11/06/1987 AgreementBAy SHORE MANOR
A /K /A MONROE COUNTY HOME
ADULT CONGREGATE LIVING FACILITY
FOR THE ELDERLY - LEVEL II
A G R E E M E N T
This agtteement ent eAed into th is 6th day o6
November
19 87 , by and between the County o6 Montoe, State o{,
Ftotr i.da, heviceina6tett caned "County ", and _ ,I_ u)a h d T (ilaP 6 h
heAeinabteA catted "Raident ", and John Battitto
fUTTNF4SFTH:
heAeinabteA cawed "Rers pontsibt e Patty",
WHEREAS, the tLuident deziu n to use the jac t ty o6 the County
known as the MonhLoe County Home, a /k. /a Bay Shone ManoA and,
WHEREAS, the County has reviewed the appei.cation ob the te,6ident �oA -
admiz,sion to the MonAoe County Home and has deteAm.ined that the Aestdent is
eP.ig.ibte 6oA admi6zion to said home, now, thene6otte,
In conzideAation o f the mutuat cov enants , pAomiz ets and pttem i 6 e6
heAe%n contained, the patches agtcee ate bottowz :
A. BAy SHORE MANOR
1. To �utcnish Aaam, baatcd, P.inem, } 1 Cc K�xW-AgvJ"
and genekat peuonat carte.
2. To atucang e Got the tAanws U etc o� the Ae�sident to the
haapitae o� the te6ident',s choice when o&detced by the
attending physician aA the hea.Pth of the tes dent
Aequi.tes same, and to immedcatee.y noti6 y any
Aespows.ibte panty (as designated herein) o6 tsuch. ttanzjett.
3. To make Ae�unds on a pets diem basis in accoAd with date
ob diachaAge 6tom the home. Re6unds cannot be made as
tong a-s peAzonat bePongings remain in the Ae/sident'ts
Room. Re6unds cannot be made ass .bong ats thetce cute
out,standing expenditut a 6otL t;ehvices Aecei.ved by the
Ae6.ident.
4. In the event oU ctotsutte ob the 6acc?,ity Gott any Aeason,
a pu- tutted peA diem te6und tshatt be made in accotcd
with date o{ ctat6utce. within seven (7) days.
5. OtheA:
B. THE RESIDENT OR RESPONSIBLE PARTY
1. To pAovide such peuonat ctothin.g and e6 6 ects as
needed oA desited by the to ident.
2. To pay the monthly hate agtceed upon and Such
ehatcga as detenm.ined by the Montoe County Home
to be necuzaACy 6oA the opeAation o6 the home.
3. That, upon ceAti6.icati.on by a physician otc the
adm.in ustt atoA o6 the home, the Aes.ident is no
tongeA eapabte o6 meeting the Aequitements 6oA
occupancy in this bac t ty, the to ident, next o6
kin, tega, AepAe s entativ e oA agency acting on the
Ae,s ident' b ehat6 , w,i.Q.Q. have to make aAAangem
6oA the immediate tAansbet to an apptoptiate 6 aeit ty.
In the event a Ae�s.ident hays no pm on to AepAez ent
him /heA, thiz 6ac City shaU aussii t Aes ident in
contacting an apptopn,iate Soeiat SeAvice Agency 6oA
ptaeement. Appti.cant agAees to vacate the 6acit ty
within bon ty - eight ( 48) houtr6 a6teA d it6 quati 6 ieation.
4. To eompty with att Aequ.itcements " set 6oAth. the
apptieation made by the Ae,5ident.
5. To eompty with a22 kut" and Aegutations atabti -shed
by the County 6oA opetcation and eontAot o6 6aid home.
6. Agtea, .i6 not paying the maximum Rate, to pay
.incAe"e in. income during the coonse o6 Aesidency,
up to the maximum Aate..
7. OtheA: R esident w.itt pay Jot att med.ieat b.itt
which .include, medic.inez, Medicate Hozpitat
e ue ti e, Ventat and E Cate biZZ.6.
C. FINANCIAL ARRANGEMENTS
The tm ident and /oA Aespons ibte panty agneez to pay to the
County $ j 00 , pet month as tent 6oA use o6 the 6aciZitie6.
PAYMENT WILL BE FROM THE FOLLOWING SOURCES:
1. Personae 6unds o6 Ae�s,ident
2. Rezponzibte patty w.itf- pay
3. Uneatcned income o6 Aea.ident
witt pay:
Soeiat Security
C.ivit Sety ice Annuity
V. A. Pe" ion
0the TeamzteA Penz ion
$ 619.00
$ 426.00
$ 150. 00
2
f '
D. STANDARD ADMISSION WAIVER
The County, th)Lough its emptoyeu, hays agreed to exeAcise .such
Aeazon able catce towaAd the tes ident ah W on hen known condition may tequiAe.
However, this home is in no .sense an .insuneA ob his oA hen satiety oA wetbane
and ashumes no Habit ty ass such.
The management ob this home w.iQ,2. not be Aespons.ibte 6m any
vatuabtez oA money Zebt in the posz etmion ob this petr6on white he oA she tis
a Ae�s.ident o6 this home.
E. TERMINATION
Ib Ae�s.ident is absent bAom the home in excess ob boutteen (14)
continuous days, such absence sha.P_,2 automatically teAminate this agreement
and the An ident .6haU Remove a,e.Q. ob hi6 on hen pnopeAty on beP-ongings
.immedi.atety. Ib tes.ident ba.i L to Aemove .sam the us ident does hetceby
authoAize the County to Aemove za,id propWy on betong.ing6 and deti..vetc game
to Ass ponz ibte paAty.
F. MEDICAL SERVICES
The panties agree that Monroe County shah not be Aesponz ibte bon
oA a6.6ume any &uponz ib.i e ity bon payment ob any medicat on hosp-ctat SeAv.icu
untn6 speci4icatty agreed to by the paAti,e6 oA then Aepnes entatives at the
tim o6 the Aenden,ing o6 z env,ic e.
G. DURATION OF AGREEMENT
E-ithen panty may tenmdnate this agreement on thiAty (30) days
wA tten notice. Othenw,i s e, it w,itt Remain in eb b ect untit a di b event
agreement iz executed. Howeve t, this does not mean that a to ident w.itt be
bonced to remain in the bacLt ty against his /hen w.itt b o A any .length ob time.
E OF RMDENT
W17NES7S AS TO RESIDENT
Il
3
DATE:
APPROVED: I o
Stigna uAe o4 , epnesen a ve
o4 MonAoe Cou ty Home a /k /a
Bay Shone Manors
Stig natuAe o6 Bx ecutkv e
Di.LectoA-- MonAae County
Sociat SvLvices
gnaw o County
AdministAataA
Thin iz to cvLti6 y that thi.s Admizzion AgAeement ass appAov ed by
the County Home and the County AdminiztAatoA ways Aati6ied by the
ManAoe County Boand o6 County CommizzioneAz at theiA meeting
held on the .' 7 - day o{ 4, c/ e— /n 3e -I , 19
<.
Stig n uAe o y C atiAman
MonAoe Coun Boand oA
County Commizzioneu
M