LiveWell™ Training Program 2017
The LiveWell program is open to assisted living, residential care, memory care, skilled nursing facilities and adult care homes located in Oregon. We are selecting 40 communities to do the program in 2017. Note: Adult Care Home training will take place in June 2017, exact date and location to be announced. If you are with an adult care home and wish to apply, please contact Lisa McKerlick, firstname.lastname@example.org for additional instructions.
1) Sign the
** Please complete all fields**
**You must include Facility contact info on Page 5 of this document to be eligible.**
2) Get a letter of support from your CEO.
3) Fill out this online application and attach your documents below.
You may also
print the application
and submit all completed documents by email to email@example.com.
For further information: contact Barbara Kohnen Adriance at 503-416-3675, email: firstname.lastname@example.org.
Requirements for participation:
Staff must attend ALL training and sharing events over the course of the pilot.
1. Participating organizations must commit to providing time for staff to learn and do the LiveWell™ program.
2. Each organization must identify one person who will be the main contact for the program for the duration of the pilot.
3. Each organization must identify one person to be responsible for providing data from their organization to the facilitator for inclusion in the report required by the Oregon Department of Human Services to evaluate effectiveness of the program.
4. By the start of the program, CareOregon will need your monthly data over the past six months on the number of:
a. Medication errors
b. New staff
c. Departed staff
Project timeline. All events located in Portland unless specified:
4/4 or 4/18 (select one)
5/12 or 5/15 (select one)
Master class day 1
7/11, Medford or
7/14 or 7/17, Portland (select one)
Master class day 2
10/13 or 10/16, Portland or 10/27 Medford (select one)
1/9/2018 Medford or 1/12 or 1/19 Portland (select one)
March 16, 2018
Final collection of data and surveys
Site visits, data collection, support via phone, web, email
Legal name of organization
Select a choice
Primary contact name for letter of agreement and other administrative oversight
Primary contact email
Project leader name (if different from primary contact)
Project leader email (if different from primary contact)
Why does your community wish to be involved in this pilot?
What is your community team’s existing experience with improvement work? Is there any improvement work currently underway? If so, please describe.
Give an example of a large improvement project that has been completed by your facility team.
What other large initiatives will be implemented in your community over the next year?
What reporting or documentation processes and tools are currently used to ensure safety and quality? Do you use paper or electronic documentation?
As a participant in this pilot, your community will be required to provide monthly data (such as staff turnover and medication errors) to be used for evaluation of the program. You will be provided a data entry chart to fill out every month. Who will be responsible for providing this data to CareOregon?
Do you have the ability to provide up to five staff members for two initial master classes? (See attached schedule)
To work well, this program needs at least eight hours of staff time per week to start. Can you commit to this level of staffing?
How many staff do you employ today?
What are the recruiting and hiring processes for hiring staff?
What do you to to retain staff?
What proportion of residents is funded through Medicaid?
Who will be the senior lead for this program? Please provide their job title.
Attach a scan of the signed Participation Agreement
Attach the letter of support from your CEO
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