Register to learn more about upcoming events, get involved in one or more subcommittees, or volunteer to mentor others in the nursing home industry.

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Become a registered member of the coalition

Register for information about upcoming events or to get more intimately involved with the coalition. This registration form was designed to help coalition leaders manage participation efficiently and get participants involved in areas where they have demonstrated interest. Please take a few minutes to complete this questionnaire. Make sure to hit the "Submit" button at the bottom of the page when you are done.

First Name
Last Name
Job Title
Organization
Address
City
State	Zip
County
Email
Phone

Discipline:

Activities
Direct Care Professional
Nurse
Nursing Home Administrator
OT/PT/SLP
Physician
Social Worker
LTC Ombudsman
Other:

Nursing Home Open-Door Mentor Program
My nursing home has been successful in implementing one or more person-centered care practices and we are willing and interested in opening our doors to other nursing home professionals in Ohio so they can see how we did it. The coalition is free to distribute my name as a mentor contact in the areas specified below, and I am willing to answer questions from other professionals about them. Furthermore, my nursing home doors are open to anyone who would like to see policies in practice. (Important note: Please be sure to gain approval from the proper members of your organization's administration before selecting this option)

We would like to spotlight the following care practice(s):

Activities Program

Bathing experience

Care planning

Dealing with death & dying

Dementia

Dining services

Intergenerational programs

Medication pass and/or schedule

Mentoring program

Neighborhood/community design

Resident council

Sleeping/waking schedules

Staff recruitment, orientation, and/or retention practices

Other:

Why?

I would be willing to be a guest speaker at future coalition conferences (or other educational offering).