Client Rights and Responsibilities

This section sets out the standing under which this policy is issued, who owns it, who is bound by it, and how it is kept current. It is not itself a procedure. The obligations begin at Section 1.

This policy makes sure every client of Sample Agency, LLC knows, before services begin, what the client may expect from the Agency, what the Agency asks of the client, and how to raise a concern, and that staff respect those rights on every visit. Ohio's licensing rules for nonmedical home health agencies do not prescribe a client rights notice, so this policy sets the Agency's own standard for all clients and adds the rights that Ohio Department of Medicaid and Ohio Department of Aging rules give clients in those programs.

This policy applies to every client of Sample Agency, LLC, whatever the payer (private pay, long-term care insurance, PASSPORT, the Ohio Home Care Waiver, MyCare Ohio or another program), from the first contact through discharge, and to the client's representative whenever a representative acts for the client (Policy OH-HC-CR-03).

For the purposes of this policy, the following terms have the meanings below. Ohio Revised Code Chapter 3740 and Ohio Administrative Code Chapter 3701-60 call the person served a "patient", and the Ohio Department of Aging and Ohio Department of Medicaid rules call that person an "individual". In this manual the person served is the "client"; the three words mean the same person.

Every client of Sample Agency, LLC has the rights listed in Section 5 and is asked to meet the responsibilities in Section 8. Before services begin, or at the latest at the first visit before any service is given, the Agency gives the client and any representative the written rights notice (Form OH-HC-CR-01-A), explains it in a way the client understands, and keeps the signed acknowledgment in the client record. A client on an ODM-administered waiver also has each right in OAC 5160-45-03(A) (Section 6). No client is ever penalized for exercising a right or making a complaint; a waiver client has the right to request assistance with problems, concerns and issues, and to suggest changes, "without fear of repercussion" (OAC 5160-45-03(A)(12)), and the Agency gives every client the same protection as its own standard.

As the Agency's own standard, every client of the Agency has the right:

1. to be treated with dignity, courtesy and respect, and to have the client's culture, beliefs, privacy, home and belongings respected;
2. to be free from abuse, neglect, exploitation and misappropriation of property, and from restraint, seclusion and any other restrictive intervention (Policies OH-HC-ANE-01 and OH-HC-SVC-05);
3. to be served without discrimination, and to receive information in a language and format the client understands, free of charge (Policy OH-HC-CR-02);
4. to receive in writing, before services begin, the services the Agency will provide, the planned schedule, the charges and who pays them, and to receive written notice of any change in charges (Policies OH-HC-ADM-02 and OH-HC-BUS-01);
5. to take part in planning the services, to have the activity plan reflect the client's preferences, routines and goals, and to receive a copy of it (Policy OH-HC-SP-01);
6. to refuse any service or task, and to have the aide supervisor talk through any concern about the refusal, without losing any other service;
7. to ask for a change of aide or visit time, and to have the request met as far as the Agency is able;
8. to know the name and job title of every staff member who visits, and to see the staff member's Agency identification;
9. to be served only by staff who have been screened through the database review and criminal records check that Ohio law requires (ORC 3740.11; OAC 3701-60-05 to 3701-60-07) and who are trained and supervised (Policies OH-HC-HR-02, OH-HC-TRN-01 and OH-HC-SUP-01);
10. to confidentiality of personal and health information, and to see and obtain a copy of the client's own Agency record (Policies OH-HC-PRV-01 and OH-HC-RM-01);
11. to make decisions about the client's own care and affairs, to appoint a representative, and to receive written information about advance directives (Policy OH-HC-CR-03);
12. to receive written notice before the Agency reduces or ends services, with the reason, except in the situations listed in Policy OH-HC-DC-01;
13. to make a complaint or suggestion to the Agency or to any outside agency at any time, to have it looked into promptly, and to be told the outcome (Policy OH-HC-CMP-01);
14. to have the client's money and property treated with care, and to receive written instructions for claiming payment for a loss due to theft or property damage caused by the Agency or its staff (Policy OH-HC-ETH-02);
15. to be free from the staff conduct the Agency prohibits, including requests for money, gifts or tips (Policy OH-HC-ETH-01); and
16. to receive services in a way that supports the client's independence and choices, consistent with the person-centered services plan when the client has one.

These rights apply to every client whatever the payer. No staff member may ask a client to give up a right as a condition of receiving services.

For a client enrolled on an ODM-administered waiver, OAC 5160-45-03(A) lists the individual's rights. The rights notice repeats them for waiver clients, and the Agency acts on each one that concerns a provider as shown below. (The right in OAC 5160-45-03(A)(9) concerns non-agency providers and does not involve the Agency.)

• If the Agency is ODA-certified, it is subject to all state and federal laws on individual confidentiality, including ORC 5160.45 to 5160.481, 42 CFR 431.300 to 431.307 and 45 CFR Parts 160, 162 and 164 (OAC 173-39-02(B)(4)).
• If the Agency is ODA-certified, its employees must not engage in the unethical, unprofessional, disrespectful or illegal behavior listed in OAC 173-39-02(B)(8). As the Agency's own standard, the same list protects every client (Policy OH-HC-ETH-01).
• If the Agency is ODA-certified, it has written instructions any individual may use to obtain payment for loss due to theft or property damage caused by the provider or its employee (OAC 173-39-02(A)(5)(b); Form OH-HC-ETH-02-A). The Agency gives these instructions to every client.
• For waiver clients, the federal home and community-based settings rule requires settings that ensure "an individual's rights of privacy, dignity and respect, and freedom from coercion and restraint" (42 CFR §441.301(c)(4)(iii)). The Agency's services in the client's home support those rights.

As the Agency's own standard, each client, or the client's representative, is asked to:

1. give accurate and complete information about the client's needs, any health conditions that affect the services, and any changes;
2. tell the office as soon as possible, and if possible at least 24 hours ahead, when the client will not be home or wants to cancel or change a visit (Policy OH-HC-BUS-01);
3. treat staff with respect and provide a safe place to work, including keeping pets secured and weapons stored away during visits, and not smoking in the room while an aide is giving hands-on care;
4. not ask staff to do tasks that are not in the activity plan, that are unsafe or illegal, or that are for other members of the household, and not offer staff money, gifts or tips;
5. confirm each visit as the Agency asks, for example by signing the visit record or confirming the electronic visit verification entry (Policy OH-HC-BUS-02);
6. pay any private-pay charges as agreed (Policy OH-HC-BUS-01); and
7. tell the Agency about any problem with the services, so that it can be put right.

A client on an ODM-administered waiver has also signed a waiver agreement that lists the client's responsibilities in OAC 5160-45-03(B)(1). Those that involve the Agency include: participating in the development and maintenance of back-up plans ((B)(1)(e)); not directing the provider to act contrary to program rules ((B)(1)(g)); verifying service delivery, including the date and location, start and end times, and the signatures of the provider and the individual or authorized representative, where "All signatures will be obtained within three business days of the completion of service delivery." ((B)(1)(h)); reporting service delivery issues, significant changes and incidents to the case manager ((B)(1)(n), (q), (r)); and keeping scheduled appointments and notifying the provider and case manager of a missed visit ((B)(1)(o)). When an agency provider serves the client, the client identifies a location in the residence where a record containing a copy of the client's medication profile, if one exists, will be safely maintained (OAC 5160-45-03(B)(2)). A client who does not meet a responsibility is never penalized without discussion: the supervisor first talks with the client and any representative to find a solution, and ending services is a last resort under Policy OH-HC-DC-01.

1. At or before the first visit, and before any service is given, the aide supervisor or the intake staff member gives the client and any representative Form OH-HC-CR-01-A, together with the notice of nondiscrimination (Form OH-HC-CR-02-A), the advance directive information (Policy OH-HC-CR-03) and, where the Agency is a HIPAA covered entity, the notice of privacy practices (Policy OH-HC-PRV-01).
2. The staff member goes through each right and responsibility in plain language, in the client's preferred language through a qualified interpreter where needed, and in large print or another format the client needs (Policy OH-HC-CR-02), and answers questions.
3. For a waiver client, the staff member also goes through the waiver rights in Section 6 and writes the case manager's name and phone number on the notice.
4. The client or representative signs the acknowledgment on the notice. If the client cannot or will not sign, the staff member writes the reason, the date and who was present.
5. The client keeps a copy in the home folder. The signed original goes in the client record within two business days, as the Agency's own standard.
6. If the client cannot understand the notice at the start of services, for example because of confusion or acute illness, it is given to the representative and explained again to the client when the client is able.
7. The notice is given again whenever the Agency changes it, when a new representative begins to act, when the client starts or stops receiving services through a Medicaid program, and, as the Agency's own standard, every year at a supervisory visit.

Every staff member in a client's home:

• knocks or rings, waits to be let in, and says who they are and why they are there;
• uses the name the client prefers, and asks before entering a room, opening drawers or moving belongings;
• protects the client's privacy during personal care by closing doors and curtains and keeping the client covered as much as possible;
• explains each task before starting it and stops if the client says no, then tells the supervisor about the refusal the same day;
• never discusses other clients, and never shares what is seen or heard in the home except with the Agency as part of the job;
• tells the supervisor about any request that is outside the activity plan, rather than refusing rudely or agreeing to it; and
• never threatens, argues with, blames or treats differently a client who complains. Any staff member who retaliates against a client is disciplined under Policy OH-HC-ETH-01.

The rights notice tells each client that a concern may be raised with any of the following, at any time and in any order, and that the client does not have to complain to the Agency first:

• The Agency: the complaint officer, Pat Sample, on (614) 555-0111, or the office on (614) 555-0100 or office@example.com. Complaints are handled under Policy OH-HC-CMP-01.
• The Ohio Department of Health, which licenses the Agency: contact the Ohio Department of Health, Bureau of Survey and Certification, Complaint Unit: use the online Complaint Form at https://complainttracking.odh.ohio.gov/publiccomplaint/publiccomplaintform or email HCComplaints@odh.ohio.gov; if you cannot use the internet or email, call 1-800-342-0553 or the Home Health Hotline at 1-800-669-3534. You may file a complaint anonymously.
• Suspected abuse, neglect or exploitation of an adult: Adult Protective Services, a program of the Ohio Department of Job and Family Services: call 1-855-OHIO-APS (1-855-644-6277) at any time, contact the county Job and Family Services office, or use the Ohio Adult Protective Services Online Referral at https://aps.jfs.ohio.gov/. If someone is in immediate danger, call local law enforcement immediately.
• The long-term care ombudsman: contact the Office of the State Long-Term Care Ombudsman, Ohio Department of Aging: 1-800-282-1206, OhioOmbudsman@age.ohio.gov, www.Ombudsman.Ohio.gov. Regional ombudsmen also help people living in their own homes with problems with home care and other support services. Ombudsman services are free.
• For a Medicaid client: the client's case manager; for PASSPORT, ODA's designee for the region; and the Ohio Department of Medicaid consumer hotline, 1-800-324-8680.
• Discrimination: the U.S. Department of Health and Human Services, Office for Civil Rights (Policy OH-HC-CR-02).

The Department of Health's complaint unit does not handle billing or reimbursement disputes, employment disputes, guardianship or power of attorney matters, or incidents more than one year old; staff help a client find the right agency for those. Separately, Ohio law forbids an employer to discharge, demote, transfer or otherwise retaliate against an employee because the employee filed an adult protective services report (ORC 5101.63(E)).

Accountability under this policy is allocated as follows.

The signed Form OH-HC-CR-01-A, each re-issue, and any note that a client could not or would not sign are kept in the client record and retained under Policy OH-HC-RM-01: for Medicaid services, at least six years after the date of receipt of payment and until any audit or review is completed (OAC 5160-44-31(B)(15); OAC 173-39-02(B)(10)(a)(i)), and, as the Agency's own standard, six years after the last service or last payment, whichever is later, for every client. Each quarter, as the Agency's own standard, the Administrator checks the records of at least ten clients admitted in the quarter (or all of them if fewer) for a signed notice dated on or before the first service, and asks at least five clients or representatives whether staff respect their rights. Findings go to the quality improvement program (Policy OH-HC-QA-01).

Every staff member is trained on client rights, dignity and privacy at orientation before the first client contact and at least every year (Policy OH-HC-HR-05). Aide supervisors and intake staff are also trained to explain the notice, use an interpreter, and answer questions about outside agencies. Staff are retrained whenever the notice changes.

This policy implements the following authorities.

• OAC 5160-45-03(A), (B) (effective January 1, 2024)
• OAC 5160-44-31(A), (B)(15), (D), (E) (effective January 1, 2024)
• OAC 173-39-01(B); OAC 173-39-02(A)(5)(b), (B)(4), (B)(8), (B)(10)(a) (effective April 1, 2025)
• OAC 5160-1-33 (authorized representative; effective January 13, 2017)
• ORC 3740.11 (database reviews and criminal records checks); ORC 5101.63(E) (no retaliation against reporters)
• ORC Chapter 3740 and OAC Chapter 3701-60 (licensure; no client rights requirement for nonmedical licensees)
• 42 CFR §441.301(c)(4) (home and community-based settings)
• 45 CFR §164.520 (notice of privacy practices)

The following documents are read together with this policy.

This policy is adopted by the governing body of Sample Agency, LLC. The effective date, the person who approved it, and the date of approval are shown in the header block and recorded in the signature lines below.

Every version of this policy, the date it took effect, a summary of what changed, and who approved it is recorded below. Where a rule cited in Section 15 is amended, the amendment is recorded in this table and a new version of this policy is issued.