Are you sure you want to exit? Your progress will be lost.
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.
✔
I acknowledge and authorize
✔
I consent to the collection of my consumer health data.*
✔
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:
“COLLABORATION AND PARTNERSHIP EQUALS EXCELLENT CARE” Excellent Home Health Care, Inc (EHHCI) has been established for the sole purpose of providing individuals and their families with the best possible home health care...
Home Helpers Home Care of Naperville is among the best in home care today. We only hire caregivers who are really passionate about their jobs. We make sure all our caregivers are properly trained and have undergone...
Resurrection Home Care LLC is a leading provider of in-home care services in the United States. Our mission is to provide compassionate and personalized care to seniors, individuals with disabilities, and those recovering...
When the time comes that extra care is required, whether due to age or health condition, many people prefer the familiarity and comfort of their own home. At Homewatch CareGivers®, we believe that good care should not...
Life moves in one direction – forward. No matter what each person’s circumstances are, SYNERGY HomeCare steps in with effective, comforting, life-affirming care that moves people, and their loved ones, emotionally and...
Private Home Care - Niles, IL is a home care provider that services in Hoffman Estates, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Senior Helpers, we are here to help anyway we can. No matter how big or how small the task. We are licensed, bonded and insured and have screened and continuously trained caregivers that are immediately available to...
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...
We’re here to help you continue living independently. If you or a loved one is having trouble with activities of daily living, home safety or personal care, we can provide a specialized program to make life easier and...
In 2019 Susie Murphy started D’Vine Caregivers as a natural extension of her 35 years of excellence in matching nannies and domestic helpers with young families. She now brings her skills and insight in finding and...
Personalized In-Home Assistance Is Only A Call Away Turn to our home service professionals when you or your loved one is in need of help at home. Serving Cook, Kane, Mchenry County and surrounding areas.
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...
FirstLight Home Care of Hoffman Estates, IL is a home care provider that services in Hoffman Estates, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
PROVIDING CARE BEYOND COMPARE ALMOND HOMECARE LLC is a dedicated and compassionate organization that aims to provide exceptional and quality in-home care services for the elderly.
Home Health Network, Inc is a home care provider that services in Hoffman Estates, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
BKD Personal Assistance Services, LLC - DBA Brookdale at Home Hoffman Estates is a home care provider that services in Hoffman Estates, IL. Home care services allow seniors to remain safely in their own home while...
Alpha Healthcare Institute Excellence with Compassion Alpha Healthcare Institute nurses, CNAs, and home health aides deliver professional and compassionate care in the comfort and familiarity of home setting. We are...
Popular Home Care LLC is a home care provider that services in Hoffman Estates, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Carefinity Home Care proudly provides non-medical home care services to individuals with disabilities, injuries, difficulties with mobility, or illnesses. We are composed of highly trained and competent staff members who...
Carelink Home Health, LLC is a home care provider that services in Hoffman Estates, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
The main goal of providing in home care is to provide a better quality of life to our patients and the confidence to their families that their loved one is well looked after. Whether elderly, an adult or child with...
When it comes to in-home senior care and other services designed to help seniors age gracefully, A Place At Home is there to provide you with compassionate professionals to assist you or your loved ones throughout the...
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...
“COLLABORATION AND PARTNERSHIP EQUALS EXCELLENT CARE” Excellent Home Health Care, Inc (EHHCI) has been established for the sole purpose of providing individuals and their families with the best possible home health care...
Home Helpers Home Care of Naperville is among the best in home care today. We only hire caregivers who are really passionate about their jobs. We make sure all our caregivers are properly trained and have undergone...
Resurrection Home Care LLC is a leading provider of in-home care services in the United States. Our mission is to provide compassionate and personalized care to seniors, individuals with disabilities, and those recovering...
When the time comes that extra care is required, whether due to age or health condition, many people prefer the familiarity and comfort of their own home. At Homewatch CareGivers®, we believe that good care should not...
Life moves in one direction – forward. No matter what each person’s circumstances are, SYNERGY HomeCare steps in with effective, comforting, life-affirming care that moves people, and their loved ones, emotionally and...
Private Home Care - Niles, IL is a home care provider that services in Hoffman Estates, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Senior Helpers, we are here to help anyway we can. No matter how big or how small the task. We are licensed, bonded and insured and have screened and continuously trained caregivers that are immediately available to...
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...
We’re here to help you continue living independently. If you or a loved one is having trouble with activities of daily living, home safety or personal care, we can provide a specialized program to make life easier and...
In 2019 Susie Murphy started D’Vine Caregivers as a natural extension of her 35 years of excellence in matching nannies and domestic helpers with young families. She now brings her skills and insight in finding and...
Personalized In-Home Assistance Is Only A Call Away Turn to our home service professionals when you or your loved one is in need of help at home. Serving Cook, Kane, Mchenry County and surrounding areas.
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...
FirstLight Home Care of Hoffman Estates, IL is a home care provider that services in Hoffman Estates, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
PROVIDING CARE BEYOND COMPARE ALMOND HOMECARE LLC is a dedicated and compassionate organization that aims to provide exceptional and quality in-home care services for the elderly.
Home Health Network, Inc is a home care provider that services in Hoffman Estates, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
BKD Personal Assistance Services, LLC - DBA Brookdale at Home Hoffman Estates is a home care provider that services in Hoffman Estates, IL. Home care services allow seniors to remain safely in their own home while...
Alpha Healthcare Institute Excellence with Compassion Alpha Healthcare Institute nurses, CNAs, and home health aides deliver professional and compassionate care in the comfort and familiarity of home setting. We are...
Popular Home Care LLC is a home care provider that services in Hoffman Estates, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Carefinity Home Care proudly provides non-medical home care services to individuals with disabilities, injuries, difficulties with mobility, or illnesses. We are composed of highly trained and competent staff members who...
Carelink Home Health, LLC is a home care provider that services in Hoffman Estates, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
The main goal of providing in home care is to provide a better quality of life to our patients and the confidence to their families that their loved one is well looked after. Whether elderly, an adult or child with...
When it comes to in-home senior care and other services designed to help seniors age gracefully, A Place At Home is there to provide you with compassionate professionals to assist you or your loved ones throughout the...
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...
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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.