Nursing Home Facilities

Answer 1

form_title=Nursing Home Facilities form_header=10003 What is the current living arrangement for the care recipient?*= {Select One,Home (lives alone),Home (lives with spouse),Home (lives with partner),Home (with care services),Assisted Living,Residential Care Home,Lives with family,Hospital,Nursing Home,Retirement Community} What is the length of time for housing or care needed?*= {Select One,Long-term care (10 weeks or more),Short-term care (Less than 10 weeks)} Would you like any personal care services along with regular care? (see below for specific personal services)*= () No - personal care services are not required. () Yes - care recipient needs the personal services selected below. () Bathing () Eating/feeding () Dressing/grooming () Toileting How are you planning on paying for the care?*= [] Private funds [] Both private funding & other sources [] Long-term care insurance [] Medicare [] Medicaid/Public assistance [] Veteran's Administration funds Who is it that you are needing care for?*= {Select One,Mother,Father,Spouse,Son,Daughter,Grandparent,Other Relative,Friend,Client,Myself}