Registered Nurse Assigned

Supporting Our Team to Serve with Confidence and Compassion

We hold our caregivers to the highest standard because our clients deserve nothing less. Excellence in home care doesn’t happen by chance. It happens through leadership, accountability, and ongoing support. It is our responsibility to equip our team with a registered nurse overseeing the education, guidance, and hands-on training they need throughout the care plan process. As client needs evolve, we ensure our caregivers are confident, informed, and fully prepared to deliver safe, compassionate, and professional care. When we invest in our staff, we strengthen the quality of care in every home we serve.

$100 for our nursing visits

Your Care Team

● Scheduling Coordinator – Manages scheduling, caregiver assignments, and day-to-day communication to ensure consistent and reliable coverage.
● Wellness Care Coordinator – Oversees the overall care experience, conducts in-home visits, ensures quality assurance, and supports smooth caregiver transitions.
● Care Professionals (Caregivers) – Provide hands-on, non-medical care including personal assistance, companionship, safety monitoring, and support with daily living activities.
● Registered Nurse (RN) – When applicable, assists with care plan development, provides clinical insight, and ensures services align with the client’s health needs.
● Office Manager – Supports operations, coordinates internal processes, and helps maintain a seamless experience for clients and families.
● HR Director – Recruits, hires, and trains qualified caregivers while ensuring compliance, professionalism, and alignment with company standards.

Attendance Policy: No Call / No Show & Late Arrivals

At Bloom Homecare, reliability and punctuality are essential to maintaining safe and consistent care for our clients.
● No Call / No Show:
A “No Call / No Show” occurs when a scheduled Care Professional does not arrive for a shift and fails to notify the office prior to the start time. This is considered a serious violation of company policy. Immediate action will be taken to secure replacement care, and repeated occurrences may result in disciplinary action up to and including termination.
● Late Arrival Policy:
Care Professionals are expected to arrive on time for every scheduled shift. If a caregiver anticipates being late, they must notify the office as soon as possible so appropriate arrangements can be made. Continued lateness may result in corrective action, as it impacts client safety and continuity of care.

Bloom Homecare is committed to minimizing disruptions by maintaining strong communication, accountability, and backup staffing protocols to ensure our clients receive dependable, uninterrupted care.

Legal Paperwork

You can also Email your forms to: admin@bloomhc.com

Request Of Home Care Services

I understand that no services will be initiated or performed until I, or my personal representative(s), authorize Bloom Homecare to arrange services for me. I understand that I will be informed when services are arranged, and will be notified of any subsequent changes made in these services.

Release of Information:

I authorize any of my healthcare providers or claims representatives to release any information relating to my health and related medical services to Bloom Homecare, if this information is relevant, helpful or necessary to their delivery of services on my behalf. Service Interruption/Emergency Contact(s):

I understand that my personal representative can access any protected health information (PHI) that Bloom Homecare keeps on my behalf. I give Bloom Homecare permission to disclose my PHI to my personal representative(s) in the same way in which the agency would disclose this information to me. I understand that my personal representative(s) can also authorize Bloom Homecare to disclose my PHI to others. I also understand that, as outlined in the Bloom Homecare Privacy Practices, I can update who I have chosen to be my representative(s), though information already shared cannot be retracted.

Payment:

I understand that, as outlined in the Bloom Homecare Payment Terms & Conditions, I am responsible for paying my bill immediately upon delivery of services. EFT & Merchant services are billed biweekly.

We email your invoice and care notes to review. If the bill is past due, the service contract may be placed on hold until my account is paid in full.

Late Fee:

I am aware that accounts that are 30 days past due will incur a $25 late fee.

Schedule Changes:

We request 24-hour notice to Bloom Homecare to cancel or reschedule services. I am aware that I may be billed for the full shift and the caregiver will get paid for his/her shift.

Call (248) 315-0515

Credit Card Fee:

Credit Card Fee of 2% of total invoice

ACH Policy:

ACH is zero charge of total invoice. We withdraw the balance from a checking or savings account biweekly. Holiday Policy:

Holidays will be charged at 1.5 times the applicable rate for the appointment. Honor holidays are:

● New Year’s Day
● Easter
● Memorial Day
● July 4th
● Labor Day
● Thanksgiving
● Christmas Eve
● Christmas Day

Overtime Charges:

Our caregivers work 40 hour per week.
Clients decide if they want their caregiver to be scheduled overtime. Your hourly rate will be time and a half.
If you don't want to pay the Over Time, we will assign a different caregiver.
If there's an emergency and we staff a caregiver who is in Over Time Status, you will be billed for this to make sure we get the appropriate care for our clients.

Minimum of Hours

Shifts are scheduled at minimum increments of four (4) continuous hours. 12 Hours total for the week.
We can discontinue services if we can't provide the appropriate care for your loved one if you're under our minimum hours.

Limitation of Liability:

All Bloom Homecare employees are insured, background checked, and drug tested. I understand that Bloom Homecare employees may use my vehicle to attend errands and appointments, and that the employee may also use their private vehicle as well.
I further understand and appreciate that there are risks inherent in this service that accidents can occur no matter how cautious and careful the driver is.
All such risks are known, appreciated and accepted by me. I accept full responsibility for such damage.
I agree to carry a standard auto insurance policy if an Bloom Homecare employee will be driving my car.
I also understand that all of Bloom Homecare employees personally have active drivers license, auto insurance, and the agency also has comprehensive liability insurance & workers compensation.

Standard Homeowner’s Insurance

I also agree to carry a standard homeowner’s insurance policy or similar tenant’s policy on my residence.
All losses require a police report.
To prevent any potential losses, I agree to remove all items of concern or store them in a safe place. Money or gifts may not be given directly to any agency employee.

Direct Hire of Care or Service Providers:

All scheduling must go through Bloom Homecare office. I will not directly hire, or have a representative working on my behalf directly hire for me, any Care or Service Provider, or the Agency representing any Care or Service Provider, if they have provided service for me via Bloom Homecare within the last 180 days, unless Bloom Homecare gives written consents for this direct hire.
I also understand that employees who have been terminated by Bloom Homecare are not allowed to make private employment arrangements with me or my personal representatives within 180 days of their termination or employment unless I receive written authorization from the director at Bloom Homecare.
I understand that by doing so violates this agreement and that I will be liable to the agency for the financial damage caused.
Said financial damage will be the greater of the average gross revenue of the highest three billing periods in the last 3 months of service, or $5,000, plus all related attorney/court costs the agency incurs in enforcing this agreement.
Bloom Homecare further reserves the right to discontinue my care if I violate this agreement.

Termination:

I may withdraw from my Service Agreement with Bloom Homecare at any time, though I may be billed for services scheduled to be delivered within 24 hours of my cancellation.
I am aware that Bloom Homecare would appreciate a notice of 14 days verbally or in writing when possible.
Bloom Homecare may terminate this Service Agreement at any time for any reason. If the Agreement is terminated by Bloom Homecare I will only be responsible for services already delivered or being delivered in the month of termination.

Personal Property & Valuables Policy

For the safety and protection of all parties, clients and families are strongly encouraged to secure or remove valuables, including but not limited to cash, jewelry, medications, important documents, and personal items prior to the start of services. While our caregivers are thoroughly screened and expected to uphold the highest standards of integrity and professionalism, the agency cannot be held responsible for the loss, misplacement, or theft of items that are not secured. By signing this agreement, the client and/or responsible party acknowledges this policy and agrees to take reasonable precautions to safeguard personal property during the provision of home care services.

Transportation Waiver

Transportation I understand that the following Bloom Homecare employee is providing transportation services so I can attend medical appointments and ordinary activities of daily living such as errands including grocery shopping, pharmacy, etc.

I understand that Bloom Homecare will be driving their car or client's vehicle to attend errands and appointments.

We need 24 hour advance notice for all medical transportation scheduled: If the client is a fall risk, amputee or at risk we must use medical transportation resources

I understand and appreciate that there are possible risks that inherent in this service. Accidents can occur no matter how cautious or careful my driver was. All known risks are accepted by me.

Having read this waiver and acknowleding these facts and in consideration for the provision of said transportation services by Bloom Homecare

Method of Payment

3% Fee for credit card

0% Fee for EFT

Final Signature:

I understand that I may reserve the right to decline the use of an electronic signature. I agree that any electronic signature on this document, provided by me, is legally binding. My electronic signature on this document serves as consent I have been informed that I may request an electronic copy, for my records, of the electronically executed service agreement at any time. I acknowledge a physical copy of this service agreement is in my possession and will be retained.