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Assisted Living Admissions Survey November 2022
1.
Assisted Living Facility Info
Assisted Living Facility Name
County
Respondent Name
Respondent Email
2.
Residents and Medicaid Waiver Enrollment
How many residents did you have on November 30, 2022
Of the residents on November 30, 2022, how many were on an HCBS waiver
What is your Total Licensed Resident Capacity
How many beds have you de-licensed since the start of the COVID-19 pandemic?
3.
Admission Policies
Since the beginning of the pandemic has your assisted living facility had to place a hold on all new admissions?
4.
Please select the answer that describes your assisted living's current approach to new admissions? CHECK ALL THAT APPLY
Insufficient staffing
Ability to meet the specific needs of the new admission
Supply and re-supply of personal protective equipment (PPE)
Potential admission must be reviewed by corporate staff
Admissions over the weekend are very difficult to process and to staff
Other (please specify)
5.
Do you currently maintain a waiting list for new admissions to your assisted living facility?
Yes
No
6.
Referrals
Approximately how many referrals did you turn down for any reason during the month of November 2022?
7.
As of today, how many non-certified staff working as nurse aides do you have that will need to complete training and/or testing for certification before the expiration (January 2023) of the state's nurse aide training waiver?