Patient and Family Rights and Responsibilities

Effective date: January 6, 1997

HOSPICE OF THE CHESAPEAKE

John & Cathy Belcher Campus 90 Ritchie Highway Pasadena, Maryland 21122

STATEMENT OF PATIENT AND FAMILY RIGHTS AND RESPONSIBILITIES

MISSION STATEMENT

The mission of Hospice of the Chesapeake is to care for life during the journey with illness and loss. Our Chesapeake Life Center provides services to anyone in the community grieving a death. Our commitment is to provide high quality, cost effective care regardless of age, race, creed, gender, religion, sexual orientation, diagnosis, or ability to pay, with a goal of improving quality of life through comprehensive palliative and supportive services.

ADMISSION CRITERIA

Admission requirements are: * An attending physician who agrees to be responsible for the patient's care * The patient's desire for Hospice care * The availability of a care coordinator who is responsible for the patient's care twenty-four (24) hours a day. If patient has no care coordinator, must work with the team to develop a plan when no longer can safely care for self independently. * A life expectancy of six months or less

Admission is based upon patient and family need without regard to ability to pay or race, creed, sex, age, national origin, sexual orientation, or handicap.

BILL OF RIGHTS

We believe that it is our obligation to promote and protect your rights, as well as those of each patient under our care, including each of the following:

1. The right to a verbal and written explanation of your rights as a patient and the right to receive information in a manner that you understand. 2. The right to exercise your rights as a patient of this agency and to have your property treated with respect. 3. The right to have your cultural, psychosocial, spiritual, and personal values, beliefs, and preferences respected. 4. Right to be free from physical and or/or mental abuse and neglect. 5. The right to effective pain and symptom management, and the right to receive information about factors that affect palliation and comfort.

6. The right to be informed of the Hospice of the Chesapeake policies concerning the management and disposal of controlled substances.

7. The right to make an advance directive and to receive Hospice of the Chesapeake's policy respecting the implementation of that right. 8. The right to be fully informed in advance about the care and treatment to be furnished by this agency and any changes in the care and treatment that may affect your wellbeing. As a patient, you may participate in planning and implementing your care. You have the right to be given an explanation of the likely outcome. 9. The right to refuse any portion of planned treatment without relinquishing other portions of the treatment plan, except where partial treatment is medically contraindicated. 10. The right to be informed of short-term inpatient care options for respite, pain control and management. 11. The right to know, before services are provided, which services, to the best of our knowledge, will be paid by Medicare, Medicaid and other Federal or private insurers and which services are not covered. You also have the right to know the charges of any services for which you will have to pay and to be notified of changes in charges or coverage within 30 working days of this agency becoming aware of such changes. 12. The right to confidentiality in all matters associated with your care including your clinical records. Hospice families can expect that discussion of their cases will be confined to hospice personnel unless the information is deemed a question of safety to patients or others. Clinical records are released with written permission of the patient the medical power of attorney, or when required by law. 13. The patient has the right to access, request amendment to, and receive an accounting of disclosures regarding his or her own health information as permitted under applicable law. 14. The right to voice grievances without discrimination, reprisal or interruption of care and to be informed of the State Home Health Hotline number and the accreditation agency’s hotline number. 15. The patient's family or guardian has the right to exercise the patient's rights when the patient has been judged incompetent. 16 Patient/Caregiver has a responsibility to act reasonably while receiving services, including: participation in their plan of care; to provide all medical and pertinent information impacting patient care; communicating with hospice staff; asking questions; following instructions; accepting consequences when instructions are not followed; following rules and regulations; showing respect and consideration toward staff; meeting financial commitments; and provide for staff safety while in their homes. 17. Responsible for safeguarding the hospice patient’s medications from use by anyone other than the patient. This may include compliance with a plan to obtain a locked box and in counting and witnessing the current count of controlled substances.