Remote Monitoring Services Agreement

Medicare Covered
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This Remote Monitoring Services Agreement (“Agreement”) is entered into by and between the Community and the Resident, each a “Party”, and, collectively, the “Parties”.

WHEREAS, Community provides remote monitoring services and solutions for the benefit of the Resident; and

WHEREAS, Resident has been determined by Community to potentially benefit from such services,

NOW THEREFORE, for and in consideration of these premises, the Parties agree as follows:

1. WHAT ARE REMOTE MONITORING SERVICES?
The purpose of the Community using a third party, EyeWatch LIVE®, for audio/video monitoring is to enhance resident safety by monitoring, detecting and informing of potential or actual adverse events. EyeWatch LIVE® utilizes cutting-edge technology with advanced artificial intelligence (“AI”) combined with nursing-trained, dementia certified Monitoring Agents to perform Human Intervention (”HI”) by confirming AI analysis and notifying the Community based on criteria established by the Community.

Service Description
Intervene12™ The Community shall utilize EyeWatch LIVE® to perform Remote Monitoring Services live using two-way audio communication with the Resident, if deemed appropriate by Community, and two-way notification to the Community to render assistance. Remote Monitoring Services shall include detection, intervention and Community notification for adverse events such as but not limited to precursors to falls, actual falls, the Resident wandering out of their Room (“elopement or wander risks”), other residents wandering into the Resident’s Room (“intrusions”), and other health conditions that may be introduced in the future.
Detect12™ The Community shall utilize EyeWatch LIVE® and its AI technology to detect a fall after it has occurred and provide notification to the Community, potentially alleviating the concern that the Resident may be laying on the ground unattended for a lengthy period. Detect12™ may also help identify unwitnessed and unreported falls, whereby the Resident may fall and pick themselves up and return to their normal activity without notification to Community staff.
Safety Checks Instead of Community staff entering the Room periodically or as required by state regulation as a precaution against the Resident falling or other safety risks, EyeWatch LIVE® may perform such Safety Checks so long as it is permissible by state regulation. In doing so, EyeWatch LIVE® may be able to avoid disturbing the Resident’s sleep and put them at added risk for falls. EyeWatch LIVE® may also be used to supplement current Community staff safety checks, thereby increasing the frequency of visibility the Community has on the Resident overnight.

2. WHO CAN BENEFIT FROM REMOTE MONITORING SERVICES?
The Community uses Remote Monitoring Services to aid in its efforts of improving the safety and wellbeing of the Resident, especially in cases where the Resident 1) cannot or should not transfer, ambulate and/or toilet independently without the assistance of staff; 2) may be at high risk for falls due to a prior history, medical condition, or medication side effect, as determined by their medical provider(s); 3) may wander and put themselves at risk of elopement; 4) may exhibit behavioral issues such as sundowning; 5) may be mute or unable to speak coherently; 6) may be deaf or profoundly hard of hearing; 7) may be blind or visually impaired and at risk of accidental injury; and 8) may have a history of seizures. Based on the Community’s evaluation and/or recommendation from the Resident’s medical provider and/or request for Remote Monitoring Services by the Resident’s family or guardian, it has been determined that the Resident could benefit from receiving Remote Monitoring Services.

3. WHEN ARE SERVICES ACTIVE?
The Community currently offers Remote Monitoring Services to residents between the hours of 8 pm to 8 am. Coverage hours are subject to change based on the Community's discretion or based on any service coverage change made by EyeWatch LIVE™. Should such a change occur, the Community will provide you written notification. Recording may still take place during 8 am 8 pm as an added safety measure. Be advised that recordings capture a line of sight to the area in and around the bed, often to the doorway of the bathroom, and often to the entry door of the room.

4. PRIVACY
As part of the Remote Monitoring Services, the Community may provide a wall-mount Privacy Button furnished by EyeWatch LIVE for use by the Resident, their family and/or visitors, and by Community staff when performing sensitive tasks with residents in order to protect their privacy and dignity. The Privacy Button has a set period of time in which, when depressed, ceases video or any actions that may trigger the Al. The Privacy Button may be installed in a location to decrease the potential of misuse by the Resident due to confusion, however, the Community shall comply with any request made by those needing to access such Privacy Button to locate the Privacy Button in an accessible location in order to comply with the Americans with Disabilities Act (ADA). The Community shall maintain the Privacy Button or, in instances of its misuse, inform the Resident of its removal. In addition to the Privacy Button, the Resident's data is stored in a manner that adheres to recommended HIPAA and HITRUST best practices.

5. SERVICE INTERRUPTIONS
Neither the Community nor EyeWatch LIVE guarantees that service will not be interrupted by such events as equipment failure, a power outage, Internet outage, fire, or other natural disaster, however, both the Community and EyeWatch LIVE shall make every effort to restore service as quickly as possible and shall notify Resident of any delays in service restoration.

6. INSTANCES OF THEFT, ABUSE & NEGLECT
The Community takes allegations of theft, abuse and neglect seriously and while no community can guarantee a resident's safety, EyeWatch LIVE's visible cameras and Remote Monitoring Services may help to deter such criminal activity. However, neither the Community nor EyeWatch LIVE guarantees such criminal activity will be detected or prevented. If evidence of such activity is discovered by EyeWatch LIVE", it will be reported following all legal and statutory requirements.

7. NOTIFICATION TO MONITOR AND RECORD ANYONE IN ROOM
In order to meet federal and state regulations, the Community and EyeWatch LIVE require notification for audio and video surveillance and recording. By signing this Remote Monitoring Services Agreement, you grant permission for such activity to take place. Additionally, a sign provided by the Community shall be placed on the Resident's Room door and/or the entry to the Community or memory care neighborhood and shall serve as notice to all those entering that audio/video surveillance and recording may be taking place and entering such space is an act of consent to such activity.

8. EMERGENCY USE
In the event of an emergency, such as instances of the fire alarm sounding, a tornado or emergencybroadcast siren, or a potential missing resident, where quick identification and location of residents may be critical, the Community may utilize EyeWatch LIVE® to quickly view and locate residents, if doing so may aid Community staff, law enforcement and/or first responders in determining the overall safety of all residents. The Resident is hereby notified that even if declining Remote Monitoring Services and declining its use by another resident sharing the Room, the Community and EyeWatch LIVE® shall have the right to conduct such surveillance.

9. NOT A GUARANTEE
Neither the Community nor EyeWatch LIVE® makes any claims, expressly or implied, that the Resident will not experience an adverse event such as but not limited to a fall or elopement while using the Remote Monitoring Services, nor are the services guaranteed to detect every adverse event or precursors to such adverse event. The Resident acknowledges that EyeWatch LIVE® is not a substitute for a private duty caregiver providing one-on-one bedside support. And the Community acknowledges that the Remote Monitoring Services are not a substitute for adequate on-site staffing nor do the services count toward the Community staffing requirements under state and federal regulations. The Resident hereby waives and releases the Community from any and all claims, causes of action, demands, obligations, damages or liability asserted or arising out of the Community's use of Remote Monitoring Services, unless caused by negligence or intentional misconduct.

10. WHO CAN ACCESS RECORDINGS?
The vast majority of Remote Monitoring Services are performed live by EyeWatch LIVE® dementia-trained nursing staff. While recording is taking place, the primary purposes of such recording are to confirm what may be observed and to improve training for EyeWatch LIVE® Monitoring Agents and Community caregivers. Community caregivers do not have access to live audio/video feeds or any such recordings. Since such videos are used by EyeWatch LIVE® to detect and confirm adverse events, and since such recordings may contain Personally identifiable information (PII) or protected health information (PHI) of the Resident and/or others, and since the primary purpose of the recordings is for the Community to confirm the services contracted with EyeWatch LIVE® takes place, such recordings are not available to the Resident or their family. Due to data storage limits, such recordings are only preserved for a nominal period of time.

11. WHAT DOES IT COST?
The Community has entered into a contract with EyeWatch LIVE® to provide Remote Monitoring Services as a means to improve health outcomes, decrease risks of falls and other adverse events, decrease ER visits and their associated Medicare co-pay costs to families including instances when the Resident may not have injured themselves (such as when they lay on the floor or lower themselves to the floor). The following charges shall be billed to the Resident for Remote Monitoring Services.

Service Cost
Intervene12™ up to $250/month*
Detect12™ up to $250/month*

*Monthly out of pocket cost is determined by what insurance coverage and deductibles the resident has.  In most cases there will be no monthly out of pocket cost.

12. WHEN DO SERVICES GO INTO EFFECT AND WHEN DOES SERVICE END?
This Agreement shall become effective as of the date of its execution and shall remain in effect until the earlier of the duration of the Resident's stay at the Community, including when transferring to another room at the Community if such room is serviced by EyeWatch LIVE®, or at the end of a seven (7) day written notice of cancellation by the Resident. Associated charges as shown above for Remote Monitoring Services during the duration of such term will be prorated on a daily basis.

13. ENTIRE AGREEMENT
This Agreement embodies the entire agreement and understanding of the Parties with respect to Remote Monitoring Services and supersedes all prior and contemporaneous oral and written agreements and understandings relating to such subject matter.

IN WITNESS WHEREOF, each of the Parties has caused this Agreement to be executed as of the date first above written.

Responsible Party Name
Clear Signature

Upon submitting this form, a PDF copy of your signed agreement will be sent to the email address you provided.