Resources - Assisted Living Partners


  Cognitive Assessment Tool
  Online Self Reporting Tool
This information will help guide you on how to report required incidents to DIA.
  CDAC Planning Worksheet
UPDATED JULY 2013 - This worksheet will help programs to take CDAC eligible services, evaluate the frequency and time needed for the service and will automatically convert information to 15-minute units. In July 2013, all CDAC providers will bill at 1 unit for every 15 minutes of service. This worksheet will help you to work with the tenant to determine which services will be reimbursed by CDAC and will go on the CDAC Agreement. This form is used in conjunction with the Medicaid Fee Breakdown tool.
  Tenant Document Audit Tool
This tool can be used to audit tenant charts to ensure you have required documentation on file.
  Guide for RNs
This tool will help guide you on how and when to complete a nurse review, evaluation, and service plan. Learn what "triggers" to watch for which may indicate a significant change in condition.
This program is great to help you keep track of GDS scores, nurse review due dates, and evaluation/service plan due dates!
  Medicaid Fee Breakdown
UPDATED WITH JULY 1 3% INCREASE --This tool will help providers to breakdown the fee structure and apply outside funding sources such as HUD and Medicaid Elderly Waiver.
  HUD Fair Market Rates
HUD Fair Market Rates for Iowa - 2010
  LPN Orientation
This tool is designed to document LPN orientation/delegation by the RN.
  Dementia Training Certificate
This certificate can be used to document dementia training provided to staff.
  Involuntary Transfer Letter
This is a sample involuntary transfer letter for assisted living programs.
  AL Monitoring Entrance Form
This monitoring entrance form is used by DIA to gather information from programs during an onsite visit.
  Quality Assurance Checklist
This tool can be used to assist when audting a tenant chart.
  Assisted Living Annual Systems Inspection Form
This tool is used to document mechanicals systems (heating, cooling, plumbing, electrical, etc.) are found to be in proper working order.
  Nurse Review Worksheet
This nurse review worksheet will help nurses to determine if the issue at hand is a significant change in condition AND if changes might be necessary to the tenant's service plan.
  Nurse Review Guide
Nurse Reviews is one of the most cited areas for Assisted Living Programs. As we assist programs throughout the state, we find nurses are confused about how to write a nurse review. A nurse review is a narrative that "tells the story" about what is going on. There is a definite theme to a nurse review. This Nurse Review Guide provides a script of what should be included in a nurse review. This process has proven to be very successful for programs to maintain regulatory compliance.
  Assisted Living On-Call (Supervision)
This document can be used for staff to complete required documentation for Medicaid AL On Call Supervision. You are required to document census and a shift signature from one staff member who would be responsible to provide assistance to the tenant.
  PERs Documentatioin form
This tool can be used by Elderly Waiver Personal Emergency Response (PERs) providers to document pendant checks.
  Meal Census Form
This tool can be used to record meals for Medicaid Home Delivered Meals.
  Medication Pass Monitoring Tool
This tool can be used to document employee competency with completing a medication pass.
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