Rental Agreement

I have chosen Rose Village care home and agree to pay a monthly/daily rental fee of $ on the 1st of each month/daily. I understand there will be a late fee assessed of $ /day beginning on the 3rd of each month if the monthly fee is not received by on the 1st of the month. I understand I am required to give a 30-day notice prior to moving, and I will honor the move-out date. Rose Village Care Homee personnel (Manager) reserve the right to notify resident/family that the resident must move if her physical and or mental changes noted that require a higher level of care. Also, if the resident has unacceptable behaviors or if the resident does not abide by facility rules. Rose Village Care Home will work with the family in good faith to assist resident with relocation if the need arises. However, resident/family must make a good faith effort to relocate within 1-2 weeks if the above agreement is not adhered to.

I, , agree to pay $1500.00 a non-refundable Community fee on and an adjusted monthly fee of $ for a total move-in fee of $ .

One person is designated as the responsible part of the resident. The responsible party may or may not be the legal guardian, Power of attorney, and or health care power of attorney for the resident. All future references to the responsible party in this agreement may include responsibilities of the resident and/or the resident's legal guardian, power of attorney, and/or health care power of attorney. The responsible party will be responsible for giving information about the resident to other family members, friends, legal guardian, power of attorney, and/or health care power of attorney, and informing them of this agreement.

Rose Village Homecare located at a personal Residential Care Home does enter into this Admission Agreement with a responsible party for the resident , under the following terms and conditions.

And the parties here to do hereby agree as follows:

HOME'S RESPONSIBILITY

The home shall exercise such reasonable care towards the resident as his known condition may require; however, the home is in no sense an insurer of the resident's safety or welfare and assumes no liability as such.

The home shall provide personal care on a nondiscriminatory basis so that all residents are admitted and receive benefits and services without regard to race, religion, color, national origin, age, sex, or handicap. The home shall not be responsible or liable for the loss or damage of any money, jewelry, documents, or any other personal property or possessions. All articles retained in the resident's possession, including dentures, eyeglasses, hearing aids, etc., shall be entirely the responsibility and liability of the responsible party.

Records pertaining to resident shall be treated as confidential and properly safeguarded and shall be made available only to authorized persons and agencies.

RESIDENTS ACCEPTED

A resident may:

A. Not have a disease endangering other residents.

B. Exhibit symptoms of mental or emotional disturbance but is not considered at risk of imminent harm to self or others.

C. Need assistance with movement.

D. Require assistance with bathing, dressing, and grooming.

E. Require assistance with routine skin care, such as application of lotions or treatment of minor cuts and burns.

MEDICATION - I ask that residents set up an account at a pharmacy that offers delivery or have the responsible party of the resident commit to picking up the medications at the pharmacy and have it delivered to Homecare. While a close eye is kept on the health of the resident.

Rose Village Care Home, not being a skilled facility, is not accountable for nursing services. If skilled nursing is needed on a routine basis, we require the resident to contract directly with home health or hospice. Medicare-funded nursing services are received through the doctor's orders when needed. The nurse or family can work directly with the doctor if skilled nursing or hospice is necessary.

Medical Expenses - The resident or responsible party will pay for the resident's medical expenses, e.g., medications, medical apparatus, etc. Haircut and nails care are the responsibility of the resident or his/her family. In the event that a volunteer or caregiver helps the resident with nail care, we are not to be held liable for the condition and/or complications that may ensue from cutting hair or nails.

Documents - The facility needs copies of the power of attorney and physician's directives. When dealing with the frail elderly, we expect the unexpected. Should the resident be found without a pulse or failing to breathe, fall that requires medical attention, or other life-threatening situations, a 911 call will be made. If the resident is under the care of hospice and has a DNR (Do not resuscitate order) posted, we will bypass the emergency response system and call the nurse directly if the resident is having difficulty or is deceased.

Belonging - The resident is responsible for supplying their clothes and personal items. Please mark each item with a name before moving in. Depends/pullups/wipes or other personal items such as tissue papers, lotion, and bodywash are supplied by the family or hospice. Protection must be worn if the resident is at all incontinent. This keeps our facility odor-free. Rose Village Homecare will be in charge of the resident's laundry unless the family wants to do it at their home. Therefore, laundry detergents will be needed. Bring items that do not need special care (such as dry cleaning or ironing).

Fees -There is a three days period with no penalty Late payments will receive a $50.00 late fee. If check is returned insufficient funds, the responsible party/resident will receive an additional charge of $100.00.

If this continually being a problem and medication is not received on time, then the responsible party agrees that the resident, shall, at the sole option of Jovial Living Home, be transported to the responsible party's home or other such place at the responsible party shall designate The responsible party agrees to accept physical custody of the resident and pay all transportation charges as well as all past due charges due to (X) Homecare If responsible party refuses to accept physical custody of the resident under the circumstances outlined above, it is agreed that the resident be transported to and placed in the nearest public institution for the care of the aged and infirm at the expense of the responsible party Should collection of any sums due hereunder be deferred to an attorney for collection the resident or legal guardian and responsible party hereunder shall jointly pay attorney fees and collection expenses (X) Residents are not considered discharge until personal belonging and medication has been removed from the premises (X) Due to the nature of this small business and in order to maintain its stability, no refunds are given, after this period (Services are purchased by the day, week or month and can't be refunded without putting the stability of the home in danger ) (X) Homecare requests a thirty day notice in writing, if a discharge is planned so as to begin interviewing potential residents for the vacancy (X) Employee of our faculty or Health Care Agency cannot be hire in the purpose of competition A $5000 00 payment will be required (X) I have received a copy of the liability statement and have read the policies of Homecare and agree to abide by them Should the resident's physical and/or mental condition change requiring more care, the monthly service rate may increase A new financial agreement will be signed if a resident's service rate is changed. Also should the resident's condition changes such as sickness, physical and/or mental condition change requiring higher care that Homecare cannot handle the resident will be transferred to the appropriate facility that meets her needs or hospital of the resident's or family choice In case of emergency we always call 911 / Hospice if patient is on Hospice.

Responsible Party Agreement

Should collection of any sums due hereunder be deferred to an attorney for collection...

Refund Policy

WHAT ARE THE BASIC PRE-ADMISSION FEE REFUND REQUIREMENTS?...