Click here for the Application in Microsoft Word Format

All applicants must be certified by a physician that they have terminal cancer and that nothing more can be done for them, either medically or surgically. The family or responsible party is asked to verify that they are fincancially unable to pay for care in another nursing facility or unable to continue to provide the necessay care at home. Prior to admission the necessary forms required are:

An applicant exhibiting psychotic or violent behavior cannot be accepted in the Home. There is no discrimination as to age, color, handicap, national origin, race, religeon, or sex. Application forms are available for download, or at all Twin Cities hospitals, at which the Social Service Department will help prepare it. If one is unable to obtain an application through this website, or the Social Service Department, a form may be obtained from the Home by calling 651-646-2797 and having it mailed or faxed. There is usually a waiting list, so it is advisable to submit an application as soon as the need for placement is determined. We would contact the social worker when a bed becomes available. It is necessary to have the social worker give the name and telephone number of the family member to be contacted if the patient is discharged home, or transferred to another facility, before a bed becomes available. In that case, we would notify the family rather than the social worker. Before admission, the application is reviewed by the Admissions Committee. In order to assure that the transition to Our Lady of Good Counsel Home goes as smoothly as possible, we suggest that the patient's family or legal guardian, and the patient if possible, visit the Home prior to admission.