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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.
✔
I acknowledge and authorize
✔
I consent to the collection of my consumer health data.*
✔
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:
We provide the highest standard of caregivers to care for those that once cared for us. We treat seniors and their homes with the utmost care, compassion, and respect.
Whether you need Senior Helpers' assistance 24/7 or just a few hours a day, our offices are here to help with flexible service options. We provide professional and compassionate in-home care so that our seniors can age...
Harvest In-HomeCare Inc. - Plainfield, IL is a home care provider that services in Bloomingdale, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Whether your loved one is in need of around-the-clock care or home assistance a few hours every week, our in-home caregiving services in Carol Stream, Saint Charles, Aurora, and Elgin help individuals with mental and...
Leverage Home Care Services offers compassionate companion care to enhance well-being through emotional support and social interaction. Our caregivers provide meaningful conversations, accompany clients on transitions,...
ComForcare Home Care ® is a non-medical private duty home care agency based in Carol Stream, Illinois. We are licensed, bonded and insured. We cover DuPage county, as well as the outlying areas. We are committed to...
Lisa Capista, owner of Amada Senior Care Plainfield, understands the importance of compassionate care personalized for seniors so they can live safely and independently at home. From her own experience caring for...
Optimum Senior Care Optimum Senior Care offers in home senior care and caregiver services to the elderly population in the Chicago Metro area. Our mission is to cherish and protect the independence and dignity of our...
At FirstLight Home Care of Oak Brook, we provide exceptional care so that your loved one has the support they need to enjoy the quality of life they deserve in the place they call home. We exist to help people have...
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...
UCCT CORP Duplicate is a home care provider that services in Bloomingdale, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Illinois Home Care Specialists, Inc. of Bloomingdale, IL is a home care provider that services in Bloomingdale, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or...
Home Health Connect, Inc is a home care provider that services in Bloomingdale, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Standard Home Care, we offer a tailored approach for all of our clients’ needs to ensure they are able to age gracefully in their home. provide a superior quality in-home care service where our clients are treated with...
Nurture Care Home Health, Inc is a home care provider that services in Bloomingdale, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A Mishle Group Health Care Services Incorporated of Bloomingdale, IL is a home care provider that services in Bloomingdale, IL. Home care services allow seniors to remain safely in their own home while receiving medical...
Healing Touch Homehealth Services, Inc is a home care provider that services in Bloomingdale, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Crescent Care Home Health, Inc is a home care provider that services in Bloomingdale, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We are committed to providing high quality, client-centered and affordable Home Care services to our clients to assist them to lead a dignified and independent lives in the comfort and safety of their own homes. Our...
Preferred Health Care, Ltd is a home care provider that services in Bloomingdale, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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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.