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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:
Hands with Heart provides post-surgical care, medication reminders, meal prep, transportation, light housekeeping, personal care assistance and JOYFUL companionship. Whether at home or in a facility we provide personal...
At Home Matters, we’ve made it our mission to provide high quality care for seniors that allow our clients to remain safe, comfortable, and independent at home. Our approach is unique, based on years of research in the...
One You Love Homecare of North, South, and West Houston proudly serves the seniors across Houston, including Sugar Land, Missouri City, Katy, Richmond, Fulshear, Cypress, Spring, The Woodlands, Fresno, Pearland,...
William Long, owner of Amada Senior Care Clear Lake, has made it his personal mission to help the seniors in our community live safer and more enjoyable lives. According to William, “I believe that each of our elders has...
At Interim HealthCare, we are dedicated to providing compassionate, personalized care to individuals in the comfort of their own homes. Our team of skilled caregivers offers a wide range of services, including home...
Conrerstone Caregiving services : Non-Medical Home Care Services: Daily assistance with bathing, dressing, and toileting. Preparing meals and shopping for groceries. Light housekeeping and laundry. Providing...
Angels of Home Health, LLC is a Texas-based home health care agency committed to providing compassionate, patient-centered care in the comfort of clients' homes. The agency collaborates with patients and families, to...
Absolute Kheir Services Inc is a home care provider that services in League City, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ALTHA HOME HEALTH LLC is a home care provider that services in League City, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
SYNERGY HomeCare of Southeast Houston, TX is a home care provider that services in League City, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Gentry Care Homes, our mission is to deliver exceptional, compassionate care in a safe, nurturing, and dignified home setting. We are devoted to enhancing the quality of life for our residents by promoting...
Qstaff Home Healthcare is a home care provider that services in League City, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Jeby Health Care Services Inc is a home care provider that services in League City, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Health Vision Home Health Services Inc is a home care provider that services in League City, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
V & R Health Care Services Llc is a home care provider that services in League City, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Comprehensive Home Care Provider. Licensed, bonded and insured. Specializing in 24 hour and Live In Care. Stay Home or Get Back HOME with CareBuilders at Home. Also beautiful and quaint specialized residential care homes...
Nurse Next Door Home Care Services Galveston provides senior home health care that matches Mom, Dad, you or your loved one with the perfect Caregiver. It's about caring, not just health care. That's why we're here to help...
Regency Home Health is a home care provider that services in League City, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Senior Helpers of Greater League City is a licensed home care and home health office. We provide personal and medical care with a platform of public health and epidemiology.
Griswold Home Care SE Houston brings 40+ years of trusted, 5-star rated service. We offer RN-led assessments, no hourly minimums, and award-winning support. As a VA-approved national provider, we’re proud to serve...
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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.