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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.
✔
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:
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 are here to help! Whether its specialized care or just dependable and compassionate assistance. 24 hr Care - Respite Care - Veteran Care - Alzheimer's/Dementia Care
Our Goal is to help individuals improve their quality of life and provide holistic care for their individual needs and goals. We understand that home care is personal. Patients and their families need to feel comfortable...
Always Best Care combines national strength and standards with local accessibility and personal service. Your local always Best Care team helps families throughout New Haven Connecticut and surrounding communities of...
To be the leading provider of compassionate, personalized home care services in Connecticut, enriching the lives of our clients and their families through exceptional care, innovative solutions, and unwavering commitment...
Our goal is for you and your loved ones to feel that you are safe and secure in your own home. We want to be there to facilitate your independence by assisting with some of the more difficult aspects of life you or your...
Homewatch CareGivers of New Haven, CT is a home care provider that services in North Haven, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Oxford Home Care was founded upon the goal to provide an exceptional brand of care that helps the elderly, the sick, and the disabled members of our communities remain and stay healthy in their own homes. We recognize how...
Welcome Home Care, LLC is a home care provider that services in North Haven, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our mission at CityCARE Home Health is to provide consistent quality home care that enables our clients to live happier, healthier lives at home. We are a local home care agency serving Connecticut and delivering in-home...
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...
Elderly Caregivers LLC - Connecticut is a home care provider that services in North Haven, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At SENIOR HELPERS of Upper Fairfield, New Haven, and Central Connecticut, we are dedicated to supporting families in our community with personalized care, no matter how big or small the task. Our mission is simple: to...
At Home Forever exists to help people have their best day, every day. Our mission is to provide compassionate home care so that the families we serve have peace of mind knowing their loved ones are receiving the support...
At OPAAT, we pride ourselves in providing exceptional care to seniors in the comfort of their home or their place of residence (i.e. assisted/independent living, long-term care, and short-term rehab facilities). We do...
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 are here to help! Whether its specialized care or just dependable and compassionate assistance. 24 hr Care - Respite Care - Veteran Care - Alzheimer's/Dementia Care
Our Goal is to help individuals improve their quality of life and provide holistic care for their individual needs and goals. We understand that home care is personal. Patients and their families need to feel comfortable...
Always Best Care combines national strength and standards with local accessibility and personal service. Your local always Best Care team helps families throughout New Haven Connecticut and surrounding communities of...
To be the leading provider of compassionate, personalized home care services in Connecticut, enriching the lives of our clients and their families through exceptional care, innovative solutions, and unwavering commitment...
Our goal is for you and your loved ones to feel that you are safe and secure in your own home. We want to be there to facilitate your independence by assisting with some of the more difficult aspects of life you or your...
Homewatch CareGivers of New Haven, CT is a home care provider that services in North Haven, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Oxford Home Care was founded upon the goal to provide an exceptional brand of care that helps the elderly, the sick, and the disabled members of our communities remain and stay healthy in their own homes. We recognize how...
Welcome Home Care, LLC is a home care provider that services in North Haven, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our mission at CityCARE Home Health is to provide consistent quality home care that enables our clients to live happier, healthier lives at home. We are a local home care agency serving Connecticut and delivering in-home...
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...
Elderly Caregivers LLC - Connecticut is a home care provider that services in North Haven, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At SENIOR HELPERS of Upper Fairfield, New Haven, and Central Connecticut, we are dedicated to supporting families in our community with personalized care, no matter how big or small the task. Our mission is simple: to...
At Home Forever exists to help people have their best day, every day. Our mission is to provide compassionate home care so that the families we serve have peace of mind knowing their loved ones are receiving the support...
At OPAAT, we pride ourselves in providing exceptional care to seniors in the comfort of their home or their place of residence (i.e. assisted/independent living, long-term care, and short-term rehab facilities). We do...
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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.