SERVICE AND AGENCY AGREEMENT
Disclosure of Services and Agency Agreement
This Agreement made, effective immediately with acknowledgment of Disclosure.
Hereinafter referred to individually and collectively as The Senior Specialists LLC
Address: 28215 112th St E Buckley, WA 98321, Phone: 360-761-7736.
The Senior Specialists LLC, make referrals to senior housing and care options, provides Home Care and Real Estate services. And is therefore in subjection to RCW 18.330 under Washington State’s “Elder & Vulnerable Adult Referral Agency Act”.
We provide a personalized service to clients, their family members or legal representatives who are looking for senior housing and or care options. The relationship is at will, and client may terminate relationship with written notice at any time. Referrals are made to Independent Living, Assisted Living, and Memory Care, Adult Family Homes or Home Care options. Referrals are based off information gathered during the intake process which includes health history, personal preference, care needs and financial abilities. Information gathered in the intake form is covered by Washington State health care information confidentiality law. This document will act as a medical release and will only be shared with providers related to admission and or care services.
The Senior Specialists LLC and their employees, owners and officers are not considered providers and will not be liable or responsible for the acts or omissions of a housing or care provider. Clients will not be asked to sign waivers of potential liability for losses of potential property or injury, or to sign waivers of any rights of clients established by state or federal laws.
The Senior Specialists LLC and its affiliates acts as Dual Agents representing the Resident and the Providers. We are paid by senior providers a referral fee for clients that choose to use their services. Referral fees are charged according to individual contracted terms with Senior Specialists providers. Exact charges will be disclosed upon request. Referrals fees are due from providers after the client takes financial responsibility. According to the contract, these costs cannot be passed onto the client. Refunds to providers are given if a client passes away, is hospitalized, or is transferred to a setting with a more appropriate level of care within the first 30 days of admission. The refund is a prorated portion of the fees based upon a per diem calculation.
Referrals are made only to senior housing providers that have been verified and meet the standards set forth. Profiles are maintained on every property to include the type of license held by the provider; the provider's authority to care for individuals with mental illness, dementia, or developmental disabilities; accepted payment sources; level of medication management services and personal care services provided; cultural accommodations; primary languages spoken; activities provided; behavioral conditions that can and cannot be met; and food preference accommodations. Profiles are updated annually. State survey are checked at the time of referral and all findings are disclosed to clients within 30 days, either verbally or electronically.
Agency. We have appointed The Senior Specialists, LLC to represent us in the search of long-term care, housing and services. This agreement creates an agency relationship with The Senior Specialists, LLC , client and or their representative. This agreement supersedes any and all other agreements that might have been implied verbally, in writing or with an internet search such as A Place For Mom or Caring.com
Terms of Agreement. This agreement will expire at the time of client’s acceptance of 3rd party services or by written notice. Client shall be under no obligation to The Senior Specialists LLC except for those obligations existing at the time of termination or completion of securing long term care and or housing.
No Warranties or Representation. The Housing Specialists, LLC make no warranties or representation regarding the suitability or care of any referrals to Long Term Care Providers. The client agrees to be responsible for conducting all investigations necessary to satisfy suitability of said services.
Compensation. Placement and Referral services are free to all seniors and their families. If clients are already working with A Place For Mom or Caring.com or another agency, they may choose to work with The Housing Specialists LLC and pay for our services privately.
Medicaid or Medicare Clients. Referral Agents cannot collect a referral fee for clients who are beneficiaries of Federal or State health care programs like Medicaid or Medicare. Should a client become a Federal or State funded consumer, then the referral fee will be prorated to cover only the private pay portion of the stay. *Agents can work on a private pay basis with family, friends, or professionals of the senior
Release of Medical Records. I hereby give permission to release all medical records to The Senior Specialists LLC, for the purpose of moving into long term care and or receiving home care to include; diagnosis, medication lists, history and physical, therapy and chart notes.
Clients may at any time file a complaint of violations of the “Vulnerable Adult Referral Agency Act” with the Attorney General’s Office - 1125 Washington Street SE, PO Box 40100, Olympia, WA 98504-0100
Attorney General Phone: Mon-Fri, 10am to 3pm, (360) 753-6200
1-800-551-4636 (in state only)
1-800- 833-6384 (for hearing impaired)
1-206-464-6684 (out of state callers)