Your Rights as a Client of A Caring Alternative, LLC.

WHAT ARE MY RIGHTS?
When you receive services from A Caring Alternative you have certain rights and responsibilities. One of these rights is that you be informed of your rights upon initiation of services. The information below will tell you about your rights and responsibilities and what to do if you have questions or problems. You are requested to please read (or have read to you) these rights and ask any questions you may have. You will also be requested to sign a form stating you have been informed of your rights.

DEFINITIONS
What is a right? A right is something you can do by law.

What is a responsibility? A responsibility is something that you agree to do to the best of your ability.

What is a rule? A rule is something set up in a program unit so things will run smoothly.

What are rights’ restrictions?
Rights’ restrictions limit or take away a person’s right to do something. A person’s rights should be restricted as a last resort and only after other positive behavioral supports have been tried and have failed. Rights’ restrictions cannot and should not be imposed on people without safeguards to protect those rights. This does not mean that individual rights can never be restricted. Due process must be in place before a person’s rights are restricted in any way except in real emergency situations. Any restrictions of your rights must be part of your current Person Centered Plan. The agency’s Human Rights Committee must approve any restrictions before they are used, except in emergency situations. All restrictions must be time-limited and reviewed periodically for reauthorization by a qualified professional.

What is due process?
Due process is a set of procedural safeguards to protect individual rights. Before a person’s rights can be restricted in any way, due process must be in place to protect the person. The type and extent of due process used depends on which right is being restricted. The greater the impact that the restriction has on a person’s life, the greater the requirement is for review and protection. The person’s participation in this decision making is an important part of due process.
 

Guidelines for using due process when considering rights restrictions:

1. A person’s need should guide restrictions.
2. Restrict only specific rights.
3. Use the least amount of restriction possible.
4. Always obtain consent and approval.
5. Plan for review and reinstatement of rights.
6. Each the person what it takes to have rights reinstated.

YOUR RIGHTS are guaranteed by Law
We have laws in North Carolina which protect the rights of persons receiving mental health, developmental disabilities or substance abuse services. These rights apply to services provided by A Caring Alternative and by other providers of behavioral healthcare services in the state. (These rights are found in North Carolina General Statutes 122C, Article 3.) It is the service provider’s responsibility to inform you of your rights within the first three visits to a program (or within 72 hours if you receive service in a 24-hour facility). Any program-specific rules must be explained at that time as well. Unless you have been declared legally incompetent by a court, you may exercise all your civil rights. This means that you may buy or sell property, make purchases, register and vote, marry and divorce, bring civil actions, enter into contractual relationships and sign legal papers.

You have basic HUMAN RIGHTS
It is our policy to assure your right to dignity, privacy, humane care and freedom from mental and physical harm, abuse, neglect or exploitation is protected.

You have a right to dignity, privacy, humane care, and freedom from physical punishment, abuse, neglect or exploitation. Definitions of abuse, neglect and exploitation are as follows:

Physical Abuse: any action that results in physical injury or pain such as spanking, hitting, rough treatment or unauthorized use of physical or mechanical restraints.
Psychological/Emotional Abuse: any action or threat that may cause an individual to feel humiliation, harassment, deprivation, or intimidation.
Verbal Abuse: any action that belittles or threatens an individual. It may include oral, written, or gestural use of language as well as the use of profanity, calling people by inappropriate names, and/or referring to adults with childlike references.
Sexual Abuse: non-consensual sexual activity of any kind. Any sexual contact between an employee of A Caring Alternative and a person receiving services is strictly forbidden, whether consent was present or not.
Neglect: any action or absence of action that fails to provide proper care or treatment in a safe environment.
Exploitation: any illegal or improper use of a consumer’s resources for another person’s profit or advantage.

You have a right not to be discriminated against in the provision of services on the basis of age, sex, ethnic background, religious preference, financial condition, sexual preference, or disability.

You have a right to live as normally as possible while receiving services from A Caring Alternative. A Caring Alternative has no restrictive rules or regulations that you are expected to follow while receiving services from A Caring Alternative.

You have a right to befree of the following interventions prohibited by statute:

1. Corporal punishment;
2. Contingent use of painful body contact;
3. Substances administered to induce painful bodily reactions;
4. Electric shock;
5. Insulin shock;
6. Unpleasant tasting foodstuffs;
7. Contingent application of any noxious substances which include but are not limited to noise, bad smells or splashing with water; and
8. Any potential physically painful procedures or stimulus administered for the purpose of reducing the frequency or intensity of a behavior.

You have a right to be informed of the agency's on-call service. You may receive some of your services when our office is not open (before 8:00 a.m., after 5:00 p.m., or on weekends). Each service department has been provided a crisis phone so that you or your worker may contact them during scheduled hours of service when the office is closed.

You have a right to know the names and qualifications of all people involved in your care. You may also request a change in the professionals who provide you services.


You have THE RIGHT TO BE FREE FROM UNNECESSARY PHYSICAL RESTRAINT AND PHYSICAL ABUSE
Some services may be authorized to use restrictive interventions (i.e. an approved restraint) to control dangerous behaviors. You will be informed about these approved interventions if the services you receive involve the use of any restrictive interventions. To protect our service recipients, there are very strict rules governing staff conduct when a restrictive intervention is used. You have the right to refuse any planned restrictive interventions.

Only A Caring Alternative authorized and trained staff may use restrictive interventions if it is an emergency situation and the individual’s behavior is perceived as being dangerous to him/herself, to other people, to property or if is determined, based on very strict rules, that it is necessary for the person’s care. Special safeguards must be in place when these interventions are used, and service recipients or their guardians have the right to request that a designated person be notified.

Some emergencies may require law enforcement assistance or initiation of involuntary commitment procedures. These interventions and protective devices (used in a few programs) may never be used as retaliation, for the convenience of staff or in a manner that may cause harm or undue discomfort to the individual.

At no time is corporal punishment allowed. Staff must protect service recipients from harm in the treatment setting and must report any suspicion of abuse, neglect or exploitation.

You have THE RIGHT to confidentiality.
You have a right to confidential treatment based on state and federal laws. The very fact that you are receiving services or any other information about your care is confidential. These same laws also require us to share information with others under the following conditions:

1. When you give us written permission, we may share information with any person that you name;
2. Your next of kin or other family members with a legitimate role in your services may receive certain information about your services, if it is in your best interest; and if you are under 18, your parents may be informed about your care when it is in your best interest and not considered to be harmful;
3. When a doctor needs information to provide emergency treatment;
4. To other professionals when necessary to coordinate appropriate and effective care;
5. If we transfer your care to another public agency;
6. If we are ordered by the court to release your record;
7. If an attorney needs information from your record because of a suit, a commitment proceeding, or guardianship proceeding;
8. If you become imprisoned, we may share your files with prison officials;
9. When a client advocate has been assigned to work on your behalf;
10. When a staff member suspects abuse or neglect;
11. If we have reason to believe you are a danger to yourself or others, or if we believe that your are likely to commit a crime, we may share this information with law enforcement officials;
12. When a child is receiving services and his/her parents are divorced, both biological parents may have access to their child's record unless parental rights have been terminated; and
13. For the purpose of audits and program evaluation by internal or external sources.

A Caring Alternative maintains a computer system for billing and statistical purposes. Security measures are maintained to abide by all confidentiality regulations and laws. All A Caring Alternative staff sign statements, which obligate them to maintain confidentiality on all information according to all regulations and laws.

You have THE RIGHT to privacy.
You have the right to be free from any unwarranted search of your person or property. Some service programs in the Provider Network have special procedures about Search and Seizure which will be explained to you if you receive services from these programs.

You have the right to exercise all civil rights and only if you have been declared incompetent, can these rights be restricted.

You have a right to receive a free appropriate education. All US citizens have a right to be educated in a non-segregated setting within the public school system.

You have a right to work. Laws protect individuals from discrimination based on specific characteristics unrelated to job performance ability (Americans with Disabilities Act). People cannot be paid less money than others would be for the work they do.

You have a right to be heard in court, to bring lawsuits, to have the representation of an attorney, to bring witnesses on your behalf. This is known as “due process.”

You have a right to free speech and expression. Everyone has the right to speak up for him or herself and to express himself or herself in the manner they desire.

You have the right to equal access to treatment for all persons in need regardless of race, ethnicity, gender, age, sexual orientation, or sources of payment.

You have THE RIGHT to an Individualized Person centered Plan.
You have the right to take part in the development and periodic review of your individualized Person Centered Plan. This plan must be in use no later than 30 days after your services start. You have the right to request a copy of your Person Centered Plan. You have the right to receive services in the least restrictive environment possible that is appropriate for your age and situation. You have the right to request an accommodation for individual needs. Examples of accommodations include but are not limited to: transportation, specific staff, Sign Language Interpreter, Foreign Language Interpreter, etc. To request an accommodation, please notify ACA staff of your needs.

You have the right to receive services from A Caring Alternative if you meet the following admission criteria:

1. A Caring Alternative has the resources to staff and supervise the services you receive;
2. Your needs can be safely and adequately met in the service location;
3. You live in the geographic area served by A Caring Alternative;
4. A Caring Alternative can provide the services within the time lines established by the contracting agency/funding source/family;
5. Your safety as well as the employees' safety can be assured within the service location;
6. You agree to receive the services.

You have THE RIGHT to be informed about medications.
If medication is part of your agreed upon Person-Centered Plan, only a physician will prescribe necessary medication based on accepted medical standards. You have the right to know the risks, benefits and alternatives to medication.  You may refuse to take medications, but you will be informed of the risks of doing this.

You have THE RIGHT to accept or to refuse Treatment
Before you agree to your individualized Person Centered Plan, you will be informed of the benefits and/or risks involved in the treatments and services you will receive. You have the right to consent to your individualized Person Centered Plan and the right to withdraw consent at any time. You will be informed of the risks of refusing treatment/service. There are situations (i.e. if you are a risk to yourself or others) when you may be legally required to receive services.

You have a right to the extent allowed by law,to accept or refuse all treatment except:

1. In an emergency;
2. If your treatment has been order by the court, or
3. If you are under 18 years old, your parents can give permission even if you object.
4. IF you are voluntarily admitted you or your legally responsible person has the right to consent to or refuse any treatment offered. Consent may be withdrawn. If treatment is refused, the qualified professional will determine if other treatment modalities are possible. If all appropriate treatment modalities are refused, you may be discharged from

You have THE RIGHT to be free from unjustified suspension or termination of services.
Each consumer should be free from the threat or fear of unwarranted suspension or expulsion from a facility. Suspension/discharge from services should only occur upon the recommendation of the consumer’s Person Centered Planning team and review and agreement by the Agency Director. You have a right to be free from unwarranted suspension or expulsion from services. Suspension of services will occur only if your safety or the safety of A Caring Alternative staff cannot be assured. A Caring Alternative and the lead agency will make every effort to correct the reasons resulting in suspension. If after two weeks your or the employees' safety cannot be assured, then you will be expelled from services. You may be re-admitted for services when your safety or the employees' safety can be assured.

You Have a Right to be Informed of A Caring Alternative Discharge Criteria.
A Caring Alternative will terminate services based on the following criteria:

1. If your condition deteriorates (physical/behavioral) to the degree that your needs cannot be adequately met by A Caring Alternative resources;
2. If you refuse to participate in services as determined by your individualized plan of care;
3. If all relevant goals are accomplished and need for services no longer exists;
4. If you no longer meet the eligibility requirements of the sponsoring funding source as determined by the lead agency;
5. If you move out of the geographical area served by A Caring Alternative;
6. If you choose to discontinue services;
7. Failure to pay for services provided (if applicable);

You Have the RIGHT to Access Self Help Groups within your community.
Please use the following contact information for your resources. If you wish to obtain additional resources for your county please request this from A Caring Alternative.

Burke County

• Burke County Health Department 828-439-4400
• Burke County United Way 828-433-0681
• Salvation Army 828-430-8392
• Burke United Christian Ministries 828-433-8075
• Transportation Assistance 828-439-0867
• Good Samaritan Clinic 828-439-9948
• Burke Council on Alcoholism and Chemical Dependency 828-433-1221
• Western Regional Vocational Rehabilitation 828-433-2423

Catawba County

• United Way 704-324-4357
• Vocational Rehabilitation 828-328-2331
• Salvation Army 828-322-8109
• Catawba County Health Department 828-326-5800
• Social Security Administration 828-328-4732

Caldwell County

• United Way 828-758-9300
• Caldwell County DSS 828-757-1180
• Caldwell County Health Department 828-426-8200
• Yoke Fellow Christian Service Center 828-754-7088

McDowell County

• McDowell County DSS 828-652-3355
• McDowell Mission Ministry 828-689-3981
• Vocational Rehabilitation 704-245-1223
• McDowell County Health Department 828-652-6811

Alexander County

• Alexander County DSS 828-632-1080
• Alexander Health Department 828-632-9704
• Christian Crisis Center 828-632-0022
• Emergency Management 828-632-2241
• Vocational Rehabilitation 828-328-2331

You have THE RIGHT to see your own record.
If you wish to see your record, you have the right to do so under certain circumstances specified by law and according to agency procedures. You have the right to have those circumstances and procedures explained to you. Your therapist or case manager must be present to answer your questions. You have a right to review the information in your record with a staff person unless more than one professional determines that it would be harmful for you to have it.

You have THE RIGHT to know the cost of services.
Fees for services should be discussed with you at your first visit. If this does not occur, please let us know. A listing of charges for services is available to you upon request. You may appeal the fee set for services by completing a request for reduction of fees. If you are covered by health insurance, you will need to contact the insurance company for specific information (i.e. co-payments, covered services and other terms and conditions that may affect your reimbursement) regarding your particular coverage. You have a right to know the costs of services. If the area program or the Department of Social Services refer you, A Caring Alternative does not charge you any fee for the services we provide. If you have a Medicaid deductible, services you receive by A Caring Alternative may be used to meet part or all of your deductible. If services are used to meet your Medicaid deductible, you may be asked to pay this directly to A Caring Alternative.

YOUR RIGHTS in a 24-Hour Facility
You are guaranteed additional rights by NC State law and by the Division of Mental Health, Developmental Disabilities and Substance Abuse Services’ rules when you are living in a treatment facility in the community. These rights must be shared with you within 72 hours after entering the facility.

At the time of admission to a 24-hour facility, staff may search you and your belongings to prevent dangerous or illegal substances from being brought into the facility. If there is reasonable belief that dangerous or illegal substances are present, then the facility itself may be searched. Staff may also search individuals who are minors.

YOUR RIGHTS as an ADULT Living in a 24-Hour facility
Rights (1 -4) may not be restricted (limited or taken away). Rights (5 – 23) may be restricted under some circumstances related to your treatment by the qualified professional responsible for your services. There is a special procedure to establish a restriction.

You have the right to:

1. Prompt medical treatment when you are ill and for medical services for prevention of illnesses. (You or your insurance company may be billed for medical care beyond the facility’s regular service.)
2. Send and receive unopened mail and have access to writing materials and assistance from staff with written communications and postage.
3. Contact and consult with a doctor, lawyer, advocate or other private professional at your own expense.
4. Make and receive confidential calls. You can ask people to leave the room or not to listen when you are talking on the phone. Long distance calls will be at your expense or made collect.
5. Have visitors on a regular basis.
6. Meet with people you choose under appropriate supervision.
7. Have the right to make visits outside the facility unless you have special circumstances related to your commitment.
8. Be outside daily and have access to facilities and equipment for physical exercise several times each week.
9. Keep and use personal clothing and possessions except as prohibited by law. (The facility will help you to develop and maintain an inventory of clothing and possessions to prevent loss.)
10. Participate in religious worship of your choice.
11. Keep your driver’s license unless prohibited by law.
12. Have individual storage space for your own private use.
13. Privacy in the bathroom and adaptive equipment, if needed.
14. Dignity, privacy and humane care in the provision of personal health, hygiene and grooming care. You will have the opportunity for a shower or tub bath and to shave on a daily basis. Personal hygiene articles will be provided if you cannot afford them.
15. Receive regular services of a barber or beautician.
16. Have a quiet atmosphere for uninterrupted sleep during scheduled sleeping hours. Unless determined inappropriate by the treatment team, the facility will provide areas accessible for personal privacy for at least limited periods of time.
17. Keep and spend a reasonable amount of your own money.
18. Decorate your own room within reasonable limits.
19. Have opportunities for social integration in the community. You may participate in community activities of your choosing.
20. Attend your Person Centered Planning team meetings and make suggestions concerning your care.
21. Help make rules for your program.
22. Be free from unnecessary medication.
23. Receive an individualized written discharge plan containing recommendations for further services. The discharge plan will be given to you or your legally responsible person.

YOUR RIGHTS as a MINOR residing in a 24-Hour facility
If you are a minor in a residential facility, you have the following additional rights.

You have the right to:

1. Adult supervision and guidance.
2. Access to opportunities to mature physically, emotionally, intellectually, socially and vocationally.
3. An appropriate level of structure, supervision and control.
4. Treatment separate and apart from adult service recipients, when practical.
5. Communicate with your parents or the guardian, agency or individual having legal custody.
6. Special education and vocational training in accordance with federal and state laws.

If you are an ADULT or a MINOR who is receiving services in a day/night or 24-Hour program, you have two special rights which relate to social integration and self governance.

You have THE RIGHT to:

1. Participate in appropriate and generally acceptable social interactions.
2. Provide input into program operations and rules to the extent possible, given your length of stay.

ADVANCED INSTRUCTION
In North Carolina, an advanced instruction for mental health treatment is a legal document that tells doctors and health care providers what mental health treatments you would want and what treatments you would not want if you later become unable to decide for yourself.

The designation of a person to make your health care decisions, should you be unable to make them yourself, must be established as part of a Health Care Power of Attorney. Further information can be requested from the person in charge of your care or from A Caring Alternative.

MEDICAID Appeals
You have the right to disagree with the clinical decision made by A Caring Alternative clinical staff to:

1. Deny a request for services and
2. Reduce, suspend or terminate a current service.

Medicaid provides consumers who receive Medicaid funding with an appeal process that follows Federal and State laws and helps to resolve disagreements.

A Caring Alternative or approved service provider will evaluate your treatment needs. Sometimes evaluations show that a person who requests a specific service may not benefit from or be eligible for that service. Evaluations may also show that a person who is receiving a service may no longer need it. When either of these clinical decisions is made, the agency must inform you in writing.

The letter contains the reason for the decision, the laws that support your appeal rights and the appeal steps and deadlines. The complete appeal process is outlined in the Medicaid Appeal Rights policy which can be accessed from any A Caring Alternative, LLC office.

A Caring Alternative RULES Related to Service Recipients

The following rules apply to all programs and services.

1. All programs and buildings are maintained as smoke free environments. Smoking is not allowed in agency vehicles.
2. As in all public buildings, no weapons, drugs or alcoholic beverages are permitted on the premises.
3. Sometimes service recipients who are eligible for transportation services are transported in agency vehicles. Adults must wear seatbelts and children, depending on their age, must be seated according to state and federal law.
4. Depending on the circumstances, your failure to follow rules might result in suspension or dismissal from a program.

YOUR RESPONSIBILITIES
We want to partner with you to help provide you with the best and most appropriate services possible and to protect your rights. In turn, we ask that you accept these responsibilities:

1. Know and understand that you choose your treatment and service providers. Let us know who you prefer to see.
2. Give us all the facts about the problems that bring you to us for help along with a list of all other doctors providing care for you.
3. Participate in the development of your Person Centered Plan, and do your best to follow your plan.
4. Keep appointments and attend all activities that are part of your individualized Person Centered Plan. It is required that you arrive on time for all group and individual sessions.
5. Call and let us know if you cannot keep an appointment. Failure to meet scheduled appointments will be identified as non-compliance.
6. Participation in any illegal or suspicious activity or acting out, or defacing A Caring Alternative property will not be tolerated. Any threat or act of violence directed toward staff, other clients, or visitor to the clinic is grounds for immediate dismissal from the program. Any individual dismissed under these circumstances will be barred from reentry for one (1) year and must have approval from the staff and President.
7. Selling, giving away, or using drugs on A Caring Alternative premises will be defined as non-compliance and will result in an immediate discharge.
8. If you have Medicaid or Medicare, please bring your card each time you come in for an appointment.
9. Known or suspected abuse or neglect will be reported immediately.
10. Spouses, family members, or significant others will be permitted to participate in your treatment with your expressed permission and consent.
11. You are encouraged to discuss with your assigned staff any sexual and/or physical abuse, with expectation of a referral to the most appropriate service provider for assistance.
12. Let us know about changes in your name, insurance, address, telephone number or your financial status.
13. Be responsible for the fee you have agreed to pay. Let us know if you have problems making payments.
14. Be considerate of our staff and other people you may meet in our offices.
15. Respect the rights and confidentiality of our other service recipients. You will be expected to honor the Federal Confidentiality Law.
16. Tell us how you feel about the services you receive. ACA would like to receive feedback in regards to the services you are receiving. This information will be collected though ACA’s quarterly surveys. In addition to the surveys, please utilize our consumer suggestion boxes which are located in the lobby of all office locations.
17. Tell us if you have a concern or complaint about your services.

A Caring Alternative Consumer Rights Committee
A Caring Alternative (ACA), serving Burke, Catawba, Caldwell, McDowell and Alexander Counties, has established a Client Rights Committee (CRC) to manage the operational oversight of client rights issues. The CRC is charged with ensuring the protection of client rights for all consumers served by A Caring Alternative. The CRC is made up of volunteers who donate their time and energy to ensure that client rights are upheld. Members represent specific disability areas and ages and work together across the disabilities. CRC members are appointed by ACA President. All CRC meetings are open to the public.

For further information on client rights or the ACA Client Rights Committee please contact ACA Quality Assurance Director at (828) 437-3000.

You Have THE RIGHT to Make a Complaint
A complaint is an oral or written expression of concern regarding rights, services or administrative issues that the person making the complaint believes is a problem.

You have the right to make a complaint if you are not satisfied with your services. The Division of Mental Health, Developmental Disabilities and Substance Abuse Services has created a statewide complaint process that is used by all Local Management Entities in North Carolina to resolve complaints from consumers about rights’ violations, clinical service decisions and administrative issues and service quality. We want to know your concerns, and we try very hard to resolve everyone’s complaints. While it is the intent of this agency and our employees to provide quality services to you, there may be times when you are dissatisfied. If you have complaints about your services, you should contact A Caring Alternative supervisory staff at the office located in your area. Your complaint will be investigated within 72 hours and a response will be given to you within (5) working days. If you make a complaint about services, you will not be subject to discrimination or reprisal. Documentation of your complaint and the resolution of your complaint will be maintained in the A Caring Alternative office.

If you are not satisfied with the resolution of your complaint,you have a rightto file a grievance. Please contact the Team Leader from the department in which you receive services in order to discuss your concern(s).

• Community Support Services: (828) 437-3000
• Community Support Team Services: (828) 437-3000
• Intensive In-Home Services: (828) 437-3000
• Targeted Case Management: (828) 430-4388
• Day Treatment Services: (828) 413-2251

You may also express your grievance in writing by sending a letter to:

A Caring Alternative
PO Box 1536
Morganton, NC 28680

A Caring Alternative will respond to your grievance within ten (10) working days from receipt of the grievance.