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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:
SYNERGY HomeCare of Madison is led by Russell Bercier, who brings a wealth of experience from the insurance and finance industries and is deeply committed to giving back to his community.
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...
Our comprehensive support services are designed to enhance both your personal and professional experiences. From managing medications and implementing therapeutic treatment plans to providing on-site job assistance and...
Welcome to Homestead Care Group, a dedicated homecare provider founded on compassion, experience, and a commitment to quality. Our story began with a shared vision between two professionals passionate about delivering...
We are a senior home care service that allows your loved ones to stay where they feel most comfortable: at their home in the capital city or in surrounding areas like Waunakee, Verona, or Fitchburg.
Home Helpers provides a comprehensive set of home care services provided by skilled, trained, professional and compassionate caregivers in Madison, WI dedicated to meeting your family’s needs. We work with you to create a...
Lisa and Dennis, owners of Senior Helpers Madison are committed to delivering the best possible in-home care to seniors in the Madison community and surrounding areas. Their vision is to provide the highest quality home...
United Heart Home Health is a home care provider that services in Madison, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Whether you or your loved one needs a little extra help around the house following a medical procedure, long-term assistance with activities of daily living, 24-hour live-in care, or you are starting to look for Senior...
Recover Health of Wisconsin is a home care provider that services in Madison, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Caring Hearts Home Care is a compassionate and dedicated service provider committed to enhancing the quality of life for individuals in need of assistance with daily activities due to aging, illness, or disability.
Integrity, Love, Support & Community. Aalair Home Care is a local agency that is built on integrity, love, kindness, and compassion. We are dedicated to supporting the care of your loved one and fully committed to...
Home Hlth United Vns is a home care provider that services in Madison, WI. 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...
Village Caregiving, LLC of Madison, WI is a home care provider that services in Madison, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Midwest Home Care, LLC. (MHC) is a private comprehensive homecare agency providing services to help individuals manage the tasks of everyday living. We provide a wide range of services to enable elders remain at home and...
Maxim Healthcare Services, Inc is a home care provider that services in Madison, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
UniqueIHPC Wellness, health, happiness, dignity, and safety in the communities we serve are our top priorities. UniqueIHPC aims to contribute to improving the quality of life of our clients and their families through our...
At Visiting Angels, we strive to make staying at home a positive experience. We do this by allowing you to select your caregiver from a group of skilled elderly home care providers, allowing you to maintain your schedule,...
A home care agency allows your loved one to stay at home while providing the security and companionship he or she desires. Cairasu Home Care provides an individualized approach to caring for your loved ones through In...
AGAPE (Greek) is the highest form of love. At Agape, a faith based company, we believe that love is the greatest connection and we reflect this love through our quality of care. Rene Gibbs founded Agape Services in...
Independent Hlth Care is a home care provider that services in Madison, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Full Spectrum Health Services of Madison, WI is a home care provider that services in Madison, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Meriter Home Care Agcy is a home care provider that services in Madison, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Alora Home Health, we understand that finding the right care for your aging family members can be stressful and overwhelming. That's why we're here to offer compassionate personal care and companionship and...
Life is so much more than a to-do list. It's a series of moments with the people we love, making memories that make up a lifetime. BrightStar understands this, and is committed to making more of those moments possible in...
Apara Care Health at Home is a home care provider that services in Madison, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Krista Natarelli and Rick Schneider, daughter-and-father co-owners of Amada Senior Care of Madison, together have more than 50 years’ experience in healthcare and insurance.
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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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.