Resolution 208-1979RESOLUTION NO.208 -1979
RESOLUTION APPROVING THE AGREEMENT TO BE USED
FOR ALL RESIDENTS WHO SHALL USE THE MONROE
COUNTY HOME, ADULT CONGREGATE LIVING FACILITY
FOR THE ELDERLY - LEVEL II.
BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA:
1. That the Agreement to be used for all residents
who shall use the Monroe County Home, Adult Congregate
Living Facility for the Elderly - Level II, a copy of which
is attached hereto, is hereby approved and shall be used
for and by persons who are allowed to reside in said home.
2. That the County Administrator is hereby authorized
to execute said Agreement in behalf of Monroe County and to
allow for use of the Monroe County Home, Adult Congregate
Living Facility for the Elderly - Level II located on Stock
Island, Monroe County, Florida.
Passed and adopted by the Board of County Commissioners
of Monroe County, Florida, this I8_th day of September, 1979.
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY FLORIDA
By 1,
airman -
(Seal)
APPRO VED AS TO FO-gM
AWD 41.19AL SUFR0EMCY.
sip L
AnaMey-S Wig*
APPROVED ON
BOOK It T �1 PAGE S 4
303
MONROL" COUNTY HONIF , ADULT CONGR-EGRATI:
LIVING FAC I I, TY FOR T111ELDERLY - LEVEL I I
A G R E E M E N T
This Agreement entered into this — day of
by and between the County of
Monroe, State of Florida, hereinafter called "County", and
a
hereinafter called "Resident", and
Party"
, hereinafter called "Responsible
IV I T N L S S L• I II:
WHEREAS, the Resident desires to use the facilities
of the County known as The Monroe County Flome, and
WHEREAS, the County has reviewed the application
of the Resident for admission to The Monroe County Home and
has determined that the Resident is eligible for admission
to said home, now, therefore,
IN CONSIDERATION of the mutual covenants, promises
and promises herein contained, the parties agree as follows:
A. THE MONROE COUNTY F1OME
1-. To furnish room, board, Linens, prescribed
medicines and general, personal care.
2. TO arrange for the transfer of the
Resident to the hospital of Resident's
choice, when ordered by the attending
physician or the heal-th of the Rest
dent requires same, and immediately
notify any responsible party (as
designated herein) of such transfer.
3. To make refunds in accordance with the
folic), of the Home. Refunds cannot
be made as long as personal belong-
ings remain.in the Resident',; room.
Refunds cannot be made ,as long as
there are outstanding expenditures
for services received by the Resident.
4. Other:
B. THE" RESIDENT OR RESPONSIBLE PARTY
1.. TO provide such personal clothing rind
effects as needed or desired by the
Resident.
Z.
To pay the monthly rate agreed upon and
such charges as clotcrmined by -The Monroe.
County Mollie to be necessary for the
operation of the home.-
3.
That, upon ccrtificatior, by a physician
or the Administrator of The 1101fle, that
the Resident is no longer capable of
meeting tl,e requ irenicnt s for occupancy
in this facility, the Resident, next of
kin, Legal representative, or agency.
acting on the Resident's behalf, will
be notified and the Resident will have
to make arrangements for immediate
transfer to an appropriate facility.
In the event a Resident has no person
to represent him/her, this fac..lity
shaI I assist Resident in contacting an
appropriate social sc:.rvice agency for
placement. Applicant agrees to vacate
the facility within forty-eight (48)
hours after disqualification.
4.
I,o comply with all requirements as set
fort), in the Application made by the
Resident.
5.
fo comply with all rules and regula-
tions established by the County for
operation and control of. said home.
6.
Other: --
C. I'INAN(,IAI.
ARRANGE-NIENTS
The Resident and/or responsible party agrees to
pay to tile. County $
rent for use of the facilities.
D.
, per month as
payment will be from the follo,ving sources:
1. Personal. funds of Resident $
2. Responsible party will pay $
3. Unearned income of Resident
w:i.11 pay:
Social_ Security $
Civil. Service Annuity $
VA Pension $
Other $
STANDARD ADMISSION WAIVER:
"Ihe County through _its employees has agreed to
exercise such reasonable care toward the Resident as his or
her known condition may require; however, this home is in no
sense an insurer o.f his or her safety or welfare and assumes
no liability as such.
3 as
a
The Management of this home will not be.respon-
sible for any valuables o'r money left :in the possession of
.this person while he or she is a resident of this home.
E. TERMINATION
If Resident'is absent from the .home in excess of
fourteen (14) conti.nUous clays, Such absence shall automa-
tically terminate this Agreement and the Resident shall
remove all of his or her property or belongings immediately.
If Resident fails to remove same., the Resident does hereby
authorize the County to remove said property or belongings
and deliver same to Responsible Party.
F. MEDICAL SERVICES
The parties agree that Monroe County shall not be
or assume any responsibility for.payment-of.any medical or
hospital's.ervices, unless specifically agreed to by the
parties or their representatives at the .time of the render-
ing of service.
G. DURATION OF AGREEMENT
Either party may terminate this agreement on five
(5) days written notice. otherwise, it wi.11. remain in
effect until a cliff-erent agreement is executed. 1-1owever,
this does not mean that a Resident will be forced to remain
in the facility against his/her will for any length of time.
Signature of Resident
Witnesses as to
Resident
Signature of
Responsible Party
Witnesses as to
Responsible Party
Signature of
Representative of.
Monroe County Home
Date:
HE