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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:
Capital City Nurses CHC- Local/DC is a home care provider that services in Fort Washington, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Supreme Healthcare Services provides high-quality, compassionate in-home care for seniors and individuals with disabilities. Our dedicated caregivers offer assistance with daily activities, medical support, and...
Senior Helpers of Southern Maryland is a home care provider that services in Fort Washington, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A Homemade Plan of Lanham, MD is a home care provider that services in Fort Washington, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Dominion Home Healthcare Services, we provide exceptional care and support through personalized in-home skilled nursing care. Our team of compassionate and skilled professionals is committed to ensuring your health and...
Gifted Hands Home Care LLP is a compassionate and reliable home care agency dedicated to providing exceptional in-home care services for individuals in need of assistance with daily activities.
Options for Senior America - Gaithersburg, MD is a home care provider that services in Fort Washington, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance...
Imagine the best care possible provided in the comfort and dignity of the home of clients. This is the dream, which inspires the operations of Compassion North America Home Health Services.
At Compassionate Hearts Health Care we fulfill the needs of both the elderly and the children. With the help of doctors, hospitals, nurses, LPNs, CNAs and the latest technology, we work closely with the families of our...
Welcome to Family Soft Touch Home Care, your trusted partner in non-medical home care services in Fort Washington, Maryland. We specialize in providing compassionate and personalized care to individuals in the comfort of...
Caring Matters Home Care (R3141) is a home care agency servicing Prince George and Charles Counties in Maryland. We are fully licensed and fully insured, and we provide services for you or your loved ones in your own...
Americare In Home Nursing is a home care provider that services in Fort Washington, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At LDM Group, we are dedicated to enhancing the quality of life for individuals and families by providing compassionate, professional, and personalized home health care services. Our mission is to deliver exceptional care...
About Us CRM Health Services team is for home health care services 24/7 to help you out with Nursing Care help. Even if more specialized care is required, our team specializes in post-operative support, wound management,...
Horizon Health LLC is a home care provider that services in Fort Washington, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
Leading Radiant Health Services is a diverse group of professionals who have worked in home healthcare for over a decade. We recognize the critical role that healthcare workers play in keeping our community safe. That is...
Capital City Nurses CHC- Local/DC is a home care provider that services in Fort Washington, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Supreme Healthcare Services provides high-quality, compassionate in-home care for seniors and individuals with disabilities. Our dedicated caregivers offer assistance with daily activities, medical support, and...
Senior Helpers of Southern Maryland is a home care provider that services in Fort Washington, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A Homemade Plan of Lanham, MD is a home care provider that services in Fort Washington, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Dominion Home Healthcare Services, we provide exceptional care and support through personalized in-home skilled nursing care. Our team of compassionate and skilled professionals is committed to ensuring your health and...
Gifted Hands Home Care LLP is a compassionate and reliable home care agency dedicated to providing exceptional in-home care services for individuals in need of assistance with daily activities.
Options for Senior America - Gaithersburg, MD is a home care provider that services in Fort Washington, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance...
Imagine the best care possible provided in the comfort and dignity of the home of clients. This is the dream, which inspires the operations of Compassion North America Home Health Services.
At Compassionate Hearts Health Care we fulfill the needs of both the elderly and the children. With the help of doctors, hospitals, nurses, LPNs, CNAs and the latest technology, we work closely with the families of our...
Welcome to Family Soft Touch Home Care, your trusted partner in non-medical home care services in Fort Washington, Maryland. We specialize in providing compassionate and personalized care to individuals in the comfort of...
Caring Matters Home Care (R3141) is a home care agency servicing Prince George and Charles Counties in Maryland. We are fully licensed and fully insured, and we provide services for you or your loved ones in your own...
Americare In Home Nursing is a home care provider that services in Fort Washington, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At LDM Group, we are dedicated to enhancing the quality of life for individuals and families by providing compassionate, professional, and personalized home health care services. Our mission is to deliver exceptional care...
About Us CRM Health Services team is for home health care services 24/7 to help you out with Nursing Care help. Even if more specialized care is required, our team specializes in post-operative support, wound management,...
Horizon Health LLC is a home care provider that services in Fort Washington, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
Leading Radiant Health Services is a diverse group of professionals who have worked in home healthcare for over a decade. We recognize the critical role that healthcare workers play in keeping our community safe. That is...
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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.