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:
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Gentle Hands Home Care, LLC offers a wide range of home care services that are dedicated to help improve the quality of life and the health of your loved one at home. We respect and support our clients to stay at home and...
Alvita Care is a leading home care provider in New York City, Westchester, Long Island, and New Jersey. We’re best known for in-home senior care, but our caregivers are available to people of all ages, physical...
7 Day Home Care provides the same level of care that we demand for our own family. We are family-owned and have helped hundreds of clients since our inception. Our compassionate team of skilled professionals develops...
Harmony Home Care is a premium provider of in-home care services in New York City. We are committed to exceptional client service, and we maintain high standards for our caregivers. We believe caregivers should be kind...
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Senior Helpers of New York takes in-home care seriously, and strives to deliver the best possible in-home care to seniors in the New York area. President and Co-Founder Kathy Livingston focuses on ethics and quality care....
Friends For Life HomeCare & Medicaid Consultants in Massapequa, NY, provides compassionate and comprehensive in-home care services tailored to meet the unique needs of individuals and families. They specialize in...
Right at Home - Lower Manhattan, NY is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
When we started LifeWorx in 2004, we wanted to build more than caring, empathetic care services. We wanted to build a community of giving. A place you join as an individual, ‘me’, but where you become part of a greater...
VIPrivate Care is your solution for discreet, premium healthcare on your time. From private duty nurses to round-the-clock medical advice, our team of Registered Nurses, Physical Therapists, Home Health Aids and other...
Home Helpers Home Care of South Bergen County is more than an in-home health care agency – we’re your extended family when family can’t be there. We’re a locally owned, trusted provider of quality, compassionate in-home...
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Empire State Home Care Services Inc CHHA is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Avalon Nurses Registry, Inc. is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
All Metro Health Care is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Little Sisters of the Assumption Family Health Svs is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
HHC Health & Home Care is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Avondale Care Group, Llc is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A & T Healthcare Llc is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Cabrini Care At Home is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
All Season Home Attendant is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Continuity Home Health Care is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Fedcap Rehabilitation Services, Inc is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Affable Home Care, Inc. is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Metropolitan Jewish Home Care Inc is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Priority Homecare is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Extended Home Care is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
En-Care, Inc. is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bioscrip Nursing Services Llc is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Isabella Home Care is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Yai Home Health Services is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Fegs Home Care Services, Inc. is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Advanced Monitored Caregiving, Inc. is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Chinese-American Planning Council Home Attendant is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Jewish Home/Hosp Lifecare Comm Svcs Manhattan Lthh is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Vns of NY Home Care CHHA is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Galaxy Home Care is a company with deep roots in home health care. Our management team and staff have decades of home health care experience so that we can provide the full range of in-home care services to individuals...
Our services cover many everyday tasks and can be adjusted and customized to meet the unique needs of your loved one. Our referred caregivers want to make sure you are always getting the exact care you need. If something...
When we started LifeWorx in 2004, we wanted to build more than caring, empathetic care services. We wanted to build a community of giving. A place you join as an individual, ‘me’, but where you become part of a greater...
Best Senior Home Care provides non-medical companion services to seniors in their own home. We can provide companions for a few hours a day, several days a week, or as many hours a day as you require, including live-in...
Sara Companion HomeCare Services is a New York State Licensed Home Care Agency dedicated to providing client and family centered home care services. Our goal is to provide quality continuity of care. Our business...
WHY US? Love and Care LLC offers quality homecare including homemakers, health aides and companions. We screen compassionate and capable caregivers who can play a critical role in delivery of exceptional home health...
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...
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.