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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:
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“The care you need, in the place you love.” Serving Fort Wayne, Kendallville, Warsaw, Marion, and surrounding areas Companion Care - In-home companion care helps seniors stay socially active and engaged, with...
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Our Parents Keeper LLC offers personalized in-home care services for seniors and individuals requiring assistance. Our compassionate caregivers support daily activities, promote independence, and enhance quality of life,...
Team Select’s mission is to change lives for the better. We advocate for families in need, treat our patients like the heroes they are, and empower our team members to make the world a better place. With more than 15...
Pediatric Nursing Specialists of Indiana is a home care provider that services in Fort Wayne, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Finding the right in-home care can be overwhelming. We simplify the journey, guiding you every step of the way to ensure you receive the compassionate care you deserve.
At Home Healers Homecare LLC offers compassionate, personalized in-home care services for seniors and individuals with disabilities. Our experienced caregivers provide assistance with daily activities, medical support,...
United Home Care Services, LLC is a home care provider that services in Fort Wayne, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Inspired Homecare is dedicated to providing exceptional, family focused care for our client. We provide extraordinary quality surpassing excellence for your health. Our goal is to meet our clients’ needs in the nurturing...
QUALITY OF LIFE PERSONAL CARE SERVICES is a home care provider that services in Fort Wayne, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Through our unique system of in-home care that we call Interactive Caregiving™, our Comfort Keepers® engage clients in their care to enhance their independence and well-being. Interactive Caregiving™ includes four...
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MAGNOLIA ANGELS FORT WAYNE is a home care provider that services in Fort Wayne, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At LAVISH ROYALTY HOME CARE/ STAFFING, we provide reliable and affordable Home Care/Staffing services in the US. As your trusted Home Care Agency since 2021, our staff guarantees personalized attention to all of your...
At Black Pearl Life Services LLC, our mission is to provide unparalleled support and care that goes beyond the ordinary. We are dedicated to empowering individuals to lead fulfilling lives while contributing to the...
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At Helping Hands Home Care Services, we provide reliable and affordable home care services in the Fort Wayne and surrounding area. Our staff guarantees personalized attention to all of your Home Care needs. We care about...
BrightStar Care of Fort Wayne, IN is a home care provider that services in Fort Wayne, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Care Services Inc is a home care provider that services in Fort Wayne, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Compassionate Care Services of Fort Wayne, IN is a home care provider that services in Fort Wayne, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ILOVE HOME CARE is a home care provider that services in Fort Wayne, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
BrightStar Care of Fort Wayne, IN is a home care provider that services in Fort Wayne, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At PrecisionCare, it is our mission to improve the quality of life of our clients by providing excellent services that greatly exceed industry standard.
BB'S HOME CARE LLC is a home care provider that services in Fort Wayne, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Maxim Healthcare Services Inc is a home care provider that services in Fort Wayne, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Indiana’s Division of Home and Community-Based Care regulates and licenses agencies like JT UKRIST LLC, ensuring they meet standards in health care services for individuals needing assistance with daily living activities...
Home Health Network Inc, The is a home care provider that services in Fort Wayne, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Guardian Homecare provides compassionate and personalized in-home care services, ensuring comfort, dignity, and independence for seniors and individuals with disabilities. Our dedicated caregivers offer assistance with...
Welcome to FOTS Homecare Solutions where everyone is important and respected. With compassion, the FOTS Homecare Solutions team will ensure that the Individuals and families served by us have their needs met by empowering...
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Home Nursing Services is a home care provider that services in Fort Wayne, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Divine Home Healthcare Inc is a home care provider that services in Fort Wayne, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
Blessing Hands Home Care Agency Llc is a home care provider that services in Fort Wayne, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
Melissa leads the Senior Helpers Fort Wayne team with a passion for serving the elderly and being a part of their journey to a better quality of life. Senior Helpers of Fort Wayne provides a full range of senior home care...
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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.