You have the right to be fully informed of the following, before care begins:
• You have the right to participate and make decisions in planning your own care and treatment, including any changes; be involved in developing your plan of care and be advised in advance of the disciplines that will furnish care, and the frequency of visits proposed to be furnished.
• You have the right to receive all the information necessary to make informed decisions about care and treatment plans, to receive information about the services covered under the hospice benefit, receive information about the scope of services that the hospice will provide and specific limitations on those services, to receive that information in a way that is understandable (i.e. information must be given in the language of the client, and provisions made for clients who are speech and hearing impaired), and to have access to your records;
• You have the right to accept or refuse treatment, services or supplies, and to be informed of what refusing could mean;
• You have the right to receive written information about the Agency’s policy on patient/client Advance Directives, including your rights under state law and how such rights are implemented by this Agency;
• You have the right to formulate Advance Directives, either through a Living Will, Durable Power of Attorney, or the appointment of a health care representative;
• You have the right to choose your attending physician;
• You have the right to receive service without regard to whether or not an Advance Directive has been executed;
• You have the right to receive effective pain management and symptom control from the hospice for conditions related to the terminal illness;
• You have the right not to receive any experimental treatment unless you agree to it, and only after it has been fully explained in a way that you can understand;
• You have the right to receive necessary professional services 24 hours a day, 7 days per week;
• You have the right to receive continuous and consistent services in a timely manner;
• You have the right to receive service without regard to race, creed, color, sex, age, or handicap;
• You have the right to know the names and professional qualifications of the people who will be caring for you before treatment begins; and the frequency of visits proposed to be furnished.
• You have the right to be free from mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, misappropriation of patient property including damage to or theft of property, and exploitation of any kind;
• You have the right to have your property treated with respect by the employees of this Agency;
• You have the right to be informed of, and to understand, the way all billing and payment is handled by this Agency; you have the right to be informed of the services and supplies dispensed by this Agency (directly or through contract), for your individual needs, and the right to be provided upon request with a monthly itemized statement of specific charges, including those submitted to the payor. You have the right to be informed orally and in writing of your insurance coverage and any direct pay responsibilities prior to starting your plan of care and to be notified of any changes in payment information as soon as possible, but not later than 30 days from the date the Agency becomes aware of the change.
• You have the right to be informed of this Agency’s ownership and control, as well as any relationships which may bring profit to this Agency when it makes referrals;
• You have the following rights with respect to the privacy of your health information: to receive a copy of the Agency’s Notice of Privacy Practices at the time of first service delivery; to lodge complaints about the Agency’s privacy practices; to request restrictions on the uses and disclosures of health information; to request to receive confidential communication; to access your protected health information for inspection and/or copying (a reasonable, cost based fee for copying, labor and supplies will be charged); to amend your health care information; and, to request an accounting of disclosures of health information.
• You have the right to be told if this Agency’s liability insurance will cover injuries to its employees when they are in your home, and if this Agency’s insurance will cover theft or property damage that occurs while you are being treated;
• You have the right to be told, in advance, of treatment options, transfers, and when and why care will be discontinued;
• You have the right to be referred to another agency if you are not satisfied with this Agency or if this Agency cannot meet your needs;
• You have the right to education, instructions, and a list of requirements for continuing care when the services of this Agency are over;
• You have the right to voice grievances about this Agency, treatment or care by the caregiver, or lack of respect for property by anyone furnishing services for this Agency, and must not be subjected to discrimination or reprisal for voicing such a grievance. You have the right to receive a written response from this Agency about its investigation of that grievance and its resolution.
• You have the right to be advised of the availability of toll-free home health hotline numbers:
To Express Concerns or Complaints About the Quality of Services:
Indiana State Department of Health Toll-free Hotline:
1-800-246-8909 (24 hours, 7 days)
(The Indiana State Department of Health shall investigate all such complaints.)
Community Health Accreditation Program Toll-free Hotline:
1-800-656-9656 (Monday through Friday 8:00am-5pm EST)
For Complaints about Fraud: 1-800-622-4792 (Indiana)
1-800-HHA-TIPS (1-800-447-8477) (National)
Your family, legal representative or guardian may exercise your rights on your behalf if and when you should ever be judged incompetent.