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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:
At SYNERGY HomeCare, we build connections and forward momentum in people’s lives. We call it the Synergy Effect. We believe our purpose is to provide the best care possible. Equally important is helping people feel, see...
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...
Optimum Senior Care Optimum Senior Care offers in home senior care and caregiver services to the elderly population in the Chicago Metro area. Our mission is to cherish and protect the independence and dignity of our...
Ace-Premier Home Care Services, Inc. offers compassionate and personalized in-home care for seniors and individuals with disabilities. Our skilled caregivers provide assistance with daily activities, medical support, and...
At Evanston CareNow Homecare it is our mission to provide our older adult with exceptional home care services and achieve the optimum wellness the older adult deserves.
Home & Hearth Caregivers is available 24/7 for you or your loved one. We serve Cook, DuPage, Kane, Kendall, Lake, McHenry and Will counties. Our experienced Care Plan Managers will be happy to provide a complimentary home...
Home Nursing And Home Services is a home care agency locally-based and privately-owned. Our founders are caregiving professionals who have been in this line of work for years. With their experience, they inspire the rest...
With home care services, our office can provide personal care plans through an in-home evaluation and interviews between the client, family and the ComForCare team to help determine the best plan of action for the...
Serenity Home Healthcare LLC provides compassionate and personalized in-home care services for seniors and individuals with disabilities. Our dedicated caregivers assist with daily activities, medical support, and...
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...
NorthShore Home Care is a home care provider that services in Glenview, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
The Victoria's Angels is a home care provider that services in Glenview, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Homecare of Midwest, A Division of Midwest Palliat is a home care provider that services in Glenview, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Patient Plus Homehealth Care, Inc is a home care provider that services in Glenview, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Prestige Plus Home Care, Inc is a home care provider that services in Glenview, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Since opening the doors in 2011, our mission at Always Best Care Glenview and the North Shore has been to enable seniors to remain as independent and safe as possible wherever it is they call home. We do this through...
Inswan Home Healh Agency, Ltd is a home care provider that services in Glenview, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Metropolitan Home Health Care, Inc is a home care provider that services in Glenview, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
24/7 At Home Care Services, Inc, IL is a home care provider that services in Glenview, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Chicago Care at Home Specialists Inc. provide senior home care, personal care, respite care, and companion care to assist the elderly in continuing to live in their own home independent.Our experienced and caring...
Alpha Employment Agency is a home care provider that services in Glenview, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Pathways Home Health Service, Llc is a home care provider that services in Glenview, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Partners in Healthcare of Glenview, IL is a home care provider that services in Glenview, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Tlc Healthcare Services of Il, Inc is a home care provider that services in Glenview, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Vision & Mission At FirstLight Home Care, we envision a world in which all adults may age with comfort, dignity and independence in the place they call home. We exist to help people have their best day, every day. Our...
Senior Helpers of Greater Chicagoland is the premier provider of in-home senior care. We offer tailored home care services ranging from companion care for seniors who need daily assistance to in-depth specialized care for...
Jennifer Novy, owner of Amada Senior Care North Shore, has dedicated her professional and personal life to caring for seniors. As a life-long Chicagoan, she now uses her senior care experience to help neighbors in Lake...
We strive to provide excellent home care services promoting a better quality of life for our clients and their families. We aim to: Serve families and provide a better quality of life Respond to our customers’...
Many of us know a senior who is living alone—and lonely. Many people know an older couple who is struggling with their health. And some of us know seniors who are trying desperately to take care of their home and other...
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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.