Homeward Bound Heroes Submission Form

This form allows Activity Directors to submit Homeward Bound Heroes stories and pictures.
  • We are attempting to get positive social media out in regards to our short term residents stay at the facility during these COVID-19 times. Most people have a stigma in regards to going to a nursing home for rehab/recovery during this time due to negative LTC facility press. In an effort to change that, we would like to have stories with Sub-acute residents photos showing them with a positive expression (Smiling, waving, giving the thumbs up or holding the attached sign or a sign they personal wrote) that depicts them feeling safe and free of COVID-19 while residing in the facility.

    The resident must sign a photo release form and try to capture the resident in his or her room with a nice background, with clean clothing on. No mask is required if they are in their room alone. No oxygen tubes, preferably not in a walker or wheelchair if possible. Sitting in a chair would be best if standing is not an option.

    We would like this to be completed as soon as possible prior to their d/c.

    The following questions should be asked so we can create a story or quote from them:

  • Submittor Details

  • Enter your name.
  • Please enter your Alaris email so that we may contact you regarding this submission if need be.
  • Homeward Bound Hero Details

  • Please select facility the event was held at.
  • Enter the name of the patient.
  • Questions for the Patient

  • Please include staff member name and position.
  • Upload Image(s)

  • Drop files here or
    Upload images of the resident.
  • This field is for validation purposes and should be left unchanged.