Partner Application Form

Low Needs Unit (LNU)

Eligibility-

  1. Must be completely independent with no limitations around Activities of Daily Living (ADL)
  2. Individual with a medical concern needing a temporary place of shelter until their living arrangements become available (Shorter Stay)
  3. Must be able to self-evacuate independently from the building in case of an emergency

Features-

  1. Shared large capacity room
  2. Case Management services around discharge planning
  3. All meals provided and made available in the dining facility

Recuperative Respite Unit (RU)

Eligibility-

  1. Must be independent in their Activities of Daily Living (ADL)
  2. Individual is experiencing a medical illness or injury
  3. Must be able to self-evacuate the building in the case of an emergency

Features-

  1. Private Room Placement
  2. Full scope of case management services
  3. All meals provided and made available in the dining facility

High Needs Unit (HNU)

Eligibility-

  1. Patients who have some limitations with Activities of Daily Living (ADL) and need hands on assistance – unit is staffed with a CNA 24/7
  2. Patients requiring a hospital bed due to mobility restrictions, Shortness of Breath, etc
  3. Patients must be able to evacuate in the event of an emergency

Features-

  1. Meals and medications are delivered to the room
  2. Each room has an emergency call light, bedside commode, mounted tv, bedside table, and hospital chair
  3. Full scope of Case Management services
Referral Information
Current Health Information
HNU Specific Information
Background Information
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Your Form was submitted Successfuly!

You will now receive an e-mail to the address you submitted at the end of your form application.  This e-mail will have a Submission Confirmation code in the subject line.

Please reply back to the e-mail and provide the following information.

  • Client Name:
  • Client Date of Birth:

The team will review your application and respond with Approved/Denied based on availability or ask questions for follow-up if needed.

Thank you sincerely,

Administrative Staff