Our Affiliates

Our national partner, LeadingAge, is an association of 6,000 not for profit organizations dedicated to expanding the world of possibilities for aging

Together, we advance policies, promote practices and conduct research that supports, enables and empowers people to live fully as they age.

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Forms and Policy

MEET OUR SAPPHIRE BUSINESS PARTNERS! VALUE ~ GROWTH ~ SUCCESS

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The forms, documents, policies and procedures attached here are provided to LeadingAge Washington members as a resource. Their origins may be from other states and retirement communities as well as outside agencies. They are intended to be of assistance when drafting your own documents or policies to meet your communities’ corporate compliance, regulatory and legal responsibilities.

Members Only documents.

For login please email Angie at anapier@leadingagewa.org

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Abuse_Neglect Compliance Abuse_Neglect Compliance (amended May 2006)
Abuse and Neglect Activities/Parkinson’s Exercises for Aging Populations
Admission_Residents
Administrative Manual Table of Contents for P & P Advanced Directive
Advance Directive/Durable Power of Attorney Forms Aggressive or Assaulting Behaviors_Managing
Aggressive and Assualtive  Resident Policy Aggression – Effectively Responding to Hostile Residents
Alzheimers  Resource & Fact Sheet
Anti-Discrimination Arrest Records in Housing Decisions
Armed Intruder Policy Assessments – Mini-Mental
Assisted Living_Policies and Procedures Sample Manual (1-6)  1Hiring_policies-and-procedures

Legal_reasonable-accomodations-_policies-and-procedures

3Records_policies-and-procedures

4Safety_emergencies_policies-and-procedures

 5Services_policies-and-procedures

6Wellness_policies-and-procedures

Armed Intruder Policy Assessments – Mini-Mental
Assistive Devices – Bed Rail Safety Procedures Authorization_Release Health Information
Assistive Policies – Motorized Cart, Scooter, Wheelchair Policy & Agreement

B

Beauty Shop Price Comparison Bed Alarm, Assistive Devices Assessment Policy
Bed Rail Safety Procedures – Assistive Devices Behaviors_Managing Aggressive or Assaulting
Behavior Aggressive and Assaultive Bipolar Fact Sheet
Boarding Home Regulations   and more…. see below
Disclosure of Services Form (10-351) pdf
Disclosure of Services Form (10-351) word
Collateral Interview Full Inspection Process
Environmental and Food Services Observations Exit Preparation
Guidelines (2011) Purple Book
Interior Finish Construction Checklist IDR Process
Medicaid Rates July 2010
Pre-Inspection Prep Residential Care Services Notes
Request for Documentation Resident Group Meeting
Resident Characteristic Roster Resident Interview
Resident List Resident Record Review
Resident Sample Staff Record Review
Building_Resident Safety
Business Associate Agreement Contract Business Associate Agreement Contract #4

C

Caregiver Training Requirements DOH Presentation #1 Caregiver Training Requirements DSHS Presentation #2
Caregiver Training Requirements HoCA Presentation #3
Catheter Care in Assisted Living Survey Results Care Coordination Log
CCRC Disclosure & Transparency
CCRC Affleck Letter CCRC Resident Disclosure Template
CDC Influenza Website Cell Phone Policy
Changes in Condition
Computer Stations Member Feedback Community Educational Assistance Program Policy for Staff
Complaint & Incident Investigation Procedure Complaint/Incident Investigation Guidance Q * SURE 
Continuing Competency Rules

Coordination of Services

Resident Arranged Health Care Services #1
Resident Arranged Health Care Services #2 Resident Arranged Health Care Services #3
Resident Arranged Health Care Services #4 Resident Arranged Health Care Services #5
Resident Arranged Health Care Services #6 Resident Arranged Health Care Services #7
Credit and Background Checks on Residents_Member Feedback Aug 2008

D

Death with Dignity Final Policy_Member Sample Death with Dignity Opt-Out Physician Assisted Suicide Procedures
Death with Dignity Opt-In Physician Assisted Suicide Procedures Death with Dignity Opt-In Policy Sample Willing Provider
Death with Dignity Opt-Out Sample Policies, Experiences from Oregon Death with Dignity Opt-Out Sample Policies, Experiences from WA
Death with Dignity Opt-Out Sample Policy and Principle Statement Death with Dignity Opt-Out Unwilling Health Care Provider Notification
Death with Dignity Willing Provider Policy
Decisional Capacity Decision Capacity_Guardianship
Decision Tree – Scope of Practice Dementia Screening Tool
Dementia Fact Sheet Dental – Institutional Residence Verfication for Dental Services
Dental – NEW Coverage Policies issued by DSHS Rates Mgmt Depression Fact Sheet
Dealing with Depression in Later Life
Diabetes in Assisted Living Diet Aide Performance Evaluation
Diet (Prescribed) Release Form
Disaster and Fire Drill Record Disaster Planning
Discharge_Resident Disclosure & Transparency
Driver_ Application for Qualified Status Drug Testing and Policies 4-28-09
Drug and Alcohol Testing Referral Sheet Drug and Alcohol Free Workplace Policy

DSHS Boarding Home Re-Inspection Process

Collateral Interview Full Inspection Process
Environmental and Food Services Observations Exit Preparation
Interior Finish Construction Checklist IDR Process
Pre-Inspection Prep Residential Care Services Notes
Request for Documentation Resident Group Meeting
Resident Characteristic Roster Resident Interview
Resident List Resident Record Review
Resident Sample Staff Record Review
 DSHS Social Service Providers: Your Billing Support is Changing
Durable Power of Attorney Forms/Advance Directives

E

Education Assistance
EIV Security Checklist Oct 2008 EIV Documentation of Verification
EIV Documenting Screening in the Resident Selection Plan EIV Security Policy
EIV File Checklist Appendix B EIV Instructions form HUD (dated Dec 7, 2009)
EIV Checklist – Bremerton
Elevator Inspections Update HUD/REAC
Ethics Committee Charter
Employee TB Testing Employment Eligibility Forms (I-9)
Entertainment – Motion Picture Licensing Corp – Fee Agreement for Leading Age Members
Evaluation Guidelines – Performance
Excercises for Parkinson’s and the Aging Population

F

Post Fall Assessment Fall Response
Fall Prevention Information & Resource Links Falls – Comprehensive Assessment
Fax Policy Fire and Life Safety Inspection form WA State Patrol
Fire Incident Report Fire Marshal Life Safety Code Door Locking K Citation July 2009
Fire Safety Handbook for Apartment Managers Fire Drill – Monthly Report WA State Patrol
Fire Marshal Inspection Guidance: Fire Doors Fire Marshall_Winterizing Your Community
Fire Drill and Disaster Record Fire Sprinkler Systems (Automatic) NFPA 25 Modified
Flooding Announcements_King County Food Requirements for a Temporary Food Event Permit
Food and Beverage Worker Manual (English) Food Services
Food Services (amended May 2006) Foundation Resources AAHSA
Foundation Resources #2 Governance Philanthropy
Full Nursing Assessment Surveyor Guidance, Quality of Life F-Tags

G

Guardianship

H

Health Information_ Authorization to Release HIPAA_Policy
HIRE Act – Clark Nuber Hoarding Fact Sheet
Compulsive Hoarding – What is it? Hoarding Animals
Hot Packs in AL
Hot Weather Resources HR Update! Dependent Children Coverage to Age 26
HUD Housing Affirmative Fair Housing Notice Aug 2009
HUD Form and Policies, Samples from RBD HUD Form and Policies, Instructions from RBD
HUD EIV Instructions (dated Dec. 7, 2009) HUD/REAC Elevator Inspections Update
HUD/REAC  Stoves and Ranges FINAL Inspection Changes
HUD Social Security Rule HUD Section 8, VAWA Guidance
HUD/Violence Against Women Act, Tenant Notice

I

IDR Process in Boarding Homes Infection Control
Influenza Policy, Seasonal Informed Consent
Incident Reporting Incident/Complaint Investigation Guidance (Q*SURE) ADSA/DSHS
Inspections
Insulin in Assisted Living Interior Finish Construction Checklist
Installation – New Fire Regulations

J

Job Analysis Bank Handbook 2016          Job Descriptions:

Human Resources Director of Nursing
Assistant  Activity Director  Activity Coordinator
Fund Development    Dining Staff
Driver VP of Development
Receptionist Treasurer CFO 
Controller
Director of Finance

K

L

Living Will Registry Loss and Theft

Low Acuity-Rug Referral Process Quick Guide

M

Mandated Reporter Marijuana (Medical) SamplesPolicy 1   *  Policy 2Sample  *  Management_Assessment and Evaluation

Emergency Filing of Marijuana Product Rules Oct 2015

Authorization Form – Tips from the DOH

Medicaid Rates 2010 – Boarding Homes Medicaid Rates 2010 –  Boarding Homes
Med D Collaterals Medicare Enrollment Periods – Understanding
Medication_Release or Destruction Medication Services (amended May 2006)
Medication Services (revised May 2006) Medical Emergencies_CPR
Med Orders for Assisted Living
Medicaid Policy – Sample 1 – Resident Applicant – Private Pay Non-Medicaid Participation Notification 7-15-2009 Medicaid Policy – Sample 2 – Resident – Private Pay Non-Medicaid Participation Notification 7-15-2009
Medicaid Policy – Sample 3 – Resident Applicant – Active Medicaid Contract Participation Notification 7-15-2009 Medicaid Policy – Sample 4 – Resident – Active Medicaid Contract Participation Notification 7-15-2009
Mental Health and Well Being Checklist Mental Health Resources
Mini-Mental Exams Mold Notification, Landlord Tenant Law Change
Motion Picture Licensing Corp – Fee Agreement for Leading Age Members

N

Negotiated Service Agreement
New Employee Mentoring Policy New Employee Initiation & Mentoring Program
NO Health Care Provider Notice of Additional Services – Disclosure Statement to Non Residents_May 2013
Nursing Assessment Nursing Assistant
Nursing Conduct and Practice (Standards)
Nursing Credential Search
Nursing Delegation
Nursing Delegation – Assumption of Delegation Nursing Delegation – Community Based Care Settings
Nursing Delegation – Change in Medication Errors Nursing Delegation – Consent for Delegation of Tasks
Nursing Delegation – Instruction for Nursing Task Nursing Delegation – Nursing Assistant Credentials and Training
Nursing Delegation – PRN Medication Nursing Delegation – Supervision or Rescinding Delegation
Nursing Home Guidelines ‘aka’ Purple Book
Nursing Home Surveys or F-Tags Nursing Home Regulations Best Practices
Nurse Practice Act / Functions of an RN and LPN

O

Obsessive – Compulsive Disorder
Oil and Gas Vehicle Record Olfactory Hallucinations
Ombudsman Ombudsman Policy
Ombudsman Best Practices for Visiting Ombudsman Role
Ombudsman LTCOP Training Outline Oxygen
Operational Costs – Best Practices

P

Parkinson’s Exercises for the Aging Population
Performance Evaluation Guidelines Personal Belongings Policy
Pet Agreement Pet Policy
Pet Registration Pet Temperament Certification
Policies and Procedures Assisted Living

Sample Manual (1-6) 

1Hiring_policies-and-procedures

Legal_reasonable-accomodations-_policies-and-procedures

3Records_policies-and-procedures

4Safety_emergencies_policies-and-procedures

5Services_policies-and-procedures

6Wellness_policies-and-procedures

 POLST_Master_2017  2017 changes to WA POLST form FINAL
POLST Form   POLST Fact Sheet
Purple Book ‘aka’ Boarding Home Guidelines (New) Purple Book ‘aka’ Nursing Home Guidelines

Q

Quality of Life and Care of Resident Q * SURE  Quality and Safety through Use of Required Elements (DSHS/ADSA)

R

REAC- Stoves and Ranges FINAL Inspection Changes REAC Elevator Inspections Update (effective Jan. 4, 2010)
RCS Online Electronic Reporting System 12/2015 Release Form Prescribed Diet
Record Retention Schedule #1 Record Retention Schedule #2
Red Flag Policy and Procedure Sample 1 Red Flag Policy Procedure Sample 2
Red Flag Policy and Procedure Sample 3 Red Flag Rules_Aging Services_AAHSA Analysis
Red Flag Rules Decision Tree Red Flag Rules Synopsis
Red Flags Renovating and Upgrading Resident Units – Best Practices
Resident Admission Resident Aggressive or Assaulting Behaviors

Resident Care Assessment Plan

Resident Arranged Health Care Services #1
Resident Arranged Health Care Services #2 Resident Arranged Health Care Services #3
Resident Arranged Health Care Services #4 Resident Arranged Health Care Services #5
Resident Arranged Health Care Services #6 Resident Arranged Health Care Services #7
Resident Grievances Resident Discharge
Resident Health Plan Recovery Resident Records
Resident Policy – Aggressive and Assaultive
Resident Rights Resident Rosters
Resident Quality of Life and Care Resident Selection Plan Update Letter
Resident Selection Plan SSN and Citizen/Non-Citizen Update Letter Resident Selection Plan SSN, Citizenship, VAWA Update Letter
Resident Supervision and Monitoring
Resident Supervision and Monitoring (amended May 2006) Resident Unresponsive or Dead
 RN 24/7 Exception and Compliance

S

Safety Building_Resident Safety Building_Resident (amended May 2006)
Schizophrenia Schizophrenia – Useful Information
Scooter Policy
Scope of Practice_Decision Tree Scope of Care and Services
Seasonal Influenza Policy Non-consensual-Sexual-contact-POLICY  AL & SNF
 Shift, 3 week Rotation Schedule Smoking Policy 

Smoke Free Public Housing Rules

Social Security Number Policy  Social Security Services and Information
Staff Support_Urgent Additions Standards of Nursing Conduct and Practice
Stoves and Ranges FINAL Inspection Changes Suicide – No Harm Contract
Suicide – No Harm Contract Document Suicide Rates in Washington State
Surveyor Guidance, Quality of Life F-Tags

T

TB Testing of Volunteers TB Testing of Employees
Tenant Selection Plan – Bremerton – Feb 2010 Tenant Notice
Theft and Loss Theft and Policy Policy 2

U

Urinary Tract Infections Urinary Tract Infections for Seniors
UTI – Sudden Cause for Confusion in Seniors

V

VAWA Guidance, HUD Section 8 VAWA Notice to Tenants
VAWA Violence Against Women Act
Vehicle Operation Agreement Vehicle Safety Policy
Vehicle Self Inspection Report Vehicle Training Checklist
Vehicle Oil and Gas Record Veterans_and_Veterans_Services_in_King_County
Visitors VolunteersVolunteer Sample Packet – Activity Directors

W

WA State Living Will Presentation Weapons Policies in Senior Housing and LTC Settings
Well Being and Mental Health Checklist Wheelchair Policy
Workplace Drug Policies and Procedures 4-28-09
Workplace Privacy Policy

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Last updated: September 23, 2017

 

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