BREVILLIER VILLAGE HOUSING & HEALTHCARE RESIDENT RIGHTS

AND CONFIDENTIALITY STATEMENT

Brevillier Village Housing & Healthcare will protect and promote the rights of each individual admitted to our facility.

THE RESIDENTS BILL OF RIGHTS:

I. The Resident Rights and Responsibilities at Brevillier Village are as follows:

a. Resident has a right to a dignified existence, self-determination and communication with and access to persons and services inside and outside the facility.

b. Resident will be treated with consideration, respect, and full recognition of his dignity and individuality, including privacy in treatment and in care for his personal needs.

c. Resident has the right to be free of interference, coercion, discrimination or reprisal from Brevillier Village in exercising his or her rights.

d. If Resident is adjudicated incompetent in accordance with law, is found medically incapable of understanding Resident Rights by his physician, or if resident exhibits a communications barrier, then resident rights and responsibilities evolve to Responsible Party.

e. Resident will be assisted, if necessary, to exercise his rights as a citizen, and to this end he/she may voice grievances and recommend changes in policies and services to Brevillier Village staff and/or to outside representation of his choice.

f. Resident has the right to be fully informed (in a language that he or she can understand) of his or her total health status including but not limited to his or her medical condition.

g. Resident has the right to participate in the planning of his or her medical treatment or changes in care and treatment.

h. Resident has the right to refuse treatment.

i. Resident has the right to refuse to participate in any experimental research.

j. Resident has the right to choose a personal attending physician.

k. Resident has the right to be fully informed in advance about care and treatment and of treatment that may affect the resident's well being.

l. Resident has the right to be free of mistreatment and physical or verbal abuse.

m. Resident has the right to self administer medications unless the facility staff has determined that it is unsafe for that resident to do so.

n. Resident will be free from mental and physical abuse and free from chemical and (except in emergencies) physical restraints, except as authorized in writing by a physician, or when it is necessary to protect resident from injury to himself or to others.

o. Resident's personal and medical records are confidential. Resident may approve or refuse release to any individual or outside facility except in the case of his transfer to another health care institution or as required by law or third party payment contract. If resident approves the release of this information, it will be in writing as in accordance with HIPAA (Health Insurance Portability and Accountability Act).

p. Resident has the right to inspect and purchase photocopies of all records pertaining to the resident upon written request and 48 hours notice.

q. Resident will be transferred or discharged only for medical reasons, for his welfare, for the welfare of other patients, or for non-payment of charges. It is understood that if he is to be transferred or discharged he will be given reasonable advance notice to insure an orderly transfer or discharge.

r. Except in a medical emergency, resident will not be transferred or discharged, nor shall his treatment be altered radically without consultations with him, or if he is incompetent, without prior notification or Responsible Party.

s. Resident has the right to manage his/her own personal financial affairs.

t. If resident does not choose to manage his personal financial affairs, or if he is unable to do so, Brevillier Village may elect to accept responsibility to manage resident's financial affairs. If resident chooses to have Brevillier Village manage his affairs, he shall designate the transfer of responsibility in writing on a document separate and apart from his Admission Agreement. If Brevillier Village accepts management of resident's personal financial affairs, resident will be given an accounting of all financial transactions made on his behalf at least quarterly.

u. A written account will be maintained on a current basis for resident with written receipts for all personal possessions and funds received or deposited with Brevillier Village and for all expenditures and disbursements made on behalf of resident.

v. Resident will not be required to perform services for Brevillier Village that are not include for therapeutic purposes in his plan of care.

w. Resident has the right to privacy in written communication.

x. Resident has the right to send and receive personal mail (at their own expense) promptly and unopened

y. Resident has the right to associate and communicate privately with persons of his/her choice (unless medically contradicted as documented by his/her physician in the medical record).

z. Resident will be permitted to meet with community groups at his discretion (unless medically contradicted as documented by his physician in his medical record).

aa. Resident will be permitted to participate in social and religious activities.

bb. Resident has the right to have regular access to the private use of a telephone.

cc. Resident will be permitted to retain and use personal clothing and possessions as space permits, unless to do so would infringe upon the rights of other residents (and unless medically contradicted as documented by his physician in his medical record).

dd. Resident has the right to share a room with his/her spouse when married residents live in the same facility and both spouses consent to the arrangement.

ee. Resident has the right to be notified if there is a change of roommate.

ff. Resident has the right to receive visitors at any reasonable hour.

gg. Resident has the right to refuse to see a visitor.

hh. Resident will permit members of recognized community organizations and representatives of community legal services programs whose purposes include rendering assistance without charge to resident to have access to Brevillier Village.

ii. Resident has the right to request to upgrade the room assigned to him and/or selected by him at any time for any reason, provided the room requested is readily available and resident is financially able to pay for the requested room.

II. "The above recitation of Resident's Rights and responsibilities within Brevillier Village does not preclude or in any way limit rights and responsibilities assured to resident under the Constitution of the United States and the Constitution of the Commonwealth of Pennsylvania."

III. Brevillier Village may limit access where it may be a detriment to resident's care and well-being. At no time, however, may Brevillier Village restrict resident's right to have legal representation.

IV. If Brevillier Village is to be closed, Brevillier Village will notify resident or responsible party in writing of such action in sufficient time for resident or responsible party to make alternate arrangements for resident's transfer and care elsewhere.

V. The resident or responsible party, by virtue of his signing of this Agreement, declares that said Agreement has been fully explained and understood.

Responsible Party (Power of Attorney for the person or legal guardian) shall have the ability to enact any of the stated rights on behalf of the resident if resident is deemed incapable. A copy of the Bill of Rights has been received by the resident for future reference.

VI. The resident has also received a copy of the "Commonwealth of Pennsylvania Department of Public Welfare Rights of Nursing/ Personal Care Home Facility Residents."

 

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      RESIDENT SIGNATURE                      RESPONSIBLE PARTY SIGNATURE

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Brevillier Village

5416 East Lake Road

Erie, PA 16511

Phone: 814-899-8600       Fax: 814-898-1910

Department of Housing & Urban Development

 

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American Association of Homes and Services of Aging.

Pennsylvania Association for Non-Profit Homes of Aging.