Individuals must meet the criteria as stated in the DHS PA Title 55, Chapter 2600 to be eligible to reside in a personal care home including:
• Undergoing a pre-admission screening for eligibility
• Having documentation from a physician stating the need for service (MA 51)
• Possessing a birth certificate, social security card and/or a photo ID
• Being age 18 or older
• Having Axis 1 diagnosis
Prior to admission or within 24 hours after admission, individuals must sign a personal care home agreement, which includes:
• Original Birth Certificate
• Original identification/ non-driver’s license
• Original Social Security Card
• Insurance cards
• Recent psychiatric evaluation (must be within the last 6 months)
• DME form (Documentation of Medical Evaluation) signed by a doctor (within 60 days prior to admission date OR within 30 days after admission date)
• MA-51 signed by a doctor (Information on MA51 must match DME)
• Note signed by a medical doctor stating resident is free of lice, scabies or other infestation
• Tuberculosis clearance, documentation free from communicable disease
• List of contacts/emergency contact phone numbers and addresses
• Prescriptions for all medications including over the counter medications, prescriptions must have med purposes and times given. Note: no medication purpose can be for agitation, must be for anxiety instead.
• List of Allergies and any special dietary needs
• For any mobility issues, a prescription is needed (i.e. walkers, canes)
• For any therapy treatment, a prescription is also needed
• A list of doctors, therapists, etc., phone numbers, addresses and also any upcoming appointments
• Complete list of belongings
• Verification of income/Awards Letter
• The process of an End of Life/funeral/burial arrangement be started, if not already arranged
Not Required, but please provide if applicable:
• Any advance directive/living wills
Application for supplemental funds for residency at a personal care home is also completed at this time, if the individual is eligible. No security deposit is required, unless specifically noted in the Personal Care Home agreement.
Any changes are provided in writing to individuals at least 30 days prior to going into effect.
Documentation of Medical Evaluation form must be completed 60 days prior to or 30 days after admission. If either the medical evaluation or the annual assessment indicates the need for a higher level of care, a plan for other placement is made as soon as possible.