CONCEPT #96 OF 100 · Real Estate & Property Management · LAYOUT: clinical_box_grid
Assisted Living & Memory Care Residency Admission Agreement & Tiered ADL Care Schedule
Standard / Reference: State Assisted Living Facility Licensure Act · 42 C.F.R. § 483.10 Resident Rights · Fair Housing Act
Why professionals use this template: 21,500/mo search demand: senior living and memory care communities needing clear residency agreements separating base suite rent from nursing ADL point tiers, medication administration, and 30-day discharge safeguards.
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ACROFORM READY
Included Financial Metrics & Line-Item Schedule
Target Roles: Assisted Living Communities, Memory Care Directors, Elder Law Attorneys & Placement Advisors · Search Keywords: assisted living residency admission agreement and adl fee schedule pdf, memory care admission contract template, activities of daily living adl point care tier, assisted living resident bill of rights disclosure
ASSIGNED RESIDENCE
Deluxe Courtyard Studio #214
RN ADL ASSESSMENT SCORE
Tier II (42 Points · Moderate)
MONTHLY RECURRING TOTAL
$5,750.00 / Month
ONE-TIME COMMUNITY FEE
$2,500.00 (Suite Prep/RN Eval)
| CODE | DESCRIPTION & TECHNICAL SPECIFICATION | BASIS / QTY | AMOUNT / DELTA |
|---|---|---|---|
| ALF-RNT | Base Monthly Suite Residency (540 SF Barrier-Free Studio, 3 Chef Meals/Day, Housekeeping & Utilities) | Monthly Base | $4,200.00 / Mo |
| ALF-ADL | Tier II Personal Care Package (35–55 ADL Points: Standby Shower Assist, Dressing & Escort) | RN Scored 42 Pts | $1,100.00 / Mo |
| ALF-MED | Licensed Nurse (RN/LPN) Electronic MAR Medication Administration & Pharmacy Packaging Audit | Daily Med Pass | $450.00 / Mo |
| ALF-COM | One-Time Community Move-In & Comprehensive Geriatric RN Baseline Care Plan Fee | Due at Move-In | $2,500.00 One-Time |
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