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A Little R & R Home Care - Consumer Terms and Conditions Non-Medical Services Permitted: 


Personal Care Workers may assist with ADL’s (activities of daily living) and IADL’s (instrumental activities of daily living), such as: 

· Personal hygiene (bathing, hair care, skin care, mouth care, dressing) 

· Mobility, ambulation and transfers 

· Toileting, bowel and bladder elimination, commode or bed pan routines 

· Meal preparation, nutrition, food storage, meal planning 

· Shopping or errands (within 5 mile radius of home) 

· Medication reminders 

· Light housekeeping 

· Escorting to appointments or assisting consumers on trips outside of home (must be approved by office) 

· Other duties as named per the agreed upon plan of care 


Non-Medical Services Not Permitted: 


Personal Care Workers may NOT assist with the following: 

· Tasks outside of plan of care 

· Deep cleaning tasks (i.e. window washing, yard work, snow removal, cleaning balconies/porches, clean out storage rooms or closets, pack or unpack boxes for moving, wash down walls, move heavy furniture, paint or rearrange furniture, steam clean carpets, etc.) 

· Purchase of alcoholic beverages or drugs, this includes Medical Marijuana 

· Administration or Handling of medications (IHSS Okay) 

· Monitoring vital signs (IHSS Okay) 

· Changing or irrigating catheters (IHSS Okay) 

· Inserting medical devices, Catheters, Enemas and Suppositories (IHSS Okay) 

· Lifting the Client (IHSS Okay) 

· Wound Care or Changing Bandages (IHSS Okay) 

· Injections of fluids or blood glucose testing (IHSS Okay) 

· Nail Care (IHSS Okay) 

· Feeding (IHSS Okay) 

· Transport with the client/family member in PCW’s car or client’s car (UNLESS PRIVATE PAY) 

· Take a house key from client or family member (UNLESS PRIVATE PAY) 


· Assist in managing money, finances, bills, etc. 

· May not linger around the house when not on duty 

· Serve an entire family by preparing meals or cleaning up after them (this includes laundry) 

· Provide Companionship (UNLESS PRIVATE PAY) 

· May Not take Money or Gifts, loans, etc. from client, family member (except for shopping) 







Consumer Consent to Plan of Care: 


A Little R & R Home Care has designed a plan of care with consumer. This plan of care specifies the services to be provided and the frequency that the service is to be provided, in accordance with CDPHE (Colorado Public Health and Environment) and Colorado Medicaid Regulations (if applies), as well as states the scope of services allowed for the consumer. The consumer or responsible party agrees to notify A Little R & R Home Care of any changes to the consumer’s condition that would warrant a temporary or permanent change to the plan of care. 


Consumer Responsibilities: 


· Consumer agrees to notify A Little R & R Home Care of any changes in health status or service needs. 

· Consumer will update A Little R & R Home Care of any address changes, change in physicians or hospital admissions. 

· Consumer agrees to treat staff with respect. 

· Consumer will provide accurate information to A Little R & R Home Care regarding their health and treatments. 

· Consumer will keep scheduled visits and will notify A Little R & R Home Care when a scheduled visit cannot be kept or are no longer required. 

· Consumer will notify A Little R & R Home Care of any missed visits or late arrivals by staff. 

· Consumer will notify A Little R & R Home Care of any complaints, incidents or occurrences regarding services at the time they occur. 

· Consumer agrees to follow the plan of care. 

· Consumer agrees to not request staff to assist other household members that are not on the plan of care. 

· Consumer agrees not to offer gifts or money to their personal care worker, nor accept gifts or money from their personal care worker. Consumer agrees to report to agency if personal care worker asks for gifts or money. 


A Little R & R Home Care Responsibilities: 


· A Little R & R Home Care agrees to abide by agency policy and procedures. 

· A Little R & R Home Care agrees to provide care to consumer with qualified care workers that have gone through training and pre-employment screening. 

· A Little R & R Home Care has provided the consumer with a grievance procedure. 

· A Little R & R Home Care will adhere to the plan of care and schedule agreed upon with consumer. 

· A Little R & R Home Care will keep consumer information confidential and will not release information without written consent of consumer, except as required by law. 


Non-discrimination Policy: 


A Little R & R Home Care does not discriminate unlawfully against consumers on the basis of race, color, national origin, sex, religion, age, disability or handicap. This is in accordance with federal rules and regulations and includes consumers with AIDS and AIDS-related conditions. 


Grievance Policy: 


A Little R & R Home Care is open Monday-Friday from 8:30am-4:30pm. For any problems, questions, concerns or complaints, please contact the Administrator or Manager on call at 970-667-1067. A Little R & R Home Care is available 24/7 to address any urgent concerns. Complaints that cannot be resolved by the agency can be directed to the Colorado Department of Health Services at 303-692-2800. 


Service Termination: 


Consumer or responsible party may terminate services at any time, for any reason. A Little R & R Home Care has the right to terminate services with a minimum of 72 hours’ notice. In circumstances where there is a safety issue or dangerous situation, this 72-hour notice can be waived. Consumer will be notified in writing and by phone. Consumer will be directed to possible referral sources if applicable. IHSS discharges do not apply to this condition. See separate page. 


Safe keeping of valuables and medications: 


Although, A Little R & R Home Care is bonded and insured, we recommend that all consumers place highly valuable personal property or narcotics in a lock box or safe. Agency does not recommend leaving items out in the open, as the possibility increases for theft or misplacement. By securing valuables and medications, consumer limits this possibility. Many consumers have more than one service provider coming into the home, as well as friends and family. This is a precautionary recommendation only, not a requirement. 


DNR Policy: 


A Little R & R Home Care will honor all DNR orders under the following contingencies: 


· DNR must be posted on the consumer’s refrigerator or on the back side of the consumer’s front door. 

· DNR copy must be in the consumer’s file at the office of A Little R & R Home Care. 

· Failure to adhere to these contingencies will result in CPR being performed. 


Agreement Modification: 


This agreement can be modified, supplemented or amended at any time but only by mutual agreement of both parties. 








Consumer/Responsible Party Signature 



Agency Representative Signature 


























Consumer Transportation: 


· Any personal care worker that operates his/her own vehicle for the purpose of consumer transport is required to keep current automobile liability insurance. A consumer that requests that the personal care worker drive the consumer’s vehicle while they are under the care of A Little R & R Home Care, must hold current registration and insurance on the vehicle to be used. 

· If personal care worker uses their own vehicle to provide transportation or run errands/shop for consumer, the consumer will be charged .565 cents per mile. The mileage must be documented and confirmed by the consumer and PCW. All money for mileage will be directly paid by agency, to the PCW. 


Financial Agreement: 


The consumer will be financially responsible to A Little R & R Home Care for all services billed. The consumer understands that there will be a minimum visit of 2 hours. If the consumer does not show for a visit or cancel a scheduled visit, the agency will bill this minimum visit charge. Consumers who wish to use insurance or outside pay source will be required to provide a TBD deposit. Consumers who are paying privately for services will be required to provide a deposit of at least one week of care. All deposits are deposited and held until completion of services and full payment of services has been provided. The consumer has the option of utilizing the deposit toward the final bill. The consumer is responsible for any deductibles, co-pays or portions of bills that are not otherwise covered by insurance or other pay source. 


The consumer will be billed bi-weekly for services. If payment is not received within 30 days, services will be suspended until the balance is paid in full. Interest will be charged at 1.75 % per month on all unpaid invoices after 30 days. If the balance is not paid within 90 days, collection efforts will be made.

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