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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:
Greenwich HomeCare is a locally owned and operated non-medical home health care agency dedicated to providing the highest quality home health aides. We are a licensed, bonded, and insured agency serving Greenwich,...
The most qualified professionals in the health and wellness community. Our mission is to provide the most qualified, experienced and compassionate nurses and specialists to healthcare institutions, hospices, government...
Efficient Aids Agency is a trusted Homemaker Companion Agency committed to providing compassionate and professional care to individuals who need assistance in their daily lives. Our experienced team offers a range of...
With Nissi Agency you can entrust your loved ones to our experienced management and dedicated staff, who will go above and beyond to ensure that your loved one receive the best care.
"The Home Care That's Designed Just For You" "At R&S Homecare Services LLC, we strive to enhance the quality of life for those we serve. Trust R&S Homecare Services LLC for dependable and cost-effective home care...
At Absolute Best Home Care, our vision is to be a meaningful contributor to the communities we serve making a lasting impact in the lives of the seniors and giving back to the community.
Our Mission is to provide our clients with options, promote independence, embrace quality of life but more importantly provide a safe space for our seniors, veterans and people with disabilities to participate. With our...
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...
Our in-home care services brighten the lives of seniors who can benefit from a helping hand and a friendly smile. Our caregivers, who are seniors themselves, make your life easier by providing compassionate care in the...
Anchored Care LLC is a compassionate home care service dedicated to providing personalized, high-quality care for seniors in the comfort of their own homes. Our trained caregivers offer assistance with daily activities,...
Interim Healthcare is a leader in the home care industry with 50 years of experience. We provide supportive services to frail and disabled individuals allowing them to remain independent in their homes. Our care...
Topnotch Care Services is a home care provider that services in Fairfield, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Shamrock Vna Hha Agency Inc is a home care provider that services in Fairfield, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Visiting Angels of Fairfield, CT is a home care provider that services in Fairfield, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Since 2000, we've been providing comprehensive home care solutions, customized to meet your unique needs. Our expert Care Managers and closely-screened caregivers work with you to understand your current needs and can...
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,...
ComForCare Home Care - Fairfield, CT is a home care provider that services in Fairfield, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
As part of our wide variety of home care services, Seven Stars Home Care Services, LLC offers in-home private duty nursing services to assist seniors, adults, and children. With Seven Stars, you or your loved one will get...
Our home care services in Fairfield, Connecticut are designed to help those clients who have decided to receive care at home. Whether it's short-term or long-term care, we work with our client's family members and...
Seniors Helping Seniors - Fairfield, CT is a home care provider that services in Fairfield, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Elderly Caregivers LLC - Connecticut is a home care provider that services in Fairfield, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Senior Helpers of Upper Fairfield, New Haven, and Central Connecticut is a home care provider that services in Fairfield, CT. Home care services allow seniors to remain safely in their own home while receiving medical...
Our mission at Home Care Assistance is to change the way the world ages. We provide older adults with quality care in Fairfield County, that enables them to live happier, healthier lives at home. Our services are...
At SYNERGY HomeCare of Fairfield, we proudly provide nonmedical care to people of any age. We provide companionship,homemaking help, personal care, memory care and even respite care to individuals and their families in...
Turtledove Home Care brings more than 40 years of experience to provide the professional and compassionate care chronically ill, elderly or disabled patients in greater Fairfield County need to remain independently in...
Whether due to a temporary situation such as recovering from illness, injury or hospitalization or something longer-term such as the challenges of aging or a disability, including senior, elder or respite home care,...
Since 1984, the founders of Preferred Care at Home have had the privilege of assisting clients improve their quality of life while still recognizing and maintaining their dignity and independence. Preferred Care at Home...
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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.