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������������������ ������ ������������������ ������ ������������������ ���������� INDIVIDUAL UNIT �� ���� ���� ���� ���� ���� �� Are different sized and types of units available? ���� ���� ���� ���� ���� �� Are units for single and double occupancy available? ���� ���� ���� ���� ���� �� Do residents have their own lockable doors? ���� ���� ���� ���� ���� �� Is a 24-hour emergency response system accessible from the unit? ���� ���� ���� ���� ���� �� Are residents able to bring their own furnishings for their unit and what may they bring? What is provided? May they decorate? ���� ���� ���� ���� ���� �� Do all units have a telephone & cable TV & how is billing handled? ���� ���� ���� ���� ���� �� Is a kitchen area/unit provided with a refrigerator, sink and cooking element? ���� ���� ���� ���� ���� �� May residents keep food in their units? ���� ���� ���� ���� ���� �� May residents smoke in their units? In public spaces? ���� ���� ���� ���� ���� �� Are bathrooms private or shared? If shared, by how many? ���� ���� ���� ���� ���� �� Do bathrooms have grab bars in showers and raised toilets? ���� ���� ���� ���� ���� �� Is a roll-in shower available? ���� ���� ���� ���� ���� �� Do residents control the A/C and heat in their units? SOCIAL & RECREATIONAL ACTIVITIES �������������������������������������������������������� ���� ���� ���� ���� ���� �� Is there evidence of an organized activities program, posted schedule, events in progress, reading materials, etc.? ���� ���� ���� ���� ���� �� Are residents participating in activities? ���� ���� ���� ���� ���� �� Are residents’ pets allowed? Who is responsible for their care? ���� ���� ���� ���� ���� �� Does the residence have its own pets? ���� ���� ���� ���� ���� �� Are visitation hours reasonable? �� ���� ���� ���� ���� ���� �� Are activities/entertainment offered outside of the building? Costs? ���� ���� ���� ���� ���� �� Are activities/entertainment brought into the building? ���� ���� ���� ���� ���� �� Are religious services are available at the facility? FEES, NEEDS & CONTRACTS ���� ���� ���� ���� ���� �� Can you obtain all forms requiring signatures? ���� ���� ���� ���� ���� �� Is there a lease contract? �� ���� ���� ���� ���� ���� �� May a contract be terminated and what are the refund policies? ���� ���� ���� ���� ���� �� Are there any government, insurance or private programs available to help cover the cost of services? ���� ���� ���� ���� ���� �� Are additional services available if the resident’s needs change? �� ���� ���� ���� ���� ���� �� Are there different costs for various levels of care, or is cost all inclusive of care services? ���� ���� ���� ���� ���� �� Do billing, payment and credit policies seem fair and reasonable? ���� ���� ���� ���� ���� �� Is there an appeals process for dissatisfied residents? ���� ���� ���� ���� ���� �� Is there a cap on which the monthly rate can be increased? ���� ���� ���� ���� ���� �� Is there assistance if I run out of money? Under what circumstances would I have to move out of facility? ���� ���� ���� ���� ���� �� Incontinence? ���� ���� ���� ���� ���� �� Dementia? ���� ���� ���� ���� ���� �� Need for someone to give me my medications/injections? ���� ���� ���� ���� ���� �� Needing more help than I do now? www.PolkElderCare.com 23


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