Membership

Preamble

One purpose of the Michigan Home Care (Michigan Home Care) is to develop and promote high standards of patient care and business practice in the provision and delivery of home health care services. In the process of bringing essential services to those in need, the Association and its members seek to establish and retain the highest level of public confidence. The provisions of this Code are informational and represent conduct which the Michigan Home Care desires of its members.

Professional codes of ethics are statements encompassing rules that apply to persons in professional roles, voluntarily adopted by the group themselves.

Purpose

1. To inform the Michigan Home Care members of acceptable guidelines for ethical conduct for home health agencies and their staffs.
2. To inform the Michigan Home Care members that they are expected to abide by all applicable laws and regulations.
3. To remind Michigan Home Care members and other home health professionals and agencies that Michigan Home Care and its members strive for integrity and ethical standards in the provision and delivery of home health services.
4. Patient Rights and Responsibilities: Michigan Home Care members shall conduct their business activities ethically and in accordance with the adopted “Statement of Patient Rights and Responsibilities”. Members will also provide a mechanism for addressing patient care ethical issues.
5. Relationship to Other Provider Agencies and Organizations:
   1. The principal objective of home care agencies is to provide the best possible care to patients.
   2. Agencies shall honestly and conscientiously and ethically cooperate in coordination of referral information and shall work collaboratively with other health care providers, education institutions, and payor sources to assure comprehensive services for patients.
6. Responsibility to Michigan Home Care:
   1. Members shall participate and contribute talent to foster a dynamic, progressive organization from which all members can benefit professionally.
   2. The Bylaws and policies of Michigan Home Care reflect mutual cooperation among members in attaining goals that assure quality care for patients, families, and significant others. The members of Michigan Home Care shall abide by those Bylaws and policies.
7. Fiscal Responsibilities:
   1. The amount of service billed is consistent with the amount and type of service provided.
   2. The agency charges include only legitimate expenses.
8. Marketing and Public Relations:
   1. Oral and written statements will accurately represent the agency’s services, benefits, costs, and capabilities.
   2. Agencies which promote their services in the public media shall portray a positive image of home care in general.
   3. The content of advertising will be guided primarily by the criteria of truth; false or misleading statements are unethical.
   4. The focus of marketing and public relations activities should emphasize the individual agency’s strengths and not competitor’s differences.
   5. Information or printed materials prepared by the Michigan Home Care shall be used to promote home care in general and not to construe endorsement of an individual member.
9. Personnel:
   1. Agency members shall comply with all applicable laws, rules, and regulations.
   2. Members shall have written personnel policies available to all staff.
   3. Members shall provide an ongoing evaluation process for all staff.
   4. Members shall hire qualified staff and utilize them at the level of their competency.
   5. Members shall provide supervision to all staff.
   6. Member shall provide continuing education and in-service training for all staff.
   7. Member shall strive to maintain adequate staffing to meet specified needs of the patient.
   8. Members shall provide a mechanism to address ethical, cultural, or other personnel generated issues.

References

1. Beauchamp, T.L., and Childress, J.F. (2001). Principles of biomedical ethics, New York: Oxford University Press.
2. Joint Commission on Accreditation of Healthcare Organizations, (2004-05). Accreditation manual for home care, Oakbrook Terrace, IL
3. Michigan Home Care, (2007) “Statement of patient rights and responsibilities”, Okemos, MI: Michigan Home Care
4. Community Health Accreditation Program (2004). Core standards (CI.7), iEvidence guidelines, New York: CHAP
5. National Association of Home Care (2006). Code of ethics, Washington DC: NAHC

The Michigan Home Care recommends to its membership the following Standards of Practice as a basis of development for each agency’s individualized standards of care.

Guidelines For Implementation

The Michigan Home Care recommends to its membership the following Guidelines for Implementation of Standards of Practice as a basis of development for each agency’s individualized guidelines.

Standard I

Services are provided in accordance with professionally recognized standards and licensing requirements of each discipline and comply with regulatory requirements.

Guidelines:

1. Professional and paraprofessional credentials are verified for authenticity and validity per agency policy.
2. Criminal background checks are conducted for job applicants, who shall be deemed eligible for employment in accordance with agency policy.
3. Employee files are maintained and updated per agency and/or regulatory policies.
4. The agency maintains a written job description for all professional staff.
5. Supervision of staff is provided per agency policy, regulations and individualized per knowledge/skill level of staff.
6. Policies and responsibilities of contracted staff are specified in appropriate contract language and includes Medicare exclusion verbage.
7. Employees are assigned to provide care in accordance with agency policy. Factors influencing the choice of personnel may include:
   1. Skill level required
   2. Availability of personnel
   3. Client/family requests
   4. Third party payor coverage
   5. Physician’s orders
8. The home care organization provides opportunities to all staff for participation in continuing education activities on an individual or group basis.
9. The home care organization selects appropriate professionals to conduct or provide for continuing education programs/activities.
10. The home care organization provides staff with access to educational resources.

Standard II

Initial assessment visit is completed by the appropriate professional per payer requirements.

Guidelines:

1. Patients are accepted on service on the expectation that the agency can meet their needs in their home setting.
2. The professional nurse (RN) or qualifying therapist completes the initial assessment on all skilled care cases.
3. The initial assessment visit determines immediate care and support needs of the patient and also determines eligibility for the Medicare home health benefit.
4. The initial assessment visit of the client may include but is not limited to the following:
   1. Holistic assessment of the client’s physical, psychological, and social status
   2. Drug regimen review
   3. Assessment of the client’s residence/environment.
   4. Assessment of the client’s concerns and immediate needs.
   5. The client’s medical history, physician orders, medical treatment plan
   6. Assessment of the client’s support systems, community resources
   7. Assessment of family dynamics, social and cultural factors affecting health
   8. An explanation of parameters of services
   9. Completion of necessary administrative paperwork related to reimbursement and agency policies
   10. Development of an individualized plan of care
   11. Establishment of an emergency disaster plan
   12. Validating and obtaining further physician’s orders as necessary.
   13. Arranging therapy and support services as assessed.
5. The assessment information is recorded in a timely and efficient manner according to regulatory requirements and agency policy.
6. The frequency of reassessment visits are determined in accordance with regulatory requirements, patient condition changes, and agency policies.

Standard III

Data collection is ongoing and systematic. The data is accessible, communicated, and recorded.

Guidelines:

1. The professional records the data in a timely, standardized, systematic, and concise form. The home care agency maintains a record keeping system that provides for:
   1. Systematic and complete collection of data
   2. Frequent updating of records
   3. Accessibility to the records, as determined by agency policy
   4. Confidentiality of the records per HIPAA standards
2. Staff are responsible for making observations on each visit that may include:
   1. Physical and mental status
   2. Environment and safety
   3. Support systems
   4. Family dynamics
   5. Social and cultural factors affecting health
3. The changes in client condition are reported to the supervisor or physician as appropriate.

Standard IV

Problem statements are derived from client needs.

Guidelines:

1. All assessment data are interpreted and analyzed in collaboration with the client and family prior to formulating problem statements.
2. The client’s potential and limitations are considered when developing a problem statement.
3. Problem statements are updated and/or revised as necessary as client condition warrants.

Standard V

The individualized plan of care includes goals and expected outcomes derived from the assessment data.

Guidelines:

1. To achieve the goals and expected outcomes the professional will:
   1. Evaluate the referral for appropriateness and accept or reject the referral accordingly
   2. Provide appropriate professional intervention
   3. Provide available community resources
   4. Provide instructions for a safe environment
   5. Minimize further dependency and deterioration as possible
   6. Initiate or develop a support system as needed
   7. Encourage client/family participation in determination of goals.
   8. Educate the client and family toward goals and expected outcomes
2. Expected outcomes for services provided by the professional may include:
   1. An improved level of functioning
   2. Maximum rehabilitation potential
   3. Projected independent living potential without caregiver assistance
   4. Physical and mental comfort

Standard VI

Plans for care are established by the physician’s written orders and include interventions to achieve the identified goals and expected outcomes.

Guidelines:

1. The professional will:
   1. Develop a written individualized plan of care
   2. Review and revise plan as condition warrants
   3. Encourage client and family to participate in the development/revision in the plan of care
   4. Include information regarding community resources in the plan of care when needed
   5. Identify emergency plans for clients
2. The paraprofessional follows a discipline specific plan of care prepared by the professional.

Standard VII

Interventions assist the client to achieve or maintain maximum potential.

Guidelines:

1. Interventions are developed based on expected client outcomes.
2. Professional interventions are:
   1. Specific/individualized
   2. Consistent with the plan of care
   3. Consistent with the defined standards of practice
   4. Conform with payer requirements/criteria
   5. In accordance with the client’s physiological, psychological, and social behavior
   6. Inclusive of teaching and education.
3. Interventions and the client’s response to the interventions are recorded systematically and timely.
4. The agency maintains a policy/procedure manual for professional interventions.
5. The agency maintains an internal review to ensure that interventions follow the established policies/procedures.
6. Agency services are coordinated with and communicated to other members of the health care team and community.
7. Paraprofessional interventions are:
   1. General in nature but individualized to the client
   2. Incorporated in the paraprofessional plan of care
   3. Consistent with the client’s physiological condition including functional status and psychological social behavior
   4. Appropriate to the level of experience and/or training of the paraprofessional
   5. Recorded systematically and timely
8. Supervision of the paraprofessional is done on an on-going basis and per regulatory requirements and agency policy
9. Agency services are coordinated with and communicated to other members of the health care team and community.
10. Care is provided in accordance with accepted standards of practice in the community.

Standard VIII

The client’s progress toward goal achievement is evaluated regularly by the client and home care provider.

Guidelines:

1. Plans toward goal achievement are dependent on continuous and ongoing evaluation of mutually agreed upon outcomes.
2. Baseline and current data are reviewed and interpreted to measure progress toward goals.
3. Active participation of client, family, or significant other is encouraged to revise priorities, goals, and interventions.
4. The professional documents revisions and evaluations.
5. A quality assurance mechanism is in place to evaluate the client’s progress toward goal achievement.

Standard IV

Continuity of care is assured through a process of planning and referral to appropriate community resources.

Guidelines:

1. The plan of care includes the utilization of available and appropriate resources. They may include any or all of the following:
   1. Support Service
   2. Client education materials
   3. Community resources
   4. Medical equipment resources
2. The client/family/significant other are provided with information needed to make decisions and choices about:
   1. Promoting, maintaining and restoring health
   2. Seeking and utilizing appropriate health care personnel
   3. Maintaining and using health care resources
3. The professional identifies and plans for services to meet health care needs.
4. During transition from one agency to another, the professional provides adequate information to assure coordination of services.
5. There is documentation in the client record of coordination among referral sources.

Standard X

An emergency disaster plan is established for the client.

Guidelines:

1. During initial assessment the emergency disaster plan will be established.
2. The emergency plan may include, but is not limited to the following:
   1. Phone numbers of police, fire, ambulance, physician, pharmacy, home care organization, primary contact person, medical equipment company
   2. Basic home safety precaution
   3. Changes in medical condition to report to physician and/or home care organization
3. The emergency plan is reviewed with the client, family, and caregivers.

The Michigan Home Care recommends to it’s membership the following Standards of Practice as a basis of development for each agency’s individualized standards of care.

Guidelines for Implementation

The Michigan Home Care recommends to its membership the following Guidelines for Implementation of Standards of Practice as a basis of development for each agency’s individualized guidelines.

Standard I

Home care services are provided in accordance with professionally recognized standards for each discipline.

Guidelines:

1. Professional and paraprofessional credentials are verified for authenticity and validity per agency policy. Criminal background checks are conducted for job applicants, who shall be deemed eligible for employment in accordance with agency policy.
2. Employee files are maintained and updated per agency and/or regulatory policies.

Definitions:

Health Care Professional (HCP):  An individual who has completed the necessary educational requirements and possesses a valid Michigan license and/or professional accreditation in his/her specific field.

Health Care Paraprofessional (HCPP):  An individual who is supervised by a health care professional. He/she has demonstrated a minimal level of clinical competency in the provision of basic client care. Training for a paraprofessional may be through classroom activity and/or on the job training under the direction of a HCP. A paraprofessional may undergo written and/or clinical evaluation to demonstrate proficiency.

Standard II

The initial assessment visit is completed by the appropriate professional person.

Guidelines:

1. The professional nurse (RN) completes the initial assessment on all skilled care cases. The licensed practical nurse (LPN) may complete the initial assessment visit on all Homemaker/Home Health Aide cases.
2. The initial assessment visit of the client may include but is not limited to the following:
   1. collection related to the status of the client’s physical, psychosocial and environmental conditions
   2. An explanation of parameters of services
   3. Completion of necessary administrative paperwork related to reimbursement and agency policies
   4. Development of a nursing/service plan of care
   5. Establishment of an emergency plan
   6. Determination and/or confirmation of the appropriate skill level required
   7. Obtaining physician’s orders as necessary
   8. Arranging therapy and support services as necessary
3. The assessment information is recorded in a timely and efficient manner according to agency policy.
4. The need for and frequency of reassessment/supervisory visits are determined in accordance with agency policies.
5. Employees are assigned in a timely manner in accordance with agency policy. Factors influencing the choice of personnel may include:
   1. Skill level required
   2. Availability of personnel
   3. Client/family requests
   4. Third party payor coverage
   5. Physician’s orders
6. A designated on call coordinator is available for scheduling and clinical concerns after regular office hours.

Standard III

Data collection is ongoing and systematic. The data is accessible, communicated, and recorded.

Professional Level Guidelines:

1. The data collection may include:
   1. Holistic assessment of the client’s physical, psychological, and social status
   2. Assessment of the client’s residence/environment
   3. Assessment of the client’s concerns and immediate needs
   4. The client’s medical history, physician orders, medical treatment plan, when appropriate
   5. Assessment of the client’s support systems, community resources
   6. Assessment of family dynamics
   7. Assessment of social and cultural factors affecting health
2. The professional records the data in a timely, standardized, systematic, and concise form. The home care agency maintains a record keeping system that provides for:
   1. Systematic and complete collection of data
   2. Frequent updating of records
   3. Accessibility to the records, as determined by agency policy
   4. Confidentiality of the records

Paraprofessional Level Guidelines:

1. The paraprofessional is responsible for making observations on each visit. This may include:
   1. Physical and mental status
   2. Environment and safety
   3. Support systems
   4. Family dynamics
   5. Social and cultural factors affecting health
2. The paraprofessional reports client changes and unusual conditions to the supervisor.
3. The paraprofessional documents according to agency policy.
4. The paraprofessional maintains confidentiality regarding client information.

Standard IV

Problem statements are derived from client needs.

Professional Level Guidelines:

1. All assessment data is interpreted and analyzed in collaboration with the client and family prior to formulating problem statements.
2. The client’s potential and limitations are considered when developing a problem statement.
3. Problem statements are derived from assessed health related needs.
4. Problem statements are written in an accepted format that is recognized by the health care provider’s discipline and agency policy.
5. Problem statements are revised when necessary after review of ongoing data collection.

Paraprofessional Level Guidelines:

1. Problem statements are developed and written on the paraprofessional’s plan of care.
2. The paraprofessional reports any changes in client status to the supervisor.

Standard V

Plans for service include goals and expected outcomes derived from the assessment data.

Professional Level Guidelines:

1. To achieve the goals and expected outcomes the professional will:
   1. Evaluate the referral for appropriateness and accept or reject the referral accordingly
   2. Provide appropriate professional intervention
   3. Provide available community resources
   4. Provide instructions for a safe environment
   5. Minimize further dependency and deterioration as possible
   6. Initiate or develop a support system as needed
   7. Encourage client/family participation in determination of goals
   8. Educate the client and family toward goals and expected outcomes.
2. Expected outcomes for services provided by the professional may include:
   1. An improved level of functioning
   2. Maximum rehabilitation potential
   3. Projected independent living potential without caregiver assistance
   4. Physical and mental comfort

Standard VI

Plans for service include interventions to achieve the identified goals and expected outcomes.

Professional Level Guidelines:

1. The professional will:
   1. Develop a written plan for service
   2. Review and revise plan as condition warrants
   3. Encourage client and family to participate in the development of and changes in the plan of care
   4. Include information regarding community resources in the plan of care when needed
   5. Identify emergency plans for clients

Paraprofessional Level Guidelines:

1. The paraprofessional follows the paraprofessional plan of care prepared by the professional.
2. The paraprofessional will report changes in the client’s physical condition and psychosocial behavior to the appropriate professional.
3. The paraprofessional strives to provide the client with personalized, reliable, and timely service.

Standard VII

Interventions assist the client to achieve or maintain maximum potential.

Professional Level Guidelines:

1. Interventions are developed based on expected client outcomes. They may provide one or more of the following:
   1. Comfort
   2. Restoration/rehabilitation
   3. Improvement
   4. Health promotion/maintenance
   5. Prevention of complications
   6. Learning
   7. Safety
2. Professional interventions are:
   1. Specific/individualized
   2. Consistent with the plan of care
   3. Consistent with the defined standards of practice
   4. In accordance with the client’s physiological, psychological, and social behavior
   5. Inclusive of teaching and education
3. Interventions and the client’s response to the interventions are recorded systematically and timely and are easily retrievable, according to agency policy.
4. The agency maintains a policy/procedure manual for professional interventions.
5. The agency maintains an internal review to ensure that interventions follow the established policies/procedures.
6. The agency maintains a written job description for all professional staff.
7. Agency services are coordinated with and communicated to other members of the health care team and community.

Paraprofessional Level Guidelines:

1. Paraprofessional interventions are developed by the professional. They are based on the professional assessment, plan of care, and expected outcomes and provide one or more of the following:
   1. Comfort
   2. Restoration/rehabilitation
   3. Improvement
   4. Health promotion/maintenance
   5. Prevention of complications
   6. Learning
   7. Safety
2. Paraprofessional Interventions are:
   1. General in nature but individualized to the client
   2. Incorporated in the paraprofessional plan of care
   3. Consistent with the client’s physiological condition including functional status and psychological social behavior
   4. Appropriate to the level of experience and/or training of the paraprofessional
   5. Recorded systematically and timely and are easily retrievable according to agency policy
3. Access to professional guidance/supervision is available during the hours of services.
4. The agency maintains a policy/procedure manual for paraprofessional intervention.
5. The agency maintains an internal review to ensure that interventions follow the established policies/procedures.
6. The agency maintains a written job description for all paraprofessional staff.
7. Agency services are coordinated with and communicated to other members of the health care team and community.
8. Care is provided in accordance with accepted standards of practice in the community.

Standard VIII

The client’s progress toward goal achievement is evaluated regularly by the client and home care provider.

Professional Level Guidelines:

1. Plans toward goal achievement are dependent on continuous and ongoing evaluation of mutually agreed upon outcomes.
2. Baseline and current data are reviewed and interpreted to measure progress toward goals.
3. Active participation of client, family, or significant other is encouraged to revise priorities, goals, and interventions.
4. The professional documents revisions and evaluations.
5. A quality assurance mechanism is in place to evaluate the client’s progress toward goal achievement.

Standard IV

Continuity of care is assured through a process of planning and referral to appropriate community resources.

Professional Level Guidelines:

1. The plan of nursing care includes the utilization of available and appropriate resources. They may include any or all of the following:
   1. Support Service
   2. Client education materials
   3. Community resources
   4. Medical equipment resources
2. The client/family/significant other are provided with information needed to make decisions and choices about:
   1. Promoting, maintaining and restoring health
   2. Seeking and utilizing appropriate health care personnel
   3. Maintaining and using health care resources
3. There is a current listing and description of community resources available.
4. The professional identifies and plans for services to meet health care needs.
5. During transition from one agency to another, the professional provides adequate information to assure coordination of services.
6. There is documentation in the client record of coordination among referral sources.

Standard X

An emergency plan is established for the client.

Professional Level Guidelines:

1. During initial assessment the appropriate professional will establish the emergency plan related to the care or service provided.
2. The emergency plan may include, but is not limited to the following:
   1. Phone numbers of police, fire, ambulance, physician, pharmacy, home care organization, primary contact person, medical equipment company
   2. Basic home safety precautions
   3. Changes in medical condition to report to physician and/or home care organization
3. The emergency plan is reviewed with the client, family, and care givers.

Paraprofessional Level Guidelines:

1. The paraprofessional is responsible for knowledge of the emergency plan and to follow the emergency plan if necessary.

Standard XI

Continuing educational growth of staff is encouraged.

Professional and Paraprofessional Level Guidelines:

1. The home care organization provides opportunities to all staff for participation in continuing education activities on an individual or group basis.
2. The home care organization selects appropriate professionals to conduct or provide for continuing education programs/activities.
3. The home care organization provides staff with access to educational resources.

The Michigan Home Care recommends to it’s membership the following Standards of Practice as a basis of development for each agency’s individualized standards of care.

Guidelines For Implementation

The Michigan Home Care recommends to its membership the following Guidelines for Implementation of Standards of Practice as a basis of development for each agency’s individualized guidelines.

Standard I

Hospice services are provided in accordance with professionally recognized standards.

Guidelines:

1. The agency has a process to insure that a person’s qualifications are consistent with his/her job responsibilities and applicable laws/regulations.
2. Competency to perform job responsibilities is assessed, demonstrated, and maintained per policies of the agency and applicable laws/regulations.
3. The agency assures adequate number and mix of appropriately trained staff to meet the needs of the client.

Standard II

The initial assessment is completed by the appropriate personnel.

Guidelines

1. The appropriately licensed professional completes the initial assessment on all clinical care clients.
2. The initial assessment visit of the client/family may include but is not limited to the following:
   1. Data collection related to the client’s physical, psychosocial, spiritual status and environmental conditions, as appropriate to the service provided
   2. An explanation of services
   3. Disclosure of financial responsibility
   4. Development of a service plan of care
   5. Client/advocates authorization for care, treatment, services
   6. Obtaining physician’s orders as necessary
   7. Arranging support services as necessary
3. The assessment information is recorded in a timely, efficient and retrievable manner according to agency policy.
4. The need for and frequency of reassessment/re-evaluation is determined in accordance with agency policies, applicable laws/regulations and client status.
5. Services are delivered in a timely manner in accordance with agency policy. Factors influencing the assignment of responsibilities include:
   1. Skill level required
   2. Availability of personnel
   3. Client/family requests
   4. Third party payor coverage
   5. Physician’s orders
   6. Applicable laws/regulations
6. On-call coordinator services are available to meet the needs of the client.

Standard III

Assessment data collection is systematic, documented and communicated within the agency policies and applicable laws/regulations.

Guidelines

1. Data collection may include:
   1. Assessment of the client/family physical, psychosocial, and spiritual status
   2. Assessment of the client’s environment of care
   3. Assessment of the client’s goals of care and immediate needs
   4. The client’s medical history, physician orders, medical treatment plan, when appropriate
   5. Assessment of the client/family support systems, community resources
   6. Assessment of family dynamics
   7. Assessment of social, cultural, ethnic and spiritual beliefs/practices affecting health
   8. Assessment of learning needs/barriers that may affect services
   9. Assessment of abuse, neglect and exploitation of the client
2. The hospice agency maintains a record keeping system that provides for:
   1. Systematic, complete, and retrievable collection of data
   2. Frequent updating of records
   3. Confidentiality of the records

Standard IV

Plans of service are developed for all clients/families based on agency policy, services provided, applicable laws/regulations, and place of service.

Guidelines

1. All assessment data are interpreted and analyzed in collaboration with the client, family and caregivers prior to formulating a plan of service.
2. The plan of service includes goals/expected outcomes that are individualized to the patient/family and appropriate to the service delivery.
   1. To achieve the goals and expected outcomes the professional will:
      • Provide appropriate professional intervention
      • Coordinate available community resources
      • Provide instructions for safety
      • Initiate or develop a support system as needed
      • Encourage client/family participation in determination of goals
      • Educate the client/family toward goals and expected outcomes
   2. Expected outcomes for services provided may include:
      • An improved level of well-being
      • Optimal independence
      • Comfort
3. Plans for service include interventions to achieve the identified goals and expected outcomes.
   1. Interventions are developed based on expected client outcomes. They may provide one or more of the following:
      • Comfort
      • Restoration
      • Health promotion/maintenance
      • Prevention of complications
      • Education
      • Safety
   2. Interventions are:
      • Specific/individualized
      • Consistent with the plan of care
      • Consistent with the defined standards of practice
      • In accordance with the client/family physiological, psychosocial and spiritual needs
      • Inclusive of teaching and education
   3. Interventions and the client’s response to the interventions are recorded according to agency policy
   4. The agency maintains a policy/procedure manual for clinical practices
   5. The agency maintains an internal review to ensure that clinical practices follow the established policies/procedures
4. The client/family progress toward goal achievement is evaluated as appropriate to the service provided.
   1. Plans toward goal achievement are dependent on evaluation of mutually agreed upon outcomes
   2. Baseline and ongoing data are reviewed and interpreted to measure progress toward goals
   3. Active participation of client, family, or caregiver is encouraged to revise priorities, goals, and interventions
   4. Revisions to the plan of service are documented per agency policy

Standard V

Continuity of care is assured.

Guidelines

1. The plan of service includes the utilization of available and appropriate resources. They may include any or all of the following:
   1. Core Hospice services
   2. Additional Hospice services
   3. Client education materials
   4. Community resources
   5. Other medical providers
2. The client/family/significant other are provided with information needed to make decisions and choices about:
   1. Promoting, maintaining and restoring wellness
   2. Seeking and utilizing appropriate health care personnel
   3. Maintaining and using health care resources
3. During transition from one agency to another, the professional provides adequate information to assure coordination of services.
4. There is documentation in the client record of coordination among referral sources and contracted services.

Standard VI

An emergency plan is established for the client.

Guidelines

1. An emergency plan related to the care or service provided is established by all agencies.
2. The emergency plan may include, but is not limited to the following:
   1. Emergency contact’s names and phone numbers
   2. Basic home safety precautions
   3. Changes in medical condition to report to physician and/or home care organization.
3. The emergency plan is reviewed with the client, family, and care givers.
4. The emergency plan is understood by staff providing services.

Standard VII

Continuing educational growth of staff is encouraged.

Guidelines

1. The hospice organization provides resources to all staff for participation in continuing education activities.
2. Continuing education is based on identified needs.

Standard VIII

The agency collects data to monitor its performance, per agency policy and applicable laws/regulations.

Guidelines

1. Data is systematically gathered and analyzed on an on-going basis.
2. Data collected is based on the risk/safety of the client/care provider.
3. Undesired patterns are identified and changes made to ensure safety.
4. Re-evaluation of impact of change is monitored.

Standard IV

The agency follows ethical practice in the delivery of services.

Guidelines

1. The agency develops policies that address:
   1. Patient rights/responsibilities
   2. Patient/family decisions regarding care/treatment.
   3. Informed consent
   4. Right to refuse care/services
   5. Advanced directives
   6. Resolution of complaints
2. The agency reviews its policies to promote access to care.

Link to Standards of Practice for HME/Infusion

Section 1: Eligibility

Eligibility for membership shall be from one of the following categories:

A. Service Line Member: Eligible organizations must be engaged in the delivery of home care through certified home care services, hospice services, private home care services, home pharmacy/infusion services or home medical equipment services. Each legally recognized business unit shall be eligible for a membership. For purposes of membership, each organization with a filed assumed name is considered a legally recognized business unit. Each service line membership shall have one vote in association elections. Service line members may serve on the Board of Directors, and may hold office.

B. Associate Members: Businesses that provide goods or services to the above organizations are eligible as associate members. Associate members may also be local, regional and national associations that have an interest in home care delivery in the state of Michigan, but do not directly provide that care. Holding companies and organizations formed to provide group contracting and/or services for a coalition of home care industry service providers are ineligible for membership. The Board of Directors shall determine whether any applicant shall be denied membership on the basis of this provision. Each associate membership shall have one vote in association elections. There will be one Board of Directors seat reserved for associate members, and no more than one seat, regardless of the number of associate members. The associate representative of the Board of Directors shall not hold office.

C. Individual and Honorary Membership: Individuals may choose to become members of the association because they have an interest in the purpose of the Michigan Home Care. In addition, the association may wish to honor certain individuals with a perpetual membership because of their history of service to the association. Individual members may not be employed by an organization defined in other membership category that is not a member of the Michigan Home Care. Individual and honorary members may not vote in association elections and may not serve on the Board of Directors.

Section 2: Duration

Membership of a person or organization eligible under Article III, Section 1 shall commence with the presentation to the Board of Directors and shall continue until termination, suspension or expulsion, as provided in these bylaws.

Section 3: Termination

A. Any individual member may cancel his/her membership at any time by written notice to the Board of Directors.

B. All other categories of members may cancel membership at any time by submitting to the Board of Directors either a written notice to such effect signed by the administrative head of the member organization, or a copy of a resolution authorizing termination of membership duly adopted by the Board of Directors of the member organization.

C. The Board of Directors may cancel membership for delinquency in payment of dues or at its discretion when it is determined an organization has misrepresented itself in its membership classification. Two-thirds vote of all voting members of the association may cancel membership for conduct detrimental to the association after a full and fair hearing.

Section 4: Suspension

At any regular or special meeting of the Board of Directors, any member may be suspended by a majority vote of the Board of Directors present for failure to comply with the Articles of Incorporation, Bylaws, Code of Ethics or any duly adopted policy, rule, or regulation of the association, or has been adjudged to have violated criminal or civil law in either federal or state court on issues related to health care fraud. Suspension from either the Medicaid or Medicare program will also constitute grounds for suspension from the association. Ten days written notice shall have been given to such member setting forth the intention to suspend the specific reason therefore and the right of the member to appear and be heard in person or by representative at said meeting.

Section 5: Expulsion

At any regular or special meeting of the Board of Directors, any member may be expelled by a majority vote of the Board of Directors present for failure to comply with the Articles of Incorporation, Bylaws, Code of Ethics or any duly adopted policy, rule, or regulation of the association, or has been adjudged to have violated criminal or civil law in either federal or state court on issues related to health care fraud. Expulsion from either the Medicaid or Medicare program will also constitute grounds for expulsion from the association. Ten days written notice shall have been given to such member setting forth the intention to propose expulsion, the specific reason therefore, and the right of the member to appear and be heard in person or by representative at said meeting.

Section 6: Dues

All members will pay annual dues at the beginning of each fiscal year. The Executive Committee shall determine the dues structure and present it for approval to the Board of Directors no later than 30 days prior to the Annual Business Meeting. The Board of Directors shall present proposed dues changes to the voting membership for action at the Annual Business Meeting. During the first year of membership, any member who joins before mid-fiscal year shall pay dues for the entire fiscal year in which the membership is approved. The dues of any new member who joins after mid-fiscal year shall be one-half the annual dues as per the dues schedule. No dues shall be refunded for canceled memberships.