ALS-Accessible Housing Application

ALS-Accessible Housing Application Form Template

Finding appropriate housing is one of the most critical decisions for individuals living with ALS (Amyotrophic Lateral Sclerosis). As the condition progresses, homes must accommodate changing mobility needs, medical equipment, adaptive technology, and often full-time caregivers. This ALS-Accessible Housing Application template is designed specifically to help housing providers, nonprofit organizations, assisted living facilities, and specialized care communities gather the essential information needed to match residents with appropriate, dignity-centered housing.

Why specialized housing applications matter for ALS care

Unlike standard rental applications, housing for individuals with ALS requires careful consideration of:

• Accessibility features: Wheelchair ramps, wide doorways, roll-in showers, and ceiling lift systems
• Adaptive technology infrastructure: Voice control systems, environmental control units, eye-gaze technology mounting, and reliable power backup
• Caregiver accommodations: Separate sleeping quarters, respite areas, and accessibility for multiple support staff
• Medical equipment space: Room for ventilators, suction machines, hospital beds, and assistive devices
• Future planning: Flexibility for evolving care needs and optional end-of-life planning support

This template captures all these nuanced requirements while maintaining a respectful, person-centered approach that honors the dignity and autonomy of applicants and their families.

Who uses this ALS housing application template?

This form is ideal for:

• ALS-specialized assisted living facilities offering progressive care environments
• Nonprofit housing providers serving people with neurodegenerative conditions
• Disability housing organizations with ALS-accessible units
• Independent living communities with adaptive technology integration
• Hospice and palliative care residences offering specialized ALS support
• Property managers with universally designed, medically equipped units
• Healthcare administrators coordinating housing transitions for ALS patients

What makes this template different?

Standard housing applications don't account for the progressive nature of ALS or the complex care ecosystems required. This Paperform template includes:

Medical and mobility assessment: Gather information about current and anticipated mobility aids, medical equipment, and adaptive technology needs without requiring medical jargon

Caregiver and support network details: Collect information about family caregivers, home health aides, visiting nurses, and therapy providers who will need facility access

Adaptive technology requirements: Understand what environmental controls, communication devices, and smart home integrations are essential for independence and quality of life

Accessibility specifications: Identify specific entrance, bathroom, kitchen, and bedroom modifications required now and potentially in the future

Financial and insurance information: Collect details about funding sources including insurance, Medicaid, veterans benefits, and private pay arrangements

Optional support planning: Provide a respectful pathway for residents who wish to discuss advance directives, palliative care preferences, or end-of-life planning resources when they're ready

The form uses conditional logic to show relevant questions based on care stage, ensuring applicants only see fields that apply to their current situation. This reduces cognitive burden during what's already a stressful process.

Streamline your intake process with Paperform

With Paperform's document-style editor, you can customize this template to match your organization's specific offerings, bed availability, and admission criteria. Add your facility photos, videos of accessible units, or virtual tours to help applicants visualize their potential new home.

The Guided Mode option transforms this application into a conversational, one-question-at-a-time experience—ideal for applicants with limited motor control who may be using eye-gaze or adaptive input devices. Each question appears individually, reducing visual overwhelm and making the form accessible for those with visual processing challenges.

Automate your housing workflow with Stepper

Once an application is submitted, Stepper can automate your entire intake workflow:

• Trigger internal notifications to care coordinators, medical directors, and facilities managers
• Create CRM records in healthcare or housing management systems
• Generate PDF summaries of applications for clinical review committees
• Schedule facility tours based on applicant availability and unit readiness
• Send personalized follow-up emails with next steps, required documentation, or waitlist updates
• Route applications to appropriate care teams based on level of support needed
• Update spreadsheets or Airtable bases with applicant information for pipeline tracking

You can also use Stepper to coordinate with external partners—automatically notifying social workers, discharge planners, or ALS Association chapter coordinators when applications are received.

HIPAA considerations and privacy

While Paperform itself is not HIPAA-compliant, this template is designed to minimize collection of Protected Health Information (PHI). It focuses on functional needs, accessibility requirements, and care coordination rather than detailed medical diagnoses or treatment history. For organizations requiring HIPAA compliance, consider:

• Collecting detailed medical information through secure, HIPAA-compliant portals after initial application
• Using this form for preliminary screening and care needs assessment
• Following up with compliant documentation workflows for final admissions

Always consult with your compliance team about appropriate data collection and storage for your specific organizational requirements.

Compassionate design for difficult transitions

Applying for specialized housing is emotionally challenging. Many applicants are leaving homes filled with memories, acknowledging disease progression, and facing uncertain futures. This template balances the practical information you need with the compassionate approach applicants deserve.

The optional end-of-life planning section appears only if applicants choose to engage with it, respecting their readiness to have those conversations. Language throughout emphasizes autonomy, dignity, and person-centered care—not just medical management.

Integration with your existing tools

Connect this form to your existing systems:

• Google Sheets or Airtable: Automatically log all applications in a central database
• Slack or Microsoft Teams: Get instant notifications when priority applications arrive
• HubSpot or Salesforce: Track applicant journey from inquiry to move-in
• Calendly or scheduling tools: Let qualified applicants book tours instantly
• Email platforms: Send automated acknowledgments and status updates
• Document systems: Store applications alongside facility records

With over 3,000 integrations available through Stepper, Zapier, and Make, plus native connections and webhooks, Paperform fits into healthcare and housing workflows seamlessly.

Get started with this template

Whether you're an ALS-specialized care community, a nonprofit housing provider, or a forward-thinking property manager, this template helps you gather the right information while treating applicants with the respect and dignity they deserve. Customize fields, add your branding, and start accepting applications that lead to better housing matches and improved quality of life for people living with ALS.

Paperform's SOC 2 Type II compliance, data residency controls, and enterprise-grade security give you confidence that sensitive applicant information is protected. Use role-based permissions to control who on your team can view applications, and export data securely when coordinating with care partners.

Start with the template as-is, or adapt it to your facility's specific admission criteria, waitlist process, or care philosophy. With Paperform, you get the flexibility to serve your community exactly as they need—with forms that work as hard as your care team does.