YOU HAVE THE RIGHT TO:

1. To be fully informed of these rights and all rules governing patientconduct. The patient has the right to considerate and respectful care, full recognition of personal dignity and individuality, privacy in treatment and in care of personal needs. The patient has the right to know by name the home care staff responsible for his care and request proper identification.
2. To have a relationship with our staff that is based on honesty and ethical standards of conduct. To have ethical issues addressed, and inform you of any financial benefit we receive if we refer you to another organization, service, individual or other reciprocal relationship.
   
   Our staff is prohibited from accepting gifts or borrowing from you.
   
   
3. To have cultural, psychosocial, spiritual and personal values, beliefs and preferences respected. You will not be discriminated against based on social status, political belief, sexual preference, race, color, religion, national origin, age, sex or handicap.
4. To be fully informed of his health condition, unless medically contraindicated and documented in the clinical record. The patient has the right to be fully informed and involved in the treatment plan established by the home care staff.
5. To accept or refuse care, treatment and services without fear of reprisal or discrimination. You may refuse part or all of care/services to the extent permitted by law. However, should you refuse to comply with the plan of care and your refusal threatens to compromise our commitment to quality care, then we or your physician may be forced to discharge you from our services and refer you to another source of care.
6. To receive appropriate initial and ongoing assessment and management of pain; education about you and your family’s role in managing pain when appropriate, as well as potential limitations and side effects of pain treatments. Your personal, cultural, spiritual and/or ethnic beliefs will be taken into account when addressing pain management.
7. To confidentiality of written, verbal and electronic information including your medical records, information about your health, social and financial circumstances or about what takes place in your home, and to approve or to refuse release of any information to any individual outside the agency, except in the case of transfer to another agency or health facility, or as required by law or third-party payment contract.
8. To expect that the home care staff within its available resources will make a reasonable response to the request by a patient for services, and provide reasonable continuity of care.
9. To have family involved in decision making as appropriate, concerning your care, treatment and services, when approved by you or your surrogate decision maker and when allowed by law.
10. To be assured that he, the family, or significant other(s) will be taught about required services, so that the patient can develop or regain self- care skills and the family or others can understand and help the patient. The patient is informed about the nature and purpose of any technical procedure that will be performed as well as who will perform the procedure.
11. The patient’s family or guardian may exercise the patient’s rights when  the patient has been judged incompetent.
12. To be cared for by personnel who are competent through education and experience.
13. To file a complaint regarding quality of care with the agency without fear of recrimination. Agency employees must respect the patient’s personal property. The patient has the right to file a complaint when personal property has not been treated with respect.
14. To be free from mental, physical, sexual and verbal abuse, neglect and exploitation.
15. To be informed about the care that is to be furnished, name(s) and responsibilities of staff members who are providing and responsible for your care, treatment or services, planned frequency of services, expected and unexpected outcomes, potential risks or problems and barriers to treatment prior to the start of care. The patient has the right to be informed of any changes in the treatment plan and goals. The patient has the right to receive this information orally (or in writing, when requested).
16. To make informed decisions regarding care or services. The patient is involved in resolving conflicts about care or service decisions.
17. To be involved in resolving ethical issues. To have ethical issues addressed, and inform you of any financial benefit we receive if we refer you to another organization, service, individual or other reciprocal relationship.
18. To formulate advance directives and to receive written information about the Agency’s policies on advance directives, including a description of applicable state law. The patient is involved in decisions to withhold resuscitation. The patient is involved in decisions to forgo or withdraw life-sustaining care. You will be informed if we cannot implement an advance directive on the basis of conscience.
19. To address your wishes concerning end of life decisions and to have health care providers comply with your advance directives in accordance with state laws.
20. To choose your health care providers and communicate with those providers.
21. To choose whether or not to participate in research, investigational or experimental studies or clinical trials.
22. To have communication needs met and to receive communication in a manner the patient can be reasonably expected to understand.
23. To be informed verbally and in writing at the time of admission, the  approximate maximum dollar amount, if any, of care or services to be borne by the patient. To be informed of the organization’s charges and policies concerning payment of services, including, to the extent possible, insurance coverage and other methods of payment. The patient has the right to examine and receive an explanation of his home care bill for services rendered, and to be informed of all changes in charges within 30 calendar days of the date the home care provider becomes aware of any changes.
24. When Serenity Palliative Care and Hospice cannot meet the patient’s needs the patient has a right to prompt and orderly transfer to another organization or level of care or service. When a patient is referred to another organization, the patient is involved in the decision and is informed of any known financial benefit to the referring organization.
25. Serenity Hospice will inform and distribute written information to the patient, in advance, concerning its policies on advance directives, including a description of applicable State law.
26. To refuse filming or recording or revoke consent for filming or recording of care, treatment and services for purposes other than identification, diagnosis or treatment.
27. To receive pastoral and other spiritual services.
28. To have an environment that preserves dignity and contributes to a positive self-image.
29. The patient and their family have a right to doge complaints with, or recommend changes to the Agency about the care that is being provided. The patient has a right to have complaints heard, reviewed, and if possible, resolved. The patient can contact the Agency at any time by calling the phone number listed on the back cover of the booklet. The patient has the right to file a complaint by calling the State’s “hotline” listed (for your state) below. The purpose of this hotline is to receive complaints or questions about local HHA’s and to receive complaints concerning the implementation of the advance directives requirements.

Your Responsibility

1. Provide complete and accurate information to the best of your knowledge about your present complaints and past illness(es), hospitalizations, pain, medications, allergies, and other matters relating to your health.
   
   Remain under a doctor’s care while receiving skilled hospice services.
   
   
2. Notify us of unexpected changes in your condition (e.g., hospitalization, changes in the plan of care, symptoms to be reported, pain, homebound status or change of physician).
3. Follow the plan of care and instructions and accept responsibility for the outcomes if you do not follow the care, treatment or service plan.
4. Ask questions about your care, treatment and service or other instruction when you do not understand what you are expected to do. If you have concerns about your care or cannot comply with the plan, let us know.
5. Discuss pain, pain relief options and your questions, worries and concerns about pain medication with staff or appropriate medical personnel.
6. Notify us of schedule changes – to tell us if your visit schedule needs to be changed due to medical appointment, family emergencies, etc.
7. Notify us of insurance changes – to tell us if your Medicare or other insurance coverage changes or if you decide to enroll in a Medicare or private HMO (health maintenance organization) or hospice.
8. Promptly meet your financial obligations and responsibilities agreed upon with the agency.
9. Follow the organization’s rules and regulations.
10. Inform us of changes in advance directives – to inform us of the existence of, and any changes made to advance directives.
11. Advise us of problems - to tell us of any problems or dissatisfaction with the services provided.
12. Provide a safe environment – to provide a safe and cooperative environment for care to be provided (such as keeping pets confined during your care).
13. Show respect and consideration for agency staff and equipment.
14. Carry out mutually agreed responsibilities.

This hospice is in compliance with Title VI of the Civil Rights Act of 1964, with Section 504 of the Rehabilitation Act of 1973 and with the Age Discrimination Act of 1975. We do not discriminate on the basis of race, color, religion, sex, national origin, age or disability with regard to admission, access to treatment or employment. We will make every effort to comply with these and similar statutes.