FC Senior Options Referral

ATTENTION

Senior Options is experiencing significant challenges with securing Home Health aides for our clients due to critical workforce shortage issues, and this has resulted in the creation of a waitlist for Homemaker service.

Finding Home Health Aides for respite and personal care is also extremely challenging so please bear this in mind when referring to our program as part of your continuity of care planning with clients. We strongly encourage you to utilize Medicare skilled care benefits for home health aides where applicable.

While we're experiencing these challenges, please consider how our other services such as home delivered meals, emergency response systems and transportation may assist your client or offer caregiver relief.

★ Client must be at least 60 years of age and a resident of Franklin County, Ohio. For those less than 60, please call 211 for additional assistance.

Client Information

Client Birth Date:

Client Address:

(Begin typing address & select address from list.)

Unit Type:

Unit Number:

City:

County:

State:

Zip Code:

Who agreed to referral?

Is client currently in hospital or nursing facility?

Caregiver Contact Information

Name:

Phone:

Email:

Caregiver Address: