Need Assistance with Policies & Procedures, Forms, Training, and other Compliance Related Matters?
Contact Debi Ilea at The ALF Help Desk by phone at (865) 368-6119 or by email at theALFhelpdesk@gmail.com. You can find more information on their website: https://alfhelpdesk.com/.
Products Available at https://alfhelpdesk.com/products/:
- $500 – Policies and Procedures + Full Forms Bank: Administrative, Resident, and Staff Policies and Procedures as required by statutes and administrative codes governing assisted living facilities in Arizona, plus all the Administrative, Resident, and Staff Forms that go with said procedures.
- $300 – Policies and Procedures: Administrative, Resident, and Staff Policies and Procedures as required by statutes and administrative codes governing assisted living facilities in Arizona (NO FORMS).
- $200 – Forms Bank: Administrative, Resident, and Staff forms (NO POLICIES).
- $150 – Generic Welcome Pack: New resident welcome pack with instructions and all forms required at move-in.
- $500 – Custom Welcome Pack: New resident welcome pack, customized with facility name, logo, contact info, and photos, and all forms required at move-in. Includes Furniture Layout Floor Plans for every bed in your facility (up to 10 beds).
- $75 – Referral / Placement Pack: Policy and procedure regarding use of referral or placement agents by facility, plus a sample Facility / Agent Contract, a Residents Referred List, and a Resident Acknowledgment of Disclosure.
- $75 – Resident Transport Pack: Policy and procedure regarding the emergency and non-emergency transport of residents, plus the Resident Info Sheet that must be given to EMS, a HIPAA Release, a Post Discharge Screening Form, a Post Discharge Notice, and a Record of Non-Emergency Transport Form.
- $50 – Tuberculosis Infection Control Pack: Policy and procedure regarding TB infection control, plus the TB Screening Forms, TB Staff Training Forms, and the facility wide Annual Risk Assessment Form (w/ a sample completed form).
- $50 – Staff Qualification Verification Pack: Policy and procedure regarding verification of staff qualifications, plus a Staff File Checklist identifying all the items that should be maintained for staff (including fingerprint card verification, APS registry verification, caregiver training certificate verification, and ALF manager certificate verification), a Staff Information Sheet, and a Staff Qualification Verification form..
- $25 – Fall Prevention and Recovery Pack: Policy and procedure regarding a fall prevention and fall recovery program, plus the training program and the caregiver acknowledgement form.
- $25 – Required Postings Pack: List of items that must be posted in and around the facility, plus the Agency Phone Numbers List, Inspection Records Notice, Manager Designee List, Resident Rights, Pool Rules, Online Drug and Toxicology Guide QRs (so you no longer have to maintain books that have to checked for the most recent edition all the time), and a No Smoking Sign w/ the Smoke Free Arizona Act Info (included for free).
- $25 – Advance Directives Pack: The Resident Advance Directives Acknowledgement Form, Resident DNR Permission and Acknowledgement Form, AZ Healthcare Directives Registry Poster and Guide (included for free), and the AZ Attorney General’s Life Care Planning Pack w/ Forms (included for free).
- $25 – Hospice Agreement: Contract between hospice provider and the facility in which the hospice agency agrees that it will not poach the Facility’s residents and that its staff will provide the Facility with written documentation each and every time one of the hospice agency’s staff administer medication to a Facility Resident. Failure to provide the documentation will act as an assumption of liability for all issues arising from the administration.
- $25 – Negotiated Risk Agreement: Contract between resident and the Facility in which specific treatments can be detailed; in which the Facility has the opportunity to make sure the resident and/or the resident’s family is informed that treatment may have significant consequences upon the resident’s health and quality of life; and in which the resident agrees not to hold the Facility liable for the results of treatment. May be used for end of life issues, such as morphine administration.
FORMS
Please review the forms used with the Arizona Department of Health Services Regulations before implementing them in your Facility. Keep in mind these forms are examples of what you can use, some forms may be out of date.
Free Forms
2024 Minimum Wage Poster (English) Check your local laws if your facility is exempt from Minimum wage The Fair Wages and Healthy Families Act
Completed W-9 (Request for Taxpayer Identification Number and Certification), A4 (Employee’s Arizona Withholding Election)
DURABLE HEALTH CARE POWER OF ATTORNEY
DURABLE MENTAL HEALTH CARE POWER OF ATTORNEY
LIVING WILL (End of Life Care)
PREHOSPITAL MEDICAL CARE DIRECTIVE (DO NOT RESUSCITATE) Register your documents on the Arizona Health Care Directives Registry. (Optional)
You can mail, email or fax copies of the documents and the registration form to the registry. The
information to send the documents to is on the cover of this packet and below.
AZ Healthcare Directives Registry
2901 N. Central Ave. Ste. 1100
Phoenix AZ 85012
OR Email: documents@azhdr.org OR Fax: 602-264-8823
| Arizona Long Term Care System | Health Care Plans in Arizona | ||||
 Step 1- Apply for AHCCCS ID >> Applications may also be submitted to altcsregistration@azahcccs.gov The DE-101 form is required to begin an application. (Financial Hardship is considered to waive the cost of the application) Step 2- If Needed Apply for an NPI>> Step 3- Submit an application directly with a Health Plan Call (toll-free): 888-621-6880 Fax (toll-free): (local): 888-507-3313 602-253-6385 Mailing address: 801 E. Jefferson Street, MD 3900 Phoenix, Arizona 85034 If you are contracted with ALTCS and operate a Assisted Living Home please complete this years survey. 2019 ALTCS Survey | American Indian Health Program Arizona Complete Health-Complete Care Plan Providers> Banner-University Family Care Providers> Care 1st Health Plan Providers> Magellan Complete Care Providers> Mercy Care Providers> Health Choice Arizona Providers> UnitedHealthCare Community plan Providers> | 1-800-334-5283 1-888-788-4408 1-800-582-8686 1-866-560-4042 1-800-424-5891 1-800-624-3879 1-800-322-8670 1-800-348-4058 | Website Member handbook Website Member handbook Website Member handbook Website Member handbook Website Member handbook Website Member handbook Website Member handbook Website Member handbook | Provider Application Provider Application –AzAHP Organizational Data Form –AzAHP Facility Application Provider Application –AzAHP Organizational Credentialing Form (PDF) –AzAHP Facility Application (PDF) –W-9 Form (PDF) –AzAHP Organizational Credentialing Form (PDF) –AzAHP Facility Application (PDF) –W-9 Form (PDF) Provider Application Submit a request include care provider full name, tax ID, service address location(s), and (NPI). |
| Arizona Department of Veterans’ Services | VA AID AND ATTENDANCE PROGRAM | |
 Married Veteran: $2,296 Single Veteran: $1,937 Surviving Spouse: $1,245 Comparison of Eligibility and Benefits: 2021 VA Aid and Attendance vs. Arizona Long Term Care System (ALTCS) Cemeteries The Arizona State Veterans’ Cemeteries provide a lasting final benefit in honor of Veterans and their families with a final resting place in appreciation and gratitude for their service and sacrifice to our nation. Arizona Veterans’ Memorial Cemetery at Camp Navajo Arizona Veterans’ Memorial Cemetery at Marana Southern Arizona Veterans’ Cemetery | Step 1 – Request your military service records (including DD214) there are other paid services online Step 2– Check Eligibility You may be eligible for this benefit if you get a VA pension and you meet at least one of the requirements listed below. At least one of these must be true: You need another person to help you perform daily activities, like bathing, feeding, and dressing, or You have to stay in bed—or spend a large portion of the day in bed—because of illness, or You are a patient in a nursing home due to the loss of mental or physical abilities related to a disability, or Your eyesight is limited (even with glasses or contact lenses you have only 5/200 or less in both eyes; or concentric contraction of the visual field to 5 degrees or less) Housebound benefits eligibility You may be eligible for this benefit if you get a VA pension and you spend most of your time in your home because of a permanent disability (a disability that doesn’t go away). Note: You can’t get Aid and Attendance benefits and Housebound benefits at the same time. Step 3– Make an Appointment To make an appointment to see a VBC, call 602-535-1215. VBCs assist clients by: -Educating them on eligibility requirements for benefits -Processing VA compensation and pension applications -Appealing VA decisions -Representing claimants at VA hearings -Filing for survivor’s benefits -Applying for discharge upgrades -Referring claimants to other agencies for potential benefits -Requesting military service records and certifying DD-214s (discharge paperwork) -Discussing State Veteran Benefits |
| Adult Protective Services (APS) | What is Abuse, Neglect and Exploitation? | |
 File a Report By phone: Monday – Friday: 7:00 a.m. – 7:00 p.m. Saturday, Sunday and state holidays: 10:00 a.m. – 6:00 p.m. 1-877-SOS-ADULT (1-877-767-2385) Online: The online reporting form is available 24 hours a day, seven days a week. For life-threatening emergencies, call 911 immediately. File a Report Online | Abuse can take many forms. Not all abuse is seen with the naked eye. Abuse can take many forms, including: Physical abuse, including intentional infliction of physical harm and injury Sexual abuse or sexual assault Unlawful imprisonment Neglect is the deprivation of: Food Water Medication Medical services Shelter Cooling Heating Supervision Other services necessary to maintain minimum physical or mental health Exploitation is the illegal or improper use of an individual or their resources for another person’s profit or advantage. This can include: Misusing cash, credit cards or bank accounts Stealing money or household goods and property Forced panhandling Prostitution Abuse, neglect and exploitation can occur for many reasons. Also, individuals can be victimized by friends, family members or strangers. |
Animal Care & Control
Tax Exemptions for HCBS
Arizona State Plan on Aging 2023-2026
The State Plan focuses on developing new partnerships and maintaining ongoing partnerships to support
the Aging Network and address an individual’s needs. By strengthening the infrastructure for Non-Medical Home and Community-Based Services (NMHCBS) Arizona will continue building a future in which every older Arizonan has the opportunity to enjoy wellness, longevity and quality of life in viable,
healthy communities.
Arizona Center for Disability Law (ACDL)
Domestic Violence Community Resources and Shelters>
Arizona
- Adult Day Health Care, Adult Foster Care
- Assisted Living Homes & Centers
- Behavioral Health Facilities,
- Group Homes (DDD)
- Independent Living
- Low Income Housing
- Skilled Nursing Facilities,
Arizona Long Term Care Assistance, Housing Assistance (Assisted Living, Memory Care, Group Home DDD, Behavioral, Vents & Trach’s, TBI), Placement, Advocacy, Adult Protective Services, File a Complaint, In Home Care Services, Mobile Services, Social Security Assistance, Veteran Services, POA, Guardianship, Surrogate Decision Makers
Medicaid Waiver Programs, Assistance for Unqualified Aliens, Same Day Discharge Planning, Case Management Education, List of Hospitals & Rehabs
Assisted Living Provider Resources
AZDHS Licensing & Regulations, NCIA Board Regulations, Training Schools, Forms, Cost of Care, Long Term Care System, VA Aid & Attendance, Insurance, Purchasing, Refinancing, Franchising, Mobile Services
Durable Health Care Power of Attorney, Durable Mental Health Power of Attorney, Living Will, Pre Hospital Medical Care Directive (Do Not Resuscitate) , Ombudsman Poster, W9, Minimum Wage Poster, Long Term Care Medical Assessment -ALTCS
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