Item D23
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: June 21,2006
Division: Community Services Division
Bulk Item: Yes ~ No
Department: Social Services
Staff Contact Person: Susan Scarlet
AGENDA ITEM WORDING: Approval of revised Policy and Procedures for Bayshore Manor
Admission, Retention, Discharge, and Refund and Bayshore Manor Financial Eligibility for Rent
Subsidy; also approval for increase in personal care allowance from $30.00/month to
$35.00/month.
ITEM BACKGROUND: Present Bayshore Manor Adminssion Policies are outdated.
PREVIOUS RELEVANT BOCC ACTION: Prior Policies and Procedures last approved in
1991/1992.
CONTRACT/AGREEMENT CHANGES: $30.00 to $35.00 personal care allowance
STAFF RECOMMENDATIONS: Approval
TOTAL COST:
N/A
BUDGETED: Yes
No
COST TO COUNTY:
N/A
SOURCE OF FUNDS:
REVENUE PRODUCING: Yes
No-X AMOUNTPERMONTH_ Year
APPROVED BY: County Atty --X....- OMB/Purchasing ---1L
Risk Management _X_
DIVISION DIRECTOR APPROVAL:
~~~ ~..rJ.~
Sheila Barke
DOCUMENTATION:
Included x
Not Required_ To Follow
DISPOSITION:
AGENDA ITEM #
CONTRACT SUMMARY
RECEIVED
JUN 07 2906
PURCHASI G
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
Contract with:
Contract #_
Effective Date:
Expiration Date:
Contract Purpose/Description:
A roval of revised Polic and Procedures for Ba shore Manor Admission, Retention,
Dischar e and Refund and Ba shore Manor Financial Eli ibilit for Rent Subsid . also
a roval for increase in ersonal care allowance from $30.00/month to $35.00/month.
Contract Manager: Susan Scarlet
(Name)
4533
(Ext.)
Ba shore Manor / #9
(Department/Stop #)
for BOCC meetin on
6/21/06
A enda Deadline: 6/6/06
CONTRACT COSTS
Total Dollar Value of Contract: $ - 0-
Budgeted? YesD No D Account Codes:
Grant: $ l-J I A
County Match: $ t-J / A.
Current Year Portion: $
- - - -
-----
- - - -
-----
- - - -
-----
- - - -
-----
ADDITIONAL COSTS
Estimated Ongoing Costs: $--.!yr For:
(Not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, etc.)
CONTRACT REVIEW
Changes
Date In Needed,..,/' /. . Revi<::>ver.
Division Director HmO~YesDNo~ ~ a~~
RiskManagement~ b-7{)io YesONoET O'O~
tl / ~~ I\'ls~ ~/ 2
o.ro.lPurchlbing M!JlOl. YesO No'lt'f /~ ("
CountyAttomey "'~ YesONoW~~~~
Comments:
Date Out
6' ~ /3--a;b
/<Ch
OMB Form Revised 2/27/01 MCP #2
RECEIVED
JUN 1 2 2006
BY:- 6MB
=
BA YSHORE MANOR
FINANCIAL ELIGIBILITY FOR RENT SUBSIDY
POLICY: It is the policy of Bayshore Manor to determine financial eligibility for rent
subsidy only for an individual who has been found appropriate for ALF services through
an assessment of strengths, needs, preferences, and health status; and to use the
Department of Children and Families (DCF) Guidelines for the Florida Medicaid
Institutional Care Program as a tool for establishing eligibility criteria.
PURPOSE: To ensure that ALF services are available to eligible seniors residing in
Monroe County regardless of financial circumstances.
PROCEDURES:
1. Once an individual (or individuals in a couple) is assessed and found eligible for
residence based on strengths, needs, preferences, and health status, the Bayshore
Manor Senior Administrator or her/his designee will refer the individual to the
Department of Social Services (DSS), Welfare Program.
2. Welfare Program Senior Administrator or her/his designee will assign a social worker
to complete a review of the applicant individual's personal finances; full financial
disclosure is required by the applicant.
3. Assets, income, and resources will be evaluated and documented by the social
worker to determine applicant eligibility for County subsidized ALF services as
follows:
a. Asset Limit for an individual is $2,000.00 and for a couple is $3,000.00.
b. Transfers of Income and Resources may affect eligibility if they are made
within 36 months of the application for rent subsidy and 60 months if used to
establish a trust.
o A person may be ineligible for a period of time if income or
resources are transferred for less than fair market value in order to
become eligible for a rent subsidy.
o The period of ineligibility will vary depending on the value of the
transferred income or resources.
o Anyone determined ineligible due solely to transferred income or
resources cannot qualify for County assistance.
c. Allowable Transfers by an applicant individual are listed below:
o Any resource to a spouse or disabled adult child.
o The homestead, without penalty, to one of the following relatives:
1. Her/his spouse
2. Her/his minor child (under 21 years) or a blind or disabled adult
child
3. Her/his sibling who has equity interest in the home and resided
there at least 1 year prior to the applicant's admission to the
ALF.
1
Revised 617/2006
4. Her/his son or daughter who resided in the home for at least 2
years immediately before admission and who provided care that
delayed the applicant's admission to the ALF.
d. Resources that will be reviewed and that count toward financial eligibility for
subsidy are listed below: (this list is not exhaustive)
o Real property other than homestead.
o Bank accounts, Certificates of Deposit (CDs), money market funds.
o Stocks/bonds.
o Trusts.
o Life Insurance cash value if the face value of the policies owned on
any insured individual totals more than $2,500.00 ($1,500.00 for
SSI recipients).
e. Resources that will be reviewed but do not count toward financial eligibility for
subsidy are listed below (exclusions): (this list is not exhaustive)
o Homestead, if the individual or a dependent lives there, or if the
individual is absent but intends to return.
o Vehicle (one is excluded).
o Burial funds up to $2,500 (or $1,500.00 for SSI recipients).
o Irrevocable pre-paid burial contracts.
o Life insurance, if the total face value of all policies owned by the
individual for anyone insured does not exceed $2,500.00
(exclusions is $1,500.00 for SSI recipients).
4. Documentation of financial assets, income, and resources will be obtained and
analyzed by a social worker with a determination of subsidy eligibility determination.
a. Documentation and subsidy determination will be recorded by the social
worker and provided to Bayshore Manor Senior Administrator or her/his
designee.
b. Documentation and subsidy determination will be maintained at Bayshore
Manor in the resident record.
5. Monthly rent for Bayshore Manor is paid by the resident at the beginning of each
month (no later than the 3rd day of each calendar month).
6. Monthly rent is paid by the resident at either the subsidized or full-pay rate.
a. Full-pay rate is established by the Monroe County Board of County
Commissioners (BaCC); the current full-pay rate in $2,846 per month.
o An increase in the full-pay rate is made in August of each year; the
monthly rate is correlated to overall facility operational costs
o Full-pay residents will receive written notification at least 30 days in
advance of the rate change.
o The Bayshore Manor Senior Administrator analyzes costs and
recommends to the Community Services Division Director a full-pay
rate each May.
o A recommended rate increase of 5% or less can be approved by
the County Administrator.
o A recommended rate increase of over 5% must be submitted to the
BaCC for approval no later than regular June meeting of the
BaCC.
2
Revised en /200e
b. A resident eligible for the County rent subsidy will pay her/his entire monthly
gross income up to the full-pay rate minus a personal care allowance that is
established in accordance with State guidance.
o Gross monthly income includes Social Security, Supplemental
Security Income, pensions, interest, income from mortgages,
contribution/gifts, Veterans Administration (VA), and other income.
o Effective 7/1/06, the personal care/use allowance is $35 per month;
the personal care/use allowance can be adjusted by the County
Administrator or the Deputy County Administrator at any time to
follow State guidance.
1. Personal care/use allowance will be skipped or reduced any
month when full payment would result in the resident having
more than $100 in her/his possession and as otherwise outlined
in the resident agreement.
7. The County/Bayshore Manor is not responsible for the payment of any healthcare
(primary, behavioral, dental, or other collateral) provider services and/or any
diagnostic or therapeutic services and supplies incurred by resident.
8. The County/Bayshore Manor is not responsible for the payment of a resident's over-
the-counter or prescription medications nor non-prescription medical and personal
hygiene supplies.
3
Revised 6/7/2006
BAYSHORE MANOR
a/k/a MONRQE COUNTY
ASSISTED LIVING FACILITY FOR THE ELDERLY
AGREEMENT
THIS AGREEMENT entered into this day of
between Monroe County, Florida (hereinafter "County"),
"Resident"), and (hereinafter "Responsible Party").
, by and
(hereinafter
WHEREAS, Resident desires to live in the County facility known as
Bayshore Manor; and
WHEREAS, County has reviewed Resident's application for admission;
now therefore,
IN CONSIDERATION of the mutual covenants herein contained, the
parties agree as follows:
A. COUNTY:
1. Shall furnish room, board, linens and assistance with activities of
daily living as may be required, based upon Resident's mental and/or
physical limitations both at and subsequent to the time of admission.
2. Shall arrange for transportation of Resident to:
a) physician's office for appointments; and
b) hospital if such transportation is ordered by physician or if, in
the opinion of the Director or his surrogate, Resident's
condition so warrants. The responsible Party (as designated
herein) will be immediately notified if Resident requires
hospitalization.
3. Shall make refunds on a per diem basis, commensurate with the date
of discharge from Bayshore Manor. Refunds will not be made for any days that personal
belongings remain in Resident's room nor as long as there are outstanding expenditures
for services received by Resident. No refunds shall be made to resident who is paying
less than the maximwn rate.
msword/forms/contr.res (resident)
4. Shall, in the event of closure of the facility for any reason, make a
pro-rated per diem refund as of the date of such closure. Such
applicable refund will be made within seven (7) days of closure, in
compliance with Florida Statutes.
5. Shall notify Resident and/or Responsible Party in writing thirty (30)
days in advance of any rate change.
6. Shall maintain no affiliation with any religious organization, except
to provide assistance to Resident in contacting such an organization
upon Resident's request.
7. Shall, if Resident is paying less than the Facility's Full monthly rate
due to acceptance of economic assistance from County or any other
governmental agency, and subject to the availability of funds, pay for over-
the-counter prescribed medication. This provision applies only if Resident
has insufficient medical insurance to cover such expenses.
8. Shall provide to Resident whose monthly rate is less than the
maximum rate, or who is paying the maximum rate but has no
additional funds, on a monthly basis, Thirty five ($35) Dollars for his/her
personal use.
Such monthly reimbursements will be skipped or reduced any month when
full payment would result in Resident having more than One Hundred
($100) Dollars in his/her possession; or any month that Resident receives
funds for personal use from any source, such as OSS, family, friends, etc.,
to the extent necessary to assure Resident at least Thirty five ($35) Dollars
for personal use.
9. Other
B. RESIDENT and/or RESPONSIBLE PARTY
1. Shall provide all clothing and personal effects (medications, perineal
hygiene supplies and medical supplies) as required by Resident.
2. Shall pay the agreed upon monthly rate no later than the third day of
each calendar month.
2
3. Shall comply with all requirements set forth in the application for
admission.
4. Shall fully comply with all rules and regulations as now established
by County or as may, in the future, be amended or established.
5. Shall make arrangements for Resident's immediate transfer to an
alternative, appropriate facility upon certification by a physician that
Resident is no longer capable of meeting the requirements for residency in
the facility. In the event that Resident has no person or agency, whether
Responsible Party, next of kin or other person or agency appointed to act
on Resident's behalf to represent him/her. Bayshore Manor shall assist
Resident in contacting an appropriate social service agency for placement.
Resident agrees to vacate the facility within seven (7) days after
d isq ual ification.
6. Shall remove Resident from Bayshore Manor and terminate this
agreement at anytime the Resident and Responsible Party are provided
written notice of their breach of any of the provision of this agreement.
7. Shall maintain on file with Bayshore Manor an up-to-date name,
address and telephone number for Responsible Party or next of kin.
8. By signature(s) hereon, Resident and Responsible Party verify the
truth of any statements and representations made on the application for
admission to Bayshore Manor. Any fraudulent statement shall be cause for
County to terminate this agreement upon providing at least seven (7) days
written notice to the Resident and Responsible Party.
9. Shall pay for such medications, as may be prescribed for Resident
by his/her physician, as well as necessary non-prescription medical
and personal hygiene supplies. The county has no responsibility
for medications, physician costs or hospitalization costs. The County
is not responsible for any prescription co-pays, premiums or
deductibles.
10. Move in
11. Other
C. PAYMENT
3
1. Resident and/or Responsible Party agree to pay County i
per month for residency at Bayshore Manor. This rate is subject to
annual increase.
2. MontWy payments shall be derived from the following sources:
a)
MontWy income of Resident
Social Security Income
Supplemental Security Income
Railroad Retirement Income
Civil Service Income
V A Pension
Other - Disability Pension
$
$
$
$
$
$
b)
Resident shall pay:
$
c)
Responsible Party shall pay:
$
TOTAL: $
3. At any time that the required montWy payment is not made, Responsible
Party shall remove Resident from Bayshore Manor immediately or be financially
responsible for all costs associated with enforcement of this agreement including,
but not limited to, montWy residential fee, and costs of collection including
attorney's fees and court costs.
4. Shall, if Resident is not paying the standard full-pay rate, pay any
increase in Resident's income (from any source) to County during his/her stay at
Bayshore Manor, up to but not exceeding the maximum rate as may from time to
time be adjusted by County.
D. STANDARD WAIVER
County shall continually exercise such reasonable care as to maintain the health
and safety of Resident. However, County does not provide any assurance or guarantee
for Resident's health and safety and shall have no liability for same. County shall have
no liability or responsibility for cash or other valuables which Resident may, at any time,
have in his/her possession on the premises of Bayshore Manor. Resident shall hold
4
County harmless for any and all claims arising directly or indirectly from any negligent or
intentional act of Client.
E. RESIDENT'S PERSONAL CASH
At no time shall Resident possess more than One Hundred ($100.00) Dollars cash
on the premises.
F. MEDICAL AND DENTAL SERVICES
County shall have no responsibility for liability in the provision of any services
including hospice, visiting nursing services, home physical therapy or podiatry, or any
other medical, nursing, alternative therapy or ancillary service performed at Bayshore
Manor. It is understood that agreements and contracts for those services are strictly
between the provider and resident (client). Further, Bayshore Manor does not refer or
recommend service providers to the client at any time.
County shall not be responsible for the payment of any health care provider
services and/or any diagnostic or therapeutic services and supplies incurred by Client.
Furthermore, County shall not be responsible for the payment of Client's over-the-
counter or prescription medications.
G. TERMINATION OF AGREEMENT
In the event that Resident vacates Bayshore Manor for more than fourteen (14)
consecutive days, except for hospitalization, this agreement shall automatically terminate,
and Resident or Responsible Party shall remove all of Resident's personal property
immediately. If property is not removed within seven days of the effective date of
the termination, County is authorized to remove and dispose of such property after having
made a reasonable effort to deliver it to Resident or Responsible Party without success.
In addition to the methods of terminating this agreement, detailed in Paragraphs B-5 and
G above, it may be terminated by Resident upon written notice to County at any time.
Additionally, County may terminate the agreement upon forty-five (45) days written
notice to Resident or Responsible Party, certified mail, return receipt requested.
H. DURATION OF AGREEMENT
5
Unless otherwise terminated, this agreement shall remain in full force and effect
until such time as a new agreement is duly executed.
I. AMENDMENT TO AGREEMENT
The parties may amend this Agreement only in writing and signed by County,
Resident and a Responsible Party.
J. NOTICE
Any notice required by this Agreement to be made by either party shall be made as
follows:
BAYSHORE MANOR
RESPONSffiLE PARTY
Name: Susan Scarlet
Address: 5200 College Road
Key West. Florida 33040
Phone: 305/294-4966
Name:
Address:
Phone:
Parties may substitute the above by written notice no later than the effective date
of the substitution.
K. FLORIDA LAW
Both parties shall at all times comply with the Laws of the State of Florida and
Monroe County. Further, Resident agrees that the proper jurisdiction and venue of
any claims mising under this Agreement shall be in Monroe COlmty, Florida.
Witnesses as to Resident:
Signature of the Resident
Witnesses as to Responsible Party:
Signature of Responsible Party
6
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BAYSHORE MANOR
ADMISSION, RETENTION. DISCHARGE. AND REFUND
POLICY: It is the policy of Bayshore Manor to meet or exceed the admission,
retention, discharge, and refund requirements of the State of Florida for a
standard Assisted Living Facility (ALF).
PURPOSE: To ensure that each resident has the capabilities necessary to
maintain themselves with available staff assistance in a standard ALF setting and
to ensure that discharge and refund procedures are known at the time of resident
admission to the facility.
PROCEDURES:
Admission
1. The Bayshore Manor Senior Administrator or her/his designee will conduct an
assessment of each applicant seeking admission to the ALF.
2. The assessment will determine the strengths, needs, preferences, and health
status of the individual seeking ALF admission and will include a medical
examination report and a determination of financial eligibility.
3. The individual seeking ALF admission must meet the following criteria:
a. Be at least 60 years of age, unless the age requirement is waived
by the Community Services Division Director or her/his designee.
b. Be a resident of Monroe County or have an immediate family
member that resides in Monroe County.
c. Satisfy admission financial requirements as described in approved
Bayshore Manor policy and procedure.
d. Be free from signs and symptoms of any communicable disease
that can likely be transmitted to other residents or staff.
e. Be able to perform the activities of daily living - such as
ambulation, grooming, eating, bathing, and dressing - with
supervision or with staff assistance if necessary.
f. Be able to transfer independently, with supervision, or with staff
assistance i'f necessary.
g. Be able to self-administer medications; if assistance is necessary,
may not require more than personal supervision of or assistance
with self-administered medication.
h. Be willing and able to contract with a third-party professional
healthcare provider if administration of medication is required.
I. Be able to participate in social and leisure activities to some extent.
J. Be able to supply, change, and properly dispose of her/his own
incontinence products if incontinent of bladder or bowel.
1
Revised 6n /2006
k. Be competent; if adjudicated incompetent, have a legal guardian
who is able to make decisions on her/his behalf and provide
Bayshore Manor with a photocopy of all relevant court documents.
I. Be nonviolent.
m. Be in sufficient health so as not to require licensed professional
care on a 24-hour basis.
1. Provide a copy of a physical examination conducted by a
licensed physician or ARNP within 60 days prior to
admission but no later than 30 days after admission that
evaluates and addresses the following:
-/ any required supervision or assistance with activities
of daily living
-/ any required nursing or therapy services
-/ any required special diet
-/ any required assistance with administration of
medication
-/ a list of current medication(s) prescribed
-/ a statement that in the opinion of the examining
physician or ARNP, on the day the examination is
conducted, the individual's needs can be met in an
ALF
-/ date of the examination with the name, signature,
address, phone number, and license number of the
examining physician or ARNP.
n. Be capable of self-preservation in an emergency situation involving
the immediate evacuation of the facility independently or with staff
assistance.
4. A couple seeking ALF admission together must both meet individual criteria
listed in #3 above.
Retention
1. The Bayshore Manor Senior Administrator or her/his designee will determine
the appropriateness for continued residence of an individual living in the ALF.
2. The criteria for continued residence shall be the same as for admission
described above.
Discharae
1. The Bayshore Manor Senior Administrator or her/his designee will determine
when an ALF resident may be discharged and when the resident's admission
contract will be terminated based on the following criteria:
a. When a resident vacates Bayshore Manor for more than 14 days,
except for hospitalization, the residency agreement automatically
terminates and the resident or responsible party will remove the
resident's personal property immediately.
2
Revised 6/7/2006
o If property is not removed within 7 days of the effective date of
termination, County/Bayshore Manor is authorized to remove
and dispose of such property after having made reasonable
effort to deliver it to resident or responsible party.
b. With the certification by either a physician or the Senior Administrator
or her/his designee that the resident is no longer capable of meeting
the requirements for residence in the ALF, the resident (or responsible
party) will be notified to immediately vacate the facility. A resident may
not be bedridden for more than 7 consecutive days.
c. If in the judgment of the Senior Administrator or her/his designee the
resident manifests such chronic behavior as to pose a physical or
mental danger to himself/herself or others or manifests such chronic
behavior as to interfere with the care and comfort of other residents,
the resident (or responsible party) will be notified to immediately vacate
the ALF.
d. Notwithstanding provisions in Florida Statutes and Administrative
Code, if the resident is receiving care from a licensed hospice and
nears the end of life and/or the health condition deteriorates such that
the resident requires total help with activities of daily living and
instrumental activities of daily living, the resident will be asked to
relocate to another facility or domicile. This request will be made
regardless of other additional or alternate means by which the resident
may arrange for care.
2. The County may discharge a resident upon 45 days written notice to resident
or responsible party.
3. The resident and/or responsible party may request discharge at any time
upon written notice to the County/Bayshore Manor.
Per Diem Refund
1. The Bayshore Manor Senior Administrator or her/his designee will determine
the termination date of a resident from the ALF due to discharge, transfer, or
death.
2. The termination date will be the date the ALF room is vacated by the resident
and cleared of all personal belongings.
3. If the resident's belongings are not removed from the ALF, the resident or
responsible party will be responsible for the actual cost of moving and storing
the belonging with 14 days advance notification.
4. If the resident's possessions are not claimed within 45 days after notification,
the ALF will dispose of them.
5. The Bayshore Manor Senior Administrator or her/his designee will determine
when a refund is due to an ALF or responsible party based on the signed
resident agreement and as follows:
a. A pro-rated, per diem refund will be made to the resident or
responsible party commensurate with the date of termination from
Bayshore Manor, except that such refund will be reduced to the extent
3
Revised 6/7/2006
of any outstanding expenditures for services received by the resident
as well as to the extent of any damage to the facility as may have been
caused by the resident, above and beyond reasonable wear and tear.
Such a refund will be made by Monroe County within 45 days of
discharge.
b. In the event of closure of the facility for any reason other than in the
case of a mandatory evacuation, a pro-rated, per diem refund will be
made to the resident or responsible party as of the date of closure; and
such refund will be made by Monroe County within 7 days of closure.
c. No refunds will be made to a resident who is paying less than the full-
pay rate.
4
Revised 6/7/2006