Aspen Care Consent Forms
At Aspen Care, we offer a warm homelike setting for elderly men and women that are: somewhat oriented to time, place and person; that may or may not have control of their bladder/bowels; that are either ambulatory with or without assistive devices or wheelchair bound as long as they can transfer to and from their wheelchair with the assistance, from a single staff.
Aspen Care is located in a quiet northeast neighborhood 2 blocks west of Louisiana and just north of Candelaria. The owner is a special education teacher who wanted to work with the elderly population and people with special needs. Her husband is a clinical psychologist in Albuquerque. The owner is on the premises daily and always available by cell phone. At least one caregiver is on duty 24 hours a day. There is double staffing provided for showers, cleaning or whenever needed. The staff is first aid and med aid certified and is offered in-service training annually in many areas of care for the residents. Fingerprinting and background check are required for each staff. The night staff will remain awake and make rounds to check on residents every 2-3 hours throughout the night. Each resident’s room has a call light that signals an alert tone at two different stations in the house. The 7 bedroom, 2 ½ bath home have all private with one semi-private (or large private) accommodations. Each room offers free cable TV, and is wired for private phone lines. Bathrooms have toilets that are slightly higher than normal, with grab bars around toilets and showers, and emergency call buttons by each toilet. Advanced security and alarm system includes an alert tone activated by all exits and entrances to the facility. Aspen Care is fully handicapped accessible, including one complete handicapped bathroom, wheelchair entrance, widened door to bedrooms and bathrooms, all door handles are designed for easy grip, and carpeted areas of home is glued without padding to facilitate easy mobility of wheelchair and/or walker use.
Aspen Care provides highly nutritious meals and can provide special needs diets.
PLEASE NOTE THAT DUE TO COVID-19 OUR DAILY ACTIVITIES HAVE CHANGED. Please speak to Administrator concerning our activities.
Aspen Care utilizes any licensed home health agency the resident elects to use in case intermittent nursing care, physical therapy, occupational therapy or hospice is needed.
STATE OF NEW MEXICO
CLIENT’S RIGHTS AND RESPONSIBILITIES
As a resident, you have the following rights:
I have reviewed and received (via email or print out) a copy of Resident's Rights - Initial Here:
According to 7 NMAC 8.2, section 19, STAFFING;
Aspen Care will meet or exceed these directives at all times.
Aspen Care will have one direct care staff person on duty and awake for each 8 residents. There will be two direct care staff on duty when extra help is needed to care for residents.
The undersigned is the duly authorized agent or relative of who is A resident at 3225 Georgia St. NE, Albuquerque, New Mexico, a community residential program for senior adults, operated by Aspen Care, a New Mexico Corporation.
In consideration of the acceptance of as a resident in the facility, I
hereby release Aspen Care, its directors, stockholders, and employees of and from any and every claim, demand, action or right of action of whatever kind of nature which might arise from or be reason of any bodily injury or personal injuries known or unknown, death, or property damage resulting from any activities and the performance of duties and care while a resident in the facility, including first aid treatment or medical refusal.
This release does not include release of liability for acts of negligence by Aspen Care of its staff.
It is the policy of this facility to inform new clients about Advance Directive options, in accordance with state regulations, before providing services, and give each new client information concerning his/her rights to:
Some clients have an Advance Directive and some do not. This facility does not decline requests for services based on whether a person has or does not have an Advance Directive.
Please indicate if you have an Advance Directive and want the facility to abide by it.
You may decline to answer. A checkmark denotes indication that you have Advance Directive.
I have received and reviewed a copy of the facility questions and answers about Advance Directives, and have discussed it with a representative of the facility; I fully understand my rights concerning these issues.
I further understand that if I have an Advance Directive and want the facility to abide by it, it is my responsibility to provide a copy to the facility’s office.
RELEASE OF LIABILITY
The undersigned is the duly authorized agent or relative of who is
A resident at 3225 Georgia St. NE, Albuquerque, New Mexico, a community residential program for senior adults, operated by Aspen Care, a New Mexico Corporation.
In consideration of the acceptance of as a resident in the facility, I hereby release Aspen Care, its directors, stockholders, and employees of and from any and every claim, demand, action or right of action of whatever kind of nature which might arise from or be reason of any bodily injury or personal injuries known or unknown, death, or property damage resulting from any activities and the performance of duties and care while a resident in the facility, including first aid treatment or medical refusal.
TO WHOM IT MAY CONCERN
We, the undersigned, hereby give Aspen Care/Staff permission to take to an emergency room or other emergency facility for treatment deemed necessary, and may sign for said treatment in lieu of family. Emergency services may also be used if a resident has a fall.
I, , hereby authorize Aspen Care/Staff to assist in the self-administration of medications.
MEDICAL INFORMATION RELEASE
I authorize this facility to obtain information regarding the physical and mental condition of and I direct that all healthcare givers, pharmacists, and other holding medical information including, but not limited to, medical records and diagnosis respond as if I were requesting the information for myself.
DUE TO COVID-19 Precautions and as required by New Mexico Department of Health:
Bed Hold Policy
A. BEDHOLD: A resident who is on leave or temporarily discharged has expressed an intention to return to the facility under the terms of theadmission policy for bedhold, shall not be denied readmission, if level of 7.9.2 NMAC 18 care remains the same. B. LIMITATION: The facilityshall hold a resident's bed until the resident returns, until the resident waives his right to have the bed held or until the maximum time allowable as defined by facility policies expires. The facility is responsible for notifying resident and/or family of their bedhold policy
ADMISSION CONSENT FORM
I, ,hereby request/consent that be admitted
To ASPEN CARE, 3225 Georgia St., NE, Albuquerque, NM 87110.
I acknowledge that the facility has provided me/us with the following information.
Leave this empty:
Your legal name
Your email address
If you have questions about the contents of this document, you can email the document owner.
Document Name: Aspen Care Consent Forms
Agree & Sign