Employee

Handbook 2017
Kosciusko Home
Care and
Hospice, Inc.
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Table of Contents
PHILOSOPHY, MISSION, VISION .................................................................................................................... 3
CODE OF CONDUCT, BUSINESS ETHICS ......................................................................................................... 4
EQUAL EMPLOYMENT OPPORTUNITIES........................................................................................................ 6
IMMIGRATION LAW COMPLIANCE ............................................................................................................... 7
HIRING PRACTICES ........................................................................................................................................ 8
DRUG AND ALCOHOL TESTING, PHYSICAL EXAMINATIONS ........................................................................ 10
NATURE OF EMPLOYMENT ......................................................................................................................... 14
EMPLOYMENT CATEGORIES........................................................................................................................ 15
INTRODUCTORY PERIOD ............................................................................................................................. 16
STAFFING..................................................................................................................................................... 17
NON-DISCLOSURE ....................................................................................................................................... 18
OUTSIDE EMPLOYMENT.............................................................................................................................. 19
CONFLICT OF INTEREST ............................................................................................................................... 20
PERSONNEL RECORDS ................................................................................................................................. 21
RESIGNATION .............................................................................................................................................. 24
JOB DESCRIPTIONS ...................................................................................................................................... 25
PERFORMANCE EVALUATIONS ................................................................................................................... 26
PERSONNEL DATA CHANGES ...................................................................................................................... 27
SALARY ADMINSITRATION .......................................................................................................................... 28
RECORDS RETENTION ................................................................................................................................. 29
403(b) .......................................................................................................................................................... 32
BEREAVEMENT LEAVE ................................................................................................................................. 33
COBRA ......................................................................................................................................................... 34
HEALTH SAVINGS ACCOUNT ....................................................................................................................... 35
HEALTH INSURANCE.................................................................................................................................... 36
JURY DUTY ................................................................................................................................................... 37
LIFE INSURANCE .......................................................................................................................................... 38
PAID TIME OFF ............................................................................................................................................ 39
WITNESS DUTY ............................................................................................................................................ 40
WORKERS COMPENSATION ....................................................................................................................... 41
PAYDAY ....................................................................................................................................................... 42
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TIMEKEEPING .............................................................................................................................................. 43
BREAKS AND MEALTIMES ........................................................................................................................... 45
PAYCHECK DEDUCTIONS ............................................................................................................................. 46
BUSINESS TRAVEL EXPENSES ...................................................................................................................... 47
GRATUITIES ................................................................................................................................................. 49
SEXUAL AND OTHER UNLAWFUL HARASSMENT ........................................................................................ 50
PERSONAL RELATIONSHIPS ......................................................................................................................... 52
WORKPLACE CONDUCT............................................................................................................................... 53
ATTENDANCE .............................................................................................................................................. 54
GROOMING AND DRESS CODE.................................................................................................................... 56
PROBLEM RESOLUTION............................................................................................................................... 59
DISCIPLINE PROCESS ................................................................................................................................... 60
TELEPHONE USE AND ETIQUETTE ............................................................................................................... 62
USE AND RETURN OF EQUIPMENT ............................................................................................................. 63
PROPERTY INSPECTIONS ............................................................................................................................. 64
ITEM DONATION ......................................................................................................................................... 65
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PHILOSOPHY, MISSION, VISION

PHILOSOPHY: Kosciusko Home Care and Hospice, Inc. subscribes to the concept of health defined by the
World Health Organization as: a state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is
one of the fundamental rights of every human being without distinction of race, religion, political belief,
economic or social condition.
To this end, the Agency is committed to providing a high performance of health care essential to the
improvement of a patients physical and psychological condition. At the same time, the Agency
recognizes and respects the broad base of patient rights, in all care and service delivery, and the need to
effectively conduct all business and direct care activities related to this care in an ethical manner.
Agency employees will not impose their own belief systems or their own standards of living on patients.
Furthermore, the Agency respects the autonomy and privacy of the patient and family to make decisions
and choices affecting their present and future health status.

MISSION STATEMENT: The mission of Kosciusko Home Care and Hospice, Inc. is to make a positive
difference in the lives of those we serve, to treat all individuals with integrity, compassion, and respect,
and to deliver the highest quality of home health care and hospice services to those in need.

VISION STATEMENT: The Agency will endeavor to provide quality health care, promoting the highest
level of independence to any who utilize our resources, regardless of the ability to pay.
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CODE OF CONDUCT, BUSINESS ETHICS

POLICY: The Agency is committed to providing a safe and welcoming environment for all employees and
patients. To promote safety and comfort for all, the Agency asks all individuals to act appropriately at all
times when they are in the Agency office or other locations.

Employees are encouraged to be responsible for their personal comfort and safety and ask any person
whose behavior threatens their comfort to stop such behavior. If an employee feels uncomfortable in
confronting the person directly, they should report the behavior to their supervisor. Supervisors should
contact the Administrator if they feel any employee action warrants disciplinary action.
PROCEDURE:
1. Employees are expected to behave in a mature and responsible way and to respect the rights
and dignity of others. The Agency Code of Conduct does not permit language or any action that
can hurt or frighten another person or that could affect operations. This includes, but is not
limited to:
a. Any conduct or action that is contrary to established rules and regulations or
detrimental to the best interest of the Agency.
b. Violations of the harassment policy include, but are not limited to:
i. Angry or vulgar language including swearing, name-calling or shouting
ii. Physical contact with another person in any angry or threatening way
iii. Any demonstration of sexual activity or sexual conduct with another person
iv. Harassment or intimidation by words, gestures, body language or any other
menacing behavior
c. Theft or behavior that results in the destruction of property
d. Carrying or concealing any weapons, devices or objects that may be used as weapons.
Refer to Weapons Control Policy and Procedure.
e. Using or possessing illegal chemicals on Agency property, in Agency vehicles or at
Agency-sponsored programs.
f. Falsifying documents such as applications, resumes, time sheets, reports, clinical or
personnel file documentation.
g. Excessive tardiness or absenteeism.
h. Inappropriate attire or grooming.
i. Use of Agency equipment, facilities, data or property for personal gain.
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j. Unsafe or inappropriate use of equipment and vehicle.

2. Business Ethics
a. Kosciusko Home Care and Hospice, Inc. expects all employees to conduct business in
accordance with the letter, spirit, and intent of all relevant laws and to not engage in
any behavior that is illegal, dishonest, or unethical.
3. Sanctions
a. Employees who ignore or do not comply with this Code of Conduct and Business Ethics
may be subject to disciplinary action, up to and including termination of employment.
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EQUAL EMPLOYMENT OPPORTUNITIES

POLICY: Kosciusko Home Care and Hospice, Inc. gives equal employment and advancement
opportunities to all people; we make employment decisions at Kosciusko Home Care and Hospice, Inc.
based on each persons performance, qualifications, and abilities. Kosciusko Home Care and Hospice,
Inc. does not discriminate in employment opportunities or practices on the basis of race, color, creed,
religion, national origin, sex, marital status, sexual orientation, status with regard to public assistance,
membership or activity in a local commission, disability, age, or any other characteristic protected by
law.
GUIDELINES:
The Agency will make reasonable accommodations for qualified individuals with known disabilities
unless making the reasonable accommodation would result in an undue hardship for Kosciusko Home
Care and Hospice, Inc.
Equal employment opportunity applies to all facets of employment, pre-employment, and the terms and
conditions of employment, as well as discharge from employment.
If an employee has a question about any type of discrimination at work, they are encouraged to talk
with their immediate supervisor or the Administrator.
Any employee who does not comply with the Equal Employment Opportunity Policy may be subject to
disciplinary action, up to and including termination.
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IMMIGRATION LAW COMPLIANCE

POLICY: Kosciusko Home Care and Hospice, Inc. is committed to employing only people who are United
States Citizens or who are aliens legally authorized to work in the United States. The Agency does not
illegally discriminate because of a persons citizenship or national origin.
PROCEDURE:
1. Every new employee at Kosciusko Home Care and Hospice, Inc. is required to complete the
Employment Eligibility Verification Form I-9 and show document(s) that prove identity and
employment eligibility.
2. If an employee leaves the Agency and are rehired, they must complete another Form I-9.
3. If an employee has any questions or wants further information on the immigration laws, they
are instructed to contact the Administrator.
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HIRING PRACTICES
POLICY: Kosciusko Home Care and Hospice, Inc. strives to employ the most qualified individuals for all
positions within the organization.
GUIDELINES: For all professional positions, the Agency will employ only individuals who meet the
licensure or certification requirements for the particular professional position and are found to be in
good standing.
Employees hired to provide direct care must be at least 18 years of age.
PROCEDURE:
1. Interested individuals will be required to complete a job application and/or provide a resume.
a. Applicants are instructed to given accurate and true information on all job applications
and resumes.
b. If it is discovered that any information is misleading, false or has been omitted, the
Agency may reject the applicant from further consideration.
c. If it is discovered that any information is misleading, false or has been omitted and the
individual has been hired, the Agency reserves the right to terminate employment.
2. Interviews:
a. Interviews will be scheduled according to Agency needs.
b. Applicants who qualify for employment may be requested to attend a second and/or
third interview.
c. The final decision to hire will be made by the immediate supervisor and approved by the
Administrator.
3. Tests:
a. Written skills tests and competency testing will be administered to all aides. Refer to
Aide Competency Policy and Aide Registration Policy.
b. Competency assessment tools will be used to evaluate clinical staff in defined areas
based on job expectations.
4. Pre-employment drug testing and physical examination.
a. Refer to Drug and Alcohol Testing and Physical Examination Policy.
5. Reference Check:
a. Information supplied on the application form or during an interview will be subject to
verification.
b. At least two (2) reference checks will be obtained.
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c. If a candidate refuses to allow references checks or verification of employment, the

applicant is to be advised that he or she will no longer be considered for the position.
6. License Certification:
a. For professional positions all applicants must be able to furnish for inspection their
current license or certification. Licenses will be verified to ensure the person is in good
standing.
b. A copy of the applicants original licenses, certificate or electronic verification will be
retained for the personnel file.
c. See Aide Registration Policy and Procedure for home health aide procedure.
d. The Agency will obtain copies of updates licenses and registrations on an ongoing basis.
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DRUG AND ALCOHOL TESTING, PHYSICAL EXAMINATIONS

POLICY: Kosciusko Home Care and Hospice, Inc. is a drug and alcohol-free workplace.
GUIDELINES: Kosciusko Home Care and Hospice, Inc. reserves the right to require a post-offer physical
examination and Test for Controlled Substance to applicants, random Test for Controlled Substance, and
a Test for Controlled Substance in the event of a work-related accident.
DEFINITIONS:
1. Applicant-an individual who is applying for a position with the Agency.
2. Covered employees-an employee who has direct patient contact and who is not license by a
Board or Commission under Title 25 of the Indiana Code.
3. Randomly selected covered employees-covered employees who are selected to undergo a Test
for Controlled Substances.
4. Test for Controlled Substances-means a test that utilizes a urine specimen in a five panel test
that tests the specimen for the presence, at minimum, of amphetamines, cocaine, marijuana,
opiates, and PCP
PROCEDURE:
1. Post-offer applicants
a. Kosciusko Home Care and Hospice, Inc., requires a post-offer physical examination and
Test for Controlled Substance to all applicants who have been offered a position. An
applicants refusal to submit for a Test for Controlled Substance will result in the
applicants conditional employment being terminated due to failure to take and pass a
Test for Controlled Substance.
b. The physical examination and Test for Controlled Substance will be performed by a
contracted Provider of Care.
i. Agency reimbursement
1. Employees with less than 6 months of employment:
a. If a new hire chooses to terminate employment with Kosciusko
Home Care and Hospice, Inc. within the first six (6) calendar
months of employment, the terminating employee will be
required to reimburse Kosciusko Home Care and Hospice, Inc.
for the total cost of the pre-employment physical examination
and the Test for Controlled Substance.
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b. The total fee will be deducted from the terminating employees

final paycheck.
c. If the amount exceeds the employees final paycheck, further
arrangements will be made with the terminating employee to
pay the balance that is due.
2. If an employee with less than 6 months of employment terminates
employment with Kosciusko Home Care and Hospice, Inc. for reasons
other than his own free choice, then no reimbursement of the physical
or Test for Controlled Substance expense will be charged to the
employee.
c. Positive Test for Controlled Substance. See Step 5.
2. Work-related accidents or injuries
a. All employees involved in a work-related accident or injury while performing job duties
for Kosciusko Home Care and Hospice, Inc. will be subject to Test for Controlled
Substance and alcohol testing. If the employee refuses, the employee may be subject to
disciplinary action, up to and including termination of employment.
b. Positive Test for Controlled Substance. See Step 5.
3. Random testing
a. Identifying the sample population
i. On July 1 of each year, the Agency will determine the number of covered
employees on its employee roster.
ii. The Agency will multiply the number of covered employees by 50% to identify
the number of covered employees the Agency must randomly test before June
30th of the following year.
iii. Once the number of required tests is determined, the Agency will randomly
select the appropriate number of individuals from the list of covered employees
and complete the required number of Tests for Controlled Substances by June
30th of the following year.
iv. In the event a selected covered employee is not employed by the Agency at the
time of the test, anther Covered Employee will be selected from the list
compiled to meet the required number of Tests for Controlled Substances.
c. Positive Test for Controlled Substance. See Step 5.
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4. Reasonable suspicion
a. The Agency reserves the right to require employees to undergo a Test for Controlled
Substance at any time the Agency has reasonable suspicion that an employee is engaged
in the illegal use of a controlled substance. Reasonable suspicion may exist base on,
among other things:
i. Direct observation of drug use or alcohol use of possession.
ii. Observation of physical conditions that indicate symptoms of being under the
influence of drugs or alcohol, including but not limited to:
1. Odor;
2. Gait;
3. Speech;
4. Appearance;
5. Statements;
6. Evidence of use;
iii. A pattern of abnormal conduct or erratic behavior
iv. Arrest or conviction for a drug-related offense, or being identified as the focus
of a criminal investigation into illegal drug possession, use or trafficking;
v. A news report of a drug-related arrest;
vi. Evidence that the employee has tampered with previous drug/alcohol test.
5. Positive Test for Controlled Substance
i. If an applicant or employee has a positive Test for Controlled Substance, the
applicant or employee will be given forty-eight (48) hours to present proof from
a physician that the medication has been prescribed and is being used to treat a
medical condition.
ii. If the applicant or employee is unable to present proof from a physician that the
medication has been prescribed and is being used to treat a medical condition,
the Agency must have the test verified by a confirmation test at the applicant or
employees expense.
iii. If the confirmation test is positive, the Agency will terminate the applicants
employment offer or the employees employment.
6. Records
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a. The Agency will maintain documentation showing the employees name, date of hire,
dates and results of any Test for Controlled Substance and type of disciplinary action
take for positive Test for Controlled Substance result.
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NATURE OF EMPLOYMENT
POLICY: Employment at Kosciusko Home Care and Hospice, Inc. is presumed to be voluntary and
indefinite for both employee and employer.
DEFINITIONS:
At will: an employee is free to resign at any time, with or without cause. Likewise, the Agency
may terminate the employees employment at any time, with or without cause or advance
notice, as long as any applicable federal or state laws are not violated.
GUIDELINES:
Employment at Kosciusko Home Care and Hospice, Inc. is at will employment. The policies in this
handbook are not intended to create a contract, nor should they be construed to constitute contractual
obligations of any kind. Employees may terminate employment at any time, with or without cause or
advance notice.
The Agency cannot violate federal or state laws, and generally cannot rightfully terminate employees
who refuse to do something that is contrary to public policy and sound morality, such as breaking the
law.
The provisions in the handbook have been developed at the discretion of management and, except for
the policy of employment-at-will, may be amended or cancelled at any time, at the sole discretion of the
Agency and with the written approval of the Agency Administrator.
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EMPLOYMENT CATEGORIES
POLICY: Kosciusko Home Care and Hospice, Inc. has several different classifications of employees. It is
important for employees to understand these classifications.
GUIDELINES:
Employees are either EXEMPT or NONEXEMPT from federal and state wage and hour laws. This
classification may be changed only with written notification by Kosciusko Home Care and Hospice, Inc.
management.
1. NONEXEMPT employees: entitled to overtime pay under the specific provision of federal and
state laws.
2. EXEMPT employees: excluded from specific provisions of federal and state wage and hour laws.
In addition to Nonexempt and Exempt status, employees also belong to one of the following
employment categories:
o INTRODUCTORY employee: performance is being evaluated to determine whether
further employment in a specific position is appropriate. Upon completion of the ninety
(90) day introductory period, the employee will be told of their new employment
classification.
o PART-TIME employee: not in a temporary or introductory status AND scheduled for less
than thirty (30) hours per week.
o REGULAR FULL-TIME employee: not in a temporary or introductory status AND who are
regularly scheduled to work the full-time schedule at the Agency.
o FLEX employee: employment relationship with the Agency, but are assigned to work on
an irregular or unpredictable basis.
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INTRODUCTORY PERIOD
POLICY: Kosciusko Home Care and Hospice, Inc. will employ new employees on an initial three (3) month
(or 90 calendar days) introductory period from the date of hire.
GUIDELINES: Employees of Kosciusko Home Care and Hospice, Inc. that are within their initial three (3)
month period are not considered to be on a permanent status.
PROCEDURE:
1. Orientation will begin for an employee when all pre-employment requirements have been
satisfied.
a. Reference checks.
b. Verification of job qualifications.
c. Background checks.
d. Drug screen.
e. Pre-employment physical examination.
f. Other applicable requirements.
2. Employees will complete orientation to all facets of their job, working conditions, Agency
policies and procedures.
3. Orientation to the specific job will be conducted by the supervisor and may include a mentor or
proctor.
4. Employees will be given a copy of the employee handbook at the beginning of the orientation
period. Knowledge of all information contained within the handbook and updated as
appropriate will be the responsibility of the employee throughout the duration of their
employment with Kosciusko Home Care and Hospice, Inc.
5. Employees who have satisfactorily completed the introductory period are then assigned the
regular employment classification, as appropriate.
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STAFFING
POLICY: Kosciusko Home Care and Hospice, Inc. maintains appropriate staffing to meet business and
patient needs.
GUIDELINES:
The maintenance of a stable workforce is vital to promote good staff relations and to assure the
continuity of patient care.
Holidays:
New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, Christmas Day
PROCEDURE:
1. Weekends:
a. Full-time and part-time staff will be expected to work weekends. Flex staff may be asked
to work weekends.
b. Weekend rotation requirements are subject to changes, depending on patient census
and staffing availability.
c. Supervisors will advise employees regarding current rotational schedules.
2. Holidays:
a. Full-time and part-time staff will be expected to work holidays.
b. Flex staff may be asked to work holidays, as well.
3. Vacation Requests:
a. Will be considered on a first come, first served basis as staffing allows.
4. Low census: Staffing will be adjusted during periods of decreased work loads.
a. Full-time employees will be given priority according to seniority.
b. Part-time employees will be given next available hours, according to seniority, after full-
time staff are scheduled.
c. Flex employees will be used if there are insufficient full and part-time staff.
5. Refused assignments:
a. If at any time an employee declines an assignment for personal reasons; he or she will
not be guaranteed replacement hours.
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NON-DISCLOSURE
POLICY: This policy provides guidelines for Kosciusko Home Care and Hospice, Inc. employees to protect
confidential business information and trade secrets.
DEFINITIONS:
Confidential business information includes, but is not limited to, the following:
o Compensation data
o Computer processes
o Computer programs and codes
o Customer and vendor lists
o Financial information
o Marketing strategies
o Pending projects and proposals
GUIDELINES:
An employee who improperly uses or discloses a trade secret or confidential business information may
be subject to disciplinary action, up to and including termination of employment and legal action. This
applies even if the employee does not get any benefit from releasing the information.
Employees may be asked to sign a non-disclosure agreement as a condition of employment.
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OUTSIDE EMPLOYMENT
POLICY: Kosciusko Home Care and Hospice, Inc. holds all employees to the same job performance
standards and scheduling expectations regardless if they have other jobs.
GUIDELINES:
An employee may not hold an outside job that is a conflict of interest with the Agency.
An employee may not receive payment or anything in return from a person outside Kosciusko Home and
Hospice, Inc. in exchange for a service that are provided as part of the employees job at the Agency.
Agency employees may not work privately for the Agencys current patients.
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CONFLICT OF INTEREST
POLICY: Kosciusko Home Care and Hospice, Inc. employees are not to engage in activities contrary to the
Agencys interest or in activities inconsistent with responsibilities entrusted to them. A conflict is created
whenever an employee achieves personal gain or incurs obligation to others at the expense of the
Agency. Such personal gain need not be direct and might include gain by employees family members or
other relatives.
GUIDELINES:
Situations in which a conflict of interest may arise:
1. Corporate transactions: sale, purchase, rental, or lease of property, employee services or
supplying products.
2. Receiving gifts, special payments or favors of greater than a nominal value from an individual or
organization that is providing goods or services to the Agency or receiving goods or services
from the Agency. At no time should an employee solicit, request or otherwise indicate gifts,
payments, favors, etc., are expected.
3. Misuse of proprietary company information or confidential information not available to the
public, for personal or others gain. This would include mailing lists or any such information to
the Agencys disadvantage or the employees or others improper advantage.
4. Use of Agency resources to develop competitive programs for personal use or use by others.
5. Having influence over another companys transactions involving purchases, contracts, or leases.
6. Although it is not automatically assumed that there is a conflict of interest, if an employee has a
relationship with another company, they are instructed to tell their immediate supervisor at
Kosciusko Home Care and Hospice, Inc. as soon as possible so that safeguards may be
established to protect all parties.
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PERSONNEL RECORDS
POLICY: Kosciusko Home Care and Hospice, Inc. establishes and maintains records for all personnel. All
information will be considered confidential and made available to authorized personnel only. This policy
provides guidelines for Kosciusko Home Care and Hospice, Inc. employees to identify the content of
personnel files and provide for a system for maintaining accurate, complete, and current information.
PROCEDURE:
1. Personnel Records-the employee personnel record may include, but is not limited to:
a. Pre-employment Information:
i. Employment application (signed and dated).
ii. Interview documentation.
iii. Reference Checks.
iv. Criminal history and background checks, as required by law.
v. Credentials.
b. Employment Information:
i. Employment letter.
ii. Competency testing for Home Health Aides and specific competencies per job
title.
iii. License and certifications.
iv. CPR certification.
v. Signed job description.
vi. Skills checklist.
vii. Orientation checklist.
viii. Confidentiality statement (signed).
ix. Conflict of interest statement-(signed), if applicable.
x. Receipt of handbook acknowledgement.
xi. Employee benefit information.
xii. I-9 and payroll information.
xiii. Drivers license and proof of insurance, if applicable.
c. Ongoing Employment:
i. Performance appraisal and documentation of established performance plans.
ii. Counseling reports and disciplinary actions.
iii. Updated job descriptions.
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iv. Education record.

v. In-services.
vi. Updated license/certification.
vii. Competency review (written and observed, as indicated).
viii. Commendations.
ix. Incident reports.
d. Medical History/Health Status-Maintained confidentially
i. Pre-employment physical, if required.
ii. Hepatitis B declination or immunization record.
iii. TB screening (2-step Mantoux), chest x-ray or evidence of treatment, as
indicated.
iv. Drug screening.
e. Employment
i. On-going immunization and TB testing.
ii. Illness record.
iii. Attendance.
iv. Workers Compensation claims and correspondence.
v. Criminal background check results, as required.
f. Termination documentation
i. Unemployment separation records.
ii. Unemployment claims.
iii. COBRA information.
2. Release of Employee Information
a. Internal: Personnel records are confidential and will be released only to responsible
agency management personnel for review. Employees may request to review their
own personnel records. The request must be in writing, and the Agency has a
reasonable time frame to comply.
b. External: Release of personnel information on current and terminated employees will be
limited to verification of date of hire, date of termination, classification, and salary.
i. When unemployment or other type of claim is filed, the necessary information
will be released as required by law.
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ii. Original personnel files shall be retained for a minimum of three (3) years after
an employee or contractor cease to be employed by the agency.
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RESIGNATION
POLICY: Employment at Kosciusko Home Care and Hospice, Inc. is at-will employment.
DEFINITIONS:
Resignation: an employee voluntarily terminates employment with Kosciusko Home Care and
Hospice, Inc.
GUIDELINES: Kosciusko Home Care and Hospice, Inc. requests that all employees give at least two (2)
weeks notice of resignation.
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JOB DESCRIPTIONS
POLICY: Kosciusko Home Care and Hospice, Inc. maintains job descriptions for all jobs at the Agency.
GUIDELINES: Job descriptions are used to identify job requirements, set up hiring criteria, set standards
for employee performance evaluations, and establish a basis for making reasonable accommodations.
The Administrator and the employees supervisor prepare a job description for a newly created job.
A job description does not necessarily cover every task or duty that may be asked of an employee. If
there are any questions or concerns, employees are directed to speak with their supervisor or the
Administrator.
PROCEDURE:
1. Job descriptions include the following items:
a. Job information.
b. Job summary.
c. Essential duties and responsibilities.
d. Supervisory responsibilities.
e. Qualifications (Including education and/or experience, language skills, mathematical
skills, reasoning ability, and any certification required).
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PERFORMANCE EVALUATIONS
POLICY: All Kosciusko Home Care and Hospice, Inc. employees are required to have an introductory
period and annual performance evaluation. The performance evaluations evaluate the employees
overall work performance, assist in the team members continued growth and development, and ensure
that the Agencys goals are being met through the employees work effort.
GUIDELINES: The evaluations will be conducted by the employees supervisor and will be in written
form. The Agency may give merit-based pay adjustments to employees to recognize truly superior
performance, based in part on the annual performance evaluation.
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PERSONNEL DATA CHANGES

POLICY: Kosciusko Home Care and Hospice, Inc. needs correct and complete employee records.
PROCEDURE:
1. It is the responsibility of the employee to notify the Agency of any changes including, but not
limited to the following:
a. Emergency contact information.
b. Mailing address.
c. Telephone numbers.
2. The employee is to notify the Agency in writing of changes to the employees record.
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SALARY ADMINSITRATION
POLICY: Kosciusko Home Care and Hospice, Inc. has a salary administration program. The Agency is
committed to consistent pay practices, to Equal Employment Opportunity, and to offering competitive
salaries within the specific labor market.
GUIDELINES: Salaries are based on the requirements and responsibilities of each job. Compensation for
each job is based on several factors including: job analysis and evaluation, the essential duties and
responsibilities of the job, and salary survey data. The Agency may give merit-based pay adjustments to
some employees to recognize superior performance.
Employees who have questions about compensation should talk with their supervisor.
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RECORDS RETENTION
POLICY: Kosciusko Home Care and Hospice, Inc. will maintain Agency records according to the retention
schedule below. The Agency will abide by applicable state or federal regulations.
PROCEDURE:
1. Administrative:
a. CPA/State Board of Accounts Report Permanent
b. Annual tax returns Permanent
c. Endowments, Trusts, Bequests Permanent
d. Expired insurance policies Permanent
e. Licenses, Permits, Contracts Permanent
f. Meeting minutes Permanent
g. Property records Permanent
h. State Department of Health inspection reports Permanent
i. Policies and procedures Permanent
j. Payroll 10 years
k. Correspondence 7 years plus current year
l. Financial Reports 7 years plus current year
2. Director of Operations:
a. Accident/Incident reports 10 years
b. End of month reports 7 years plus current year
c. Staff communication and memos 7 years plus current year
d. Volunteer Request Log NA
e. HC/HO Referral Log NA
f. Community bereavement log NA
g. Grief Series log NA
h. HC Social Work utilization log NA
3. Quality Assurance
a. Staff Education-Nursing and Therapy Permanent
b. Flu vaccine report Permanent
c. Audit/QAPI reports 7 years plus current year
d. Hospice Item Set (HIS) 7 years plus current year
e. OASIS/Casper Report 7 years plus current year
f. Patient Satisfaction-CAHPS 7 years plus current year
g. IDG/IDT meeting notes 7 years plus current year
h. Staff communications/memos 7 years plus current year
4. Information technology
a. Disaster recovery plan Permanent
b. OASIS Export Reports 7 years plus current year
c. CAHPS Export 7 years plus current year
d. REAL Services authorizations 7 years plus current year

e. Medicaid prior authorizations
f. Security risk analysis
g. Office equipment inventory
h. User login info
i. System activity review logs
j. Security audit reports
k. Physician licenses
5. Marketing
a. Newsletters, press releases
b. Advertising
c. Hospice services information
d. Home Care services information
e. Marketing presentations
f. Website passwords, information updates
g. Patient photos for advertising
h. Agency historical information
6. Billing
a. Flu vaccine
b. Lifeline billing files
c. Lifeline incident files
d. Medicare remittance
e. Medicaid remittance
f. Electronic Medicare claims
g. Credit balance reporting
h. Room and board records and billing
i. Notice of election
j. Phone records for claim issues
k. Patient billing files
l. Room and board report
m. Mail log
7. Home Health Aide(HHA)/Homemaker(HMK) Coordinator
a. HHA/HMK in-service records
b. DAS sheets
c. HHA skills checklist/ competency testing
d. HHA/HMK schedules
8. Office Manager
a. Board of Director meeting minutes and agenda
b. Professional Advisory Committee meeting minutes and agenda
c. Financial minutes
P a g e | 30
7 years plus current year
6 years plus current year
6 years plus current year
6 years plus current year
6 years plus current year
6 years plus current
NA
Permanent
Permanent
Permanent
Permanent
Permanent
Permanent
Permanent
Permanent
Permanent
7 years plus current year
1 year after termination
7 years plus current year
7 years plus current year
7 years plus current year
7 years plus current year
7 years plus current year
7 years plus current year
7 years plus current year
7 years plus current year
7 years plus current year
7 years plus current year
Permanent
7 years plus current year
4 years after termination
NA
Permanent
Permanent
Permanent
 P a g e | 31

d. Personnel health files 30 years from termination

e. Cash log, deposits 7 years plus current year
f. Petty cash balance report 7 years plus current year
g. Accounts payable 7 years plus current year
h. Personnel files 4 years after termination (covers FICA)
9. Clinical staff
a. Patient index file 7 years after discharge
i. Referral paperwork
ii. Admission paperwork
iii. Visit notes
iv. HHA/HMK patient flowsheets
v. Phone call notes
vi. Faxed communications
vii. Physician orders
viii. Laboratory test results
ix. IDG/IDT notes
x. OASIS information
 P a g e | 32

403(b)
POLICY: Kosciusko Home Care and Hospice, Inc. offers a 403(b) savings plan for eligible employees.
GUIDELINES: All employees are eligible to join the 403(b) savings plan.
PROCEDURE:
1. Employees may enroll in the 403(b) plan and contribute as outlined in the plan details.
 P a g e | 33

BEREAVEMENT LEAVE
POLICY: Kosciusko Home Care and Hospice, Inc. provides bereavement leave to employees who are in
need of time off because of the death of an immediate family member.
DEFINITIONS:
Immediate family member:
o Employee: spouse, parent, child, childs spouse, brother, sister, grandparents
o Employees spouse: parent, child, brother, sister, grandparents
GUIDELINES: Regular, full-time employees are eligible for up to three (3) days of bereavement leave
with pay. While on paid bereavement leave, employees will receive their base pay rate but will not
receive any special forms of pay, such as shift differentials.
 P a g e | 34

COBRA
POLICY: Employees of Kosciusko Home Care and Hospice, Inc. and their dependents may be eligible for
health insurance under the Consolidated Omnibus Budget Reconciliation Act (COBRA).
GUIDELINES: Each employee is given important information concerning COBRA upon termination of
their health insurance.
 P a g e | 35

HEALTH SAVINGS ACCOUNT

POLICY: Kosciusko Home Care and Hospice, Inc. provides a Health Savings Account (HSA) to eligible
employees who enroll in the program.
GUIDELINES: Employees in the following employment classification are eligible to enroll in the life
insurance plan:
1. Regular, full-time employees.
PROCEDURE:
1. Kosciusko Home Care and Hospice, Inc. will deduct the correct amount from the employees pay
prior to the calculation of taxes.
2. The deducted monies are deposited into the HSA.
3. Employees may then use the money in the HSA to pay for allowed health care expenses.
4. Employees may contribute up to $5,000.00 each year.
5. Employees can only contribute to the HSA by having monies deducted prior to taxes.
6. If all the money in the HSA account is not used by the end of the year, the account will roll over
to the next year.
 P a g e | 36

HEALTH INSURANCE
POLICY: Kosciusko Home Care and Hospice, Inc. offers medical benefits to eligible employees and their
dependents.
GUIDELINES: Employees in the following employment classification are eligible to enroll in the employee
insurance plan:
1. Regular, full-time employees
PROCEDURE:
1. Eligible employees may enroll in the health insurance plan subject to the terms and conditions
of the agreement between Kosciusko Home Care and Hospice, Inc. and the insurance carrier.
 P a g e | 37

JURY DUTY
POLICY: Kosciusko Home Care and Hospice, Inc. encourages employees to fulfill their civic
responsibilities by serving jury duty if summoned.
GUIDELINES: Each employee will maintain employment throughout the duration of jury duty. Employees
may use any available PTO to offset loss during jury duty.
 P a g e | 38

LIFE INSURANCE
POLICY: Kosciusko Home Care and Hospice, Inc. offers a life insurance plan for eligible employees.
GUIDELINES: Employees in the following employment classification are eligible to enroll in the life
insurance plan:
1. Regular, full-time employees
PROCEDURE:
1. Eligible employees may enroll in the life insurance plan subject to the terms and conditions of
the agreement between Kosciusko Home Care and Hospice, Inc. and the insurance carrier.
 P a g e | 39

PAID TIME OFF

POLICY: Kosciusko Home Care and Hospice, Inc. provides Paid Time-Off (PTO) to eligible employees.
GUIDELINES: Employees in the following employment classification are eligible to accrue PTO:
1. Regular, full-time employees.
PTO is an all-purpose, time-off policy. PTO can be used for vacation, illness or injury, holidays, and
personal business. This PTO policy combines traditional vacation and sick leave plans into one flexible,
paid time-off policy.
PROCEDURE:
1. Employees must work forty (40) hours in a two (2) week period to accrue PTO.
2. Employees may not use PTO until after a waiting period of one-hundred eighty (180) days.
3. PTO accrual schedule is as follows:
a. Less than 5 years from date of hire: accrued bi-weekly at the rate of 0.097 per hour
worked.
b. More than five (5) years from date of hire: accrued bi-weekly at the rate of 0.1207 per
hour worked.
4. PTO compensation will be done at the base rate as of the time of the absence.
5. Unused PTO:
a. If available PTO is not used by the end of the benefit year, it may be carried over to the
next benefit year.
b. PTO Cap amounts:
i. 1-5 years of seniority=320 hours
ii. Over 5 years seniority=320 hours
c. If unused PTO exceeds the Cap amounts, the employee will temporarily stop accruing
PTO time until the total PTO amount falls below the cap.
6. Employment termination:
a. Employment of at least six (6) months is required before any PTO is paid.
b. Employees will be paid for any unused PTO that has been earned through the last day of
work.
 P a g e | 40

WITNESS DUTY
POLICY: Kosciusko Home Care and Hospice, Inc. will give employees time off to testify in court if they
receive a subpoena.
GUIDELINES: In order to receive time off to be a witness, employees must show the subpoena to their
supervisor as soon as they receive it.
PROCEDURE:
1. If an employee is summoned to be a witness on behalf of Kosciusko Home Care and Hospice,
Inc., that employee will receive time off with pay.
2. If an employee is summoned to be a witness for someone other than the Agency, the employee
will receive time off without pay. The employee may use any available PTO benefits towards
unpaid time off, if desired.
 P a g e | 41

WORKERS COMPENSATION
POLICY: Kosciusko Home Care and Hospice, Inc. provides a comprehensive workers compensation
insurance program to the employees. This program is at no cost to the employee.
PROCEDURE:
1. Employees are to notify their supervisor immediately and not later than twenty-four (24) hours,
about any work-related injury, regardless of how minor it may seem at the time.
2. Workers compensation covers only direct, work-related injuries.
 P a g e | 42

PAYDAY
POLICY: Kosciusko Home Care and Hospice, Inc. will pay employees on a bi-weekly basis.
PROCEDURE:
1. Kosciusko Home Care and Hospice, Inc. has a direct deposit program. All employees are
encouraged to use the direct deposit program and will not receive a paycheck. Instead, the
employee will receive a paystub with the appropriate pay details.
2. Paystubs are available in the office on the Thursday afternoon of the pay week. If paystubs are
not picked up by Friday at noon, they will be mailed to the employee.
3. Paystubs include details for all work performed through the end of the previous payroll period.
4. Employees are to notify the Administrator if an error is detected on the paystub.
 P a g e | 43

TIMEKEEPING
POLICY: Kosciusko Home Care and Hospice, Inc. holds all nonexempt employees responsible for
accurately recording time worked.
DEFINITIONS:
Time worked: all time that nonexempt employees spend performing Agency work.
GUIDELINES: Kosciusko Home Care and Hospice, Inc. is required by law to accurately calculate employee
pay and benefits from an employees time worked.
PROCEDURE:
1. Regular hours
a. Employees are required to accurately record all time worked.
i. Employees are to record the time work is started and stopped.
ii. Employees are to record any meal periods.
iii. Employees are to record any appropriate mileage and travel time.
iv. Employees are to record the time they leave the workplace for personal
reasons.
b. Nonexempt employees may not start working more than fifteen (15) minutes before the
scheduled start time.
c. Nonexempt employees may not continue working more than fifteen (15) minutes after
the scheduled end time.
2. Overtime hours
a. Employees may not work overtime without the express permission of their direct
supervisor.
i. Nonexempt employees will receive overtime pay in accordance with the federal
and state wage and hour laws.
ii. Overtime pay is based on actual hours worked over 40 hours per week.
iii. PTO is not counted as hours worked when calculating overtime pay.
3. If corrections or changes are made to the manual time record, both the employee and the
employees supervisor must initial all changes to the employees time record.
4. Employees will be subject to disciplinary action, up to and including termination for the
following:
a. Falsifying records.
b. Tampering with time records.
 P a g e | 44

c. Recording another employees time.

 P a g e | 45

BREAKS AND MEALTIMES

POLICY: Kosciusko Home Care and Hospice, Inc. provides employees with the federally required break
periods.
PROCEDURE:
1. Employees who work at least eight (8) hours in one (1) day are entitled to two (2), paid, fifteen
(15) minute breaks.
2. Employees who work less than eight (8) hours but more than four (4) hours are entitled to one
(1), paid, fifteen (15) minute break.
3. Employees are to schedule breaks according to workload and patient census.
4. Paid breaks at the end of the day are not acceptable.
5. All full-time employees will have one, unpaid, meal period of thirty (30) minutes per workday.
 P a g e | 46

PAYCHECK DEDUCTIONS
POLICY: Kosciusko Home Care and Hospice, Inc. is required by law to take deductions from an
employees pay.
DEFINITIONS:
Deductions: money taken from an employees pay, for items such as federal, state, and local
taxes, child support, and Social Security taxes.
GUIDELINES: Kosciusko Home Care and Hospice, Inc. pays a portion of an employees Social Security
taxes.
PROCEDURE:
1. Kosciusko Home Care and Hospice, Inc. may deduct an employees pay for federal, state, and
local taxes, Social Security taxes, and child support.
2. Kosciusko Home Care and Hospice, Inc. may be required to garnish portions of an employees
paycheck as required by law.
3. Employees may also request additional deductions that are not required by law.
 P a g e | 47

BUSINESS TRAVEL EXPENSES

POLICY: Kosciusko Home Care and Hospice, Inc. will reimburse employees for all appropriate travel
expenses.
GUIDELINES: Travel expenses include the following: travel, meals, lodging, and other expenses
necessary to meet the objective of the travel.
PROCEDURE:
1. All travel must be pre-approved by the Administrator.
2. Once travel is approved, the employee is responsible for making individual travel arrangements.
3. Travel expenses will be reimbursed, provided they were necessary to meet the objectives of the
trip and were kept within reasonable limits.
4. Mileage costs for use of a personal car will generally be reimbursed if less expensive
transportation is not available.
5. Costs of standard accommodations in mid-priced hotels, motels, or similar lodging will generally
be reimbursed.
6. Nonexempt employees will receive overtime pay in accordance with the Fair Labor Standards
Act (FLSA).
a. For one day conferences in another city, most of the hours spent traveling and working
are considered work time.
b. For conference travel that keeps an employee away from home overnight, the following
rules apply:
i. The travel time is work time when it cuts across the employees workday.
ii. Travel time on the employees non-working days which occurs during hours that
correspond with his or her normal working hours is counted as time worked.
iii. Travel time away from home that occurs outside of regular working hours is not
considered work time.
iv. The evening meal period time is not counted as time worked.
7. If an employee uses a vehicle owned, leased or rented by Kosciusko Home Care and Hospice,
Inc., the employee may not use that vehicle for personal reasons without advanced approval
from the Administrator.
8. If an employee is involved in an accident while on business travel, the employee is to
immediately report the accident to their immediate supervisor.
a. Both the employee and the supervisor are to document the details of the accident.
 P a g e | 48

b. In the event of an injury, the employee is to immediately submit to drug and alcohol
testing at a local Provider of Care and notify the supervisor of the Provider of Cares
contact information.
9. All employees are to submit a completed travel expense report to the Administrator within
three (3) days of completed business travel, including copies of receipts for every expense item.
10. Employees who fail to follow this policy or give false or misleading information on an expense
report may be subject to the following consequences:
a. An employee may be subject to disciplinary action, up to and including termination of
employment.
 P a g e | 49

GRATUITIES
PURPOSE: To provide guidance to employees regarding gifts from patients.
POLICY: Kosciusko Home Care and Hospice, Inc. recognizes that patient and families may be grateful for
services provided by employees of the Agency, particularly during the holiday season and desire to give
gifts to employees. The Agency realizes that patients and families may be offended if gifts are refused.
Employees are prohibited from soliciting gifts from patients and families.
PROCEDURE:
1. Employees are required to discuss each individual gift with their supervisor. Failure to notify the
supervisor may result in disciplinary action.
2. If the total value of the gift(s) is less than $10, the employee may keep the gift.
3. If the total value of the gift(s) is greater than $10, the employee is to give the gift to the
Administrator, who may use it for the benefit of all employees of the Agency.
 P a g e | 50

SEXUAL AND OTHER UNLAWFUL HARASSMENT

POLICY: Kosciusko Home Care and Hospice, Inc. maintains a work environment that is free from all
forms of discrimination that can be considered harassing, coercive, or disruptive, including sexual
harassment.
DEFINITIONS:
Sexual harassment: unwanted sexual advances, or visual, verbal, or physical conduct of a sexual
nature.
GUIDELINES: Kosciusko Home Care and Hospice, Inc. will not tolerate any actions, words, jokes, or
comments based on a persons sex, race, color, national origin, age, religion, disability, or any other
legally protected characteristic.
Unwelcome sexual advances (either verbal or physical), requests for sexual favors and other verbal or
physical conduct of a sexual nature constitute sexual harassment when:
1. submission to such conduct is made either explicitly or implicitly a term or condition of
employment;
2. submission or rejection of the conduct is used as a basis for making employment decisions; or
3. the conduct has the purpose or effect of interfering with the work performance or creating an
intimidating, hostile, or offensive work environment.
While it is impossible to list every action that is unacceptable conduct, the following lists some examples
that may result in disciplinary action, up to and including termination of employment:
1. Unwanted sexual advances, including verbal or physical.
2. Offering employment benefits in exchange for sexual favors.
3. Making or threatening reprisals after a negative response to sexual advances.
4. Visual conduct that includes leering, making a sexual gesture, or displaying a sexually suggestive
object, picture, cartoon, or poster.
5. Verbal conduct that includes making or using derogatory comments, epithets, slurs, or jokes.
6. Verbal abuse of a sexual nature, graphic verbal commentaries about an individuals body,
sexually degrading words used to describe an individual, or suggestive or obscene letters, notes,
or invitations.
7. Physical conduct that includes touching, assaulting, or impeding or blocking movements.
PROCEDURE:
1. Employees are required to immediately report to their supervisor any sexual or other unlawful
harassment that is experienced or witnessed.
 P a g e | 51

2. If the employees supervisor is unavailable or the employee believes it would be inappropriate

to discuss it with their supervisor, the employee should immediately contact the Administrator
or any other member of management.
3. All supervisors or managers who receive reports of sexual or other unlawful harassment or
become aware of possible sexual or other unlawful harassment are to report to the
Administrator or any other member of management.
4. All reports of sexual or other harassment will be quickly and discreetly investigated. To the
extent possible, the confidentiality of all involved parties will be maintained.
5. Employees will not be punished or suffer reprisal for reporting sexual or other unlawful
harassment.
 P a g e | 52

PERSONAL RELATIONSHIPS
POLICY: This policy provides guidelines for Kosciusko Home Care and Hospice, Inc. who are in a dating
relationship with a fellow employee or who have relatives who work in the Agency.
DEFINITIONS:
Relative: Any person who is related to you by blood or marriage, or who relationship with you is
similar to that of a relative.
Dating relationship: A relationship that might reasonably be expected to lead to consensual
romantic relationship.
GUIDELINES:
An employee may not supervise a relative or a dating partner, and dating relationships are prohibited in
the same department.
Any employee involved in a close personal relationship must avoid displays of affection and excessive
personal conversations at work.
 P a g e | 53

WORKPLACE CONDUCT
POLICY: Kosciusko Home Care and Hospice, Inc. employees follow all work rules and conduct themselves
in ways that protect the interests and safety of all employees, customers, and visitors of Kosciusko
Home Care and Hospice, Inc.
GUIDELINES: While it is impossible to list every action that is unacceptable conduct, the following lists
some examples that may result in disciplinary action, up to and including termination of employment:
1. Theft or inappropriate removal or possession of property.
2. Falsification of timekeeping records.
3. Working under the influence of alcohol or illegal drugs.
4. Possession, distribution, sale, transfer or use of alcohol or illegal drugs in the workplace, while
on duty, or while operating employer-owned vehicles or equipment.
5. Fighting or threatening violence in the workplace.
6. Boisterous or disruptive activity in the workplace.
7. Negligence or improper conduct leading to damage of employer-owned or customer-owned
property.
8. Insubordination or other disrespectful conduct.
9. Violation of safety or health rules.
10. Smoking in prohibited areas.
11. Sexual or other unlawful or unwelcome harassment. Refer to Sexual and Other Unlawful
Harassment Policy and Procedure.
12. Possession of dangerous or unauthorized materials, such as explosives or firearms, in the
workplace.
13. Excessive absenteeism or any absence without notice.
14. Unauthorized absence from work station during the workday.
15. Unauthorized use of telephones, mail system, or other employer-owned equipment.
16. Unauthorized disclosure of business secrets or confidential information.
17. Violation of personnel policies.
18. Unsatisfactory performance or conduct.
 P a g e | 54

ATTENDANCE
POLICY: Employees of Kosciusko Home Care and Hospice, Inc. will maintain proper attendance and
punctuality.
DEFINITIONS:
No-call/No-show: an incidence when an employee does not report to work at the appropriate
time and has not notified management prior to that time.
Unplanned absence: any scheduled workday that an employee is unable to start and complete
or any scheduled workday in progress that the employee is unable to complete. Previously
approved and scheduled days off are not unplanned absences.
Tardy: arriving to the workplace or the first patients home after the approved start time.
GUIDELINES: Regular attendance is expected of employees. Unplanned absences disrupt workflow,
inconvenience other employees and patients, and affect productivity.
PROCEDURE (pertains to all employees):
1. In the event of an unplanned absence, employees are required to speak with their supervisor or
designee. Do not leave a message.
2. Employees are required to submit a doctors note to their supervisor stating any restrictions to
performing their daily tasks.
3. Employees are required to submit a doctors note to their supervisor for any absence lasting
three (3) days or more before reporting back to work.
4. Kosciusko Home Care and Hospice, Inc. will respect a patients right to refuse certain staff for a
legitimate reason. Patients will be notified that refusal of staff members may affect their ability
to receive care.
5. Attendance:
a. An employee is allowed no more than two (2) unplanned absences per month.
b. An employee is allowed no more than six (6) unplanned absences per six (6) month
period.
i. The six (6) month period begins on the day of the first unplanned absence and
continues for 180 calendar days.
6. Tardy:
a. An employee is allowed no more than two (2) tardies per month.
b. An employee is allowed no more than six (6) tardies per six (6) month period.
 P a g e | 55

i. The six (6) month period begins on the day of the first tardy and continues for
180 calendar days.
7. Employees that violate the attendance policy may receive disciplinary action, up to and
including termination of employment.
PROCEDURES (pertains to HHA/HMK):
1. All employees must be on-time for the first visit of the day. Late visits will be counted as a
tardy.
2. Second visit and thereafter:
a. All employees have a one-half hour leeway before and after the scheduled time to
account for unexpected events, such as weather conditions, trains, road construction or
a motor vehicle accident.
b. All employees must contact the HHA/HMK coordinator if the employee will be greater
than one-half hour late to the patients home. Unless an appropriate reason is given, the
HHA/HMK Coordinator will document this as a tardy in the employees file.
c. Delays related to severe weather will not be documented as tardy.
3. Change of shift:
a. Employees are to find a replacement for a change of shift that is needed after the
monthly schedule has been distributed.
b. Both the employee who is scheduled and the employee who will be working must
complete the Change of Shift Responsibility form.
c. The Change of Shift Responsibility form must be turned into the HHA/HMK
Coordinator AND approved prior to the start of shift.
d. Potential for overtime must be approved by the HHA/HMK Coordinator.
PROCEDURE (pertains to RNs, LPNs, MSWs):
1. Change of shift:
a. Employees are to find a replacement for a change of shift that is needed after the
monthly schedule has been distributed.
b. Both the employee who is scheduled and the employee who will be working must
complete the Change of Shift Responsibility form.
c. The Change of Shift Responsibility form must be turned into the supervisor AND
approved prior to the start of shift.
d. Potential for overtime must be approved by the supervisor.
 P a g e | 56

GROOMING AND DRESS CODE

POLICY: Employees of Kosciusko Home Care and Hospice, Inc. will maintain a clean, neat, appropriate,
and professional appearance.
DEFINITIONS:
Personal appearance: how a person dresses, how neat that person is, and their cleanliness
standards
GUIDELINES: The personal appearance of the employees of Kosciusko Home Care and Hospice, Inc. can
affect how customers, visitors, and co-workers view Kosciusko Home Care and Hospice, Inc.
While it is impossible to list every action that is unacceptable conduct, the following lists some examples
of an acceptable personal appearance.
1. Cleanliness is essential for the comfort and protection of fellow employees, patients, customers,
and visitors.
2. Items essential to good personal hygiene include: soap, shampoo, deodorant, and toothpaste,
and are expected to be utilized by all employees.
3. Perfume, cologne, and aftershave lotion should be used sparingly or avoided altogether as some
individuals may be sensitive to strong fragrances.
4. Poorly fitting, dingy, wrinkled, faded clothing and dirty tennis shoes are prohibited. Clothing and
shoes are to be maintained in good repair at all times. When white clothing no longer appears
white (becomes yellow or gray), it will no longer be considered appropriate.
5. Extremes of dress, hairstyle, or jewelry, etc. will not be permitted. Jewelry should not be
functionally restrictive or dangerous to job performance.
6. Facial jewelry, including but not limited to eyebrow rings, nose rings, lip rings, and tongue studs,
are not permitted to be worn during work hours.
7. Shoes must provide safe, secure footing and offer protection from hazards.
8. Tank tops, tube or halter tops, midriff tops, low cut blouses and dresses may not be work. NO
cleavage may be visible while standing or bending over.
9. Skirts, at minimum, must reach the top of the knee while standing.
10. Blouses must be worn under dresses or jumpers with straps.
11. Mustaches and beards must be clean, neat, and trimmed.
12. Hair should be styled tastefully and in a manner to avoid patient contact and interference with
safe job performance.
13. Colored or printed undergarments may not be worn under white clothing.
 P a g e | 57

14. Jean and tight-fitting pants are not permitted. Professional-looking skirt, dresses, and jackets are
permitted.
15. Leggings are permitted only if a garment is worn over them that reaches the top of the knee
while standing.
16. Shorts are not permitted.
17. Flip flop shoes are not permitted.
18. Tattoos of any kind must be covered.
19. T-shirts and see through shirts are not permitted.
PROCEDURE (pertains to all staff):
1. Kosciusko Home Care and Hospice, Inc. will make reasonable exceptions to the dress code to
accommodate an individual with disabilities.
2. New employees will have a designated amount of time to acquire the necessary clothing to
comply with their positions dress code.
3. The Administrator or Administrators representative may announce exceptions to the dress
code, such as during holidays or periods of extreme weather.
4. Employees are required to carry an additional set of clothing in the event their current clothing
becomes soiled during patient care.
5. Employees are required to adhere to the dress code of their specific job description.
6. Casual Day:
a. Every Friday, may include holidays and days of extreme weather, as determined by the
Administrator or representative.
b. Casual slacks, dresses, skirts, jumpers, sweaters.
c. Casual shirts, polo shirts, sweatshirts without pockets or hoods.
d. Holiday attire is permitted, when appropriate.
e. Jeans are permitted, in good repair/taste. No tears or holes and hems must be intact.
PROCEDURE (pertains only to Field Nurses, Therapists, Social Workers, and Spiritual Counselors):
1. Business casual attire is desired with dress slacks, shirts, dresses, skirts, jumpers and sweaters.
2. Scrubs are permitted for nurses.
3. Holiday attire is permitted, when appropriate.
4. Scheduled, after-hours patient visits require adherence to the dress code.
5. Beeper call patient visits are the ONLY time that employees may wear jeans and only if in good
repair/taste. No tears or holes and hems must be intact.
 P a g e | 58

6. Fingernails must be clean and neat, no longer than in length. Chipped nail polish is
prohibited.
PROCEDURE (pertains only to Home Health Aides and Homemakers):
1. Scrub uniform attire is required.
2. Socks are required and in good taste.
3. Fingernails must be clean and neat, no longer than in length. Chipped nail polish is
prohibited.
PROCEDURE (pertains only to office staff):
1. Business casual is permitted with dress slacks, shirts, dresses, skirts, jumpers, and sweaters.
2. Holiday attire is permitted, when appropriate.
3. No flip flops permitted.
PROCEDURE (pertains to Volunteers):
1. Business and/or casual, as appropriate.
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PROBLEM RESOLUTION
POLICY: Kosciusko Home Care and Hospice, Inc. addresses issues, problems, complaints, suggestions,
and questions in a timely, fair, and honest manner.
GUIDELINES: Kosciusko Home Care and Hospice, Inc. expects all employees to treat each other with
mutual respect. Employees who disagree with a rule of conduct, policy, or procedure are free to address
the concern in a reasonable and professional manner through the Problem Resolution Procedure
without fear of reprisal.
PROCEDURE:
1. Supervisor
a. Employees are instructed to present the problem in written form to their supervisor
within seven (7) days after the incident occurs.
b. If the supervisor is unavailable, or the employee believes it would be inappropriate to
discuss the incident with their supervisor, the employee may present the problem to the
Administrator or any other member of management.
c. The supervisor and Administrator, or other member of management has ten (10)
calendar days to respond to the problem presented by the employee, in either written
or oral form.
d. The supervisor, Administrator, or other member of management documents the
response and files the documentation in the employees personnel file.
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DISCIPLINE PROCESS
POLICY: Kosciusko Home Care and Hospice, Inc. will employ sanctions against employees who violate
the policies and procedures of the Agency.
GUIDELINES: Kosciusko Home Care and Hospice, Inc. may use progressive discipline at its discretion and
ensure that disciplinary actions are prompt, uniform, and impartial.
PROCEDURE:
1. Disciplinary action may call for a progression through the following four steps, depending on the
severity of the problem, and the number of occurrences. Situations may arise that warrant
bypassing any of the steps.
2. Step 1: Verbal Warning
a. Verbal warnings will be discussed with the employee by their supervisor or
representative in the presence of a witness.
a. A plan of action is developed by the supervisor, discussed with the employee and
documented on the Verbal Warning Form.
b. Verbal warnings will be documented on the Verbal Warning Form, signed by the
employee, supervisor or representative, and witness, and placed in the employees
personnel file.
3. Step 2: Written Warning
a. Written warnings will be discussed with the employee by their supervisor or
representative in the presence of a witness.
b. A plan of action is developed by the supervisor, discussed with the employee and
documented on the Written Warning Form.
c. Written warning will be documented on the Written Warning Form, signed by the
employee, supervisor or representative, and witness, and placed in the employees
personnel file.
4. Step 3: Suspension
a. An employee may be suspended with pay.
b. An employee may be suspended without pay.
c. The employees supervisor will document the suspension on the Suspension Form.
d. The Suspension Form will be signed by the employee, the supervisor or representative,
and witness, and placed in the employees personnel file.
5. Step 4: Termination of employment
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a. The employees supervisor will document the termination of employment on the

Termination Form.
b. The Termination Form will be signed by the employee, if applicable, the supervisor or
representative, and placed in the employees personnel file.
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TELEPHONE USE AND ETIQUETTE

POLICY: The office equipment is the property of Kosciusko Home Care and Hospice, Inc. and is to be
utilized for Agency business.
PROCEDURE:
1. Employees are prohibited from making personal long-distance or toll calls from Agency phones.
2. Employees are to keep local personal calls to a minimum.
3. Employees may use Kosciusko Home Care and Hospice, Inc. postage or metering for limited
personal use, but must fully reimburse the Agency.
4. Personal copies and faxes will be kept to a minimum.
a. Personal copies will be charged $0.05 per page.
b. Local faxes will be charged $0.25 per page.
c. Long distance faxes will be estimated based on destination.
5. Employees will follow proper phone etiquette.
a. Use the approved greeting.
b. Speak courteously and professionally.
c. Repeat information back to the caller.
d. Hang up after the caller hangs up.
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USE AND RETURN OF EQUIPMENT

POLICY: Kosciusko Home Care and Hospice, Inc. will provide all employees with the appropriate
equipment to perform the assigned job duties. Employees are expected to maintain the provided
equipment in good working order, perform the required maintenance on the equipment, and follow all
operating instructions, safety standards, and guidelines.
PROCEDURE:
1. Employees are to complete the equipment form on hire and update as necessary.
2. Employees must notify their supervisor if any equipment is damaged, defective, or in need of
repair.
3. Employees are to notify their supervisor if they have any questions regarding the maintenance
or care of the equipment that is assigned to them.
4. Improper care, careless, negligent, destructive, or unsafe use or operation of equipment may
result in disciplinary action, up to and including termination of employment.
5. Employees are to return all loaned equipment upon termination of employment, both voluntary
and involuntary termination.
6. Kosciusko Home Care and Hospice, Inc. may garnish wages to cover the cost of lost or stolen
property, as well as take legal action to recover property.
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PROPERTY INSPECTIONS
POLICY: Kosciusko Home Care and Hospice, Inc. is committed to ensuring a safe, healthy place for
employees, customers, and visitors.
GUIDELINES: Kosciusko Home Care and Hospice, Inc. reserves the right to inspect all storage devices
that are provided to the employees of Kosciusko Home Care and Hospice, Inc. by the Agency, with or
without advance notice.
PROCEDURE:
1. Employees are prohibited from possessing, transferring, and selling, including but not limited to
the following items:
a. Illegal drugs.
b. Alcohol.
c. Firearms.
d. Explosives.
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ITEM DONATION
PURPOSE: To provide guidelines on the acceptance of donated goods to Kosciusko Home Care and
Hospice, Inc.
POLICY: Kosciusko Home Care and Hospice, Inc. appreciates the generosity of the surrounding
community and is grateful for donated supplies. Due to liability and space constraints, the Agency is
unable to accept all donated goods and will take appropriate action accordingly.
PROCEDURE:
1. All donated electronic devices will not be accepted. The Agency employee will advise the donor
of other community resources that may accept the donation.
2. Donated items
a. Acceptable items.
i. Perishable healthcare supplies in unopened packages may be accepted. The
Agency employee who is accepting the donation will verify the expiration date
on the supply packaging. If the date of expiration has passed, the item cannot
be accepted.
ii. Linens in good repair.
iii. Non-electric durable medical supplies.
b. Unacceptable items.
i. Electronic devices.
ii. Items in opened packages.
iii. Items found to have personal information on the donated item.
iv. Soiled linens or those in poor repair.
v. Medications.
3. All acceptable donated items will be immediately taken to the first floor storage area. Do not
store donated items in the supply rooms unless instructed by the supply manager.
4. The supply manager is responsible for cleaning and storing acceptable items, and discarding or
donating unacceptable items that are brought to the first floor storage area.
5. If the appropriate storage area for the donated item is full, the supply manager will discard or
donate the excess items.
6. All items will be discarded according to the Agency Waste Disposal policy.