About Us/Contact Us | Golden Rule Senior Placement Services

About Us

Linda M. McKenna

As Owner & Senior Care Advocate of Golden Rule Senior Placement Services,

I personally know that this task can be emotionally difficult and very overwhelming on family members when researching all the options available. I too have been put in the position of having to place numerous loved ones in a senior home environment. In addition, I have spent the last 20+ years in the home health care industry specializing in the various types of senior living communities. I am committed to providing you and your loved one with the personalized care and service you require when making assisted living decisions. Being a certified assisted living administrator and long standing member of assisted living associations, I have access to many licensed senior living facilities that provide outstanding care to their residents and are observed and reviewed by Florida’s State Regulations, Statutes, Rules and Standards on a regular basis.

You have Golden Rule Senior Placement Service’s promise…

“We treat our Seniors as we would want to be treated ourselves.”

Date:

Referred By:

Have you communicated with any other placement services? (online or other)

Yes

If you answer yes, which one(s)

Have you navigated and /or contacted any senior living communities on your own?

Yes

If yes, which one(s)

Prospective client's name:

Date of birth:

Contact name: (if different from prospective client above)

Relationship to prospective client:

Contact telephone #:

Cell phone # (for texting purposes):

Contact resides in:

Contact's e-mail address:

Medical healthcare insurance of prospective client (Part A/Part B):

Prospective client's primary care physician:

Is prospective client currently on state funded long term care Medicaid program?

YES

If no, is the prospective client planning to apply for the above?:

Yes

Prospective client's primary language:

Prospective client's spiritual denomination:

Prospective client's social interests (i.e. Activities, Hobbies, etc..)

Veteran:

Spouse of veteran:

Active during war time?:

What type of senior living placement are you interested in?

Prospective client primarily utilizes:

Cane

Walker

Wheelchair

Motorized Scooter

No assisted devices

Does prospective client suffer from any of the following?

Incontinence

Decreased Mobility

Low Vision

Oxygen Dependent

Speech

Diabetic Insulin Dependent

Hearing

None of the above

Has prospective client been medically diagnosed with any memory impairment?

Has prospective client been diagnosed with any mental illness?

What other medical diagnoses does the prospective client need monitoring for?

Prospective client's room/apartment preference?

Are you aware that placement in Senior Living Communities are primarily private pay (not including LTC Insurance Policies, Veterans Benefits, Etc.)?

Yes

What is the prospective client's monthly budget and affordability long term?:

Preferred geographical placement location:

Time frame for placement: Within 30 days?

31 Days or More?

Please enter any other pertinent information we need to know that will assist in the placement process:

About Us

PROSPECTIVE CLIENT PROFILE

PLEASE FILL IN THE ENTIRE PROFILE AS THE INFORMATION PROVIDED IS VITAL TO POTENTIAL PLACEMENT