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Who are you caring for?
Which best describes their mobility?
How well are they maintaining their hygiene?
How are they managing their medications?
Does their living environment pose any safety concerns?
Fall risks, spoiled food, or other threats to wellbeing
Are they experiencing any memory loss?
Which best describes your loved one's social life?
Acknowledgment of Disclosures and Authorization
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington. Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services. APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid. We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour. APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment. You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints. Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights. APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.I agree that: A.I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information"). B.APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink. C.APFM may send all communications to me electronically via e-mail or by access to an APFM web site. D.If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records. E.This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year. F.You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
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I acknowledge and authorize
✔
I consent to the collection of my consumer health data.*
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I consent to the sharing of my consumer health data with qualified home care agencies.*
*If I am consenting on behalf of someone else, I have the proper authorization to do so. By clicking Get My Results, you agree to our Privacy Policy. You also consent to receive calls and texts, which may be autodialed, from us and our customer communities. Your consent is not a condition to using our service. Please visit our Terms of Use. for information about our privacy practices.
Mostly Independent
Your loved one may not require home care or assisted living services at this time. However, continue to monitor their condition for changes and consider occasional in-home care services for help as needed.
Remember, this assessment is not a substitute for professional advice.
Share a few details and we will match you to trusted home care in your area:
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Comfort at home is dedicated to improving the lives of seniors by encouraging continued independence. We offer companionship and assistance with daily activities and routines to enhance and extend living at home in a...
Golden Circle Comprehensive Services is a home care provider that services in Augusta, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our Services: Compassionate Care for Every Need A Kingdom Heart Home Care offers personalized non-medical services, including personal care, companionship, meal preparation, light housekeeping, and medication reminders,...
We are a non-medical home care provider in Augusta, providing care to the elderly, disabled, and all members of our community recovering from surgery or illness or are just in need of care in their homes. Proudly...
CNS Cares - Parent is a home care provider that services in Augusta, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Visiting Angels, we strive to make staying at home a positive experience. We do this by allowing you to select your caregiver from a group of skilled elderly home care providers, allowing you to maintain your schedule,...
Life is so much more than a to-do list. It's a series of moments with the people we love, making memories that make up a lifetime. BrightStar understands this, and is committed to making more of those moments possible in...
We are Caregivers You Can Trust. Feel better in the comfort of your own home. We specialize in care and daily living assistance to an array of individuals. Whether you need daily or weekly assistance due to aging,...
Serenity Health Care Services is a home care provider that services in Augusta, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Welcome to A Home Away From Home HC, your trusted partner in private home care in Augusta, proudly serving the Central Savannah River Area (CSRA). At the heart of our commitment is a passion for providing compassionate...
Hiawatha Private Healthcare Services, LLC is a home care provider that services in Augusta, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We've been there. We understand. Neither giving nor receiving care is easy. Home Instead® puts relationships first to support those giving care, to protect the dignity of those receiving care, and to enhance the quality...
Our team of highly skilled professionals offers a range of services, including medical care, personal assistance, and companionship, tailored to meet the unique needs of each client.
CHRISTIE'S HEALTH SERVICES is a home care provider that services in Augusta, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our mission is to provide compassionate, personalized care to individuals who need assistance with daily living activities. We understand that aging, illness, or disability can be challenging, and our goal is to help our...
Addus is proud to be a nationally recognized provider of high quality, in-home care services with over 30 years experience. Our breadth of services include Contractual Home Care, Personal Care, Homemaker, Respite, Care...
ADDUS HOMECARE- AUGUSTA is a home care provider that services in Augusta, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Are you searching for trusted and qualified caregivers for your senior who may need assistance living in their home? AccordCare is the nation’s leading provider of Home Care in Augusta, GA and surrounding area. We enable...
Trinity Home Health is a home care provider that services in Augusta, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Savannah River ProHome Care, we provide reliable and affordable home care services in the comfort of your own home. Our staff guarantees personalized plans and attention in order to provide you or your loved one with...
Rest & Recover Home Care LLC is a home care provider that services in Augusta, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Welcome to For Life Home Care We understand the importance of feeling safe, comfortable, and cared for in your own home. Our dedicated team is committed to providing compassionate support tailored to your unique needs,...
If you are in need of caregiving from a distance, home health care can give you peace of mind. Trained and qualified professionals can assess safety risks and make simple corrections in the home—from placing a rug on a...
Winyah Home Health Care, an Amedisys Company is a home care provider that services in Augusta, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Help at Home of Augusta, GA is a home care provider that services in Augusta, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Guardian Angels Care LLC is a home care provider that services in Augusta, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Care Agency is a locally-owned and operated provider of home care in Augusta, Georgia that provides services to ten surrounding counties, striving to render extraordinary care to its residents in need. Our clients...
Home Help Companions Service Augusta, GA & Aiken, SC and other surrounding areas. Home Help Companions provides qualified and caring home care support for seniors—personal, non-medical care when you need it. In...
We are proud to be a care-based company backed by 15 years of experience, and our goal is to be an extended family to yours in your time of need. We provide in-home care for seniors, people with disabilities, or anyone...
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One of our advisors will contact you soon to connect you with trusted sources for care in your area.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.