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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:
We at A.L.I.C.E offer Personal Care: Assistance with activities such as bathing, dressing, grooming, and toileting. Companion Care: Providing companionship and emotional support, helping with social activities, and...
Bob Mikolich, owner of Amada Senior Care Westlake, understands that to provide the best quality of senior care it is necessary to support an entire family, not just a single client. He has seen firsthand the emotional and...
Cornerstone Caregiving is a senior home care provider in Cleveland, Ohio that is trained and ready to help your loved one today. Our leadership team holds decades of at home senior care expertise in the home care...
Our mission at Cardinal Home Care Services is to enhance the quality of life for our clients by providing compassionate, customized home care solutions. We strive to build trusting relationships with our clients and their...
Since 1996, Always Best Care has helped thousands of families with non-medical in-home care and assisted living referral services. Our passion for helping people maintain a safe, independent and dignified lifestyle...
Senior Helpers of Greater Cleveland has been caring for seniors throughout Cleveland's West suburbs for over 10 years. We offer tailored services to meet the individual needs of your loved one. Our care services range...
Senior care services from Home Instead® help to enhance the aging experience by providing practical support at home with a human touch. Our professional CAREGiversSM immerse themselves into wherever home is to assist with...
Led by an experienced nurse, our in-home care service provides compassionate, non-medical support to seniors and individuals with disabilities. We offer companionship, meal preparation, light housekeeping, medication...
We understand that finding the proper care can be a difficult and emotional decision. Our Purpose Homecare provides highly trained and compassionate caregivers to ensure your loved ones receive the care they need with the...
For over 30 years, Griswold Home Care has been referring the best Caregivers. We only refer Professional Caregivers that pass our stringent “CareAssure Screening System”. For your peace of mind, all of our Caregivers have...
Ltc Nursing Services is a home care provider that services in North Royalton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Clover Senior Care is a home care provider that services in North Royalton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Integrity Home Care is a home care provider that services in North Royalton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Helpers Home Care of Cleveland, OH is a home care provider that services in North Royalton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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,...
We at A.L.I.C.E offer Personal Care: Assistance with activities such as bathing, dressing, grooming, and toileting. Companion Care: Providing companionship and emotional support, helping with social activities, and...
Bob Mikolich, owner of Amada Senior Care Westlake, understands that to provide the best quality of senior care it is necessary to support an entire family, not just a single client. He has seen firsthand the emotional and...
Cornerstone Caregiving is a senior home care provider in Cleveland, Ohio that is trained and ready to help your loved one today. Our leadership team holds decades of at home senior care expertise in the home care...
Our mission at Cardinal Home Care Services is to enhance the quality of life for our clients by providing compassionate, customized home care solutions. We strive to build trusting relationships with our clients and their...
Since 1996, Always Best Care has helped thousands of families with non-medical in-home care and assisted living referral services. Our passion for helping people maintain a safe, independent and dignified lifestyle...
Senior Helpers of Greater Cleveland has been caring for seniors throughout Cleveland's West suburbs for over 10 years. We offer tailored services to meet the individual needs of your loved one. Our care services range...
Senior care services from Home Instead® help to enhance the aging experience by providing practical support at home with a human touch. Our professional CAREGiversSM immerse themselves into wherever home is to assist with...
Led by an experienced nurse, our in-home care service provides compassionate, non-medical support to seniors and individuals with disabilities. We offer companionship, meal preparation, light housekeeping, medication...
We understand that finding the proper care can be a difficult and emotional decision. Our Purpose Homecare provides highly trained and compassionate caregivers to ensure your loved ones receive the care they need with the...
For over 30 years, Griswold Home Care has been referring the best Caregivers. We only refer Professional Caregivers that pass our stringent “CareAssure Screening System”. For your peace of mind, all of our Caregivers have...
Ltc Nursing Services is a home care provider that services in North Royalton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Clover Senior Care is a home care provider that services in North Royalton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Integrity Home Care is a home care provider that services in North Royalton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Helpers Home Care of Cleveland, OH is a home care provider that services in North Royalton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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,...
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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.