HomeMy WebLinkAbout1995-06-26 95-290 ORDER95-290
COUNCIL ACTION
Item No.
Date 6/26/95
Item/Subject: Contract for Services with Hospice of Eastern Maine
Responsible Department: Nursing Facility.
This is the enact sane agreement for Hospice Respite Care & Hospice Hone
rCare as we have with Hospice of St. Joseph that cane before the Council and was
passed on March 29, 1995.
Bruce Shibles worked on the contract for hospice of St. Joseph. The only
change for Hospice of Eastern Maine is the nave
of the provider.
Commentsir
r; w .
City Manager
Associated information:
Budget Approval:
Finance Director
Legal Approval:
S nn
city solimxo
Introduced For: G.
Passage
_First Reading
Referral
Page_ of _
95-290
Amignedtof onolo' Woodcock June 26, 1995
CITY OF BANGOR
(TITLE.) (orbes AUU�oruing city.. Mareger to Bzecute Tw Fospice care
Agr._.,.e�ent th_Hmgice of eastern !Hine
BV tha City CoukcU of N atV Of Bakdw:
ORDERED,
MT city Manager Edward A. Barrett is hereby authorized to exec
txo dacwents, a Rro l and AgLeOtEnt for the R lsim Of Hospice ikne
Care Services W the Resident$ Of BngOr City Nursing Facility and an
Agrement beta City of Bangor aryl ibspice of Eastern Maine to provide
inpatient respite seryices, with Hospice of Eastern Maine governing the
provfsfm of hcspfce w and respite care for lwspice patients at the
Bangor City Nursing Facility. The dxmrent are attached herein as
Exhibits A and B.
IN CITE COOMCIC- 95-290
Juue '. 1995 O R D E R
P e
CETY
Title, Authorizing City Manager to E acute
Two Hospice CAre Agreements with Hospice of
117 f Eastern Maine.
Assignml K,o
- Councilma
95-290
MRREMENT BETWEEN
CITY OF BANGOR
and
HOSPICE OF EASTERN MAIIE
To Provide Inpatient Respite Services
This agreement is entered into as of this day of ,
1995, by and between the City of Bangor, a Maine municipal
corporation, and Hospice of Eastern Maine, a non-profit
corporation.
WHEREAS, Hospice of Eastern Maine is engaged in providing
interdisciplinary care
and treatment of Eastern Maine terminally
n
ill patients i order to allow these patients to continue life as
comfortably as possible primarily in a home environment; and
WHERRAS, Hospice of Eastern Maine is primarily palliative rather
than curative; (this care includes physical, emotional, spiritual,
and bereavement support i accordance with the standards of
Medicare Hospice reigulaticns)and
WHEREAS, on occasion, Hospice patients need inpatient care for
respite purposes;'and
WHEREAS, the City of Bangor owns 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 Eastern Maine, and is willing to make inpatient beds
and services available for use by Hospice of Eastern Maine
patients;
Huai THHREPORE, the City of Bangor and Hospice of Eastern Maine
hereby agree as follows:
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 cas having the most significant role in
determination and delivery of the patient's medical care.
B. Interdiscinlinary Team: a group consisting at a minimum of
a doctor of medicine or osteopathy, a registered nurse, a social
95-290
Hospice of Eastern Maine
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 erall 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 a
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.
II. SERVICES TO BE PROVIDED BY THE NURSING FACILITY
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 a s to the hospice patients in
accordance with the pate nt'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 29 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 significant changes in the
patient's condition.
E. To the extent possible, the Nursing Facility shall provide
access and flexible visiting privileges including visits by
95-290 y,+•.
Hospice of Eastern Maine
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 apace 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.
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 according to mutually
agreed upon protocol. if the admission of apatient is not
authorized i writing, a record of the oral authorization shall be
entered into the patient'srecord. The hospice shall provide the
Nursing Facility with current information 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 a es are provided in accordance with hospice
patient care protocolc
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.
95-290
Hospice of Eastern Maine
City of Bangor
Respite Agreement
Page a
N. 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 oreceive patient
information. Hospice personnel documentingin 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. QUALITY ASSURANCE
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.
S. 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 or 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
immediately the Nursing Facility c 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.
95-390
Hospice of Eastern Maine
City of Bangor
Respite Agreement
Page 5
VI. INSORANCB
Both parties shall submit a certificate of insurance issued by
any insurance company acceptable to the other party indicating
complete liability insurance coverage, including professional
liability coverage. Such inshall be in amounts reasonably
satisfactory to each party, butshallnot 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 (9) days if
such insurance is changed, cancelled or revoked.
VII. TERMINATION
This Agreement shall become effective a of the date of execution
and shallremain n effect indefinitely, provided, however, that
either party shall have the right to terminate this agreement under
the provisions outlined hereafter.
VIII. TERMINATION/
A. This agreement may be 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.
IR. CUMPERSATION
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.
95-290
Hospice of Eastern Maine ...
City of Bangor
Respite Agreement
Page 6
A. ACCESS TO INFORMATION
For the purpose of implementing Section 1861(v)(i((i) of the Social
Security Act as
amended by any written regulations thereto, the
Nursing Facility agrees 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.
Date
Hospice of Eastern Maine
Edward A. Barrett
City Manager
95-290 -S']
PROTOCOL ANO AGREEMENT
FOR THE PROVISION OF HOSPICE ROME CARE SERVICES
TO THE RESIDENTS OF BANGOR CITY NURSING FACILITY
WHEREAS, the City of Bangor owns and operates the Bangor City
Nursing Facility, (hereinafter referred t0 as THE HOME) which is an
Intermediate Care Facility which occasionally has among its
residents individuals whose source of payment for nursing home
iervices in non -Medicare, but who are Medicare eligible
ndividuals, and who are terminally ill with a medical prognosis of
sir months or less, and
WEENBAS, The Home desires to secure 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 ervices
available to such individuals in order that such individuals may
obtain the additional services overed under the Medicare Hospice
Benefit while continuing to reside in The Home, and
WHEREAS, Hospice of Eastern Maine, (hereinafter referred to as
HOSPICE) is certified by the federal government to provide
comprehensive hospice services to Medicare -eligible individuals and
desires to provide such services to the residents of The Home in
cooperation with the management and staff of The Home.
NOW THHRBFORB, The City of Bangor and the Hospice, in
consideration of mutual advantages occurring to each and to
eligible residents and their families, do hereby agree each with
the other, as follows:
SECTION I: ELIGIBLE RESIDENTS
Residents eligible for services provided in accordance with
this Agreement are persons 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 Part A coverage and
reimbursement of health a including payment to The Hospice
for hospice home care renderedinThe 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;
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Page 2
E. Receive hospice services in accordance with an individualized
Hospice Plan of Care (hereinafter referred to as Hospice Plan)
developed by the Hospice and approved by the physician identified
on the Medicare Hospice election form as being responsible for such
resident's health care.
SECTION II. SERVICES TO BE PBRBIB® BY HUSPIC6
A. HOSPICE P
The Hospice Shall develop, at the time aneligible resident is
admitted into the Hospice program, a Hospice Plan of Care for the
management and palliation of the resident's terminal illness. The
Hospice plan is a
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
admission into the Hospice program in the form of physician's
orders. The Hospice plan will be updated weekly or
me frequently
e
if deemed necessary by The Hospice and a copy of the updated
Hospice plan will be furnished weekly to The Home.
H. HOSPICE ROME CARR SERVICES
The Hospice agrees to provide Services to eligible residents a
defined in Section I., according to a Hospice plan, as defined i
Section II.A. Hospice service
shall comprise generally all of the
facilities and equipment made available to those patients
otherwise enrolled in The Hospice as routine home care patients.
Such services shall, depending upon the Hospice plan for each
eligible resident, include those hospice services listed in
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 ARD PHARMACRDTICALS
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. MKDICAL EQUIPMENT AND MEDICAL SUPPLIES
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.
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Page 3
E. CONTIN US CARE AHD HOSPICE INPATIENT CARE
The Hospice is a comprehensive provider of home ca
e
continuous c 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. Eased
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 c e 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
crisis, as defined
by Hospice rules of US Health Care Financing
Administration, Hospice agrees to place
and -the -clock nursing o aide services in The Home
to care for the patient in an uninterrupted fashion
until the patient's condition dictates a return to
routine hospice homecare or a change to Hospice
inpatient care.
2. Hospice Inpatient Care: If a Hospice patient who is a
resident of The Home expreiences
chronic or acute
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 Eastern Maine
Medical Center.
F. TRANSPORTATICH ANH AMBOLANCE
If a Hospice patient who is a resident of the Home requires
transportation or ambulance from The Home to Eastern Maine Medical
Center, Hospice will provide or arrange for such transportation or
ambulance.
G. HOSPICE 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 visite shall be solely related to the
patient's terminal illness and are understood as not duplicating or
replacing the s of the resident's attending physician, which
under Public Law 57-248, 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 SEHVICSS AMD BEEJE4 MBMT CARR
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.
Page 4 95-290
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. H03PICE ORIENTATION A TRAINING
The Hospice agrees to provide sufficient orientationand
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 HH FURNISHED 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 agreedthat, 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. COOPERATION IN PRGFESSIO NRNAG®ffiN'1'
In respect to The Home's responsibility for services
rvices carried
out within its facility, Hospice shall provide toThe 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 insurance issued by ainsurance company
acceptable to The Home, indicating that The Hospice hascomplete
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 is
certified by the US Government pursuant to Public Law 99-248, for
the provision of Hospice Services; and
95-290
Page 5
4. Subject to the patient's consent, 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.
SS ION V. FIBABCIAL RESPONSIBILITY
A. RESPONSIBILITY OF THE HOSPICE
The Hospice shall bear full financial responsibility for all
Hospice care 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.
H. POECHASH OF SERVICES BY THE HOSPICE FROM THE HO!ffi
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 may include physical therapy, occupational
therapy, speech therapy, pharmaceuticals, oxygen, personal care,
supplies and medical equipment. In the event that Hospice wishs
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 HOME
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 as 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 s include room
and board, medications not related to the management of the
terminal illness, nursing and personal care as 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.
P 95-290
Page 6
D. IN.^aDRANCE
Both parties shall submit acertifcate of insurance issued by
any i company acceptable the other party indicating
complete liability insurance coverage, including professional
liability coverage. Such insurance 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.
SECTION W. JOINT REVIEN 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 discuss services endered to residents who are
Hospice patients, and to maker commendations 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 releasee, media advertisements, or any form of
publicity or marketing which concerns the arrangment between the
parties. Nothing herein prevents The Home or the city of Bangor
from complying with the requirements of 1 MRSA S 401 at sea., as it
may be amended from time to time
SECTION VIII. COMPLIANCE WITH G ERNMMNT REGULATIONS
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 requirements
that a patient live at home and have a primary caregiver. To that
end, Hospice will admit eligible residents who execute, as part of
95-290
Page S
the Hospice admission process, a "Request For The Provision of
Hospice Home Care Services to a Nursing Home Resident", a copy of
which is appended to the Agreement as Appendix D and, by reference,
is made a 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 in 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 av aggregate cost of $10,000 or more over 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 or by 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 subcontract,
with a aggregate value or cost of $10,000 o va 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 services pursuant to such subcontract,
the related organization shall make available, upon written request
by the Secretary of the Department of Health and Human Services o
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
records of such organization that are nary to verify the
nature and extent of the costs of the services provided under this
Agreement.
C. APMCABLH IAN
This Agreement shall be governed by and construed i
accordance with the laws of the State of Mine, and Public Law
9]248.
C ••1' • l tl9A
This Agreement shall be 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. IN EWNTFICATION 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
or arise out of any omission, fault, negligence or other misconduct
by The Mom, its employees, independent contractors or volunteers
n 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 S 8101 at sea, or
other provisions of law, and that The Home's obligation to
indemnify Hospice under this paragraph shall be subject to all
humanities 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 S 2904, the Maine Workers Compensation Act Of 1992, 39-A MRSA
9 101 at seg, 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 a
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 1995.
Hospice Signature Title
Printed Name:
City Manager
The Home Signature Title
Printed Name: Edward A. Barrett
VF�
HOSPICE ROUTINE HOME CARE
95-290
ej.
Eased 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. Rome visits by licensed practical nurses or licensed
vocational nurses.
3. Home visits by social workers.
4. Home visits by chaplains_
5. Home visits by home health aides or homemakers.
6. Home visits 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.
8. 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.
95-390
HOSPICE ADMISSION CRITERIA
Admission to the Hospice Program of Care is dependent on
patient and family needs and their expressed request for care. The
concern of those seeking assistance in coping with terminal disease
is not 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,, ehigh-risk, high technology
institutionalized types of therapies are the only forms of
treatment they will accept, even when cure is increasingly less
likely. For such patients, admission to the Hospice Program with
its emphasis on the appropriate use of technology, highly
personalized palliative care,
and with its acceptance of the
inevitability of death maybe stressful, inappropriate and poorly
received. Therefore, the Hospice Program requires the patient and
the family to sign a statement 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 less is validated
by the Hospice physician.
9. 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 orenation, age
or national origin shall not be used as criteria foradmission.
7. 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.
S. 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.
95-290
10. Patients/families at Eastern Maine Medical Center 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.
95-290
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 persona
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 (60) days after receiving such billing from
The Home.
95-290
J
APPSHDIR D
Request for the Provision of Hospice Home'tare Services to a
Nursing Rome Resident
I,, a resident 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 and services 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 not considered my
place of residence for the provision of routine home care services,
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