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Application to live in Viewlands House Registered Care Home

If you would prefer to fill out a paper copy, please call 01738 639841, and we will arrange to post a copy to you.

Marital status
Married
Single
Widow/Widower
Date of birth

Next of kin (1)

Next of kin (2)

Power of Attorney - Welfare

Power of Attorney - Financial

Doctor

Medical History:

Can you walk unaided?
Yes
No
Are you in a wheel chair?
Yes
No
If so, can you propel yourself?
Yes
No
Can you see?
Well
Not very well
Not at all
Can you hear?
Well
Not very well
Not all all
Do you require help with:-
Do you need a special diet
Yes
No
Do you have trouble with your bladder?
Yes
No
Do you have trouble with your bowels?
Yes
No
Do you smoke?
Yes
No

Please note - The Abbeyfield Perth Society operates a No Smoking Policy.

It is advisable to contact Social Work Services (duty Care Manager) to inform them that you are coming in to Residential Care. When your savings fall to £35,000, please contact Social Work Services again to inform them of your financial position.

 

To obtain the Free Personal Care/Nursing Care Allowance you must contact Social Work Services before admission to Viewlands House. A full needs assessment will be carried out and unless the Social Work Services Care Manager agrees your need for admission to Viewlands House, the Free Personal Care/Nursing Care Allowance will not be payable although you would however be entitled to claim Attendance Allowance.


DECLARATION


  1. I apply to live in Viewlands House, and I acknowledge that residents are encouraged to furnish their own rooms.

  2. I confirm that any furnishings I bring into my room at Viewlands House will comply with current fire-proofing regulations.

  3. I authorise the Society to make enquiries of my Doctor, and also the person named above, in connection with this application.

  4. The charges for accommodation, food, heating and personal laundry are currently from £1000.00 per week for residential care and from £1200.00 per week for nursing care, for self funded residents. These charges are reviewed annually, any increases take effect from 1st April. I undertake to pay my fair share of any increase in charges as may be determined by the Society from time to time.

  5. I understand that Viewlands House provides Nursing Care if required but that a separate arrangement will be made with the resident and their family / Care Manager where a resident has dementia and it is felt that Viewlands House is no longer able to meet their needs. In this event it may, therefore, be necessary for the resident to transfer to a more suitable environment.

  6. If I wish to leave I undertake to give the Society two months notice in writing of my intention to do so.

Do you have a Social Worker?
Yes
No
Are you self-funding?
Yes
No
If you are self-funding, please confirm you would be able to self-fund for a minimum of 3 years.
Yes
No
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