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Standard Assurance To Comply with Older Americans Act <br /> Requirements Regarding Clients Rights <br /> For <br /> Agencies Providing In-Home Services through the <br /> Home and Community Care Block Grant for Older Adults <br /> As a provider of one or more of the services listed below, our agency agrees to notify all Home <br /> and Community Care Block Grant clients receiving any of the below listed services provided by <br /> this agency of their rights as a service recipient. Services in this assurance include: <br /> • In-Home Aide <br /> • Home Care (home health) <br /> • Housing and Home Improvement <br /> • Adult Day Care or Adult Day Health Care <br /> Notification will include, at a minimum, an oral review of the information outlined below as well <br /> as providing each service recipient with a copy of the information in written form. In addition, <br /> providers of in-home services will establish a procedure to document that client rights <br /> information has been discussed with in-home services clients (e.g. copy of signed Client Bill of <br /> Rights statement). <br /> Clients Rights information to be communicated to service recipients will include, at a minimum, <br /> the right to: <br /> • be fully informed, in advance, about each in-home service to be provided and any <br /> change and any change in service(s) that may affect the wellbeing of the participant; <br /> • participate in planning and changing any in-home service provided unless the client <br /> is adjudicated incompetent; <br /> • voice a grievance with respect to service that is or fails to be provided, without <br /> discrimination or reprisal as a result of voicing a grievance; <br /> • confidentiality of records relating to the individual; <br /> • have property treated with respect; and <br /> • be fully informed both orally and in writing, in advance of receiving an in-home <br /> service, of the individual's rights and obligations. <br /> Client Rights will be distributed to, and discussed with, each new client receiving one or more of <br /> the above listed services prior to the onset of service. For all existing clients, the above <br /> information will be provided no later than the next regularly scheduled service reassessment.U <br /> Agency Name: rCa,(1q Qr DU r� SOC..:cA,/ 5e..rU:c.t1 <br /> Name of Agency Administrator: /V4 vy lib rro�v' <br /> Signature: Date: <br /> (Please return this form to your Area Agency on Aging and retain a copy for your files.) <br />