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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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Life is Better with Villi of Montgomery At Villi, we believe “It takes a village,” and we’re here to be that village for you and your loved ones. Our mission is to bring comfort, joy, and a helping hand to your daily...
What Makes SYNERGY Different? Reliability SYNERGY HomeCare's Care Team can be relied upon to be at their assigned shift as scheduled. SYNERGY HomeCare utilizes a telephony system allowing us to know when our caregiver...
Best Care Home Care is a home care provider that services in Germantown, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Senior Helpers Rockville is committed to delivering the best possible in-home care to seniors in Montgomery County. Our top notch caregivers have a passion to serve you or your loved by providing companionship and...
1. A care team led by a Registered Nurse that develops and implements a personalized care plan for each client 2. Experienced, compassionate, and highly trained caregivers 3. On-going training and Development for all...
Capital City Nurses CHC- Local/DC is a home care provider that services in Germantown, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
MISSION Our Mission is to deliver compassionate, quality, community-based home care and to provide healthcare staffing services to a wide range of facilities when care outside the home is needed. OUR VISION Our...
Caring Arms In Home Care is a home care provider that services in Germantown, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Ardent Home Health Care Services Llc is a home care provider that services in Germantown, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Homewatch CareGivers of Germantown, we offer compassionate and dependable in-home care services designed to support the health, safety, and independence of our clients. As a locally operated franchise location backed...
Family Choice Care LLC is a trusted home care agency dedicated to providing compassionate, reliable, and personalized care for seniors. Our mission is to help older adults maintain their independence, dignity, and quality...
Cherished Hands Home Health is a home care provider that services in Germantown, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Civil Healthcare Services is a home care provider that services in Germantown, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Adcare Home Health Services, MD is a home care provider that services in Germantown, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Dedicated to serving the healthcare sector, we prioritize providing top-notch staffing solutions tailored to the specific needs of our clients and their facilities. Our home health aides provide support for your family...
NOUVEAU HEALTH CARE (NHC) is a state-licensed home health care provider in all areas in Maryland. It is committed to providing quality home health care services to Maryland residents. It implements a person-centered...
Welcome to Cogzwell Health Services Inc, your trusted partner in non-medical home health care in Germantown, MD. We specialize in providing compassionate and reliable care services tailored to meet the unique needs of...
At Peace Health Care Services, our mission is to provide compassionate, non-medical in-home care that fosters independence, dignity, and peace of mind for individuals and families in Germantown, MD, and the surrounding...
Step by Step In Home Care is a home care provider that services in Germantown, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At G&B Care Services LLC, we are committed to delivering exceptional home care and support for individuals and families. Our compassionate and experienced caregivers are dedicated to enhancing the quality of life,...
We specialize in helping people live well, happily and safely in their homes. Our true care approach is tailored for each client who needs some form of in-home healthcare, senior care or other housebound companion...
At Compassion Home Health Care, we embrace a holistic approach to health and wellness. Inherent in our mission is the belief that patient education promotes a healthier society. So our approach is not only to treat the...
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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.