The Rose House

The Rose House  

  Application for Residency

      After proper consideration, I ___________________ have determined that I would like to relocate my permanent residence to an apartment at The Rose House, a Senior Services Residence located at 673 Spring Creek Road. Branson, Missouri.  To accomplish this intent, please accept this application for my residency scheduled to commence on or about ____________.

Name                                 _____________________________

Age                                    ______________________________

Current Address                  _____________________________

Daily Living Support Needs   _____________________________

Family Support Member

Name/Residence/Phone       _______________________________       

Source of Service Fee          ________________________________

     I have been advised that  residency  at  The  Rose House  is  not appropriate  for all  Seniors  and  that,  accordingly,  there  are  certain “Requirements for Residency”.  Those  requirements, which  I  have reviewed,  are  as  follows:

                                  Requirements for Admission

     To be admitted as a Resident of Rose House and to maintain residency in the Apartment, the Resident must meet, and continue to meet, the following conditions:

1.  The Resident must be able to live harmoniously with their neighbors and staff.

2.  The Resident must present no health or social problem that could be detrimental to other Residents, or the staff.  All residents of Rose House must be able to maintain good personal hygiene and dress appropriately; with assistance from family or contracted caregivers, if needed..

3.  The Resident must be able to summon help from family or contracted caregivers for emergencies or if ill.

4.  The Resident must be capable of eating their meals with minimal assistance from family or contracted caregivers.

 5.   The Resident must be 65 years old or older in order to obtain residency at Rose House.

 6.   The Resident must be able to manage his or her own funds either alone or with another party available to Resident, such as family member.

7.  The Resident must be willing and able to participate in management of incontinence with support from family or contracted caregivers, if that is a problem.

8.  The Resident must be able to exit the building with little or no assistance.  No person will be permitted residence that requires total assistance to exit the building.

9.   The Resident must not have any ongoing condition requiring more than one caregiver to manage “seat transfer” within The Rose House Common Residence Areas.

10. The Resident must not have any behavioral symptom that exceeds manageability, such as dementia, spitting, cussing, wandering, etc.  Rose House is a tobacco-free community.

11.    No person can be admitted whose physical, mental, and psychosocial needs cannot be met within the accommodations & services available at Rose House.

12.    Rose House will not permit residency nor retain any resident whose clinical condition requires the use of physical restraints.

13.    The Resident, in making this Application agrees that they will provide The Rose House a Negative Tuberculin Lab Test Report and will, as requested by The Rose House, provide a Negative (MRSA) Lab Test Report.

       Based upon my hereby representations that I am presently able to fulfill all of the “Requirements for Residence". Please accept this Application, which will upon my acceptance and commencement of residence, become an exhibit to the Lease Agreement between myself and The Rose House.

Next Available Status

     I have been made aware that frequently The RoseHouse is at full occupancy and, as such, near term occupancy, is not possible.  Further, I understand that The Rose House does not maintain a priortized waiting list, but  that I may by paying a $1000 "Reservation Fee" be designated as the next admitted resident.  If available residency at The RoseHouse is not then available within 90 days of the Application, the "Reservation Fee" will, at my election, be returned or extended for another 90 days.  When, as, and if I do assume residency at The Rose House, this "Reservation Fee" will be applied to the "Admission Fee" required under The Rose House's  "Residency Agreement".

I wish to __pay/not pay________ the "Reservation Fee"

_________________________________

 Applicant Signature