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Create Your Login Account

You will use this email and password to log back in and update your profile anytime

Save these credentials. After submitting you can log back in anytime at the Provider Login button to update your availability, open beds, or any part of your profile.
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Provider & Home Photos *

A profile photo of yourself is required. Home photos are strongly encouraged.

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Required * — Upload a photo of yourself

JPG or PNG — Max 5MB

A friendly photo builds immediate trust with families and coordinators reviewing your profile.
Upload photos by category. Each category supports multiple uploads — helpful for homes with multiple bedrooms or living areas. Click a category to add photos.
Exterior
Front of home, entrance, driveway, ramp if applicable
+ Add Photos
Living Room(s)
All common living spaces where residents spend time together
+ Add Photos
Bedroom(s)
Upload one photo per bedroom — label not required, just upload all
+ Add Photos
Bathroom(s)
Show grab bars, roll-in shower, or any accessibility modifications
+ Add Photos
Kitchen & Dining
Where meals are prepared and eaten together
+ Add Photos
Outdoor Space(s)
Backyard, patio, garden, or any outdoor area residents use
+ Add Photos
Other Areas
Activity rooms, sensory spaces, laundry, garage, or anything else worth showing
+ Add Photos
Each category accepts multiple photos. Upload as many as you need — more photos increase your chances of getting referrals.
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Basic Information

Your home and contact details

Home Type * — Select All That Apply
Adult Foster Home (AFH)
24-Hour Group Home
Residential Treatment Home
AFH = up to 5 residents, licensed provider. 24-Hour Group Home = awake staff around the clock. Residential Treatment Home = structured behavioral or mental health treatment setting.
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Location

Where your home is located

Setting Type
Urban
Suburban
Rural
Home Structure
Single Level
Multi Level
Tell us about the location of your home
Check all that apply. After checking, please fill in the detail field to help us give accurate information to coordinators and families.
On Bus Line
Near Grocery / Shopping
Near Medical Facilities
Near Park or Recreation Area
Other
Check all that apply. After checking, fill in the detail so coordinators and families have accurate information.
3

Availability & Capacity

Current openings and who you serve

Gender Accepted
Male Only
Female Only
Both
Bedroom Type
Private Bedrooms Only
Shared Bedrooms Available
Both Options
Current Residents in Your Home

This helps us understand your current home dynamic when matching a new individual.

This helps us assess compatibility with a potential new placement.
4

What Kind of Individual Are You Looking For?

Help us match the right person to your home

Your honest answers here are the most important part of this form. The better we understand who fits your home, the better the match — for you and for the individual.

Support Level You Can Accept — Check All That Apply
Low Support — Independent with prompting
Moderate Support — Daily assistance needed
High Support — Significant needs
2B Level — Behavioral complexity
2M Level — Medical complexity
Dual Diagnosis — IDD plus Mental Health
Other — specify below
Medical Needs You Can Support
Medication Management
Seizure Management
Tube Feeding / G-Tube
Wound Care
Diabetes Management
Aspiration / Choking Protocol
Constipation Protocol
GERD Management
Catheter Care
Colostomy / Ostomy Care
Oxygen / Respiratory Support
Skin Integrity / Pressure Sore Prevention
Dysphagia / Modified Diet
Nursing Delegation
Home Health Nursing Visits
Physical Therapy at Home
Other — specify below
Mobility & Physical Needs You Can Accommodate
Uses Walker or Cane
Manual Wheelchair
Power Wheelchair
Hoyer Lift Transfers
Bed-Bound or Limited Mobility
Incontinent — Requires Toileting Assistance
Full ADL Assistance
Communication Abilities You Can Support
Verbal — Limited Communication
Nonverbal
AAC Device User
Sign Language
Picture / Symbol Communication
Other — specify below
Special Population Experience
Adults 18 to 30
Adults 30 to 60
Seniors 60 Plus
Minors — Under 18
Transitioning from State Hospital
Transitioning from SACU / Crisis
LGBTQ+ Affirming Home
Trauma History Experience
Other — specify below
Be honest. A great match benefits everyone — especially the individual.
Placement Readiness & Compatibility

These questions are used by CDDPs and services coordinators when reviewing providers for a referral. Answer honestly — this protects you and the individual.

Community & Service Support
Wheelchair Accessibility Details
Single Level — No Stairs
Widened Doorways
Roll-In Shower
Accessible Bathroom
Ramp Access at Entry
Hoyer Lift Installed
Hospital Bed Available
Grab Bars Throughout
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Behavior & Crisis Support Capabilities

Be specific and honest — this is used by hospitals and CDDPs to determine placement fit

Check every behavior your home has experience supporting. There are no wrong answers — an honest profile protects you, the individual, and your home.

Behavioral & Crisis Needs You Can Support — Check All That Apply
Verbal Aggression
Physical Aggression Toward Staff
Physical Aggression Toward Others
Self-Injurious Behavior (SIB)
Elopement / Running Away
Property Destruction
Psychosis / Hallucinations
Suicidal Ideation
Fecal Smearing
Sexually Inappropriate Behavior
Sexually Offending Behavior
Registered Sex Offender
Pica (Eating Non-Food Items)
Hoarding
Loud Vocalizations / Screaming
Night Disturbances
Refusal of Care
Medication Refusal
Oppositional / Non-Compliant Behavior
Anxiety / Panic Attacks
Depression / Withdrawal
Trauma Responses / PTSD
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Staffing

Your staffing structure and coverage

Languages Spoken in the Home
English
Spanish
Russian
Somali
Vietnamese
Other
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Home Environment

What life looks like in your home day to day

Activities Offered — Check All That Apply
Community Outings
Arts & Crafts
Cooking / Baking
Board Games / Card Games
Video Gaming
Sports / Exercise
Music / Singing
Gardening
Movie Nights
Volunteering
Church / Spiritual Activities
Swimming / YMCA
Shopping Trips
Bowling
Fishing
Hiking / Nature Walks
Restaurants / Dining Out
Reading / Library
Day Programs / ATE
Sensory Activities
Puzzles
TV / Movies at Home
Please be truthful. An accurate picture of your home helps us find individuals who will truly thrive with you. There are no wrong answers.
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Additional Notes

Anything else you want us to know

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You're in the network!

Thank you for joining Oregon Care Connect. We will begin marketing your home to CDDP coordinators and services coordinators immediately. We will be in touch within 1 to 2 business days.


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