee's supervisor.

            “Abuse” means the negligent or willful infliction of injury, unreasonable confinement, intimidation, or cruel punishment with resulting physical or emotional harm or pain to an elderly or disabled person by the person's caretaker, family member, or another individual who has an ongoing relationship with the person; or sexual abuse of an elderly or disabled person, including any involuntary or nonconsensual sexual conduct that would constitute an offense, (indecent exposure, assault offenses), committed by the person's caretaker, family member, or another individual who has an ongoing relationship with the person.

            “Neglect” means: the failure to provide for one's self the goods or services, including medical services which are necessary to avoid physical or emotional harm or pain, or the failure of a caretaker to provide such goods or services.                               

            “Exploitation” means: the illegal or improper act or process of a caretaker, family member, or other individual who has an ongoing relationship with an elderly or disabled person using the resources of such person for monetary or personal benefit, profit, or gain without the informed consent of such person.

                                    Department of Family and Protective Services
                                                            1-800-252-5400

YOUR RESPONSIBILITY AS A CLIENT

1. Remain under a physician's care while receiving agency services.
2. Provide the agency with a complete and accurate health history.
3. Provide the agency with all requested insurance and financial records.
4. Sign the required consents and releases for insurance billing.
5. Participate in your Plan of Care.
6. Accept the consequences for any refusal of treatment or choice of non-compliance
7. Provide a safe home environment in which your care can be given.
8. Cooperate with your physician, agency staff, and other caregivers.
9. Treat agency personnel with respect and consideration.
10. Advise the agency of any problems or dissatisfaction with the care being provided without being subject to discrimination or reprisal.
11. Notify the agency when unable to keep an appointment.

                                                AGENCY'S DRUG TESTING POLICY

Lone Star Visiting Caregivers is a drug-free workplace. The use of drugs or alcohol in the workplace or being under the influence while on duty is prohibited. Drug screening or testing may be requested as a condition of employment, conducted on a random basis, or in the event an associate is involved in a major accident during working hours. Alcohol use or chemical substance abuse during working hours and eight (8) hours prior to reporting for duty is prohibited and is considered grounds for immediate termination of employment. Any associate suspected of impairment or substance abuse is to be relieved of duty immediately. The associate is to undergo drug screening within 2 hours adhering to the appropriate lab protocol. Refusal to consent to drug testing is considered grounds for termination of employment.

Advance Directives

It is your right to decide about the medical care you will receive. You have the right to be informed of treatment options available before giving consent for medical treatment. You also have the right to accept, refuse, or discontinue any treatment at any time.

All of us who provide you with personal assistance services are responsible for following your wishes. However, there may be times when you may not be able to decide or make your wishes known.

Many people want to decide ahead of time what kinds of treatment they want to keep them alive. Advance Directives let you make your wishes for treatment known in advance.

Our agency complies with the Advance Directives Act of 1999 which requires us to:

• Provide you with written information describing your rights to make decisions about your medical care;
• Document advance directives prominently in your medical record and inform all staff;
• Comply with requirements of State law and court decisions with respect to Advance Directives; and
• Provide care to you regardless of whether or not you have executed an Advance Directive.

An Advance Directive is a document written before a disabling illness. The Advance Directive states your choice about treatment and may name someone to make treatment choices if you cannot.

There are generally four types of advance directives.

A Directive to a Physician (Living Will) is a legal document that allows you to make your wishes known concerning the provision, withdrawal, or withholding of artificial life-supporting treatment. This is executed in advance of the time when you may not be able to participate in those decisions due to your medical condition. It only goes into effect when you can no longer make decisions and you are certified in writing by your attending physician as suffering from a terminal or irreversible condition.

A Medical Power of Attorney is a legal document, which allows you to designate a particular person to make decisions regarding your medical care when you are not able to do so. This person should be someone you trust to carry out your wishes. It may also be canceled or changed at any time.

An Out-of-Hospital Do-Not-Resuscitate Order is a document, prepared and signed by your physician, which directs health care professionals acting in an out-of-hospital setting, such as your home, not to initiate or continue a life-sustaining treatment. A diagnosis of a terminal condition is no longer required for the execution of the Out-of-Hospital Do-Not-Resuscitate Order.

Declaration for Mental Health Treatment is a document that allows an adult who is not incapacitated to list instructions for consent to or refusal of mental health treatment. It allows a competent person to proclaim their preference for mental health treatment with psychoactive medications, electroconvulsive or convulsive treatments, or emergency medical care should the person be declared incapacitated.

Effective Period: Properly signed and witnessed, the Directive to Physician, Medical Power of Attorney, and/or Out-of-Hospital Do-Not-Resuscitate Order must be properly executed and witnessed by two competent adults.

At least one of the witnesses must be a person who is not:

1. Designated by the declarant to make a treatment decision;
2. Related to the declarant by blood or marriage;
3. Entitled to any part of the declarant’s estate after the declarant’s death;
4. The attending physician;
5. An employee of the attending physician;
6. An employee of a health care facility in which the declarant is a client if the employee is: providing direct client care to the declarant is a client if the employee is: providing direct client care to the declarant or is an officer, director, partner, or business office employee of the facility or any parent organization of the facility; or
7. Anyone who, at the time the advance directive is executed, has a claim against any part of the declarant’s estate after the declarant’s death.

If you executed a living will or durable power of attorney for health care before July 1, 1991, you may want to review it since new laws have gone into effect which gives you more options and information. Even if you decide not to update it, the old documents are still legal.

We must document in your medical record whether or not you have executed an Advance Directive. We will abide by your Advance Directives. Care will be provided to you regardless of whether or not you have executed an Advance Directive. It is our policy to honor the Advance Directive to the extent permitted by law and to support your right to actively participate in making health care decisions.

An ethics committee is available to serve in an advisory capacity when ethical issues, such as the withdrawal or withholding of life-sustaining treatments arise during the care of clients with or without an Advance Directive. Discussion shall involve the client and/or designated representatives, the home care staff involved in the client’s care, and the client’s physician.

Unless the physician has written the specific order “Do Not Resuscitate”, it is our policy that every client will receive cardiopulmonary resuscitation (CPR). If you do not wish to be resuscitated, you, your family, or the person(s) holding your Medical Power of Attorney must request “Do Not Resuscitate” (DNR) orders from your physician. These orders are documented in your medical record and routinely reviewed; however, you may revoke your consent to such an order at any time.

Procedures Agency Is Unable to Honor: The Agency recognizes each individual’s right to make decisions concerning his/her care, including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives as permitted under law. The Agency will honor an individual’s Advance Directive with the following exceptions:

• The Agency will not honor a request to withhold comfort measures and/or pain management medications or treatments.
• The Agency will not honor an Advance Directive of an individual who has been diagnosed as pregnant.
•  

If other treatment decisions or directives are identified during the course of care that the Agency and/or the individual’s physician are unwilling to honor, treatment will be provided until a reasonable opportunity to transfer the individual to another physician, facility, or agency has been afforded.

If CPR is initiated the agency policy is to call 911.

Infection Control

The following instructions will help control the spread of infection and protect others from illness and/or injury.

Hand washing:

Hand washing is the single most effective technique in the prevention of the spread of disease and infection. Hands should be washed thoroughly with soap and water before and after eating or food preparation, after using the bathroom, before and after performing medical procedures and immediately following contact with blood or other potentially infections materials.

Disposal of Medical Waste:

Used, disposable supplies such as diapers, incontinence pads, non-blood-saturated dressings, IV tubing, and gloves should be placed in a heavy-duty plastic bag and securely fastened at the top to close. If a heavy-duty bag is not available, the items should be double-bagged and disposed of with the client’s regular garbage.

Items heavily contaminated with blood or body fluids contaminated with blood should be placed in a leak-proof heavy-duty bag or tied securely at the neck and double-bagged. All bags should be appropriately labeled as biohazardous or color-coded and securely colored prior to removal from the home. The nurse will transport them to the office or arrange for pick-up by a biohazardous waste disposal company.

Liquids such as betadine and irrigating solutions may be flushed down the toilet.

Sharp items including hypodermic needles and syringes, scalpel blades, razor blades, disposable razors, lancets, scissors, knives, staples, IV stylets, and rigid introducers are placed directly in a hard plastic or metal container with a screw-on or tightly secured lid. The lid should be reinforced with heavy-duty tape prior to discarding in regular trash. Sharps are not to be placed in any container planned for recycling or to be returned to a store. Glass or clear plastic containers are not to be used.

Used needles and syringes should not be recapped, bent, or removed from disposable syringes or manipulated by hand.

Sanitation in the Home:

Linens soiled with infectious wastes should be placed directly into the washer and prewashed with cool water and 1 cup of bleach.

Dishes should be washed in a dishwasher or soaked and cleaned in hot, soapy water.

Family Disaster Plan

Families should be prepared for all hazards that affect their area and themselves. NOAA’s National Weather Service, the Federal Emergency Management Agency, and the American Red Cross urge each family to develop a family disaster plan. Where will your family be when disaster strikes? They could be anywhere at work, at school, or in the car. How will you find each other? Will you know if your children are safe? Disasters may force you to evacuate your neighborhood or confine you to your home. What would you do if basic services, gas, electricity, or telephones- were cut off?

Follow these Basic Steps to Develop a Family Disaster Plan

1. Gather information about hazards. Contact your local National Weather Service office, emergency management office civil defense office, and your local American Red Cross chapter. Find out what type of disasters could occur and how you should respond. Learn your community’s warning signals and evacuation plans.

2. Meet with your family to create a plan. Discuss the information you have gathered. Pick two places to meet: (1) a spot right outside your home for an emergency, such as a fire, and (2) a place away from your neighborhood in case you cannot return home. Choose an out-of-state friend as your “family check-in contact” for everyone to call if the family gets separated. Discuss what you would do if advised to evacuate.

3. Implement your plan. (1) Post emergency telephone numbers by phone; (2) Install safety features in your house, such as smoke detectors and fire extinguishers; (3) Inspect your home for potential hazards, such as items that can move, fall, break, or catch on fire, and correct them; (4) Have your family learn basic safety measures, such as CPR and first aid, how to use a fire extinguisher, and how and when to turn off the water, gas, and electricity in your home; (5) Teach children how and when to call 9-1-1 or your local Emergency Medical Services number; (6) keep enough supplies in your home to meet your needs for at least three days. Assemble a disaster supplies kit with items you may need in case of an evacuation. Store these supplies in sturdy easy-to-carry containers, such as backpacks or duffle bags. Keep important family documents in a waterproof container. Keep a smaller disaster supplies kit in the trunk of your car. A Disaster Supplies Kit should include: (1) A three-day supply of water (one gallon per person per day) and food that will not spoil, (2)

• One change of clothing and footwear per person, (3) One blanket or sleeping bag per person, (4) A first-aid kit, including prescription medicines, (5) Emergency tools, including a battery-powered NOAA Weather radio, and a portable radio, flashlight, and plenty of extra batteries, (6) An extra set of car keys and cash, (7) Special items for infant, elderly, or disabled family member.

4. Practice and maintain your plan. Ask questions to make sure your family remembers meeting places, telephone numbers, and safety rules.

5. Conduct drills. Test your smoke detectors monthly and change the batteries at least once a year. Test and recharge your fire extinguishers(s) according to manufacturer’s instructions. Replace stored water and food every six months.

Emergency Telephone Numbers:

In the case of a medical emergency, you should contact EMERGENCY MEDICAL SERVICES by telephone at 911.

In the case of a suspected poisoning, you should contact POISON CONTROL

at 1-800-764-7661.

Home Safety Guidelines

* General Information:

- Install proper locks and keep doors locked.

- Ask visitors to identify themselves before opening the door.

- Open the door only if you know the person, or if you are expecting that person.

- Be cautious with sharp objects.

- Mark glass doors and windows with decals.

* Medication Safety:

- Keep all medications in original containers and label them clearly.

- Write medication schedule and take only as prescribed.

- Be aware of the side effects of medications.

* Poison Prevention:

- Label all poisons.

- Keep all substances in their original containers.

- Do not mix cleaning products, such as chlorine and ammonia.

- Have syrup of IPECAC on hand.

- Store cleaning agents away from foods and medications.

* Fall Prevention:

- Remove all scatter rugs forever.

- Tack down the edges of all carpets.

- Never leave articles of clothing on the floor.

- Keep boxes out of hallways or stairwells.

- Keep electric cords, telephone cords, newspapers, magazines, and other clutter away from walking areas.

- Use handrails that are sturdy and strong.

- Avoid the use of extension cords.

- Lift feet when walking

- Wear proper fitting shoes with non-skid soles.

- Do activities and exercises to improve balance and strengthen legs.

- Do not attempt to climb or use ladders.

- Be careful if using tranquilizers.

- Have sufficient lighting throughout the house.

* Bathroom:

- Install grab bars or handrails by the toilet and tub.

- Place skid-proof floor covers and tub/shower mats in the bathroom.

- Install a stable tub/shower seat.

* Kitchen:

- Store commonly used items within easy reach.

- Use a cart to move heavy or awkward objects.

- Avoid the use of floor wax; Use the non-skid type and never walk on wet floors.

* Stairs:

- Install handrails and always use them.

- Place a strip of bright tape on the top and bottom step of each staircase.

- Place non-skid threads on steps.

* Bedroom:

- Use a nightlight in the hall between the bedroom and bathroom.

- Take your time, get up from bed or chair slowly to avoid dizziness.

- Sit on the edge of the bed or in a chair when putting on socks, shoes, or slacks.

- Ensure that side rails are in an upright position on hospital beds.

* Living Room:

- Avoid sharp-cornered furniture.

- Utilize proper transfer techniques (ex. Chair to bed or toilet).

- Utilize proper ambulation techniques; use a walker, cane, or crutch as prescribed.

- Utilize wheelchair safety:

                  - Install ramps; 12-foot ramp for 1-foot rise.

                  - Rearrange furniture placement and always lock wheels.

* Fire Safety:

- Make an escape plan; then practice it.

- Keep at least one fire extinguisher; check the charge often.

- Be aware that nylon catches fire.

- Do not ever smoke in bed!

- Be very careful with space heaters; do not tip them!

- Make sure your electrical wiring is not frayed and is free of shorts.

- Keep electrical appliances away from water and unplug them after use.

- Have smoke detectors properly located; check battery monthly.

- Store flammables properly.

- Turn off the oven and stove; clearly mark controls on the stove.

- Be cautious around any open flame heater or fireplace.

- Do not use lighted matches or lighters around any suspected natural gas leaks.

* Burn Prevention:

- Always check hot water for temperature; label hot and cold faucets.

- Keep pot handles turned to the back of the stove.

- Keep flammable towels away from the stove.

- Open lids away from you to avoid steam burns.

- Use heating pads with caution:

                  - Use only on low (unless the Doctor/Nurse states otherwise)

                  - Check the area frequently for redness

                  - Do not apply directly to the skin.

* Medical Equipment Safety:

The company that supplies your medical equipment should instruct you on the safe use of each item. If you have a question or need assistance with any item, please ask your nurse! If a piece of equipment breaks or seems not to work correctly, notify the company that brought the item to you immediately! Do not use an item unless you are sure it is working properly. Never smoke when Oxygen is in use.

* Cold Weather Precautions:

- Avoid icy sidewalks and porch steps.

- Always cover head, hands and feet if you are going out.

- Use warm blankets, clothes and socks.

- Plan and Get Ready

* Tornado and Severe Wind Precautions:

With winds, swirling at 200 miles per hour or more, a tornado can destroy just about anything in its path. Generally, weather signs and warnings will alert you to take precautions.

Be prepared by having various family members do each of the items on the checklist below. Then get together to discuss and finalize your Home Tornado Plan.