Co. Mgr. - Home and Community Care Block Grant for Older Adults

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• 25 Standard Assurance To Comply Older Americans Act Requirements Regarding ng C i ients Rights For Agencies Providing In-Home Services through the Home and Community Care Block Grant for+Older Adult; ; As a provider of one or more of the services listed below, our agency agrees to notify all Home and Community Care Btu Grant dents receiving any of the below listed services provided lii this agency of their rights as a service recipienL Services in this assurance include: • I n-H Akie • Horne Care (home health) • Houág and Home Improvement • Adult Day Care Of Adult Day Health Care Notification will include, at a minimum, an oral' review of the information outlined hem as well as providing each service recipient with a copy of the information i n written form. .in addition, providers of in-hole services will establish a procedure to document that client y hts ■ with in-home J information has been discussed n-h o services clients (eg. copy of signed Client Bill of Rights statenienty Clients Rights information tc be communicated to service recipients Mil include, at a minimum, the right to: • • be fatly informed, in advance; about each in-ham service to be provided and any change and any change in service(s) that may affect the wellbeing of the participant; • particip:dte in planning and changing any En.home service provided unless the client is adjudicated incompetent; ▪ voice a grievance with respect lc service that is or fails to be provided,without discrimination or reprisal as a result of Voicing a grievance; • confidentiality of reoords relating to the individual; • have proms treated with respect; and • be fully informed both orally and in Ong, in advance of receiving an in-home service! of the individual's fights and obligations_ Client Rights will be distributed to, and discussed with, each new client receiving one or more of the above lid service prior to the onset service. For all exi ling clients, the above information will be provided nil later than the next regularly scheduled service massessment. Agency Na . , & a 4 • i,_:i _ L rn imn . &y A -& 0 rl, In Name of gency mi nistr or: 5.0 _. Signature. � ,.. a_a 1.4 , : exic I . # L LA _. Daie2/ki.y. 2- ir (Reese return this form to your Area Agency on Aging and retain a copy for your files,)