Terms of Agreement
TERMS OF AGREEMENT FOR BONNIE EVANS END OF LIFE DOULA, LLC
This agreement is written with the intention of providing guidelines and outlining realistic expectations for the scope of services provided by Bonnie Evans End of Life Doula, LLC.
As an End of Life Doula, I provide an additional layer of nonmedical support, advocacy and education to a client or family caregiver. Family caregiver in this document refers to spouse, family member, partner or friend who is the primary person assisting with care. I am independent, insured, self-employed, and work for the client, not a specific hospice, palliative care organization or hospital, assisted living or skilled nursing facility. I do not practice under my nursing licenses.
SERVICES OFFERED
A. HEALTH CARE ADVOCACY
B. ADVANCE CARE PLANNING
C. END OF LIFE PLANNING
D. LEGACY SERVICES
E. KEEPING VIGIL
F. BEREAVEMENT SUPPORT
*See detailed descriptions of each service on the website: https://www.bonnieevansdoula.com
LIMITATION OF SERVICES:
AS AN END OF LIFE DOULA, I DO NOT:
Perform clinical tasks, such as taking blood pressure, dressing wounds, catheter care, or breathing treatments, as I am not practicing under my nursing licenses.
Administer medication of any kind, including pre-filled oral syringes ordered by a healthcare provider.
Make any medical or nonmedical decisions for clients. I will assist with helping to get the necessary information and resources to better prepare clients to make informed decisions. If there are questions, or advice needed about medical care, the client will be directed and assisted to contact the medical team.
Speak to medical staff or providers on behalf of a client. I will coach and counsel and encourage the client or family caregiver to voice opinions, questions, and concerns to their medical providers.
EXTENUATING CIRCUMSTANCES:
THE PANDEMIC OF COVID – 19
How this limits direct contact with clients and family caregivers is always subject to change. CDC and Rhode Island State guidelines will be followed for any home visits while considering vaccination and risk status. I am available via phone calls, texts, facetime, emails or scheduled online conferencing.
MEDICAL EMERGENCIES
In the event of a medical emergency, you should contact your licensed healthcare provider or call 911. If you are in crisis or feeling suicidal, you can reach out to a crisis hotline such as the National Suicide Helpline (800-273-8255) or call 911.
RESPONSIBILITY OF THE CLIENT/FAMILY CAREGIVER
Texts, phone calls and emails are all appropriate methods of communication.
If you need to reschedule a session, please notify me as soon as possible, via text or email.PLEASE DO NOT EMAIL ME WITH URGENT OR TIME SENSITIVE INFORMATION, QUESTIONS, OR CONCERNS.
If you text an urgent issue, please write: “URGENT” at the beginning of the text.
My cell phone and computer are not encrypted and you should not communicate any sensitive personal or medical information in this context.
If for any reason you decide to discontinue working with Bonnie Evans End of Life Doula, LLC, please communicate this as soon as possible.
RESPONSIBILITY OF THE END OF LIFE DOULA
Model of Care – I will keep the scope of my End of Life Doula practice within the End of Life Doula Model of Care endorsed by the National End of Life Doula Alliance. As outlined, it is a collaborative, nonmedical, nonjudgmental, family centered role with a holistic approach that can help empower clients and their caregivers to make informed decisions.
http://www.nedalliance.org/the-doula-model-of-care.htmlConfidentiality: It is my professional responsibility to maintain confidentiality regarding any identifying personal or medical information that is shared with me. As a nurse practitioner, however, I am a mandated reporter, meaning that if there is any suspicion of child, vulnerable adult or elder abuse or neglect it must be reported to the relevant authorities. Any notes or records will be kept confidential and in a secured location.
Respect: Clients and/or family caregivers should expect to be treated with respect, dignity and compassion at all times.
Response Time: I will make every attempt to respond to phone calls/voicemails and texts within one hour. If you do not hear back in that timeframe, please re-contact me. I will respond to emails within 24 hours.
Availability: I will make every attempt to be available as needed when issues arise, but I am not able to provide 24-hour on-call service. My hours will focus on Monday through Friday 8 am to 6 pm, but arrangements can be made outside of those hours on a case by case basis.
LIABILITY:
I/we understand that Bonnie Evans End of Life Doula, LLC has a limited role pursuant to the description of tasks outlined in the above-referenced contract for services provided to me/us.
Bonnie Evans End of Life Doula, LLC has not represented to me/us that contracting for services guarantees in any way a problem-free death experience. I/we understand that my/our End of Life Doula(s) does not make medical decisions on my/our behalf, to include the decision of when/if to seek medical care.
In consideration of the above acknowledgements, I/we (both jointly and separately) on behalf of myself, ourselves, my/our heirs, administrators, personal representatives, executors, and assigns to release and forever discharge Bonnie Evans End of Life Doula, LLC from all damages, liability or causes of actions, either at law or in equity, which I/we may have or acquire or which may accrue to me/us, my/our heirs, administrators, personal representative, executors or assigns as a result of using the End of Life Doula services or Bonnie Evans End of Life Doula, LLC.
FEES:
A weekly or monthly invoice (based on the frequency of visits or sessions) will be mailed or emailed for services rendered. I accept checks made out to Bonnie Evans End of Life Doula LLC or electronic payments via WAVE.
INTRODUCTORY 30 MINUTE SESSION: no fee
INITIAL CONSULTATION FEE: $100 (up to 3 hours)
HOURLY RATE: $35/hour for phone calls, facetime, scheduled online conferencing, or home visits.
A sliding scale based on services provided & ability to pay can be discussed.
SERVICES THAT WILL NOT BE CHARGED: being present at the bedside vigil (the day or two prior to death), care of the body following death or follow-up bereavement call.
STATEMENT OF WORK:
Check all services that may apply:
Health Care Advocacy _______
Advance Care Planning _______
End of Life Planning _______
Legacy Services _______
Vigil Support _______
Bereavement Support _______
I/we have read this contract describing the End of Life Doula’s services and agree to enter into a client/End of Life Doula relationship for the services indicated above on an as needed basis.
CLIENT OR HEALTH CARE AGENT SIGNATURE:
____________________________________________________ DATE: __________________________
END OF LIFE DOULA SIGNATURE:
____________________________________________________DATE:___________________________
Revised April 2021