LeadingAge Wisconsin and the West Bend Charitable Grant Foundation are proud to continue the Safe Resident Assistance Program. Under this Program, through the generosity of the the West Bend Charitable Grant Foundation, safe resident handling equipment grants will be awarded to LeadingAge Wisconsin member nursing homes and assisted living facilities.

The purpose of this grant is to get quality equipment in the hands of caregivers who embrace the concept of safe lifting.

To be considered for a resident equipment grant, please complete the following application in its entirety. Winners of the 2021 Safe Resident Assistance Programs grants are not eligible to win in 2022.

Applications must be completed on-line by February 11, 2022.  Grant recipients will be contacted in April and announced at the LeadingAge Wisconsin Spring Conference Annual Meeting on May 5, 2022.

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* 1. First/Last Name

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* 2. Title

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* 3. Organization Name and City

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* 4. E-Mail Address

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* 5. Area Code and Telephone Number

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* 6. We are applying for a grant to purchase the following (for details on lift equipment choices, see: 2022 SRAP Lift Options)

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* 7. If my facility is selected to receive a grant from the Safe Resident Assistance Program, my organization pledges to pay 10% of the cost of the lift plus the shipping costs.

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* 8. Does your Organization have a safe resident transfer policy?

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* 9. If requested, do you agree to share your Organization's safe resident transfer policy with the Selection Committee?

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* 10. What criteria does your Organization use to determine when a second caregiver is needed for a gait belt transfer? Please use your own words and do not cut/paste from your manual.

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* 11. What criteria does your Organization use to determine when a sit-to-stand lift will be used? Please use your own words and do not cut/paste from your manual.

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* 12. What is your Organization's policy/procedure on transferring a fallen resident from the floor? Please use your own words and do not cut/paste from your manual.

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* 13. The facility for which we seek a safe patient lift equipment grant is a:

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* 14. Please provide the requested information on the residents of this facility:

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* 15. Please tell us about the layout of your building (# of floors, wings etc.) and if there are any extenuating circumstances related to your organization's need for lift equipment that the Safe Resident Assistance Program Selection Committee should be aware of. {Note:Please limit response to 200 words or less}

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