MCO/Professional Admission Information
Sending A Referral
Looking to make a referral for one of your patients or members? Please feel free to fax or email your referral directly to:
Carrie Zumbach/Executive Director
414/662-5181 Confidential Fax
Admission Requirements
We require the following information for admission.
Some of this information we are able to obtain during the assessment process:
- TB test or chest x-ray within the last 90 days prior to the admission date
- Our physician form stating the prospective admission is free from communicable disease
- A full list of current diagnoses
- Complete medication list signed by the physician
- A hard copy of any prescriptions for controlled substances
- Guardian or HC/Financial/Durable POA paperwork (if applicable)
- DNR paperwork (if applicable)
- Demographic/Insurance Information
- List of current medical providers (PMD, specialists, etc.)
- Information for any outside providers
(Hemodialysis, adult day services, etc.)
- A current History and Physical (if available)
- Most recent hospital discharge (if available)
- Therapy notes if the prospective resident is currently completing
rehabilitation stay at an in-patient hospital unit or SNF/SAR.
Pre-Admission Assessment
We are required to complete a pre-admission assessment prior to a member/patient being accepted and admitted to the facility. This can be arranged with one of our staff. We are conducting in-person assessments.
We encourage prospective residents, and any involved parties in their care tour the facility of their choice virtually or in person.
Facility Specific Information
Both facilities feature alarmed entrances/exits but we are not considered a locked facility.
Our facilities are licensed by the Bureau of Assisted Living/Department of Health Services and can accommodate 20 residents.
We offer in house services by outside providers including visiting medical doctors, psychiatric services, podiatry, audiology, vision, therapies (PT/OT/ST), laboratory, x-ray, and hospice services. We are willing to work with providers chosen by the prospective resident as well.
We are contracted with an outside pharmacy to provide medication and other related services.
Grantosa Home
2 private upstairs rooms currently available (male or female)
- We can accept residents with canes and walkers on our first floor only. (Currently no first-floor rooms are available).
- We are unable to accept wheelchairs at this location.
- All rooms are single occupancy. We have one half bath unit available at this time.
Bluemound Home
We currently have no vacancies but are accepting applications for our waiting list. Please call for information on this process.
- We can accept prospective residents with canes, walkers and wheelchairs.
- All rooms are single occupancy and feature a half-bath.
Payment Options
We are currently contracted with My Choice Wisconsin MCO.
Private pay is accepted. We do not have an endowment fee.
In some cases, a security deposit may be required.
Private pay rates are based on a personal care assessment.
Questions about potential placement?
If you have questions, please call Carrie Zumbach, Executive Director at 414/317-8253.