Admissions

We look forward to your joining our family at Golden Age Home.  Please complete each of these pages for admission.  For Independent Living: These units are designated for those needing financial assistance.  Please complete the additional financial forms to help identify your need.   

PRE-ADMISSIONS + ADMISSIONS

Download forms individually (PDF) using the links below, or click here to download them all as a zipped file. Submit by email to marketing@goldenagehome.com

• Admissions Information

• Admissions Checklist

• AEM

• Cases of Suspected Abuse

• Disclosure Form

• DNR Form

• Information Prior to Admission

• Leasing Agreement

• Medical Admission Form

• Pharmerica Enrollment Form

• Photo Release Form

• Self Medication Form

• Service Agreement

• Visitation Options

post-admissions

Directive to Physicians and Family or Surrogates | PDF

Also known as the Living Will, this document allows the patient to direct the physician in the care expected. Family members cannot overrule the instruction given in this directive.

The Medical Power of Attorney | PDF

This document appoints an individual and a back up person to make specific decisions on behalf of the patient. The patient must no longer be competent to make decisions and instructions to the healthcare professionals in order for this to take effect. The person who has the medical power of attorney cannot overrule the wishes of the now incompetent resident, but must follow the guidelines which were set up prior to incompetence.

Out of Hospital DNR | PDF

This document is used to let health care providers and EMS know that the resident is not to be resuscitated. This means that CPR will not be administered. Family members cannot override the instructions given by the resident or individual. However, if a DNR was not completed by the individual the law provides for an eligible relative or surrogate to complete it on the resident’s behalf.

directives

As we approach the end of our lives, through aging or through severe illness, we may wish to communicate with our loved ones and the professionals who care for us about our desires for that care.

Each of us, regardless of age and infirmity, has a right to instruct or direct professionals in the care they give us.  Our wishes regarding being fed by artificial means, being resuscitated, having surgery, taking medications, etc. should be followed by our caregivers, both professional and familial, whenever possible.  

It is difficult to handle issues of choice when the patient cannot communicate because of physical or mental impairments.  For that reason laws have been passed which allow each of us to express our desires in writing.  In addition, those same laws allow us to designate a person to express our wishes and make decisions on our behalf.  The person who is designated cannot overrule our instruction but can deal with specific decisions  that may need to be made.  

Residents are not required to have Advance Directors; however, those who do will need to provide a copy to administration during the admission process or when they are completed.  Golden Age Home will honor and uphold all advanced directives established by each individual resident.  When a question occurs, the resident and/or responsible party will be consulted and will maintain ultimate control and decision-making.  

In the event of an emergency and a resident becomes incapable of communication or is incompetent and the responsible party/family cannot be reached, appropriate medical professionals will be contacted and provided a copy of any advanced directives.

Golden Age Home’s policy is not to initiate CPR (Cardiopulmonary resuscitation), but to contact emergency medical services via 9-1-1.

Without an Out of Hospital Do Not Resuscitate order, CPR (Cardiopulmonary resuscitation) will be started by emergency personnel when they arrive.

Header Photo Credit: Alexandra Lamm, Unsplash