Free Nursing Home End-of-Life Care Directive Agreement Template
Nursing Home End-of-Life Care Directive Agreement
This Nursing Home End-of-Life Care Directive Agreement (hereinafter referred to as the "Agreement") is made on this day of , 20 , by and between [Your Company Name] (hereinafter referred to as the "Nursing Home") and [Second Party] (hereinafter referred to as the "Resident" or “Legal Representative").
1. Agreement and Acknowledgment
The Nursing Home agrees to provide suitable nursing facilities and professional nursing care for the resident based on the resident's current health status. The Resident or their Legal Representative understands that the end-of-life care to be provided by the Nursing Home will be in accordance with the Resident's directives previously expressed or as stated in this agreement. This Agreement prepares for situations where the Resident becomes unable to express his/her own healthcare wishes.
2. Residents’ Rights
The Nursing Home acknowledges the Resident's right to have an established care plan that specifies goals, specifically as it pertains to end-of-life care. The care plan will respect and strive to accommodate the Resident's individualized preferences and choices regarding healthcare decisions, providing maximum comfort and dignity while respecting the Resident's autonomy to the fullest extent possible.
3. Duties and Responsibilities of the Nursing Home
The Nursing Home agrees to follow the care plan and all directives regarding the end-of-life support expressed within it. Furthermore, the Nursing Home ensures that all staff members adhere to the care plan and provide appropriate treatment that aligns with the agreed-upon terms. The Nursing Home is also responsible for communicating any changes in the Resident's health status to the Resident or their Legal Representative.
4. Consent and Withdrawal
The Resident or their Legal Representative agrees to consent, in writing, to the terms of this Agreement and the specific care plan. The consent for end-of-life care may be withdrawn or revised in writing by the Resident or their Legal Representative at any stage, thus necessitating an amendment to this Agreement.
5. Confidentiality and Secure Handling of Information
The Nursing Home agrees to keep all medical information, care plans, and personal data regarding the Resident confidential and to use it strictly for purposes related to the fulfillment of this Agreement. Both parties agree to comply with all relevant federal and state laws concerning the securing and privacy of such information.
IN WITNESS WHEREOF, both parties, [Your Company Name] and [Second Party], have read, understood, and agreed to the terms mentioned above.
[Your Name]
[Your Company Name]
[Date]
[Representative's Name]
[Second Party]
[Date]
