A) Advanced Directives

Our facility respects your right to make your own medical treatment decisions. At the time of admission, we provide information concerning an adult individual’s right to make decisions concerning medical care, including the right to accept or refuse medical or surgical treatment and the right to give advance directives. Advanced directives are instructions about your health care that you make known in advance of their need. Whether or not you choose to execute an advance directive is a personal matter and will never be a condition of providing care or a basis for discrimination for or against you. We will document in your medical record whether or not you have executed an advance directive. If we are provided with a copy of your directives, they will be placed in your medical record so that staff that need them will have access to them.

Although we will provide information we hope we will be helpful in understanding options, we do not give either medical or legal advice. Such consultation, if needed or desired, should be sought from a qualified lawyer or physician.

B) Durable Power of Attorney For Healthcare

New Hampshire has adopted a “Durable Power of Attorney For Health Care” document to assist you in documenting your wishes and designating someone to make health care decisions for you in the event that you are unable to do so yourself. We encourage you to discuss your wishes with your family members and your physician. Our Social Service staff can assist you in executing a Durable Power of Attorney. Your Advanced Directives will be reviewed with you on a yearly basis to ensure that they continue to address your wishes.

C) Guardianship

A Guardian is a legal representative that is appointed by the State of New Hampshire to act on behalf of an incapacitated person. A guardianship becomes necessary in the event that you can no longer make decisions for yourself and have not previously designated a Durable Power of Attorney for Health Care Should this become necessary, the Social Service staff can assist your family through the process.

D) Do Not Resuscitate Orders

Riverside Rest Home will offer all residents and/or their legal representatives the opportunity to provide direction with respect to their desires concerning resuscitation. Resuscitation is defined here as the immediate initiation of CPR by the facility in conjunction with notification of the Fire Department (ambulance) in an aggressive attempt to preserve a resident’s life. In the event there is no direction given, recorded in the residents medical record, accompanied by an order which is signed by the physician, the policy of the facility will be to initiate resuscitation. Should you desire more information our Social Service staff are available to assist you and a video is available from the Nursing Department.

E) Room Changes

The need to make a change in your room may arise for the following reasons:

• Medical emergency
• Non-compatible roommate
• Bed availability
• Request by you or your family/guardian

All room changes are made after careful assessment by the nursing and social service departments. You or your family/guardian will be involved in this process and we assure you that this will not occur without your being involved in the decision.

F) Agreement Changes

You will be informed of any changes to the Admission Agreement at least 30 days in advance. This notice will include any changes to the room rates or services provided.

G) State Advocacy Groups

The following list of agencies is provided for your convenience.

1. Ombudsman Office

Division of Elderly and Adult Services
6 Hazen Drive
Concord, NH 03301-6508
Telephone: 1-800-442-5640 or 271-4386

2. State of New Hampshire

Department of Health and Human Services
Division of Public Health Services
6 Hazen Drive
Concord, NH 03301-6527
Telephone: 1-800-852-3345
TTY/TDD: 1-225-4033

3. Disability Rights Center, Inc.

94 Washington Street, P.O. Box 19
Concord, NH 03302-0019
Voice and TDD: 1-228-0432
1-800-834-1721

4. Medicaid Fraud Central Unit

The Concord Center
10 Ferry Street #308
Box #27
Concord, NH 03301-0308
Telephone: 1-271-1246

5. SURVEY RESULTS

Riverside Rest Home is surveyed annually by the State of New Hampshire. Results of the most recent survey visit are available upon request for your information in the office and are also posted in the facility.