01/07/1993 AgreementRAYSHORE MANOR
A/K/A MONROE COUNTY HOME
ADULT CONGREGATE LIVING FACILITY
FOR THE ELDERLY
A G R E E M E N T
This agreement entered into this 7th day of
19 93,
cD
by and between the County of Monroe, State of Florida, = C''
GERALD ABREU SR.
hereinafter called "COUNTY" and
hereinafter called "RESIDENT" and GERALD ABREU JR.
hereinafter called "RESPONSIBLE PARTY".
c.
W I T N E S S E T H:
JANUARY
WHEREAS, RESIDENT desires to live in the County facility known as
Bayshore Manor, and
WHEREAS, COUNTY has reviewed RESIDENT'S application for admission
to Bayshore Manor and has determined that RESIDENT is eligible
for admission, now therefore,
In consideration of the mutual covenants, promises and premises
herein contained, the parties agree as follows:
A. BAYSHORE MANOR:
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 his/her
physician's office and/or arrange for RESIDENT'S
transportation to hospital if such transportation is
ordered by physician or if, in the opinion of the
Director or his surrogate, RESIDENT1.5 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.
Refunds will not be made as long as there are
outstanding expenditures for servi'es received by
RESIDENT.
4. Shall, in the event of closure of he facility for any
reason, make a pro -rated per diem fund as of the date
of such closure. Such applicable r furd--will be made
within SEVEN (7) DAYS of closure, in compliance with
-o
.n
1
RM
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 organization upon RESIDENT'S request.
7. Shall pay for such medications as may be prescribed
for
RESIDENT by his/her physician, as well as necessary
non-prescription medical supplies, provided that
RESIDENT'S monthly rate under this agreement is less
than
maximum rate and RESIDENT has insufficient medical
insurance to cover such expenses, or in the event that
RESIDENT'S monthly rate under this agreement is the
maximum rate but RESIDENT has neither sufficient
additional funds nor sufficient medical insurance to
pay
for the above.
8. Shall provide to RESIDENT whose monthly rate is less
than
the maximum rate, or who is paying the maximum rate
and
has no additional funds, on a monthly basis, TWENTY
($20.00) 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 ($100.00) DOLLARS in
his/her possession; or any month that RESIDENT receives
funds for personal use of up to TWENTY ($20.00) DOLLARS,
from any source, such as OSS, etc., to the extent
necessary to assure RESIDENT of at least TWENTY ($20.00)
DOLLARS for personal use.
9. Other: Shall pay for prescription medication and necessary
non-Lrescription medical supplies until such time as
RESIDENT'S residence located at 1407 Patricia 777
Key West, Fla. is rented for 1,000 mo. or more, a
which time RESIDENT will be responsible for all such
costs.
RESIDENT and/or RESPONSIBLE PARTY
1. Shall provide all clothing and personal effects as
required by RESIDENT.
2. Shall pay the agreed upon monthly rate no later than the
third day of each calendar month.
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 either a physician or the Director of
Bayshore Manor that RESIDENT is no longer capable of
meeting the requirements for residence 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 disqualification.
6. Shall, if RESIDENT is not paying the maximum rate, pay
any increase in RESIDENT'S income (from any source) to
COUNTY during his/her stay at Bayshore Manor, up to but
K
not exceeding the maximum rate as may from time to time
be adjusted by COUNTY.
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. other: Shall maintain in full force and effect through
stay at HaysFore manor a ea insur-
ance policies which are in ef7ect as ot the ay and
date first above written.
C. FINANCIAL RESPONSIBILITY
RESIDENT and/or RESPONSIBLE PARTY agree to pay COUNTY
$ 1690.00
facility.
per month for use of COUNTY'S Bayshore Manor
Monthly payment shall be derived from the following sources:
1. Personal funds of RESIDENT
2. RESPONSIBLE PARTY will pay
3. Monthly income of RESIDENT:
Social Security income
Supplemental Security Income
Railroad Retirement income
Civil Service income
V.A. Pension
Other
D. STANDARD ADMISSION WAIVER
$ -0-
$1690.00
$ N/A
$ N/A
$ N/A
$_ N/A
$ N/A
$ N/A
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 COUNTY
harmless for any and all claims arising directly or indirectly
from any negligent or intentional act of RESIDENT.
3
E. RESIDENT PERSONAL CASH
RESIDENT shall at no time have in his/her possession on the
premises personal cash in excess of ONE HUNDRED ($100.00)
DOLLARS.
F. MEDICAL AND DENTAL SERVICES
COUNTY shall not be responsible for the payment of any medical,
chiropractic, dental or hospital bill incurred by RESIDENT.
Furthermore, COUNTY shall not be responsible for the payment of
RESIDENT'S "over-the-counter" or prescription medications except
as detailed in paragraph A-7, above.
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 in a timely
fashion, the parties agree that 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
THIRTY (30) DAYS written notice to RESIDENT of RESPONSIBLE PARTY,
certified mail, return receipt requested.
H. DURATION OF AGREEMENT
Unless otherwise terminated, this agreement shall remain in full
force and effect until such time as a new agreement is duly
executed.
4
T. AMENDMENTS TO AGREEMENT
This agreement may be amended at any time subsequent to its
execution by both parties, or their legal representatives, by the
parties or their legal representatives signing and executing
such an amendment.
J. NOTICE
Any notice required by this agreement to be made by either party
shall be made as follows:
BAYSHORE MANOR
Name: ROBERT E. LAZARUS, M.D.
Address:5200 COLLEGE ROAD
KEY WEST, FLA. 33o4o
Phone: (305)294-4966
RESIDENT/RESPONSIBLE PARTY
Name: GERALD ABREU, J R.
Address: 1418 PATRICIA ST.
KEY WEST, FLA. 33o4o
Phone:(305)296-3780
Parties may substitute the above by proper notice.
R. 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 arising under this
agreement shall be in Monroe County, Florida.
WITNESSES AS TO RESIDENT
IGNATURE OF RESIDENT
SEE COPY OF POWER OF ATTORNEY
ATTACHED AND BY REFERENCE MADE
PART OF THIS AGREEMENT
4
WITNESSES AS TO RESPONSIBLE PARTY
DATE • 2"
DATE: I - 2- s Y
DATE: - 1 -CA3
APPROVED:
SIGN RE OF RESPONSIBLE PARTY
SIGNATURE OF DIRECTOR, BAYSHORE MANOR
SIGNATURE OF EXECUTIVE DIRECTOR,
MONROE COUNTY SOCIAL SERVICES DEPARTMENT
SIGNATURE OF
ON DIRECTOR,
COMMUNITY SERVICES DIVISION
SIGNATURE OF MONROE COUNTY ADMINISTRATOR
This is to certify that this AGREEMENT as approved by Bayshore
Manor amd the Monroe County Administrator was ratified by the
Monroe County Board of Commissioners at it's meeting held on the
/0'20-A day of 19 93
SIGN3. RE OF THE CHAIRPERSON
COUNTY BOARD OF
COUNTY COMMISSIONERS
(SEAL)
ATTEST: DANNY L. KOLHAGE, CLERK
Deputy Cerk
NY
f3
A
D IRABLE POWER OF ATTORNEY
I, GERALD ABREU, SR., currently residing at 1407 Patricia St.
33040 hereby constitute, appoint and make GERALD ABREU, JR., my son, of 1418
Patricia St., Key West, FL 33040, as my attorney -in -fact to act m n Key West, FL
every act that I may legally do through an attorney -in -fact including but
and to do
buying, selling, mortgaging or transferring, _ but not limited to, the
of real property.
IN ADDITION, my attorney -in -fact is given authorityto arrano
medical, therapeutical, and surgical procedures for me inclung Je for and consent to
drugs. the administration of
THIS DURABLE POWER OF ATTORNEY shall commence and be in full force
and effect beginning December i ,
affected by my disability or incapacity except as provided by Sta�ed> and shall not be
NOTIFICATION of the execution of this Durable Power of Attorney
given to my son, GERALD ABREU, JR., via hand delivery, on this has been
December, 1992. day of
IN WITNESS WHEREOF, I have knowing* influence, set my hand and seal thi; glY� willing
WITNESSES: s ly and without undue
-�_, day of Dc,uc,m ber, 1992.
STATE OF FLORIDA
COUNTY OF MONROE
GE ALD ABRE , SR.
RALD ABREU, JR.,
ORNEY IN FACT
BEFORE ME. the undersigned authority personally a eared, GERALD ABRE
SR., to me known to be the person described in and who executed the fore
Power of Attorney and who has ackno cribe U,
mud bc,lc)re me that he executed sane Durable
r, WITNESS, my hand and official sea] in the County and State last aforesaid this
d;A;' Of December, 1992.
SEAL, OF OFFICE i
NOTARY PUBLIC, State of Florida
(print name and W
DID TAKE AN OATH _DID NOT TAKE AN OATH
Personally known
__Produced identification: