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Emotional Health, Wellness, and Addictions Services
815.224.1610 Access our free online screening and a full library of mental health and addictions information at:
Princeton
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For any questions or comments, we can be reached at:
815-223-0834
Home Comforts Affiliated with Illinois Valley Community Hospital, Family Home Medical Equipment provides 24-hour emergency service, free delivery and a wide variety of equipment to make home care as comfortable as possible. Let our knowledgeable sales team find the best products for you, including bathroom aids, braces, supports & hosiery, canes, walkers & wheelchairs, CPAP machines, diabetic supplies, hospital beds, ostomy products, oxygen, and mastectomy products.
www.ncbhs.org LaSalle
When it comes time for you to decide on a means of transportation for your loved ones, you have a choice. Choose your local, hometown, ambulance provider. The City of LaSalle Fire Department provides local and long-distance, emergency and non-emergency ambulance transports. We are licensed to the Paramedic level of care, and exceed your expectations. City of LaSalle Medicare residents can benefit from NO OUT-OF-POCKET EXPENSE. Notify your hospital representative that you would like the City of LaSalle Fire Department to transport your beloved family member.
Macomb Streator
1319 4th St., Peru, IL 61354 Call 815.220.1682
Welcome to IVCH.................................................... 2 Telephone Directory............................................... 3 During Your Stay..................................................... 4 Your Rights and Responsibilities................... 6 Know Your Admission Status— Inpatient or Observation...................................10
TV Channels pg 5
Advance Directives................................................11 Your Privacy and Information.......................13 Be Prepared..............................................................14 Leaving the Hospital............................................16 My Hospital Discharge Checklist.................16 Speak Up....................................................................16 Your Safety................................................................17
HIPAA Explained pg 13
For the Caregiver..................................................18 Support.........................................................................19 Sometimes You Don’t Need to Go to the IVCH Emergency Room.............20 Non-Discrimination Statement.......................20 The Daisy Award....................................................23 The Sunflower Award..........................................24
Discharge Checklist pg 16
www.ivch.org
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Mission Statement Illinois Valley Community Hospital is dedicated to providing exceptional care through a commitment to clinical excellence and compassion for every patient, every day. Vision Statement By constantly exceeding expectations, Illinois Valley Community Hospital will be known as the place where patients want to receive care, physicians want to practice and employees want to work.
Welcome to Illinois Valley Community Hospital
Thank you for choosing IVCH as the local hospital to meet your medical needs. I speak for the more than 600 employees who work here when I say that we are dedicated to providing exceptional care through a commitment to clinical excellence and compassion for every patient, every day. Here’s what you can expect during your stay at IVCH: • Respect for you and your family: Our staff will be sensitive to your needs and condition, and will respect your rights. • Regular rounding visits: Your nurse will come to your room on a regular basis 24 hours a day to monitor your condition and ask if your needs are being met. Our nurses make rounding visits hourly during the day and every two hours at night. • Attention to detail: From the cleanliness of your room to the quality of your meals to the tests and treatments your doctor may order, we’ll do our best to get it done right the first time, every time. • A willingness to listen: We realize this may be an uncertain time in your life. If you have concerns, we want to know about them. Talk to your nurse or ask for a visit from our patient representative, pastoral care coordinator or a social worker. We pride ourselves on service excellence at IVCH and would like you to let us know how we are doing. After you are discharged, you may receive a patient survey from us. If we have provided very good care to you, please let us know. If we’ve fallen short, let us know that, too. We’re here to serve you. Sincerely,
Tommy Hobbs Chief Executive Officer
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Telephone Directory
Dial last four digits if calling from a hospital phone. 2 South
815-780-3522
3 South
815-780-3532
Administration 815-780-3508 Admitting 815-780-3414 Cardiac Rehab
815-780-3407
Central Scheduling
815-780-3199
Community Outreach
815-780-4618
Day Surgery
815-780-3441
Diagnostic Imaging
815-780-3431
Emergency Department
815-780-3411
Event Registration
815-780-3337
Hospice 815-780-4600 Human Resources
815-780-3546
ICU 815-780-3558 Laboratory 815-780-3511 Lobby Shoppe
815-780-3450
Medical Records
815-780-3464
Obstetrics 815-780-3443 Occupational Health
815-780-3202
Pastoral Care
815-780-3426
Patient Accounts
815-780-3418
Patient Representative
815-780-3592
Public Relations
815-780-3521
Physical Rehabilitation
815-780-3509
Respiratory Care
815-780-3483
Social Service
815-780-3504
Volunteer Services
815-780-3387
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During Your Stay CALLING YOUR NURSE
You can call your nurse by pressing the call button attached to your bed. LANGUAGE SERVICES Patients who do not speak English or are deaf can communicate with the IVCH staff through the Illinois Video Interpretation Network (IVIN). IVIN has interpreters who speak Spanish and other languages who can translate what a patient is saying to IVCH caregivers. Interpretation services are available 24 hours a day, seven days a week, through videophones that can be taken into patient rooms. Deaf patients can use sign language to communicate with an interpreter who can be seen on a small video monitor. The interpreter, in turn, can sign back to the patient and speak with the nurse who is caring for him or her.
YOUR MEALS IVCH doesn’t have set meal times for patients—you can eat whenever you are hungry. You’ll find a food menu on your table when you are admitted, and you can order by dialing ext. 3469 on your room phone anytime between 7:00 a.m. and 6:00 p.m. VISITING HOURS IVCH welcomes the friends and family members of our patients. Here is what you need to know about visiting an IVCH patient: Medical/Surgical Units (2 South and 3 South)
• V isitors are welcome anytime, but please be sensitive to the time needed for patient care and recovery.
Intensive Care Unit
• C all ahead, 815-780-3558, to determine if the patient you want to visit can receive visitors.
• I f you’re at IVCH, you must dial 3558 on the phone in the hallway outside ICU before entering to ensure patient privacy.
Obstetrics Unit Visiting hours for OB patients are 11:00 a.m. to 8:00 p.m. Visiting hours may be limited depending upon the patient’s condition, hygiene needs and breastfeeding schedule. An adult must accompany siblings of the newborn while they are visiting the hospital, and visitors must wash hands prior to having contact with the infant. Family and visitors are expected to abide by conduct that is supportive of the hospital environment. Day Surgery
• No restrictions
ROOM TELEPHONE Telephones are provided in all patient rooms, free of charge. All incoming calls come directly to your extension. To place a local call, dial 9-1-815 then the number. Long-distance calls require a credit card. Friends and family can call your room from outside the hospital by dialing 1-815-780 then the room number with a 3 in front of it. For example, if you are in room 265, your phone number is 815-780-3265. THE SOUNDS OF CARE—A NOTE ABOUT NOISE It is our goal at Illinois Valley Community Hospital to provide you with a quiet, healing environment. We cannot promise to be as quiet as your home, but we make every effort to keep hospital noises minimal. You may hear the sound of call lights and IV pump alarms. These sounds alert the nursing staff to a need for nursing attention. It is our
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goal to answer call lights and assist our patients as promptly as possible. We try to program pump alarms to the lowest volumes possible and to anticipate when an infusion is going to be complete instead of waiting for the pump to alarm. You also may hear the sound of carts. These may be supply carts, dietary carts, housekeeping carts, or Lab and Radiology staff carts. We try to keep the wheels working as quietly as possible. We can keep your door closed to eliminate hallway noise if you request. We also can provide ear plugs that you may have and use as needed for your sleep. White noise machines also are available. Please let your nurse know if any noise is preventing you from resting, and if we have your permission to keep your door closed for your comfort and privacy. Your rest and healing are very important to us. MAIL AND FLOWERS Mail and packages will be delivered to you by a hospital volunteer. Individual florists deliver flowers to patient rooms. Please note that flowers are generally prohibited in the Intensive Care Unit because room space is needed for medical equipment. Patient mail received after discharge will be forwarded to the patient’s home. Outgoing mail may be taken to the nurses station or given to your attending nurse. Postage stamps are available in the gift shop. PERSONAL BELONGINGS If you have valuables, such as jewelry and cash, please give them to a relative or friend to take home during your stay. Contact lenses, eyeglasses, hearing aids and dentures should be stored in your bedside stand when not in use. Please don’t put them on your bed or food tray because they may be damaged or lost. The hospital cannot be responsible for replacement of personal belongings. FIRE SAFETY We periodically conduct fire drills. If you hear an alarm, stay where you are. In the event of an actual emergency, hospital staff will notify you. SMOKING IVCH is a smoke-free facility. Smoking is prohibited everywhere in the hospital and on the surrounding grounds. Patients and visitors are not allowed to smoke anywhere. ATM For your convenience, an automated teller machine (ATM) is located on the first floor near the West Street entrance. CAFETERIA The hospital’s cafeteria is located on the first floor.
TV 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
CHANNELS T V Guide NBC (Peoria) W TTW (Chicago PBS) Fox (Bloomington) ABC (Chicago) Headline News CNBC CNN USA Cartoon Network Discovery WTBS Freeform TNT Weather Channel WGN (Chicago) T he Learning Channel (TLC) EWTN AMC MSNBC QVC CBS (Chicago) Animal Planet Univision M usic HGTV Food Channel Travel Channel T urner Classic Movies (TCM) N BC Sports Chicago F ox Sports 1 E SPN E SPN2 E SPNews B ig 10 Network H istory N ational Geographic A&E S yfy
19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 TV
Televisions are available in each patient room. Please be considerate of others by keeping the TV volume down. www.ivch.org
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QUIET TIME
Weekdays
Children and toddlers aren’t the only people who need an occasional nap. Hospital patients need their quiet time, too. That’s why you see Silent Hospitals Help Healing posters everywhere you go at IVCH. The posters encourage everyone to:
Breakfast: 7:00 a.m. – 10:00 a.m.
Lunch: 11:00 a.m. – 1:30 p.m.
Dinner: 4:00 p.m. – 6:00 p.m.
· K eep their voices down. · Limit movement in the halls. · Silence their cell phones. These apply 24 hours a day but especially from 1:00 p.m. to 3:00 p.m., the hospital’s official Quiet Time for patients, visitors and staff. Thank you for your cooperation! CONCERNS? If you have concerns about the care you or your family member received, we encourage you to speak with your physician or with our patient representative, who can be reached by calling ext. 3592, or 815-780-3592 if calling from outside IVCH.
Weekends Lunch: 11:00 a.m. – 1:30 p.m. Dinner: 4:00 p.m. – 6:00 p.m. • V isitor trays can be delivered to patient rooms for a fee. Call ext. 3469 to order. VENDING MACHINES Vending machines offering assorted snacks and beverages are accessible 24 hours a day in the cafeteria and in a room off the first floor hallway near the admitting area. GIFT SHOP The IVCH Lobby Shoppe gift shop is located on the first floor of the hospital near the West Street entrance. Some of the items available include gifts, baby items, toiletries, cards, candy, snacks and fresh flowers. Cash, checks and credit cards are accepted. Please call ext. 3450 or, if outside the hospital, 815-780-3450 for more information. Hours are: Monday through Friday: 9:00 a.m. – 4:30 p.m. Saturday: 9:00 a.m. – 1:00 p.m. PASTORAL CARE The IVCH Pastoral Care Department can help you meet your spiritual needs during your stay. If you desire information about receiving Holy Communion or other spiritual services, call ext. 3426. Area priests and ministers also assist with providing pastoral care. A quiet meditation room is located on the first floor of IVCH, just west of the admitting area as you walk down the hallway.
Your Rights and Responsibilities
As a patient, family member or guardian of a patient at Illinois Valley Community Hospital, we want you to know the rights you have under federal and Illinois state law as soon as possible in your hospital stay. We are committed to honoring your rights, and want you to know that by taking an active role in your healthcare, you can help your hospital caregivers meet your needs as a patient or family member. That is why we ask that you and your family share with us certain responsibilities. YOUR RIGHTS As a patient, you or your legally responsible party has the right to receive care without discrimination due to age, sex, race, color, religion, sexual orientation, income, education, national origin, ancestry, marital status, culture, language, disability, gender identity or who will pay your bill. As our patient, you have the right to safe, respectful and dignified care at all times. You will receive services and care that are medically suggested and within the hospital’s services, its stated mission, and required law and regulation.
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COMMUNICATION
VISITATION
You have the right to:
You have the right to:
• Have a family member, another person that you choose, or your doctor notified when you are admitted to the hospital.
• Decide if you want visitors or not while you are here. The hospital may need to limit visitors to better care for you or other patients.
• Receive information in a way that you understand. This includes interpretation and translation, free of charge, in the language you prefer for talking about your healthcare. This also includes providing you with needed help if you have vision, speech, hearing or cognitive impairments.
• Designate those persons who can visit you during your stay. These individuals do not need to be legally related to you.
• Designate a support person, if needed, to act on your behalf to assert and protect your patient rights. INFORMED DECISIONS You have the right to: • Receive information about your current health, care, outcomes, recovery, ongoing healthcare needs, and future health status in terms that you understand. • Be informed about proposed care options including the risks and benefits, other care options, what could happen without care, and the outcome(s) of any medical care provided, including any outcomes that were not expected. You may need to sign your name before the start of any procedure and/or care. Informed consent is not required in the case of an emergency. • Be involved in all aspects of your care and take part in decisions about your care. • Make choices about your care based on your own spiritual and personal values. • Request care. This right does not mean you can demand care or services that are not medically needed. • Refuse any care, therapy, drug, or procedure against the medical advice of a doctor. There may be times that care must be provided based on the law. • Expect the hospital to get your permission before taking photos, recording or filming you, if the purpose is for something other than patient identification, care, diagnosis or therapy. • Decide to take part or not take part in research or clinical trials for your condition, or donor programs, that may be suggested by your doctor. Your participation in such care is voluntary, and written permission must be obtained from you or your legal representative before you participate. A decision to not take part in research or clinical trials will not affect your right to receive care.
• Designate a support person who may determine who can visit you if you become incapacitated. ADVANCE DIRECTIVES Do you have advance directives? You have the right to: • Create advance directives, which are legal papers that allow you to decide now what you want to happen if you are no longer healthy enough to make decisions about your care. You have the right to have hospital staff comply with these directives. Ask us; we can help get your advance directive completed. • Ask about and discuss the ethics of your care, including resolving any conflicts that might arise, such as deciding against, withholding or withdrawing life-sustaining care. CARE PLANNING You have the right to: • Receive a medical screening exam to determine treatment. • Participate in the care that you receive in the hospital. • Receive instructions on follow-up care and participate in decisions about your plan of care after you are out of the hospital. • Receive a prompt and safe transfer to the care of others when this hospital is not able to meet your request or need for care or service. You have the right to know why a transfer to another healthcare facility might be required, as well as learning about other options for care. The hospital cannot transfer you to another hospital unless that hospital has agreed to accept you. CARE DELIVERY You have the right to: • Expect emergency procedures to be implemented without unnecessary delay. • Receive care in a safe setting free from any form of abuse, harassment and neglect. • Receive kind, respectful, safe, quality care delivered by skilled staff. www.ivch.org
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• Know the names of doctors and nurses providing care to you and the names and roles of other healthcare workers and staff that are caring for you. •Request a consultation by another healthcare provider. • Receive proper assessment and management of pain, including the right to request or reject any or all options to relieve pain. • Receive care free from restraints or seclusion, unless necessary to provide medical, surgical, or behavioral healthcare. YOUR RIGHT TO PRIVACY If you believe your health information was used or shared in a way that is not allowed under the privacy law or if you weren’t able to exercise your rights, you can file a complaint with our privacy officer by calling ext. 3471 or 815-780-3471 if calling from outside IVCH. No one will retaliate or take action against you for filing a complaint. You also can file a complaint with the U.S. government. Go online to https://ocrportal. hhs.gov/ocr/ smartscreen/main.jsf.
• Receive efficient and quality care with high professional standards that are continually maintained and reviewed. PRIVACY AND CONFIDENTIALITY You have the right to: •Limit who knows about your being in the hospital. • Be interviewed, examined and discuss your care in places designed to protect your privacy. • Be advised why certain people are present and to ask others to leave during sensitive talks or procedures. • Expect all communications and records related to care, including who is paying for your care, to be treated as private. • Receive written notice that explains how your personal health information will be used and shared with other healthcare professionals involved in your care. • Review and request copies of your medical record unless restricted for medical or legal reasons. HOSPITAL BILLS You have the right to: • Review, obtain, request and receive a detailed explanation of your hospital charges and bills. • Receive information and counseling on ways to help pay for the hospital bill. • Request information about any business or financial arrangements that may impact your care. Call 1-815-780-3418 if you have questions about your bill. 0% interest payment plans are available. For details, visit www.ivch.org/parasail. Bills for Central Illinois Radiology Associates will come from Change Healthcare. Phone: 866-720-2502. YOUR RESPONSIBILITIES As a patient, family member or guardian, you have the right to know all hospital rules and what we expect of you during your hospital stay. PROVIDE INFORMATION As a patient, family member or guardian, we ask that you: • Provide accurate and complete information about current healthcare problems, past illnesses, hospitalizations, medications and other matters relating to your health. • Report any condition that puts you at risk (for example, allergies or hearing problems).
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• Report unexpected changes in your condition to the healthcare professionals taking care of you.
COOPERATION
• Provide a copy of your advance directive, living will, durable power of attorney for healthcare and any organ/tissue donation permissions to the healthcare professionals taking care of you.
You are expected to follow the care plans suggested by the healthcare professionals caring for you while in the hospital. You should work with your healthcare professionals to develop a plan that you will be able to follow while in the hospital and after you leave the hospital.
• Tell us who, if any, visitors you want during your stay. RESPECT AND CONSIDERATION As a patient, family member or guardian, we ask that you: • Recognize and respect the rights of other patients, families and staff. Threats, violence or harassment of other patients and hospital staff will not be tolerated. •Comply with the hospital’s no smoking policy. • Refrain from conducting any illegal activity on hospital property. If such activity occurs, the hospital will report it to the police. SAFETY As a patient, family member or guardian, we ask that you: • Promote your own safety by becoming an active, involved and informed member of your healthcare team. • Ask questions if you are concerned about your health or safety. • Make sure your doctor knows the site/side of the body that will be operated on before a procedure. • Remind staff to check your identification before medications are given, blood/blood products are administered, blood samples are taken or before any procedure. • Remind caregivers to wash their hands before taking care of you. • Be informed about which medications you are taking and why you are taking them. •Ask all hospital staff to identify themselves. REFUSING CARE As a patient: • You are responsible for your actions if you refuse care or do not follow care instructions. CHARGES As a patient: • You are responsible for paying for the healthcare that you received as promptly as possible.
As a patient:
Please feel free to ask questions about any of the rights that you do not understand. If you have questions about these rights, please discuss them with your doctor, nurse or the hospital’s patient representative. You will receive a personal response. PATIENT GRIEVANCE POLICY It is the policy of Illinois Valley Community Hospital not to discriminate on the basis of race, color, national origin, sex, age or disability. Illinois Valley Community Hospital has adopted an internal grievance procedure providing for prompt and equitable resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act (42 U.S.C. § 18116) and its implementing regulations at 45 C.F.R. pt. 92, issued by the U.S. Department of Health and Human Services. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of Deb Puetz, RN, patient representative, 925 West St., Peru, IL 61354, phone 815-780-3592, fax 815-780-3640, email Deb.Puetz@ ivch.org, who has been designated to coordinate the efforts of Illinois Valley Community Hospital to comply with Section 1557. Any person who believes someone has been subjected to discrimination on the basis of race, color, national origin, sex, age or disability may file a grievance under this procedure. It is against the law for Illinois Valley Community Hospital to retaliate against anyone who opposes discrimination, files a grievance or participates in the investigation of a grievance. Procedure: • Grievances must be submitted to the Section 1557 coordinator within (60 days) of the date the person filing the grievance becomes aware of the alleged discriminatory action. • A complaint must be in writing, containing the name and address of the person filing it. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. • The Section 1557 coordinator shall conduct an investigation of the complaint. This investigation may be informal, but it will be thorough, affording all interested persons an opportunity to submit www.ivch.org
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evidence relevant to the complaint. The Section 1557 coordinator will maintain the files and records of Illinois Valley Community Hospital relating to such grievances. To the extent possible, and in accordance with applicable law, the Section 1557 coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. • The Section 1557 coordinator will issue a written decision on the grievance, based on a preponderance of the evidence, no later than 30 days after its filing, including a notice to the complainant of their right to pursue further administrative or legal remedies. • The person filing the grievance may appeal the decision of the Section 1557 coordinator by writing to the chief executive officer Tommy Hobbs within 15 days of receiving the Section 1557 coordinator’s decision. The chief executive officer shall issue a written decision in response to the appeal no later than 30 days after its filing. The availability and use of this grievance procedure does not prevent a person from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the U.S. Department of Health and Human Services, Office for Civil Rights. A person can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Ave., SW Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: http://www.hhs. gov/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Illinois Valley Community Hospital will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 coordinator will be responsible for such arrangements. Reviewed November 2017
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Deb Puetz, RN, Patient Representative Office: 815-780-3592 Email: Deb.Puetz@ivch.org You also have the right to file a complaint with: Illinois Department of Public Health Central Complaint Registry 525 W. Jefferson St., Ground Floor Springfield, IL 62761 1-800-252-4343 TTY for Hearing Impaired 1-800-547-0466 or Illinois QIO-KEPRO BFCC-QIO Beneficiary and Family-Centered Care Quality Improvement Organization 5201 W. Kennedy Blvd., Suite 900 Tampa, FL 33609 1-855-408-8557
Know Your Admission Status—Inpatient or Observation?
Illinois Valley Community Hospital strives to make every patient’s visit a pleasant experience. Part of a pleasant experience is understanding the reason for your visit; the care being provided; and clear communications from all caregivers you may encounter. Your doctor may keep you here at the hospital as an Observation patient. This is considered an outpatient service by Medicare and other insurers, and should not be confused with inpatient service. The purpose of Observation is to determine the need for further testing, treatment or for inpatient admission. Thus, a patient in Observation may improve and be released, or be admitted as an inpatient. The two criteria that are used to establish your status are 1) severity of illness and 2) intensity of the services provided to you. Most patients in Observation do not need to stay beyond 23 hours, however, some patients may require a second day but only if your physician feels that more testing or observation is warranted by your medical condition. MEDICARE INFORMATION Observation services do not count toward the threemidnight requirement for placement in a skilled nursing home. Medicare Part B generally covers care that you receive in the hospital outpatient setting like the emergency room, observation units, surgery centers or a pain clinic. However, Medicare Part B only covers drugs that are administered through an IV (intravenous infusion) or intramuscular injections. The medications that are taken by mouth, inhalers, eye drops, ointments and insulin that is given as a shot
are not covered under Medicare Part B when you are in an outpatient setting. The self-administered drugs are considered drugs that you would routinely give to yourself at home. While you are not giving these medications to yourself in the hospital, Medicare still considers these medications as self-administered drugs and will not cover these medications as long as you are in the outpatient setting. In this case, your hospital bill will reflect charges for these self-administered medications that will be your responsibility. The home medications that you are allowed to bring in, use and not be charged for include: prescription oral and nasal inhalers, prescription eye drops, prescription ointments, and insulin and diabetes pens. We are unable to use your oral pills that you take at home because we must know that the pills have been stored safely and are actually the medication that is written on the bottle. We do not have the resources in our pharmacy (manpower) to do this for every Observation patient. We are happy to store your home meds safely in our pharmacy and return them to you at discharge from the hospital
Advance Directives
You have the right to make decisions about the healthcare you get now and in the future. An advance directive is a written statement you prepare that expresses how you want medical decisions made in the future should you not be able to make them yourself. Federal law requires that you be told of your right to make an advance directive when you are admitted to a healthcare facility, and the Patient Self-Determination Act (see LAWS & RULES) requires certain providers participating in the Medicare and Medicaid programs to furnish patients with information on advance directives. The information is to be given to patients upon admission to a facility or when provision of care begins. Providers covered by this requirement include hospitals, nursing facilities, providers of home health or personal care services, hospice programs and health maintenance organizations. Illinois law allows you to make four types of advance directives: a healthcare power of attorney; a living will; a mental health treatment preference declaration; and a do-not-resuscitate (DNR)/ practitioner orders for life-sustaining treatment (POLST). The Department of Public Health is required by law (see Illinois Compiled Statutes - Advance Directive Information under LAWS & RULES) to make available to you standard forms for each of these types of advance directives.
want to discuss them with your family, your healthcare professional and/or attorney. You may decide to make more than one advance directive. For example, you could make a healthcare power of attorney, as well as a living will. If you decide to have one or more advance directives, you should tell your healthcare professionals and provide them with copies of any advance directives you have. You also should provide copies of your advance directives to those you have appointed to make healthcare decisions for you, and you may want to provide copies to your family members. HEALTHCARE POWER OF ATTORNEY The healthcare power of attorney lets you choose someone to make healthcare decisions for you in the future, if you are no longer able to make these decisions for yourself. You are called the “principal” in the power of attorney form and the person you choose to make decisions is called your “agent.” Your agent would make healthcare decisions for you if you were no longer able to make these decisions for yourself. So long as you are able to make these decisions, you will have the power to do so. You may give your agent specific directions about the healthcare you do or do not want. The agent you choose cannot be your healthcare professional or other healthcare provider. You should have someone who is not your agent witness your signing of the power of attorney. The power of your agent to make healthcare decisions on your behalf is broad. Your agent would be required to follow any specific instructions you give regarding care you want provided or withheld. For example, you can say whether you want all life-sustaining treatments provided in all events; whether and when you want life-sustaining treatment ended; instructions regarding refusal of certain types of treatments on religious or other personal grounds; and instructions regarding anatomical gifts and disposal of remains. Unless you include time limits, the healthcare power of attorney will continue in effect from the time it is signed until your death. You can cancel your power of attorney at any time, either by telling someone or by canceling it in writing. You can name a backup agent to act if the first one cannot or will not take action. If you want to change your power of attorney, you must do so in writing. You may use a standard healthcare power of attorney form or write your own.
After reviewing the information below on the different types of advance directives, you may www.ivch.org
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LIVING WILL A living will tells your healthcare professional whether you want death-delaying procedures used if you have a terminal condition and are unable to state your wishes. A living will, unlike a healthcare power of attorney, only applies if you have a terminal condition. A terminal condition means an incurable and irreversible condition such that death is imminent and the application of any death-delaying procedures serves only to prolong the dying process. Even if you sign a living will, food and water cannot be withdrawn if it would be the only cause of death. Also if you are pregnant and your healthcare professional thinks you could have a live birth, your living will cannot go into effect. You can use a standard living will form or write your own. You may write specific directions about the death-delaying procedures you do or do not want. Two people must witness your signing of the living will. Your healthcare professional cannot be a witness. It is your responsibility to tell your healthcare professional if you have a living will, if you are able to do so. You can cancel your living will at any time, either by telling someone or by canceling it in writing. If you have both a healthcare power of attorney and a living will, the agent you name in your power of attorney will make your healthcare decisions, unless he or she is unavailable. A MENTAL HEALTH TREATMENT PREFERENCE DECLARATION A mental health treatment preference declaration lets you say if you want to receive electroconvulsive treatment (ECT) or psychotropic medicine when you have a mental illness and are unable to make these decisions for yourself. It also allows you to say whether you wish to be admitted to a mental health facility for up to 17 days of treatment. You can write your wishes and/or choose someone to make your mental health decisions for you. In the declaration, you are called the “principal”, and the person you choose is called an “attorney-infact.” Neither your healthcare professional nor any employee of a healthcare facility in which you reside may be your attorney-in-fact. Your attorney-in-fact must accept the appointment in writing before he or she can start making decisions regarding your mental health treatment. The attorney-in-fact must make decisions consistent with any desires you express in your declaration, unless a court orders differently or an emergency threatens your life or health. Your mental health treatment preference declaration expires three years from the date you sign it. Two people must witness you signing the declaration. The following people may not witness your signing 12
Illinois Valley Community Hospital
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of the declaration: your healthcare professional; an employee of a healthcare facility in which you reside; or a family member related by blood, marriage or adoption. You may cancel your declaration in writing prior to its expiration as long as you are not receiving mental health treatment at the time of cancellation. If you are receiving mental health treatment, your declaration will not expire and you may not cancel it until the treatment is successfully completed. DO-NOT-RESUSCITATE/PRACTITIONER ORDERS FOR LIFE-SUSTAINING TREATMENT You also may ask your healthcare professional about having a do-not-resuscitate (DNR)/practitioner orders for life-sustaining treatment (POLST)(DNR/POLST Order). A DNR/POLST Order is an advance directive that says if your heart and/or breathing stops, you either want resuscitation or do not want resuscitation; it also can be used to record your desires for lifesustaining treatment. The Department of Public Health has published a Uniform DNR/POLST Order that is available for download. It also provides a link to guidance for individuals, healthcare professionals and healthcare providers concerning the IDPH Uniform DNR/POLST Order. The Uniform DNR/POLST Order requires your signature or that of your authorized legal representative (your legal guardian, healthcare power of attorney or healthcare surrogate), as well as the signature of your attending practitioner and a witness who is 18 years of age or older. A DNR/POLST Order will not be entered into your medical record unless it contains all of the required signatures. You can ask your practitioner to work with you to prepare the Uniform DNR/POLST Order. WHAT HAPPENS IF YOU CANNOT MAKE HEALTHCARE DECISIONS FOR YOURSELF AND YOU DON’T HAVE AN ADVANCE DIRECTIVE? If you cannot make healthcare decisions for yourself, a healthcare surrogate may be chosen for you. Under Illinois law, your doctor must certify that you cannot make healthcare decisions for yourself before a healthcare surrogate can be appointed. A healthcare surrogate can be one of the following persons (in order of priority): guardian of the person, spouse, any adult child(ren), either parent, any adult brother or sister, any adult grandchild(ren), a close friend or guardian of the estate. However, while your healthcare surrogate can make most healthcare decisions for you, there are certain decisions that a surrogate cannot make. For example, a healthcare surrogate cannot tell your healthcare professional to withdraw or withhold life-sustaining treatment unless you have a qualifying condition. A
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PREPARE FOR DISCHARGE CHECKLIST Do you know when you're going home? Do you know who will pick you up from the hospital? Does your family or other support person know where to park? Do you have comfortable clothes to wear home? Do you have all the belongings you brought with you? Do you have follow-up appointments scheduled? Do you have your discharge prescriptions? Have all your questions been answered?
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qualifying condition can be (1) a terminal condition (an incurable or irreversible injury for which there is no reasonable prospect of cure or recovery, death is imminent and life-sustaining treatment will only prolong the dying process); (2) permanent unconsciousness (a condition that, to a high degree of medical certainty, will last permanently, without improvement; there is no thought, purposeful social interaction or sensory awareness present; and providing lifesustaining treatment will only have minimal medical benefit), or (3) an incurable or irreversible condition (an illness or injury for which there is no reasonable prospect for cure or recovery, that ultimately will cause the patient’s death, that imposes severe pain or an inhumane burden on the patient, and for which life-sustaining treatment will have minimal medical benefit). Two doctors must certify that you have one of these qualifying conditions. There also are limitations on the decision-making authority of a healthcare surrogate that relate to mental health treatment. A healthcare surrogate, other than a court-appointed guardian, cannot consent for you to have certain mental health treatments, including treatment by electroconvulsive therapy (ECT), psychotropic medication or admission to a mental health facility, although the healthcare surrogate can petition a court to allow these mental health services. To avoid the decision-making limitations of a healthcare surrogate, you may want to consider having one or more advance directives. Final Notes You should talk with your family, your healthcare professional, your attorney, and any agent or attorney-in-fact that you appoint about your decision to make one or more advance directives. If they know what healthcare you want, they will find it easier to follow your wishes. If you cancel or change an advance directive in the future, remember to tell these same people about the change or cancellation. No healthcare facility, healthcare professional or insurer can make you execute an advance directive as a condition of providing treatment or insurance. It is entirely your decision. If a healthcare facility, healthcare professional or insurer objects to following your advance directive, they must tell you or the individual responsible for making your healthcare decisions. They must continue to provide care until you or your decision-maker can transfer you to another healthcare provider who will follow the orders contained in your advance directive.
Your Privacy and Information—HIPAA
You have privacy rights under the Health Insurance Portability and Accountability Act (HIPAA) that protect your health information. These rights are important for you to know. Federal law sets rules and limits on who can look at and receive your health information. Information is shared and discussed with the patient and, with the patient’s permission, the healthcare proxy and/or the next of kin on record. Who Must Follow This Law? · M ost doctors, nurses, pharmacies, hospitals, clinics, nursing homes and many other healthcare providers and their vendors. · Health insurance companies, HMOs and most employer group health plans. · C ertain government programs that pay for healthcare, such as Medicare and Medicaid. What Information is Protected? · I nformation your doctors, nurses and other healthcare providers put in your medical records. · C onversations your doctor has with nurses and others regarding your care or treatment. www.ivch.org
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· Information about you in your health insurer’s computer system. · Billing information about you at your clinic. · M ost other health information about you held by those who must follow this law. You Have Rights Over Your Health Information Providers and health insurers who are required to follow this law must comply with your right to: · Ask to see and get a copy of your health records. · Have corrections made to your health information. · R eceive a notice that tells you how your health information may be used and shared. · D ecide if you want to give your permission before your health information can be used or shared for certain purposes, such as for marketing. · G et a report on when and why your health information was shared for certain purposes. · File a complaint. To make sure your health information is protected in a way that doesn’t interfere with your healthcare, your information can be used and shared: · For your treatment and care coordination. · T o pay doctors and hospitals for your healthcare and help run their businesses. · W ith your family, relatives, friends or others you identify who are involved with your healthcare or bills, unless you object. · T o make sure doctors give good care and nursing homes are clean and safe. · To protect the public’s health, such as by reporting when the flu is in your area. · To make required reports to the police, such as reporting gunshot wounds. Without Your Written Permission, Your Provider Cannot: · Give your health information to your employer. · Use or share your health information for marketing or advertising purposes. · Share private notes about your mental health counseling sessions. MEDICAL RECORDS Have a question about your medical records? Call 815-780-3464.
Surgery: Be Prepared
You can help make your surgical procedure and follow-up care as safe as possible. Here’s what you need to know: BEFORE SURGERY Bring a list of any questions you have about your surgery to your pre-surgical doctor’s visit. Also bring a list of all the prescription, over-the-counter and herbal medications you are currently taking or that you took until very recently. Review the list with your surgeon and ask if there are any you should stop taking prior to your procedure. · B e sure your surgeon knows about any allergies you have to medications and food. · D on’t wear artificial nails if you are having surgery on your hand, elbow or shoulder or if you are having a total joint procedure. 14
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· A sk your surgeon whether you can eat or drink before your procedure, and if so, what kinds of food or drink, and within how many hours of your surgery. · A sk your surgeon whether you should remove nail polish or temporary dental appliances (such as a bridge), if you can wear deodorant or body lotion, and if there are other preparations you need to make prior to surgery. · F ind out if you will need therapy after your surgery, who will arrange for it and whether you can have therapy at home. A TEAM EFFORT Here’s how to work with your surgical team to get the best outcome: · Know the preparations you must make before your surgery. · Get to the hospital or surgical center early on the day of your surgery. · Review paperwork carefully before signing. · Make sure the proper part of your body is marked for surgery. · Get your post-surgical care instructions in writing before you leave. ON THE DAY OF YOUR SURGERY · Take home medications as instructed by your surgeon or anesthesia staff. · S hower or bathe and wash your hair. Don’t wear makeup or perfume. Be sure to follow any pre-surgery instructions you were given. · Leave jewelry, money, credit cards and other valuables at home. · Allow yourself plenty of time for travel. · O nce you arrive at the hospital, you will be given an Informed Consent form to sign. Read it carefully. Make sure everything on the form is correct. If you don’t understand something, ask questions before you sign the form. BEFORE YOUR PROCEDURE BEGINS · S taff at the hospital should ask you the following questions more than once before your surgery: What is your name? What is your date of birth? What kind of surgery are you having? What is the part of your body that is being operated on? · A healthcare professional will mark the spot on your body that is going to be operated on. Make sure he or she marks only the correct part. If he or she makes a mistake and has to make a new mark, be sure the old mark is completely cleaned off. · I f you won’t be awake for the marking, be sure your relative or friend watches the marking. · Y our surgical team will take a “time out” just before the procedure. This is done to make sure the team is doing the right surgery on the right body part of the right person. AFTER YOUR SURGERY · S peak up about any pain you are having and ask for relief. Be specific about the intensity and location. · I f you are given medications right after surgery, ask what they are and what they are for. Ask about side effects. If you are given a prescription for medications you must take while recovering, be sure you understand the instructions for the dosage, how frequently you need to take the medications and for how long. www.ivch.org
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· I f you are given IV (intravenous) fluids after surgery, ask what they are and what they are for. Be sure the fluid level is monitored. · A sk you surgeon if your activities need to be limited, and if so, for how long. Ask when you can resume work, exercise and travel.
YOUR ROLE AS PATIENT ADVOCATE · K now what condition your loved one is being treated for. · K now your patient rights and responsibilities.
· B e sure to get instructions for post-surgical care in writing before you leave.
Leaving the Hospital GOING HOME
When your doctor feels that you are ready to leave the hospital, he or she will authorize a hospital discharge. Please speak with your nurse about our discharge procedures. While we do our best to expedite the discharge process, sometimes it can take up to four hours between the time your doctor tells you that you can go home and the time you can be discharged. Here is your discharge checklist.
· K now whether your loved one has an advance directive and if so, what it specifies.
PATIENT DISCHARGE PREPARATION CHECKLIST
· I f your loved one is too ill or reluctant to ask questions, make note of his or her concerns and any you may have, and don’t be afraid to speak up.
· I understand what services have been arranged for help or equipment that I may need at home.
· Y our loved one may be prescribed medications while in the hospital and may be seen by several doctors. Keep track of it all. · A sk to speak with a social worker to find out what your options are for homecare or care at another facility.
Before I leave IVCH, the following tasks should be completed: · M y preferences have been discussed, and I have been involved in the decisions about what will take place after I leave.
· M y family or someone close to me knows that I am coming home and what I will need once I leave the hospital. · M y doctor or nurse has answered my most important questions prior to leaving the hospital. · I have the phone number of the nursing unit I should contact if a problem arises after discharge. · I understand what my medications are, how to take them and what side effects to watch for. · I understand to call my physician for any worsening of symptoms or medication side effects. · I understand how to keep my health problems from becoming worse. · I f I am going directly home, I will schedule a follow-up appointment with my doctor, and I am able to arrange transportation to this appointment.
SPEAK UP
Everyone has a role in making healthcare safe—physicians, healthcare executives, nurses and technicians. Healthcare organizations across the country are working to make healthcare safety a priority. You, as the patient, also can play a vital role in making your care safe by becoming an active, involved and informed member of your healthcare team. · SPEAK UP Ask questions and voice concerns. It’s your health, and you have a right to know. · PAY ATTENTION Make sure you’re getting the right treatments and medicines. · EDUCATE YOURSELF Learn about your medical tests and treatment plan.
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· ASK Pick a trusted family member or friend to be your advocate or support person. · KNOW Know what medicines you take, why you take them and their possible side effects. · PARTICIPATE IN YOUR CARE You are the center of the healthcare team.
Your Safety
INFECTION CONTROL Clean Your Hands Clean your hands with soap and warm water. Rub your palms, fingernails, between your fingers and the backs of your hands for at least 15 seconds. You also may clean your hands with alcohol-based hand sanitizers. Clean your hands: · Before touching or eating food · After you use the bathroom · After you take out the trash · After you visit someone who is sick · After you play with a pet Make Sure Healthcare Providers Clean Their Hands or Wear Gloves Before doctors, nurses, dentists and other healthcare providers treat you, ask them if they’ve cleaned their hands. Healthcare providers should wear clean gloves when they take throat cultures, pull teeth, take blood, touch wounds or body fluids, and examine mouth or private parts. Don’t be afraid to ask them if they should be wearing gloves.
CALL - DON’T FALL Here are some tips for preventing falls: • U se your call light. Please call for help before getting out of your bed or chair. Use your call light and wait for help to arrive. • L ook around your room and bathroom to become aware of your surroundings. When you’re in a new place, it can be hard to remember how the room is arranged. • The furniture has wheels and can move. Do not hold on to furniture for support. • I f an alarm sounds when you try to get up from the bed or a chair, it means you shouldn’t get up alone. Wait for our staff to help you. Please press your call light for help when you need to go to the bathroom Most hospital falls occur when patients need to go to the bathroom. For your own safety, let our staff help you. When you’re done, pull the call light string in the bathroom for help to get back to your bed or chair. • S ide rails – The upper side rails can be used for support when getting out of bed. Don’t climb over or between side rails. • Y our belongings – Let us know what you like to keep close by. Use the bedside stand to keep needed items within reach. Don’t bend over to pick up dropped items. Press the call light for help. • L ighting – Turn on the light at night before getting up. If you like, a low light can be left on in your room or bathroom. • V ision – Be sure to wear your glasses and turn on the lights.
Cover Your Mouth and Nose
• S pills – Report any spills so the floor can be cleaned up.
Many diseases are spread through sneezes and coughs. Cover your mouth and nose to prevent the spread of infection.
YOU AND YOUR FAMILY CAN HELP PREVENT PRESSURE ULCERS What is a pressure ulcer?
· U se a tissue or cover your mouth and nose with the bend of your elbow or hands.
• It often is called a bed sore.
· If you use your hands, clean them right away. If You Are Sick, Avoid Close Contact With Others If you are sick, stay away from other people or stay home. Don’t shake hands or touch others. If you are going for medical treatment, call ahead to see what you can do to avoid infecting other people.
• I t forms when muscles and soft tissue in the your body are squeezed between one of your bones and an outside surface such as a bed or chair. While you are a patient at IVCH, you can depend on us to: • I nspect your skin every day for redness or signs that sores may be forming. • Keep your skin clean and dry. • Moisturize your dry skin. • Remind you to move and increase your activity. • C hange your position in bed or a chair every 1 or 2 hours if you are not able to move yourself without help. www.ivch.org
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• Protect your bony areas with pillows. • K eep your heels off the bed surface with pillows placed underneath your calves. PLEASE NOTE any questions you may have for your doctor during or after your stay. Follow-up appt.?
• K eep the head of your bed as low as possible to keep you from sliding down. • Help you get from the bed to the chair or toilet. • Use briefs and protective cream to protect your skin from urine or stool. • Help you get a well-balanced diet with adequate fluids. • Informing your doctor if signs of skin breakdown are noticed.
Any restrictions? Special diet?
PAIN MANAGEMENT
Medications?
Pain management is an important part of your treatment. Please let your nurse or doctor know when:
Therapy?
· You experience any pain or discomfort. · If your pain is not relieved. · If you have any concerns about taking medications. · If you have any questions about your treatment plan.
PATIENT IDENTIFICATION Anytime staff members enter your room to administer medications, transport you or perform procedures and treatments, they must check your birth date and name before they proceed. You may be asked the same questions repeatedly, which may be annoying. Please understand that this verification process is critical to patient safety to guarantee you receive the correct medication and treatment.
For the Caregiver
While your loved one is in the hospital, who will speak up for him or her? You can, by being the patient’s advocate, the person who will help the patient work with doctors, nurses and hospital staff. To help your loved one make the best decisions about his or her care and treatment, you can follow the advice on “Your Role as a Patient Advocate.” While you are making sure that your loved one’s needs are being met, don’t neglect your own. Caregiving is a stressful and time-consuming job. You may neglect your diet, your normal exercise routine and your sleep needs. You may find that you have little or no time to spend with friends, relax or just be by yourself for a while. But downtime is important. Don’t be reluctant to ask for help in caring for your loved one. Take advantage of friends’ offers to help and look into local adult daycare programs. Find out more about how you can ease the stress of caregiving at www.caregiver.org. 18
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HOME CARE SERVICES:
ILLINOIS VALLEY ADULT DAY CENTER
Home Health is an agency that comes in the home intermittently to provide skilled services under Medicare, Medicaid or private insurance. The skilled services include nursing, physical therapy, occupational therapy, speech as well as a social worker and nurse aide if needed. A physician order is required and the patient must be homebound.
The Illinois Valley Adult Day Center is a department of IVCH that provides daycare for older adults who can no longer stay at home alone but don’t need the full-time care received in a nursing home. Call 815-223-0891 for more information.
Homemaker service agencies provide personal care and home services including help with bathing, laundry, cleaning, meals, shopping, etc., but not skilled services. They are not covered under Medicare, Medicaid, or insurance and are private pay. There may be financial assistance if the patient qualifies and the agency receives government funding.
Hospice is a licensed or certified program that provides care for people who are terminally ill and their families. Most hospice care in the Illinois Valley is provided at home. Also referred to as palliative care, hospice care emphasizes the management of pain and discomfort and addresses the physical, spiritual, emotional, psychological, financial and legal needs of the patient and his or her family. To learn more about Illinois Valley Hospice, the IVCH hospice agency, call 815-224-1307.
DURABLE MEDICAL EQUIPMENT (DME) Durable medical equipment is medical equipment ordered by a doctor for use in a patient’s home. Examples are walkers, crutches, wheelchairs and hospital beds. This equipment may be covered by Medicare, Medicaid or private insurance if the situation meets guidelines. INDEPENDENT LIVING Independent living communities are for seniors who are very independent and have few medical problems. Residents live in private apartments. Meals, housekeeping, maintenance, social outings and events are provided. ASSISTED LIVING Assisted living is an apartment in a long-term care facility for elderly or disabled people who can no longer live on their own but who don’t need a high level of care. Assisted living facilities provide assistance with medications, meals in a cafeteria or restaurantlike setting, and housekeeping services. Nursing staff is on-site. Most facilities have social activities and provide transportation to doctor’s appointments, shopping, etc. NURSING HOME A nursing home is a residential facility for people with chronic illness or disability, particularly elderly people who need assistance for most or all of their daily living activities, such as bathing, dressing and toileting.
HOSPICE
Support
DIABETES MANAGEMENT For help in controlling diabetes, contact the IVCH Diabetes Center for Excellence, a diabetes management program that has been accredited by the American Association of Diabetes Educators. Call ext. 3576 or, from outside the hospital, 815-780-3576. COUNSELING The IVCH Counseling Clinic offers psychotherapeutic treatment for a broad spectrum of emotional, behavioral and relationship problems. Call ext. 3696 or, from outside the hospital, 815-780-3696 for more information. SMOKING CESSATION Smoking is the leading preventable cause of serious illness, such as heart disease, stroke, lung cancer and emphysema. It can affect your whole body, increasing your chances of developing certain forms of cancer. Call our Community Outreach department at ext. 4618 (or 815-780-4618 from outside IVCH) and ask about our smoking cessation program.
Nursing homes provide 24-hour skilled care, and also are called convalescent homes or long-term care facilities. Many nursing homes also provide short-term rehabilitative stays for patients recovering from an injury or illness. Some facilities also have a separate unit for residents with Alzheimer’s disease or memory loss.
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Sometimes You Don’t Need to Go to the IVCH Emergency Room
Physicians are on duty 24 hours a day in the IVCH Emergency Department when you need care for a life-threatening illness or injury. For those times when you need prompt medical attention for a condition that’s not life-threatening, consider: CareToday, an IVCH urgent care clinic located next door to the Illinois Valley YMCA in Peru, is a walk-in clinic that’s open when your doctor is usually unavailable. Staffed by a doctor or nurse practitioner, CareToday treats minor fractures, provides stitches and offers other medical assistance—including X-rays— that you previously may have gone to an emergency room for. You’ll receive great care without high ER costs. CareToday is open 9:00 a.m. to 9:00 p.m. weekdays and 10:00 a.m. to 4:00 p.m. weekends. For more information, call 815-780-3855. ABOUT SELF-ADMINISTERED DRUGS No matter what your admission status is, no IVCH patients are allowed to give themselves the prescription drugs (often called self-administered drugs) they are taking at home. For safety reasons, your prescriptions are recorded when you are admitted and then supplied by the IVCH pharmacy. The only medications you are allowed to bring to the hospital and use are prescription oral and nasal inhalers, prescription eye drops and ointments, and insulin and diabetes pens. As a general rule, Medicare will not pay for self-administered drugs for observation patients. This policy is why observation patients have drug charges show up on their bills as items they are responsible for paying.
Non-Discrimination Statement
Illinois Valley Community Hospital complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Illinois Valley Community Hospital does not exclude people or treat them differently because of race, color, national origin, age, disability or sex. Illinois Valley Community Hospital: · P rovides free aids and services to people with disabilities to communicate effectively with us, such as: • Qualified sign language interpreters • W ritten information in other formats (large print, audio, accessible electronic formats, other formats) · P rovides free language services to people whose primary language is not English, such as: • Qualified interpreters • Information written in other languages If you need these services, contact the Illinois Valley Community Hospital switchboard at 815-223-3300. If you believe that Illinois Valley Community Hospital has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with: Christina Wawerski, 20
Illinois Valley Community Hospital
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1381.13-IVIL
Quality Management Director, 925 West Street, Peru, IL 61354, Telephone: 815-7803977, Fax: 815-780-3640, Email: christine.wawerski@ivch.org. You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, Christina Wawerski, Quality Management Director, is available to help you. You also can file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Ave., SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 800-537-7697 (TDD) Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. Illinois Valley Community Hospital complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. SPANISH Illinois Valley Community Hospital cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. POLISH
Illinois Valley Community Hospital postępuje zgodnie z obowiązującymi federalnymi prawami obywatelskimi i nie dopuszcza się dyskryminacji ze względu na rasę, kolor skóry, pochodzenie, wiek, niepełnosprawność bądź płeć.
CHINESE Illinois Valley Community Hospital 遵守適用的聯邦民權法律規定，不因種族、膚色、民 族血統、年齡、殘障或性別而歧視任何人。 KOREAN Illinois Valley Community Hospital 은(는) 관련 연방 공민권법을 준수하며 인종, 피부색, 출신 국가, 연령, 장애 또는 성별을 이유로 차별하지 않습니다. TAGALOG Sumusunod ang Illinois Valley Community Hospital sa mga naaangkop na Pederal na batas sa karapatang sibil at hindi nandidiskrimina batay sa lahi, kulay, bansang pinagmulan, edad, kapansanan o kasarian. ARABIC
بقوانين الحقوق المدنية الفدرالية المعمول بها وال يميز علىIllinois Valley Community Hospital يلتزم .أساس العرق أو اللون أو األصل الوطني أو السن أو اإلعاقة أو الجنس
RUSSIAN
Illinois Valley Community Hospital соблюдает применимое федеральное законодательство в области гражданских прав и не допускает дискриминации по признакам расы, цвета кожи, национальной принадлежности, возраста, инвалидности или пола.
GUJARATI Illinois Valley Community Hospital લાગુ પડતા સમવાયી નાગરિક અધિકાર કાયદા સાથે સુસગ ં ત છે અને જાતિ, રં ગ, રાષ્ટ્રીય મ ૂળ, ઉંમર, અશક્તતા અથવા લિંગના આધારે ભેદભાવ રાખવામાં આવતો નથી.
URDU
قاب ِل اطالق وفاقی شہری حقوق کے قوانین کی تعمیل کرتا ہے اورIllinois Valley Community Hospital معذوری یا جنس کی بنیاد پر امتیاز نہیں کرتا۔، عمر، قومیت، رنگ،یہ کہ نسل www.ivch.org
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VIETNAMESE
Illinois Valley Community Hospital tuân thủ luật dân quyền hiện hành của Liên bang và không phân biệt đối xử dựa trên chủng tộc, màu da, nguồn gốc quốc gia, độ tuổi, khuyết tật, hoặc giới tính.
ITALIAN Illinois Valley Community Hospital è conforme a tutte le leggi federali vigenti in materia di diritti civili e non pone in essere discriminazioni sulla base di razza, colore, origine nazionale, età, disabilità o sesso. HINDI
Illinois Valley Community Hospital लागू होने योग्य संघीय नागरिक अधिकार क़ानून का पालन करता है और जाति, रं ग, राष्ट्रीय मल ू , आय,ु विकलांगता, या लिंग के आधार पर भेदभाव नहीं करता है ।
FRENCH Illinois Valley Community Hospital respecte les lois fédérales en vigueur relatives aux droits civiques et ne pratique aucune discrimination basée sur la race, la couleur de peau, l’origine nationale, l’âge, le sexe ou un handicap. GREEK
Η Illinois Valley Community Hospital συμμορφώνεται με τους ισχύοντες ομοσπονδιακούς νόμους για τα ατομικά δικαιώματα και δεν προβαίνει σε διακρίσεις με βάση τη φυλή, το χρώμα, την εθνική καταγωγή, την ηλικία, την αναπηρία ή το φύλο.
GERMAN Illinois Valley Community Hospital erfüllt geltenden bundesstaatliche Menschenrechtsgesetze und lehnt jegliche Diskriminierung aufgrund von Rasse, Hautfarbe, Herkunft, Alter, Behinderung oder Geschlecht ab.
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Illinois Valley Community Hospital
815-223-3300
www.ivch.org
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The Sunflower Award NOMINATION FORM
In recognition of outstanding service and care provided by a non-nursing (for example, CNA, Physical Therapy, Housekeeping, Maintenance, Dietary, Radiology, Lab, EKG, etc.) caregiver, I nominate _________________________________________________________________________ from _______________________________ department as deserving of this award.
This person has displayed (please check all that apply): _____ Attention to patient safety _____ Excellent judgment _____ Compassion in all situations _____ Patience during an extreme situation _____ Teamwork to ensure patient comfort _____ Especially quick response to call light _____ Other __________________________________________________________________
Additionally, please describe your unique experience in which you observed this person providing expert care: ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________
Patient’s name:______________________________ Room Number: ______________________ Your name and relationship to patient: _____________________________________________ Phone Number: _____________________________
Date: ______________________________
Signature: _________________________________________________________________________
Put form into the Sunflower box at the West Street information desk.
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Illinois Valley Community Hospital
815-223-3300
1381.13-IVIL
Not-For-Profit-Providers
We are
Your Road to
Recovery • Warm-Water Therapy Pool • 3 Indoor Pools • Complete State-of-the-Art Exercise Center with Over 180 Different Cardio and Strength Training Units
• Low Monthly Rates • Open 7 Days a Week • Senior Discounts • Certified Personal Trainers • NO Contracts • Free Exercise Classes
At PLEASANT VIEW
Offers you a successful approach to short-term rehabilitation—always focused on you.
ME, ONLY BETTER. call
(815) 434-1130 300 Walnut Drive • Peru, IL 61354
815-223-7904
Pleasant View is a Lutheran Life Comunity, empowering vibrant, grace-filled living across all generations.
PERU VOLUNTEER AMBULANCE SERVICE
815-223-9111 Serving the Residents of the Illinois Valley since 1980 Paramedic Emergency Service • YOUR #1 CHOICE FOR TRANSFER AND CRITICAL CARE TRANSFER SERVICE
On Call for Life
111 5th Street • Peru, IL 61354 • www.peruems.com