HomeMy WebLinkAbout1995-03-27 95-152 ORDERCOUNCIL ACTION
Item No. 95-152
Date March 27, 1995
Item/Subject: Authorizing City Manager to Execute Two Hospice Care
Agreements with Hospice of St. Joseph, Inc.
Responsible Department: Legal
This Order authorizes Ed Barrett to execute the two referenced
agreements on behalf of the City. The agreements cover the
provision of hospice care and respite care for hospice patients at
the City Nursing Facility. There is no additional cost to the City
as a result of these agreements. The Municipal Operations
Committee reviewed this item at its meeting on the 21st and
recommended approval.
Department Head
Manager's Comments:
A,
City Manager
Associated Information: Order, Agreements, and Memorandum to
Municipal Operations Committee
Budget Approval: Ah .Fm�,,.uwd
Finance Director
&A(
City Solicitor r
tor
Intr For
Presage
First Reading
Referral Page of
95-152
Aeeitned to coonetlor Cohen March 27, 1995
ryp CITY OF BANGOR
(TITl6) (Drber, Authorizing City Manager to Execute Two Hospice
Care Agreements with Hospice of St. Joseph, _Inc.
-
By the Oily cooult of the My ofsonoor.
ORDERED,
THAT city Manager Edward A. Barrett is hereby
authorized to execute two documents, a ProtocolandAgreement For
the Provision of Hospice Home care Services to the Residents of
Bangor city Nursing Facility and an Agreement Between city of
Bangor and Hospice of St. Joseph, Inc. to Provide Inpatient Respite
Services, with Hospice of St. Joseph, Inc. governing the provision
of hospice care and respite care for hospice patients at the Bangor
city Nursing Facility. -The documents are attached hereto a
Exhibits A and B. --
IN CITY COUNCIL
Harch 27; 1995-
eae
CI CURB
95-152
0R0ER
Titley Authorising City managertoInstate too
Hospice Care Agreements with Hospice of St.'
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Am,
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Councilmen
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95-152
MEMORANDUM
TO; municipal OperattQ',{� committee
FROM: Bruce N. 3hib12fl;iAsat. City Solicitor
RE: Hospice Services Agreements with St. Joseph's
Date: March 13, 1995
Hospice Of St. Joseph, Inc. (Hospice) has requested that
the City Nursing Facility provide respite care for Hospice's
residential hospice program. Hospice has also offered to provide
hospice services to residents at the Nursing Facility. Agreements
covering both situations are attached for your review.
As you are no doubt aware, hospice services are provided to
terminally ill patients who have been diagnosed as having no more
than 6 months to live. The services are palliative in nature i
that they are designed to alleviate pain and suffering and not cure
the patient. The possibility of providing hospice care may be an
added selling point for Nursing Facility services.
The agreements are fairly straightforward in their
operation. The first agreement covers situations where caregivers
of hospice patients need a break and the patient spends a short
time at the Nursing Facility receiving both nursing and hospice
care. The second agreement concerns Nursing Facility residents who
might qualify for hospice care toward the end of their lives.
Under current Medicare regulations, the Nursing Facility can be
considered a patient's 'residence" for hospice care purposes.
Neither agreement requires the City to incur any expenses
as Hospice is responsible for all costs associated with both
programs. Hospice has also agreed to follow Nursing Facility
admissions regulations where applicable.
Both Agreements are of indefinite duration so full council
approval will be necessary. A council Order will be on the March
27th Council Agenda authorizing Ed Barrett to execute these
agreements. Both Judy Young and myself will be available to answer
questions from the Committee on the 219t. ElaineGerard, Hospice
Director, has been invited to the Committee meeting. Your approval
is recommended. Thank you for your time and consideration.
BNS/red
Attachments
cc: Judy Young, Burning Facility Administrator
95-152
CITY OF BANGOR
and
HOSPICE of ST. JOSEPH, INC.
To Provide Inpatient Respite Services
This .agreement is entered into asof this day of March,
1995, by and between the City ofBangor, a Maine municipal
corporation, and Hospice of Saint Joseph, a non-profit
corporation -
WHEREAS ,
orporation.WHEREAS, Hospice of Saint Joseph is engaged in providing
interdisciplinary care
and treatment of Saint Joseph terminally ill
patients i order to allow these patients to continue life as
comfortably as possible primarily in a home environment; and
WHEREAS, Hospice of Saint Joseph is primarily palliative rather
than curative; (this care includes physical, emotional, spiritual,
and bereavement support i ordance with the standards of
Medicare Hospice regulations); and
WHEREAS, on occasion, Hospice patients need inpatient care for
respite purposes; and
WHEREAS, the City of Bangor o and operates a nursing care
facility, known as the Bangor City Nursing Facility, (hereinafter
^Nursing Facility"), which offers inpatient care; and
WHEREAS, the Nursing Facility has policies consistent with those
of Hospice of Saint Joseph, and is willing to make inpatient beds
and services available for use by Hospice of Saint Joseph patients;
HOW THEREFORE, the City of Bangor and Hospice of Saint Joseph
hereby agree as follows:
I.. DEFINITIONS
The following terms shall have the following meanings for the
purpose of the agreement:
A. Attending Physician: a doctor of medicine or osteopathy
who is identified by the patient, at the time he or she elects to
receive hospice care, as having the most significant role in
determination and delivery of the patient's medical care.
B. Interdisciplinary Team: a group consisting at aminimum
of
a doctor of medicine or osteopathy, a registered nurse, asocial
95-152
Hospice of St, Joseph
City Of Bangor
Respite Agreement
Page 2
worker, and a pastoral or other counselor, who provide or supervise
the hospice care and services offered by hospice.
C. medical Director: a doctor of medicine under contract with
hospice who assumes rall responsibility for the medical
component of the hospice program.
D. Hospice Care Coordinator: a registered nurse designated by
the hospice to coordinate the implementation of the plan of care
for each patient.
E. Plan of Care: a written plan prepared by the
interdisciplinary team for each hospice patient containing an
assessment of the patient's needs, identification of services to be
provided, and a detailed description of the scope and frequency of
services needed to meet the patient's and family's needs.
Subject to the terms and conditions of, and at the request of the
hospice as provided by this agreement, the Nursing Facility shall
provide the following services to the hospice patients i
accordance with the patient's plan of care as developed and amended
from time to time by the patient's attending physician, the Medical
Director of hospice and the interdisciplinary team of the hospice
employees. -
A. Subject to the availability of beds, the Nursing Facility
shall make beds available to the hospice patients as needed.
B. The Nursing Facility shall provide all Nursing Facility
services requested by the hospice as needed, including nursing
care, dietary services, housekeeping services and oxygen•
C. The Nursing Facility shall ensure that each 24 hour period
includes a registered nurse who is responsible for the supervision
of direct patient care.
D. According to agreed upon protocol, the Nursing Facility
shall observe and record the patient's condition and response to
treatment, respond to appropriate hospice personnel when asked
about the patient, and report any significantchanges in the
patient's condition.
E. To the extent possible, the Nursing Facility shall provide
access and flexible visiting privileges including visits by
95-152
Hospice of St. Joseph
City of Bangor
Respite Agreement
Page 3
children of all ages for hospice patients twenty-four (24) hours a
day, every day of the year.
F. The Nursing Facility shall allow members of the hospice
interdisciplinary team and other caregivers to participate in the
plan of care including the documentation of visits on the patient
record.
G. To the extent possible, the Nursing Facility will provide
physical space for private visiting between patients and their
families and accommodations for family members to remain
with the
patient throughout the night, and for family privacy after a
patient's death. Rooms in the Nursing Facility serving hospice
patients shall be homelike in that patients will be permitted to
bring from home some personal belongings such as afghans, pillows,
family pictures, etc., to the extent that such belongings do not
disrupt usual Nursing Facility services.
H. To the extent possible, the Nursing Facility shall provide
appropriate space for consultation and conferences.
PATIENT SERVICE POLICIES
A. Hospice patients shall be admitted for inpatient care at
the Nursing Facility by the patient's attending physician.
B. All admissions to the Nursing Facility must be authorized
by a designated representative of hospice acording to mutually
agreed upon protocol. If the admission of apatient is not
authorized in writing, a record of the oral authorization shall be
entered into the patient's record. The hospice shall provide the
Nursing Facility with currentinformation identifying the person(s)
who are authorized to approve admissions.
C. The Nursing Facility affirms that it will work with the
hospice to ensure that its philosophy is consistent with those of
hospice, and its services are provided in accordance with hospice
patient care protocol.
D. All admissions to the Nursing Facility shall be pursuant to
and in accordance with the City of Bangor's policy, in effect at
the time, regarding admissions to the Nursing Facility. A copy of
the current admissions policy is attached and incorporated herein
by reference as Exhibit A. Hospice will be furnished copies of any
changes to said policy within 7 days of the change..
Hospice of St. Joseph 95-152
City of Bangor
Respite Agreement
Page a
IV. RESPONSIBILITIES OF HOSPICE
A. The hospice shall furnish to the Nursing Facility, at the
time of the patient's admission, a copy of the patient's plan of
care and medical history. The hospice shall also promptly
communicate orally or in writing any changes in the plan of care to
the Nursing Facility.
B. At the time of admission or on the next working day the
hospice shall furnish the Nursing Facility with a list of those
hospice individuals authorized to give or receive patient
information. Hospice personnel documenting in the Nursing Facility
patient record shall wear name tags identifying them as employees
of hospice. The documentation shall be limited to entries in the
progress notes.
C. The hospice shall ensure that the patient coordinator for
each hospice patient shall coordinate the services provided to the
patient by reviewing the plans of care and scheduling
interdisciplinary team meetings as necessary.
D. The hospice shall arrange for appropriate hospice training
to Nursing Facility personnel who will be providing inpatient care
to hospice patients pursuant to this Agreement.
V. QD rry ASSOHANCH
A. The hospice shall designate a representative of the hospice
to participate in the Nursing Facility quality assurance program to
the extent that such a program relates to the inpatient services
furnished pursuant to this Agreement.
B. The City of Bangor hereby warrants that its Nursing
Facility is duly licensed by the State of Maine. The Nursing
Facility immediately shall notify hospice concerning any proposed,
threatened o actual revocation, termination or material
modification of its license by the State of Maine.
C. The hospice warrants that it is licensed by the State of
Maine and certified by the Medicare program to provide home health
services and hospice care services.
The hospice shall notify
mediately the Nursing Facility concerning any proposed, actual o
threatened revocation, termination or material modification of its
licensure by the State of Maine or its certification as a Medicare
provider.
95-154
Hospice of St. Joseph
City of Bangor
Respite Agreement
Page 5
VI. INSURANCE
Both parties shall submit acertificate of insurance issued by
any insurance company acceptable to the other party indicating
complete liability ine coverage, including professional
liability coverage. Such shall be in amounts reasonably
satisfactory to each party, but shall not be less than three
hundred thousand ($300,000) dollars single limit for bodily injury
and property damage liability claims, and three hundred thousand
($300,000) dollars single limit for professional liability claims.
Both parties agree to notify the other within seven (7) days if
such insurance is changed, cancelled or revoked.
VII. TERMINATION
This Agreement shall become effective a of the date of execution
and shall remain in effect indefinitely, provided, however, that
either party shall have the right to terminate this agreement under
the provisions outlined hereafter.
V111 TERMII TION/AMENDMENT
A. This agreement may he terminated by either party, upon
thirty (30) days prior written notice to the other party.
B. Any provision may be amended by written proposal by either
party and subsequent acceptance by both parties.
C A hospice patient who is an inpatient at the Nursing
Facility at the time of termination may continue as an
inpatient
under the terms and conditions of the agreement until the five (5)
day respite period has ended, and the hospice patient is discharged
to his/her home.
I8. COMPENSATION
A. The hospice shall reimburse the Nursing Facility its usual
and customary room rates for the care and services provided
hereunder. The hospice shall pay the Nursing Facility within five
(5) days following the date of payment received from Medicare.
B. Subject to the preceding provisions of this section, the
hospice shall.bear the ultimate responsibility for the charges
billed by the Nursing Facility for care and services provided to
hospice patients pursuant to this agreement.
95-152
Hospice of Rt. Joseph
City of Bangor
Respite Agreement
Page 6
w�G,
For the purpose of implementing Section 1861(v)(i)(1) of the Social
Security Act as
amended by any written regulations thereto, the
Nursing Facilityagrees to make available to the Comptroller
General, the Secretary of Health and Human Services, or any duly
authorized representatives, the agreement, books, documents and
records of the Nursing Facility that are necessary to verify the
nature and extent of the costs of services provided pursuant to
this agreement.
Elaine Gerard, Director
Hospice of St. Joseph
Edward A. Barrett Date
City Manager
- 1 95-152
BANGOR CITY NURSING FACILITY
POMISGIONS PULICIES RND PROCEDURES
It is the philosophy of Bangor City Nursing Facility to provide optimum
quality nursing care to the residents of Bangor.
Priority for admission will be given to Bangor re sidents, with Bangor
residents on Medicare skilled level having firstpriority.
Non -Bangor residents may be admitted when occupancy falls below 96% and
there are no Bangor residents awaiting admission.
In order to provide short tern skilled rehabilitation services to the
unity, the facility aims to keep beds designated for short term
rehabilitation admissions.
R person with aocable disease, that would be a serious health
threat to current r residents and staff, may not be considered for ad-
mission. Each case will be considered on
a
eindividual basis to deter-
s the a of the risk to other residents and to determine if
reasonable accommodations could be made.
It is the policy of the Bangor City Nursing Facility to admit patients
without regard for r color, creed, sex (except for constraints placed
by potential rodents)enational origin, or source of payment.
In order to insure that all residents receive
r
the quality Of c which
their clinical Condition warrants, Bangor City Nursing Facility needs to
cider various factors in determining whether persons requesting ad-
on be adequately cared for. The following procedures a in
place to fulfill Bangor City Nursing Facility's goal of providing
quality nursing care in
accordance with the needs of its patients and
assuring that its patients live with dignity and comfort in and en-
vironment conclusive to their psycho -social needs.
All referrals far admission are
initially screened by the Social Service
Caseworker and the Director of Nursing for level of care, nursing care
a
needs and residency. The n of those who meet all criteria for ad-
missions
missions a e placed on the waiting list. Their name and date of referral
e placed in a bound,book. Further information such as address, next of
kin, the diagnosis etc. will be kept in a separate file.
When a bed becomes available, those on the waiting list are
wed by
the Admissions Committee consisting of the Administrator, Director of
Nursing, Social Caseworker and the Accounts Clerk. A nursing assessment
will be made by the Nursing Director. The Admission Committee shall
determine whether the potential patient has a currently available source
of payment to cover the cost of care at the Bangor City Nursing Facility.
The particular source of payment will not be a factor in determining
eligibility for admission. However, a source of payment oust be verified.
95-152
Admissions policies and procedures continued:
Potential patients who cannot demonstrate any available source of pay-
ment will not be considered for admission. The potential patient who
n
has a applicationfor Title XIX (Medicaid) reimbursement pending
shall not be considered as having anavailable source of payment until
such time as they are determined to be eligible for Title XIX assistance
by the Department of Income Maintenance.
When a nursing assessment i completed and a of payment has been
ours ssessn s c source
using thetl the ing Admission Committee will then review the application
using the following criteM a(
Residency
Behavior Status
Level of Care
Conounicable.Disease
Nursing Needs:
Therapy: P.T. - O.T. - Speech
ADL Status
Guardianship
Mobility
Current Placement & Degree of Need
Continency
Compatability with Potential Recasts
Tube Feeding
Date of Referral
Tracheostomy
Major Dressing
Decubiti
Other
The committee will then determine whether the level of s required
by theapplicant can be supplied by Bangor City Nursing Facility at that
time and whether thelevel of services
a required by the applicant can be
offered without so diluting thes
r of the facility that the
the quality of care rendered to existing residents will be jeopardized.
In making that determination: the cmmittee will consider the resources,
v
personnel and equipment available at the facility and the nursin,
medical and psycho-socialneedsof the applicant.
95-153
PROTONL AND AGREEMENT
FOR THE PROVISION OF HOSPICE HO CARE SERVICES
TO THE RBSIDEHTS OF BANGOR CITY NURSING FACILITY
WHEREAS, the City of Bangor onand operates the Bangor City
Nursing Facility, (hereinafter referred to as THE HOME) which is an
Intermediate Care Facility which occasionally has among its
residents individuals whose source of payment for nursing home
non-Medicare,ervices in but who are Medicare eligible
individuals, ndividuals, and who are terminally ill with a medical prognosis of
six months or less, and
MEMBERS, The Home desires to assure that the highest quality and
level of services are provided to such individuals with respect to
the care and management of their of their terminal illnesses, and
WHEREAS, The Home desires to make hospice home care services
available to such individuals in order that such individuals may
obtain the additional services covered
red under the Medicare Hospice
Benefit while continuing to reside in The Home, and
WHEREAS, Hospice of St. Joseph, Inc. (hereinafter referred to as
HOSPICE) is certified by the federal government to provide
comprehensive hospice services to Medicare -eligible individuals and
desires t0 provide suchservices t0 the residents of The Home in
cooperation with the management and staff of The Home.
NOW THEREFORE, The City of Bangor and the Hospice, 1
consideration of mutual advantages occurring to each and to
eligible residents and their families, do hereby agree each with
the other, as follows:
SECPIOB I: ELIGIBLE RESIDENTS
Residents eligible for services provided i accordance with
this Agreement are persona whose place of residence is The Home and
who
A. Are determined by the Health Care Financing Administration of
the US Government to be eligible for Medicare Fart A coverage and
reimbursement of health services, including payment to The Hospice
for hospice home care rendered in The Home;
B. Are utilizing payment sources other than Medicare to reimburse
The Home for its care and services;
C. Make a Medicare Hospice election as provided for In Public Law
with the result that Hospice is able to be reimbursed for hospice
services provided to that individual while residing in The Home;
D. Are appropriate for and accepted by Hospice in accordance with
Hospice admission criteria which are
made a part of this Agreement
and are appended hereto as Appendix A;
95-152
Page 2
E. Receive hospice services in accordance with an individualized
Hospice Plan of Care (hereinafter referred to am Hospice Plan)
developed by the Hospice and approved by the physician identified
n the medicare Hospice election form as being responsible for such
resident's health care.
SRCTION II. SERVICES TO BE PUFUNISHBD BY HOSPICE
A. HOSPICE PLAN
The Hospice shall develop, at the time an eligible resident i
admitted into the Hospice program, a Hospice Plan of Care for the
management and palliation of the resident's terminal illness. The
s
Hospice plan i written document which will include a detailed
description of the scope and frequency of hospice services and
supplies needed to meet the resident's need. The Hospice plan will
specify which services and supplies are related to the patient's
terminal illness, and therefore, will be furnished by Hospice.
Hospice shall furnish The Home with a copy of the resident's
admissioninto the Hospice program in the form of physician's
orders.The Hospice plan will be updated weekly o e frequently
if deemed necessary by The Hospice and a copy of theupdated
Hospice plan will be furnished weekly to The Home.
B. HOSPICE HOMES CAME SERVICES
The Hospice agrees to provide services to eligible residents a
defined in Section I., according toaHospice plan, as defined i
Section II.A. Hospice service shall comprise generally all of the
services, facilities and equipment made available those patients
otherwise enrolled in The Hospice asroutine home care patients.
Such s shall, depending upon the Hospice plan for each
eligible resident, include those hospice services listed i
Appendix B, attached hereto and by reference made part of this
agreement. If the resident's plan of care calls for nursing,
aide/homemaker, social work, counseling, chaplaincy, physician, or
other services related to the management of the terminal illness
not ordinarily provided by The Home to its residents and included
n the basic room and board charge, then The Hospice shall provide
such services.
C. DRUGS AND PHARMACEUTICAL3
The Hospice agrees to provide all drugs and pharmaceuticals
related to the management of the terminal illness and which
specified in the Hospice plan for an eligible resident.
D. mRnICAD EQUIP4IEN'1' AiH1 mpuicAL SDPPLIES
If an eligible resident's Hospice plan specifies the need for
medical equipment and medical supplies which are not ordinarily
provided by The Home to its residents and included in the basic
room and board charges, the Hospice shall provide such medical
equipment and medical supplies.
95-152
Page 3
H. CONTINUOUS CARE AND HOSPICE INPATIENT CARE
The Hospice is a comprehensive provider of home care,
continuous care and inpatient services for conditions related to
the management of the terminal illness. An eligible resident
obtains access to all components of the Hospice program. Based
upon the understanding that The Home constitutes the place of
residence for an eligible resident, Hospice will provide routine
home care to residents of The Home. In cases in which the needs
and condition of a Hospice patient so indicate, Hospice may change
the level of care from routine home care to continuous care or
inpatient services.
1. Continuous Care: If a Hospice patient who is a
resident of The Home expreiences a crisis, as defined
by Hospice rules of US Health Care Financing
Administration, Hospice agrees to place
round-the-clock nursing or aide services in The Home
to care for the patient i uninterrupted fashion
until the patient's condition dictates a return to
routine hospice homecare or a change to Hospice
inpatientcare.
2. Hospice Inpatient Care: If a Hospice patient who is a
resident of The Home expreiences chronic o cute
symptoms which, in the judgment of Hospice, cannot be
effectively managed in The Home or through continuous
care, Hospice agrees to provide short-term Hospice
inpatient care for such a patient at St. Joseph
Hospital.
F. TRANSPORTATIGN AND AMBDUANCE
If a Hospice patient who is a resident of the Home requires
transportation or ambulance from The Home to St. Joseph Hospital,
Hospice will provide or arrange for such transportation or
ambulance.
G. HGSPICE PHYSICIAN SERVICES
The Hospice shall provide home visits by a Hospice -employed
physician to residents who are Hospice patients when called for in
the Hospice plan. Such visits shall be solely related to the
patient's terminal illness and are understood as not duplicating o
replacing the services of the resident's attending physician, which
under Public Law 97-248, may continue to be provided and billed to
Medicare Part B, even though the resident may be receiving Hospice
care including the services of Hospice -employed physician.
H. FAMILY SERVICES AND BEREAVEMEIT CARE
Hospice agrees to provide counseling to family members to
assist them in adjusting to the patient's terminal condition and
assisting family members addressing the emotional stress often
associated with terminal illness in the family.
95-152
Page 4
The Hospice agrees to provide bereavement counseling to family
members for as long as one year after the death of a Hospice
patient who was a resident of The Home.
I. HOSPICE ORIENTATION ANO TRAINING
The Hospice agrees to provide sufficient orientation and
training to personnel Of The Home to acquaint them with the Hospice
concept, and as necessary, with Hospice symptom control protocol.
SECTION III. SERVICES TO BB PORNISHEO BY THE HOME
The Home shall furnish to the individual who is both a resident
of The Home and a Hospice patient all of those services which The
Home normally would have provided for in The Home's policies,
procedures, protocols and agreements with the resident or the
resident's family. It i understood and agreed that, because the
eligible resident's place of residence is The Home, The Home shall
provide those services which approximate the kind of service which
would have been provided by family members. .
With respect to the management of the patient's terminal
illness, The Home shall:
1. notify Hospice in the event of changes in the patient's
condition; and
2. provide usual and customary services of The Home subject to
the Hospice plan for such a patient; and
3. make records pertaining to care and services furnished by
The Home to a Hospice patient available to The Hospice subject to
the patient's consent.
SECTION IV. COOPRHATION IN PROPE3SIOl MANAGEXMNT
In respect to The Home's responsibility for services carried
out within its facility, Hospice shall provide to The Home the
following:
1. Current information documenting the appropriate licensure
and credentials of all Hospice personnel visiting residents of The
Home; and
2. A certificate of i issued by an insurance company
acceptable to The Home, indicating that The Hospice has complete
liability insurance coverage, including coverage for any acts of
professional malpractice, in amounts satisfactory to The Home; and
3. Current information documenting that The Hospice i
licensed by the State of Maine pursuant to Maine statutes and i
certified by the US Government pursuant to Public Law 97-248, for
the provision of Hospice services; and
95-152
Page 5
4. Subject to the patient's cent, access to all records of
Hospice services rendered to the patient; and
5. Access by representatives of The Home to attend and
participate in Hospice interdisciplinary team conferences for the
purpose of developing and evaluating the Hospice plan for such
eligible residents.
SBCTION V. FIS CIAL RESPONSIBILITY
A. RESPONSIBILITY OF THE HOSPICE
The Hospice shall bear full financial responsibility for all
Hospice'cra furnished by Hospice, directly or under arrangement
with other providers, which is related to the patient's terminal
illness, provided that such care is specified in the Hospice plan
for such a patient.
B. PURCHASE OF SERVICES BY THE HOSPICE FROM THE HOVE
Hospice may purchase from The Home some services and supplies
which The Home may agree to furnish in accordance with the Hospice
plan for a Hospice patient who is a resident of The Home.
Such services
cmay include physical therapy, occupational
therapy, speech therapy, pharmaceuticals, oxygen, personal care,
supplies and medical equipment. In the event that Hospice wishes
to purchase any such services, the terms of such sales by The Home
shall be as delineated in Appendix C, which is by reference made a
part of this Agreement.
C. RESPONSIBILITY OF THE HOMR
The Home shall bear no responsibility for the provision of or
payment for any services
or items which are called for in the
Hospice plan a related to the management of the terminal illness,
except that The Home will continue to provide those services and
items which would have been provided to its other resident not
receiving Hospice home care
Services. Such services include room
and board, medications not relatedto the management of the
terminal illness, nursing and personal care
s provided to other
residents of The Home, room furnishings to include those items
normally provided to residents by The Home and The Home's normal
program of therapies and activities unrelated to the resident's
terminal illness.
By sole virtue of the resident's receiving Hospice homecare
services and being admitted into the Hospice program, the financial
responsibility of The Home for services unrelated to the terminal
illness which are provided to such a resident shall neither
increase or decrease.
95-152
Page 6
D. INSURANCE
Both parties shall submit a certifcate of insurance issued by
any insurance ompany acceptable to the other party indicating
complete liability insurance coverage, including professional
liability coverage. Such inshall be i amounts reasonably
satisfactory to each party, butashall not be less than three
hundred thousand ($300,000) dollars single limit for bodily injury
and property damage liability claims, and three hundred thousand
($300,000) dollars single limit for professional liability claims.
Both parties agree to notify the other within seven (7) days if
such insurance is changed, cancelled or revoked.
SECTION VI. JOINT E EW OF HOSPICE SERVICES
The Hospice and The Home each agree to cooperate with each
other in reviewing the quality and appropriateness of Hospice
services rendered in The Home.
To this end, The Home and Hospice will each appoint three
persons who will constitute a Liaison Committee which will meet,
when appropriate, to review working relationships between Hospice
and The Home, to discussservices rendered to residents who are
Hospice patients, and to make recommendations for improving the
contractual agreement between the parties. Discussions and
recommendations of the Liaison Committee will be considered
advisory to The Home and to Hospice, and not binding upon either
party.
SECTION VII. PUBLIC RELATIONS
Both parties shall obtain the prior written approval of the
other for press releases, media advertisements, or any form of
publicity or marketing which concerns thea angment between the
parties. Nothing herein prevents The Home or the City of Bangor
from complying with the requirements Of 1 MRSA ¢ 401 at sea., as it
may be amended from time to time.
SECTION VIII. COMPLIANCE WITH GOVERMWENT REGNLATIONS
A. The Home as a Place of Residence
This Agreement is entered into with the understanding that
The Home constitutes, for the purpose of complying with Hospice
admission criteria, the eligible individual's place of residence.
Because The Home provides support and services to residents which
otherwise may be provided by families, Hospice agrees to accept
residency in The Home as satisfying Hospice admission requirementg
that a patient live at home and have a primary caregiver. To that
end, Hospice will admit eligible residents who execute, as part of
95-152
Page 7
the Hospice admission process, a "Request For The Provision Of
Hospice Home Care Services to a Nursing Hoa Resident", a copy of
which isappended to the Agreement as Appendix D and, by reference,
is madea part hereof. The obligation of Hospice to continue to
provide Hospice home care services to the resident of The Home is
contingent upon the resident continuing to fulfill Hospice
admission criteria, including the determination by the US Health
Care Financing Administration that The Home is considered the
patient's home residence.
B. verification of Nature and Cost of Services
If services purchased by Hospice from The Home under this
Agreement have a aggregate cost of $10,000 or more o a 12 month
period, The Home shall, until the expiration of four years after
furnishing of such services,
make available upon written request by
the Secretary of Health and Human Services or upon the written
request of the Comptroller General of the United States orby any
of the Secretary's or Comptroller General's duly authorized
representatives, this Agreement, the books, documents and records
of The Home that are necessary to verify the nature and extent of
this Agreement.
If and to the extent that The Home provides services
purchased by Hospice under this Agreement through a subcontact,
with an aggregate value or cost of $10,000 or more over a 12 month
period, with a related organization, such a contract shall contain
clause to the effect that until the expiration of four years
after the furnishing of such se s pursuant to such subcontract,
the related organization shallakeeavailable, upon written request
by the Secretary of the Department of Health and Human Services or
upon the written request of the Comptroller General of the United
States, or by any of the Secretary's or Comptroller General's duly
authorized representatives, the subcontract, books, documents and
cords of such organization that are necessary to verify the
nature and extent of the costs of the services provided under this
Agreement.
C. APPLICABLE LAN
This Agreement shall be governed by and construed in
accordance with the laws of the State of Maine, and Public Law
9'!248.
1y tl[yli p)��4:4�,Yn aafnai •n am J:la ai n:�Y
This Agreement shall b, in force and effect from the time of
signing of this agreement until it is renounced by either party by
giving thirty. (30) days prior written notice to the other party.
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Page 8
SECTION X. INDEMNIFICATION AND LIMIT OF LIABILITY
Hospice shall not be liable under contract of obligations of
The Home, except as otherwise provided pursuant to this Agreement,
r for any act or omission of The Home or The Home's officers,
employees, or agents. The Home agrees to indemnify and hold
harmless Hospice from any and all losses, damages, costs and
expenses (including reasonable attorney's fees) that are caused by
ariseor out of any omission, fault, negligence o other misconduct
by The Home, its employees, independent contractors or volunteers
in connection with this Agreement. It is understood and agreed
that nothing in this paragraph shall be deemed to waive any
immunities or limitations on liability otherwise applicable to The
Home under the Maine Tort Claims Act, 14 MRSA 5 8101 at or
other provisions of law, and that The Home's obligation to
indemnify Hospice under this paragraph shall be subject to all
immunities and limitations on liability provided in such statutes.
The Home shall not be liable under any contracts or obligations
of Hospice, axcept a otherwise provided pursuant to this
Agreement, or for any act or omission of Hospice or Hospice's
officers, employees or agents.Notwithstanding any charitable or
other immunity from liability or suit under 14 MRSA S 158-A; 24
MRSA § 2904, the Maine Workers Compensation Act of 1992, 39-A MRSA
5 101 eatggq, other statutes, or at common law, Hospice agrees to
indemnify and hold harmless The Home for any and all losses,
damages, costs and expenses (including reasonable attorney's fees)
that are caused by or
arise out of any omission, fault, negligence
or other misconduct by Hospice, its employees, independent
contractors or volunteers in connection with this Agreement
It is understood that both parties to this Agreement are
independent entities. Neither party is, or is to be considered as,
the agent of the other party for any purposes whatsoever. Neither
party has authority to enter into contract or assume any
obligations for the other party or make any warranties o
representations on behalf of the other party.Nothing in this
Agreement shall be construed to establish a relationship of
co-partners or joint venture between the two parties.
IN WITNESS WHEREOF, the parties hereunto have executed this
agreement on the day of March, 1995.
Hospice Signature Title
City Manager
The Home Signature Title
Printed Name, Edward A Barrett
1.\595 1)
HOSPICE ROUTINE HOME CARE
95-152
Based upon the needs of the patient and family as determined by
the Hospice and documented in the patient's Plan of Care and
Interdisciplinary Record of Care, the following services
related to
the management of the terminal illness will be provided to eligible
residents, as needed.
1. Home
visits
by
registered nurses.
2. Home
visits
by
licensed practical nurses or licensed
vocational
nurses.
3. Home
visits
by
social workers.
Home visits by'chaplains.
5.. Home visits by home health aides or homemakers.
6.- Home visite by volunteers -
7. Prescription drugs specifically delineated in the Plan of
Care as being related to the Hospice's palliative
management of the patient's terminal illness.
S. Durable medical equipment.
9. Nutritional counseling and meal planning.
10. Speech therapy.
11. Ostomy therapy.
12. Occupational therapy.
13. Respiratory therapy.
14. Family counseling services to family members during the
time the patient is receiving Hospice care.
15. Bereavement care and counseling for family members for as
long as one year following the patient's death.
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aR3S'TSiill
HOSPICE ADMISSION CRITERIA
Admission to the Hospice Program of care is dependent o
patient and family needs and their expressed request for care. The
concern of those seeking assistance in coping with terminal disease
isnot only whether they can find appropriate care, but also
whether they will have any Control over the care that is given.
For some patients and their families, high-risk, high technology
institutionalized types of therapies are the only forms of
treatment they will accept, even when cure is increasingly leas
likely. For such patients, admission to the HospiceProgram with
its emphasis on the appropriate use of technology, highly
personalized palliative care, and with its acceptance of the
inevitability of death may be stressful, inappropriate and poorly
received. Therefore, the Hospice Program requires the patient and
the family to sign a seatement of informed consent and request and
approval for care, containing the following components:
1. The patient/family understands the Hospice concept of care
as being palliative and not curative in its goals.
2. The patient/family understands the Hospice concept of care
as requiring the active participation of the family, if any, as
regiving members of the Hospice team consistent with the
capabilities of the family.
3. The terminal prognosis of six months or lees is validated
by the Hospice physician.
4. An appropriate primary care person is available. The
importance of the primary care person is discussed with the
patient/family.
S. The patient/family live in the service area.
6. Race, creed, color, religion, sex, sexual orientation, age
or national origin shall not be used as criteria for admission.
S. In no case shall a patient/family be admitted to the
Hospice Program without the prior consent of the patient's personal
physician, if any, as named by the patient and/or family.
8. Final determination of eligibility for admission is made by
the Hospice.
9. The patient/family understands that the Hospice retains
responsibility for determining the appropriate location for
treatment.
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10. Patients/families at St. Joseph Hospital admitted to the
Hospice Program are provided care at home or based on their needs
as identified in the interdisciplinary plan of care, irrespective
of their ability to pay.
11. To the extent admission to The Home is an issue for any
particular hospice patient, said admissions shall be pursuant to
and in accordance with the City of Bangor's policy, in effect at
the time, regarding admissions to The Home. A copy of the current
admissions policy is attached and incorporated herein as exhibit
1. The Hospice will be furnished copies of any changes to said
policy within 7 days of the change.
"' 95-152
BANGOR CITY NURSING FACILITY
ADMIBUIONS POLICIES AND PROCEDURES
It is the philosophy of Bangor City Nursing Facility to provide optimum
quality nursing care to the residents of Bangor.
Priority for admission will be given to Bangor residents, with Bangor
residents on Medicare skilled level having first priority.
Nan -Bangor residents may be admitted when occupancy falls below 98% and
there are no Bangor residents awaiting admission.
In order to provide short term skilled rehabilitation services to the
community, the facility aims to keep beds designated forshort term
rehabilitation admissions.
A person with apunicable disease, that would be a s health
r
threat to current residents and staff, may not be considered for ad-
mission. Each case will be considered on
an individual basis to deter-
mine the seriousness of the risk to other residents and to determine if
reasonable accomodations could be made.
It is the policy of the Bangor City Nursing Facility to admit patients
without regard for race, color, creed, sex (except for constraints placed
by potential recasts), national origin, or source of payment.
In order to insure that all residents receive
r
the quality of care which
r
their clinical condition warrants, Bangor City Nursing Facility needs to
r
consider various factors in determining whether persons requesting ad-
ocan beuadequately cared for. The following procedures a in
place tofulfill Bangor City Nursing Facility's goal of providing
quality nursing cac
e in accordance with the needs of its patients and
assuring that Its patientslive with dignity and comfort in and en-
vironment conclusive to their psycho -social needs.
All referrals for admission are initially screened by the Social Service
Caseworker and the Director of Nursing for level of care, nursing care
Beds and residency. The n of those who meet all criteria for ad-
missions
s r
e placed on the waiting list. Their n and date of referral
eplaced in a bound book. Further information such as address, next of
kin, the diagnosis etc. will be kept in a separate file.
When a bed becomes available, those an the waiting list are
reviewed by
the Admissions Committee consisting of the Administrator, Director of
Nursing, Social Caseworker and the Accounts Clerk. A nursing assessment
will be made by the Nursing Director. The Admission Committee shall
determine whether the potential patient has a currently available source
of payment to cover the cost of care at the Bangor City Nursing Facility.
The particular source of payment will not be a factor in determining
eligibility for admission. However, a source of payment must be verified.
95-152
Admissions policies and procedures continued:
Potential patients who cannot demonstrate any available source of pay-
ment will not be considered for admission. The potential patient who
n
has a applicationfor Title XIX (Medicaid) reimbursement pending
shall not be considered as having an available source of payment until
such time as they are determined to be eligible for Title XIX assistance
by the Department of Income Maintenance.
When a nursing assessment i completed and a of payment has been
ours ssessm s c source
usinihetl the Admission Committee will then review the application
usingg the following criteria:
Residency
Behavior Status
Levet of Care
Communicable. Disease
Nursing Needs:
Therapy: P.T. - O.T. - Speech
All. Status
Guardianship
Mobility
Current Placement 8 Degree of Need
Continency
Compatability with Potential Roonate
Tube Feeding
Date of Referral
Tracheostomy
Major Dressing
Decubiti
Other
The committee will then determine whether the level of services required
by the applicant can be supplied by Bangor City Nursing Facility at that
time and whether the level of services required by the applicant can be
offered without so diluting thea
r of the facility that the
the quality of care rendered to existing residents will be jeopardized.
In making that determination, the cmmittee will consider LM1e resources,
personnel and equipment available at the facility and the nursing,
medical and psycho -social needs of the applicant.
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APPENDS% C
Listing of Services and Items to be Purchased, as Needed, by The
Hospice from The Home.
Item/Service Unit Price
Authorized for Purchase
The Hospice shall provide to The Home a list of those persons
authorized to purchase or order items and services related to the
management of a patient's terminal illness.
Billing and Payment
The Home shall bill The Hospice on a monthly basis for all items
and services purchased from The Home by The Hospice. The Hospice
shall only be liable for payment for those items and services
specifically ordered by an authorized representative of The
Hospice. The Hospice shall pay The Home, based on an itemized
billing as requested by The Hospice, for all such ordered items and
services within sixty (so) days after receiving such billing from
The Home.
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APPENDS% D
Request for the Provision of Hospice Home Care Services to a
Nursing Home Resident
I,sident of the Bangor City
Nursing Facility (The Home), hereby request admission to the
Hospice Program of Care based upon my understanding and that of the
Hospice that The Home is considered to be my place of residence.
Because The Home provides support andservices to me that otherwise
would be provided by my family, I have requested that my residency
at The Home be considered by The Hospice a satisfying the Hospice
admission criterion that I live at home and have a primary
caregiver. Should the US Health Care Financing Administration now,
or in the future, determine that The Home is nol considered my
place of residence for the provision of routine home care
then I understand that I will no longer meet The Hospice admission
criteria of living in my home with a primary caregiver. In such
circumstances, I understand and agree that I may be discharged from
the Hospice program of care immediately upon such a determination
by the US Health Care Financing Administration.
Signature of Patient Date
Signature of The Home Representative Date
Signature of Hospice Director Date
Date
Date