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.
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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:
At AmeriCare, we work hard to find caregivers who love what they do and recognize the impact they have in their client's lives. We understand the importance of finding people who can be trusted and we work together as a...
At Homewatch CareGivers of Pleasanton, we're not just another in-home care company. We're a lifeline for families and individuals needing compassionate, personalized care. Our services cater to a diverse range of needs,...
Senior Helpers of Danville was founded in 2007 and purchased by Nicholas Magnusson in 2014. He became passionate about working with Seniors through his experience working as a Administrative Director at UCSF Medical...
Arcadia Home Care - Livermore, CA is a home care provider that services in Pleasanton, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Instead can help with compassionate, home senior care services delivered right in your loved one's home. Whether a few hours a day or long-term care 24 hours a day, a CAREGiver can assist you. All CAREGivers are...
Thrive Home Care - San Leandro is a home care provider that services in Pleasanton, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Nestvy Home Care, our mission is to provide compassionate, personalized, and high-quality home care services that empower individuals to live independently and with dignity in the comfort of their own homes. We are...
Center For Elders’ Independence PACE (Program of All Inclusive Care for the Elderly) provides high-quality, affordable, integrated healthcare services to vulnerable seniors promoting autonomy, quality of life, and the...
Care Indeed provides non-medical home care services to seniors: personal care, support with mobility, help with household chores, companionship, and transportation. We also send our trained and experienced caregivers,...
Senior care matters deeply here in the East Bay Area, where our senior population continues to grow and become more diverse. It's all about improving the lives of our older community members, ensuring their safety, and...
It doesn’t matter if you’re here because you’re looking for help living independently, or if you want to make sure someone you love has the support they need to stay in their home. We believe there’s more to caring for...
Being the family caregiver can prove to be a challenge. You may feel burnt out or just overwhelmed trying to manage your own life, while helping your loved one. If you are supporting someone through a medical crisis or...
Acasa Home Care LLC is a compassionate and professional non-medical in-home care agency dedicated to improving the quality of life for seniors and individuals with disabilities. Our team provides personalized,...
Assisting Hands of Fremont CA is a home care provider based in Newark, CA and serves Alameda County. Whether it’s help with daily activities, personal care, safety concerns due to cognitive decline, or the desire to...
Home care is a service that you can rely on when you need assistance in the comfort of your home. If you are struggling with old age, injury, or illness, this might be the right time for you to look for a caregiver who...
Capstone Health Inc. is a bonded and insured home care agency. Our well trained, professional care team provides living assistance within the following counties: Contra Costa, Stanislaus, San Joaquin, Alameda, San Mateo,...
Love Life Senior Care was built on years of hands-on experience with elderly care and a solid foundation. As a granddaughter and a daughter, I worked with the elderly from an early age. I came to understand the challenges...
Lifeguard Home Health is a home care provider that services in Pleasanton, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Golden Hope Services, LLC is a licensed, insured, bonded non-medical In-home care and registered HCO in the California department of social services. All of our care professionals are supervised, have passed both criminal...
AGING IN PLACE HOME CARE is a home care provider that services in Pleasanton, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Instead - Pleasanton, CA is a home care provider that services in Pleasanton, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
AFFIRMED HOME CARE LLC is a home care provider that services in Pleasanton, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Sunshine Home Health Care is a home care provider that services in Pleasanton, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our Home Health Company’s mission is to deliver each client the individualized, compassionate, and personal home health care they need with the utmost dignity and respect. Our team of highly skilled nurses recognizes that...
All Seasons Homecare provides assistance to those who need help with everyday tasks because of illness, surgery, or a chronic condition, yet treasure their independence and want to enjoy the comfort of their own homes. We...
We are a local community focused in-home service provider that assists individuals and families in the comfort of their home. We are dedicated to helping our clients lead dignified, independent lifestyles through our home...
We provide older adults, in Pleasanton and the surrounding area, with one-on-one support that allows them to live safely and independently at home. Our 24/7 guarantee means that we will be there when you need us – days,...
ACASA Senior Care Central Valley & East Bay provides families and loved ones quality in-home and senior care in Central Valley & East Bay, CA. If you seek caregivers for your parent, grandparent, or yourself, you may feel...
Carings In Home Care is a home care provider that services in Pleasanton, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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.