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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:
HomeWell Care Services of Chicago North Shore is a home care provider that services in Deerfield, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Senior Helpers of Buffalo Grove is a senior in-home care provider that services Buffalo Grove, IL and its surrounding cities. Senior Helpers’ healthcare professionals help seniors increase their quality of life while...
About Lifted Above Home Care We understand how important it is to have reliable and caring support for your loved ones. Let us provide the care they deserve. Contact us today. Quality Home Care Services - Lifted Above...
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...
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...
Recognized For Our Devotion To Clients and Caregivers Our goal is not to be the biggest home care company, it's to be the best home care company. The most accurate way to measure that standard is comparing ourselves to...
At Better Choice Home Health Inc., your trusted partner for compassionate, professional home health care services. Experience personalized care tailored to your needs, delivered with respect and dedication. Discover the...
At Lotuscare Services LLC, our mission is to empower and uplift individuals and families through compassionate, client-centered care and support. Based in Lansing, IL, we are dedicated to enhancing the well-being of those...
Our founders exemplified the philosophy behind Inspired Home Care, a trusted home care agency for seniors in Chicago and the surrounding areas. Amit Shrivastava grew up in India and watched his mother care for her own...
At Good Hope Home Health Care, we are dedicated to providing compassionate, professional, and personalized care that enhances the quality of life for those we serve. With a focus on supporting individuals in the comfort...
LSSI offers in home care to meet the changing needs of seniors. Services like home care extend the time that seniors can remain independent in their homes. By caring for seniors, LSSI alleviates caretaker stress and...
SYNERGY HomeCare of the North Shore, IL is a home care provider that services in Deerfield, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Gentle Homecare, Inc is a home care provider that services in Deerfield, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Aat Home Healthcare d/b/a Paramount Home Health is a home care provider that services in Deerfield, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Assisting Hands, our mission is to offer our clients the very finest personalized non-medical care, allowing them to live safely and comfortably in their own homes in Deerfield, IL and surrounding areas. Sometimes...
We’re the premiere senior in-home care specialist in the Chicagoland area. Companion Services of America offers seniors in-home care as well as a wide variety of services in various settings including the home, hospital,...
Companion Services of America provides quality home support services for clients of all ages. We are committed to enhancing our client's quality of life, maximizing their independence, and preserving their dignity,...
Our Commitment to You… We believe that everyone is entitled to live life to the fullest, regardless of personal limitations or capabilities. At times, we are faced with situations that can limit our ability to live the...
Jennifer Novy, owner of Amada Senior Care North Shore, has dedicated her professional and personal life to caring for seniors. As a life-long Chicagoan, she now uses her senior care experience to help neighbors in Lake...
Senior Helpers of Greater Chicagoland is the premier provider of in-home senior care. We offer tailored home care services ranging from companion care for seniors who need daily assistance to in-depth specialized care for...
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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.