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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:
Our vision is simple: we aim to be the leading provider of home care services. By providing personalized, compassionate support, we help our clients live with dignity and peace of mind. Reach out to us today to discuss...
The mission of CareCo Shoreline is to provide comprehensive, compassionate, and customized in-home services designed to help individuals remain in their homes, safe and strong.
There’s a reason why Unity Home Care LLC, is a leading provider of homecare in Farmington, Connecticut, and that’s simply because we truly care for you! Elderly, injured, ill, and the disabled—we make every high-quality...
At H0PE ALIVE HOME CARE AND COMPANION, we’re dedicated to providing the support needed to ensure your loved ones receive the quality care and quality of life they deserve.
Our family owned company was established in 1989 in New Britain, CT as Bright Cleaning Services with the intentions of providing housecleaning services in central Connecticut – Newington, Middletown, Avon, Glastonbury and...
To be the leading provider of compassionate, personalized home care services in Connecticut, enriching the lives of our clients and their families through exceptional care, innovative solutions, and unwavering commitment...
AFI Healing Hands International LLC is a dedicated home care agency committed to providing compassionate and high-quality care to individuals in need of assistance with daily living.
Mercy Home Health Inc. is a home care provider that services in East Hartford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A & B Homecare Solutions - New Haven is a home care provider that services in East Hartford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Homewatch CareGivers of Windsor was founded on the idea that your loved one deserves to be treated with kind, compassionate care that is tailored to their unique needs, and in their preferred surroundings. That’s why we...
Since 1996, Always Best Care has helped thousands of families with non-medical in-home care and assisted living referral services. Our passion for helping people maintain a safe, independent and dignified lifestyle...
Maxim Healthcare Services, Inc is a home care provider that services in East Hartford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Sovereign Home Health Care is a home care provider that services in East Hartford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Nursing Services Inc is a home care provider that services in East Hartford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Constant Care Home Care Agency is a licensed, non-medical full service Homecare Agency located in East Hartford, CT serving families in Connecticut. We are a family owned and operated agency who prides ourselves with the...
Comfort Helpers Companion & Homemakers, LLC has seven years track record. All employees are lincesed professionals, many have 10-15 years of experience within the field. Insured and bonded. Background checks are...
We envision fostering independence and maintaining dignity for our clients. We collaborate with our clients and their families to create a personalized strategy, ensuring exceptional home care services. By assisting our...
As a home care provider in Connecticut, we here at Decent Homecare Services LLC understand that homebound individuals need constant care and attention in order to help them cope with the inconveniences in their everyday...
Homemaker serving a meal Meal preparation Cleaning Laundry Making beds Changing light bulbs and more! Aide Services Personal care aide helping a client walk at home Medication reminders Health...
Senior Helpers - Fairfield, CT is a home care provider that services in East Hartford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At OPAAT, we pride ourselves in providing exceptional care to seniors in the comfort of their home or their place of residence (i.e. assisted/independent living, long-term care, and short-term rehab facilities). We do...
Non-Medical in Residence Companion and Home Care. From a few hours a week to 24/7 care, we'll tailor a home care plan to fit your lifestyle with the flexibility to change as your needs change. Our services include...
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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.