N.A.T.I.V.E. PLACEMENTS
Disclosure of Coordination and Advisor Referral Agreement
This is an Agreement between N.A.T.I.V.E. Placements and the Client (individual, family and/or
entity requesting placement service), and is effective immediately with acknowledgment of this
Disclosure. N.A.T.I.V.E. Placements refers clients to retirement living resources and elder care
options.
N.A.T.I.V.E. Placements provides personalized services to clients, their family members or legal
representatives who are looking for retirement living resources and/or elder care options. The
relationship is at-will, and the client may terminate the relationship with written notice at any
time.
We make referrals to:
- Independent Living Communities
- Assisted Living
- Memory Care
- Board and Cares
- Independent Living Facilities
- Single Room Occupancy
- In-Home Care agencies
- Cal-Aim
- Community Based Organizations
The referrals are based on information from the intake assessment form and client/family history
and includes health history, personal preference, care needs, and financial abilities. Intake
assessment form information is handled with care and information confidentiality law.
Clients will comply with all the provisions of placement, referral, and/or care coordination
consultation services and all other applicable statutes. Client is an equal opportunity consumer
and does not discriminate against employees on the basis of race, color, religion, gender,
gender identity, sexual orientation, marital or civil status, age, national origin, disability, or
veteran status.
Information will be requested only for the company and/ or Clientfs exclusive use. Neither Client,
nor its authorized representatives, will request client personal and or medical reports for any
other use than a use authorized by law and necessary for business purposes, and agrees to
use the information provided in a manner that is consistent with all state and federal laws
governing the use of such information.
N.A.T.I.V.E. Placements and Client will make every reasonable effort to safeguard and secure
all information provided, as well as all supporting documentation. All client information will be
held in strict confidence, except to the extent permitted by law. Reports on employees will be
requested only by Client's designated representatives. Employees will be forbidden to attempt to
obtain reports on themselves, associates, or any other person except in the exercise of their
official duties N.A.T.I.V.E. Placements will not disclose client personal information to the subject
of the information except as permitted.
This document will act as a medical release of information and will only be shared with providers
related to admission and or care services.
N.A.T.I.V.E. Placements partners are not considered providers and will not be liable or
responsible for the acts or omissions of a retirement living resources, housing, and/or care
provider.
Indemnification: Agency shall not be liable for any acts or omissions of a Community, facility,
organization, Domestic Worker. Client/ POA hereby agrees to indemnify, defend and hold
harmless Agency, including their agents and its officers, directors, members, employees,
successors, affiliates, their respective heirs, personal representatives, any and all persons, firms
or corporations, all persons, liable or who might be claimed to be liable, and assigns from any
and all causes of action, obligations, disbursements, losses, liabilities, deficiencies, penalties,
interest, claims, damages, death, injury, actions, suits, causes of action or suits of any kind or
nature whatsoever, proceedings, payroll taxes, settlements, judgments, costs, and expenses
(including reasonable attorneysf fees) which I now have or may hereafter have, arising out of, in
connection with, or in any way relating to any and all injuries, death, and damages of any and
every kind, to both person and property, and also any and all injuries and damages that may
develop in the future, or incidental to contracting with a referred community, facility, business,
organization, Domestic Worker under any and all circumstances. The scope of this duty to
indemnify, defend, and hold harmless specifically includes, but shall not be limited to, all claims
for damages, minimum or overtime wages, back pay, front pay, breach of contract,
discrimination, harassment, libel, slander, misclassification of any person as independent
contractor, and/or pre- and post-judgment interest.
This paragraph shall survive the termination of this Agreement. N.A.T.I.V.E. Placements
represents both the Resident and the retirement living and/ or elder Care Provider. Retirement
Living and Elder Care Provider pays us a referral fee for clients that choose to use their
services. Referral fees are charged according to individual contracted terms with Retirement
Living and Elder Care Provider and are due from providers after the client takes financial
responsibility. Referral fees cannot be passed onto the client. This is stated in the contract we
have with the Retirement Living and Elder Care Provider. Refunds to Retirement Living and
Elder Care Provider 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 as agreed
upon in the contract.
N.A.T.I.V.E. Placements partners will refer only to vetted community organizations. The
Retirement Living and Elder Care Providers are required per our contract to update us regularly
on the status of their facility license and state inspections outcomes.
NATIVE PLACEMENTS AGENCY AGREEMENT
We appoint N.A.T.I.V.E. Placements to represent us in the search of long-term care, housing,
and services. This agreement creates an agency relationship with N.A.T.I.V.E. Placements and
the Client. This agreement supersedes any and all other agreements that might have been
implied verbally, in writing or with an internet search.
Terms:
This agreement will expire after one year of service start date. Client shall be under no
obligation to N.A.T.I.V.E. Placements except for those obligations existing at the time of
termination or completion of securing long term care and/or housing.
Warranties:
N.A.T.I.V.E. Placements makes no warranties or representation regarding the suitability or care
of any referrals to Retirement Living Communities, Elder care services, and Care Provider. The
client agrees to be responsible for conducting all investigations necessary to satisfy the
suitability of said services.
Fees:
Placement and Referral Services are free to all clients and their families. Additional consulting
services are available for clients at their request for $75.00/hr.
Medicaid Clients:
N.A.T.I.V.E. Placements partners cannot collect a referral fee for Medicaid clients, only for the
private-pay portion of the stay and care, and/or for services requested by the client's family or
representative based on prior arrangements for services for private pay.
Complaints:
Each California county is required to maintain an Adult Protective Service (APS) agency to help
elder adults (65 years and older) and dependent adults (18--64 who are disabled), when these
individuals are unable to meet their own needs, or are victims of abuse, neglect or exploitation.
To report abuse, call this number 1-833-401-0832 and when prompted enter your 5-digit zip
code to be connected to the Adult Protective
