SCHCHA Award Nominations

2021 SCHCHA HOME Award Nomination Form
THANK YOU for nominating a HERO from your agency! SCHCHA’s Annual HOME Award Ceremony is a special event and nominating someone for these awards is an opportunity to celebrate all the great things they do each and every day.

GUIDELINES:
- Be sure to answer each question for the award for which you are submitting a nomination.
- Do not use the name of the nominee or any identifying information (such as agency name) on your narrative or in your answers.
- The only place the nominee’s name and agency should appear is in the Nominee First and Last Name Fields at the top the category, not in your narrative responses.
- The Association's PR Committee will receive the narrative portion of the nominations only so that the award selection process will remain anonymous.
- The form will not save your work if you do not hit the Submit button, so it may be best to answer the questions on a Word document first, then copy and paste into the form when the nomination is final.
- Contact courtney@ahhcnc.org with questions.
Professional of the Year

The nominee may be, but is not limited to: a registered nurse, licensed practical nurse, therapist, therapy assistant, nutritionist, pharmacist, clergy/chaplain, or social worker who has worked in home care and/or hospice for a minimum of three years. This award is intended to recognize a clinical professional in a direct care or mid-level management role.
Professional of the Year Nominee's Full Name

First Name Last Name
Nominee's Title/Credentials
Nominee's Agency Name
Nominee's Agency Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Number of Years Worked in Home Care and Hospice
Professional of the Year: To submit a nomination form on an eligible individual, address the following items in the blank space provided. Do not use the name of the nominee or any identifying information (such as agency name) in your answers. The only place the nominee’s name and agency should appear is in the Nominee Profile information above. This process will ensure the committee can review the nominations without access to identifying information of the individual nominated. Please describe your nominee by responding individually to the following items:

Describe the clinical care provided by this individual and/or how he or she serves as an advocate for patients. (25 points) Describe how this individual supports an interdisciplinary team approach. (25 points) Describe how this individual works to enhance the care that the agency as a whole provides. Provide examples of innovation, professional skills, and/or leadership qualities demonstrated by the nominee. (20 points) Describe the efforts undertaken by this individual to enhance their professional growth as well as the agency’s growth. Include formal education as well as workshops and other continuing education. (15 points) This individual deserves this distinguished award over all other nominees because . . . Use 100 words or less. (15 points)
Answer the Questions Above in the Space Provided
Caregiver of the Year

This award is presented to a non-paid friend or family caregiver who goes above and beyond the call of duty to promote patient/client well-being and enhanced quality of life including but not limited to factors such as comfort, safety and independence.
Caregiver of the Year Nominee's Full Name

First Name Last Name
Nominee's Title/Credentials
Nominee's Agency Name
Nominee's Agency Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Number of Years of Caregiving in Home Care and Hospice
Caregiver of the Year: To submit a nomination form on an eligible individual, address the following items in the blank space provided. Do not use the name of the nominee or any identifying information (such as agency name) in your answers. The only place the nominee’s name and agency should appear is in the Nominee Profile information above. This process will ensure the committee can review the nominations without access to identifying information of the individual nominated. Please describe your nominee by responding individually to the following items:

Describe how the caregiver promotes the patient/client’s well-being, quality of life, and maximum independence. (30 points) Describe the caregiver’s ability to learn care instructions and to intervene appropriately. (20 points) Describe the adjustments made in caregiver’s personal life to provide care. (20 points) Other attributes (attitude, flexibility, dependability, willing to advocate) (20 points) This caregiver deserves this distinguished award over all other nominees because . . . Use 100 words or less. (10 points)
Answer the Questions Above in the Space Provided
Physician of the Year

This award is presented annually to a S.C. physician who has demonstrated a philosophical commitment to assisting home health and/or hospice patients who wish to remain at home.
Physician of the Year Nominee's Full Name

First Name Last Name
Nominee's Title/Credentials
Nominee's Agency Name
Nominee's Agency Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Number of Years Worked in Home Care and Hospice
Physician of the Year: To submit a nomination form on an eligible individual, address the following items in the blank space provided. Do not use the name of the nominee or any identifying information (such as agency name) in your answers. The only place the nominee’s name and agency should appear is in the Nominee Profile information above. This process will ensure the committee can review the nominations without access to identifying information of the individual nominated. Please describe your nominee by responding individually to the following items:

Care-planning Process – actively participates in the care planning process, Understands Medicare/Medicaid coverage guidelines; timely paperwork completion/signature in accordance with regulatory requirements; Communicates problems with the plan of care instead of deleting care on orders (30 points) Care management and collaborative team approach – demonstrates excellence in care management to enhance patient care and quality of life. Courteous, respectful, listens and is available to staff during and after hours regarding patient care. (30 points) Outstanding consultative services – available for inservices, willing to share knowledge, discuss information on disease management, protocols, equipment, etc. Available to review policies, procedures on a consultative basis. (20 points) Other attributes – serves above and beyond the call of duty, patient advocate, makes home visits, participates in case conference (20 points)
Answer the Questions Above in the Space Provided
In-Home Aide of the Year

This award is designed to recognize in-home aides in the home health and hospice industry. The nominee must have a minimum of one year experience working in home health and/or hospice.
In-Home Aide of the Year Nominee's Full Name

First Name Last Name
Nominee's Title/Credentials
Nominee's Agency Name
Nominee's Agency Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Number of Years Worked in Home Care and Hospice
In-Home Aide of the Year: To submit a nomination form on an eligible individual, address the following items in the blank space provided. Do not use the name of the nominee or any identifying information (such as agency name) in your answers. The only place the nominee’s name and agency should appear is in the Nominee Profile information above. This process will ensure the committee can review the nominations without access to identifying information of the individual nominated. Please describe your nominee by responding individually to the following items:

Describe the care provided by this individual and how he or she serves as an advocate for patients. (30 points) Describe how this individual supports other members of the interdisciplinary team. (25 points) Describe this individual’s work habit and how he/she demonstrates excellence. (15 points) Describe efforts undertaken by this individual to enhance their professional growth. (10 points) This individual deserves this distinguished award over all other nominees because . . . Use 100 words or less. (20 points)
Answer the Questions Above in the Space Provided
Suzie Gilpatrick Personal Care Aide of the Year

This award is designed to recognize personal care aides. The nominee must have a minimum of one year experience working in home care.
Personal Care Aide of the Year Nominee's Full Name

First Name Last Name
Nominee's Title/Credentials
Nominee's Agency Name
Nominee's Agency Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Number of Years Worked in Home Care and Hospice
Suzie Gilpatrick Personal Care Aide of the Year: To submit a nomination form on an eligible individual, address the following items in the blank space provided. Do not use the name of the nominee or any identifying information (such as agency name) in your answers. The only place the nominee’s name and agency should appear is in the Nominee Profile information above. This process will ensure the committee can review the nominations without access to identifying information of the individual nominated. Please describe your nominee by responding individually to the following items:

Describe the care provided by this individual and how he or she serves as an advocate for patients. (30 points) Describe how this individual supports other members of the interdisciplinary team. (25 points) Describe this individual’s work habit and how he/she demonstrates excellence. (15 points) Describe efforts undertaken by this individual to enhance their professional growth. (10 points) This individual deserves this distinguished award over all other nominees because . . . Use 100 words or less. (20 points)
Answer the Questions Above in the Space Provided

Information of the Person Submitting the Nomination
Nominator's Full Name *

First Name Last Name
Nominator 2 if applicable

First Name Last Name
Nominator's Title and Credentials *
Nominator's Agency Name *
Nominator's Agency Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Nominator's Phone Number *

Area Code Phone Number
Nominator's E-mail *
Should be Empty:

2021 SCHCHA HOME Award Nomination Form

Professional of the Year

Caregiver of the Year

Physician of the Year

In-Home Aide of the Year

Suzie Gilpatrick Personal Care Aide of the Year

Information of the Person Submitting the Nomination