WNYAHSA

Nursing Home Admissions
Nursing home applicants or designated representatives will need to fill out an application for the facility they choose. Typically, applicants will be asked for the following information:

· Name and address
· Date of birth
· Social Security number
· Marital status
· Religious affiliation
· Medical/health insurance information
· Financial representative (who handles the senior's personal finances)
· Power of attorney
· Monthly income
· Summary of financial assets
· Summary of financial liabilities

Assisted Living Admissions
Applicants to assisted living facilities will be asked the following information:

· Name and address
· Date of birth
· Social Security number
· Marital status
· Religious affiliation
· Medical/health insurance information
· Emergency contacts
· The type of assistance needed for dressing, bathing, walking etc.
· The type of assistance needed for laundry, housekeeping, shopping etc.
· Social interests and hobbies



WNYAHSA - Western New York Association of Homes & Services for the Aging

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