EXPERIENCE OF CARE/PATIENT SATISFACTION SURVEYS
Our hospice has contracted with Strategic Healthcare Programs (SHP), a vendor approved by the Centers for Medicare & Medicaid Services (CMS), to perform mandatory Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys. The survey considers you and your primary caregiver as a unit of care. Strategic Healthcare Programs (SHP) may contact your caregiver or family member by mail or telephone after your death to evaluate the experience of care and services you and your loved ones received from our hospice agency.
Our patients are very important to us. Please ask questions if something is unclear regarding our services or the care you receive or fail to receive. Our hospice agency may also contact you, your caregiver or family at intervals to assess your satisfaction with the care and services we are providing. We will not ask the same questions included in the CAHPS® survey. Your answers will help us to improve our services and ensure that we meet your needs and expectations.
NOTICE OF NONDISCRIMINATION
Discrimination is against the law.
Affinity Care of Ohio complies with applicable Federal civil rights laws and does not discriminate, exclude people or treat them less favorably because of race, color, religion, national origin (including limited English proficiency and primary language), sex (including sex characteristics, including intersex traits; pregnancy or related conditions; sexual orientation; gender identity and sex stereotypes), age, disability (including mental illness and substance use disorders) or any combination thereof with regard to admission, access to treatment or employment.
We provide people with disabilities reasonable modifications and free appropriate auxiliary aids and services to communicate effectively with us, such as qualified sign language interpreters and written information in other formats (large print, audio, accessible electronic formats, other formats). We provide free language assistance services to people whose primary language is not English, which may include qualified interpreters and information written in other languages.
If you need reasonable modifications, appropriate auxiliary aids and services, or language assistance services, contact our Civil Rights Coordinator.
If you believe that we have failed to provide these services or discriminated in any other way, you may file a grievance with our Civil Rights Coordinator by phone at (xxx) xxx-xxxx, by email at ________ or in person or by mail at __________. If you need help filing a grievance, our Civil Rights Coordinator is available to help you.
The availability and use of this grievance procedure does not prevent you from pursuing other legal or administrative remedies.
You may also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights by any of the following methods:
• Electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf.
• By mail to U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C. 20201. Complaint forms are available at: http://www.hhs.gov/ocr/office/file/index.html.
• By phone at 1-800-368-1019 (TDD: 1-800-537-7697).
This notice is available at our website: __________
PROBLEM SOLVING PROCEDURE [PLEASE VERIFY]
We are committed to ensuring that your rights are protected. If you feel that our staff has failed to follow our policies or has in any way denied you your rights, please follow these steps without fear of discrimination or reprisal:
1. Notify the Hospice Director by phone at the phone number checked on the front cover, from 8:00 a.m. to 5:00 p.m., Monday through Friday. You may call toll free at 1-888-517-8100. You may also submit your complaint in writing to the address checked on the front cover. Most problems can be solved at this level.
2. You may contact the state complaint hotline at 1-800-342-0553, which operates from 8:00 a.m. to 5:00 p.m., Monday through Friday (except holidays). Voicemail is available 24 hours a day. If voicemail answers, please leave a message and your call will be returned. Please include your name, address, area code and telephone number. The purpose of the hotline is to receive complaints or questions about local hospice agencies and to lodge complaints concerning the implementation of advance directive requirements.
3. You may also contact the CHAP hotline 24 hours a day at 1-800-656-9656. Customer service hours of operation are 8:30 a.m. to 7:00 p.m., Eastern Time, Monday through Friday (except holidays).
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