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:
Home—there’s no place like it. It’s where your memories are. Where you raised your family and where friends have gathered for life’s celebrations. It’s been your basecamp through good times and bad. And it’s where you...
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,...
On Lok PACE is a full-service healthcare program that provides the services you need to age at home. Our services include home care, medical, transportation and other senior services. On Lok PACE: Empowering you to live...
Care Indeed Homecare Services are designed to meet the needs of families requiring personalized homecare for loved ones from qualified non-medical or medical caregivers as required. In addition to age-related issues,...
Arcadia Home Care - Campbell, CA is a home care provider that services in San Jose, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We support people to do the extraordinary everyday. ReachPoint Home Care is a local provider of home care and staffing services with over 10 years of experience and dedication to enhancing quality of life for...
Built with love in San Francisco, New York and Miami, by a team that has experienced the pain of finding and managing care ourselves, we’re committed to delivering better health outcomes for seniors, and peace of mind to...
Nurse Next Door - Santa Clara, CA is a home care provider that services over 40+ zip codes across Santa Clara County. Home care services allow seniors to remain safely in their own home while receiving medical care or...
Bonita Springs Home Care provides compassionate and personalized in-home care services. Our dedicated caregivers assist with daily tasks, promoting independence, comfort, and safety while enhancing the quality of life for...
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...
Nu Care is the perfect solution for seniors and others in need who are not ready to leave their home for an institutional setting, but need support to remain at home. We improve your life by providing compassionate,...
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...
Aging, disability, illness or injury can make living at home a challenge. We believe that no one should have to face the long list of complex decisions and unforeseen changes alone. We are experts, providing not just...
WelbeHealth is a Program of All-Inclusive Care for the Elderly (PACE), full-service healthcare provider that helps you live your life healthy and happy, in your own home.
Mother's Nest Home Care is a home care provider that services in San Jose, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
KIWI ASSOCIATES INC. DBA A1CARE is a home care provider that services in San Jose, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Prohealth Home Care, Inc is a home care provider that services in San Jose, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Right at Home helps seniors and disabled adults remain in the comfort of their own home. If you or a family member needs assistance with activities of Daily Living. Right at Home is the helping hand you seek. Our...
At Homewatch CareGivers of West San Jose, we believe in caring for the whole person, not just their condition. That’s why we offer a variety of services to ensure their overall health and emotional well-being, as well as...
Are you searching for exceptional home care, senior care, or respite care? Please do not stress or worry any longer. FirstLight Home Care of Silicon Valley offers leading home care and elderly caregiver services in Los...
When seeking a care service for seniors, those with disabilities, illness or recovering from injury or surgery, there are many factors to consider. You undoubtedly have many concerns and reservations. This is perfectly...
Focus Health is a home care provider that services in San Jose, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
National Home Health Services, Inc is a home care provider that services in San Jose, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Gentiva Health Services is a home care provider that services in San Jose, CA. 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,...
ComForCare Home Care - San Jose, CA is a home care provider that services in San Jose, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Professional HealthCare At Home, our goal is to facilitate your speedy recovery from illness, injury, or surgery in the privacy and comfort of your own home. Our committed staff provides you with comprehensive, skilled...
Royal Providence is a 3rd generation, family owned elderly care company with over 20 years of industry experience. Branching out to the Silicon Valley from Hawaii in 2011, Royal Providence is raising the standards of...
VN Home Health Care is a home care provider that services in San Jose, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Alegre Home Care is a home care provider that services in San Jose, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
With over 40 years in healthcare, the Companion Access Care (CAC) team provides services to seniors, and physically challenged adults. Because every moment counts in people’s lives, CAC ensures that our clients receive...
HELPING HANDS HOME CARE INC is completely devoted to excellence in providing non-medical care to enhance and improve the quality of lives of those entrusted to our care with respect and dignity. Client is our first...
Senior Helpers Greater San Jose is a premier provider of non-medical in-home care services for the elderly. Senior Helpers provides the highest level of care to our clients, helping them live independently and with...
FAMILY CARE PROVIDER is a home care provider that services in San Jose, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Harmonious Living Homecare is a BBB certified non-medical in-homecare agency. We are locally owned and have been in business since 2009. Our agency office is located in West San Jose, we provide service to clients in...
With home care services, our office can provide personal care plans through an in-home evaluation and interviews between the client, family and the ComForCare team to help determine the best plan of action for the...
California Seniors Care is a home care provider that services in San Jose, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
HOME CARE NETWORK was created to serve the changing needs of our society while maintaining the traditional values of the home and family. In recent years we have witnessed an increase of women in the work force, more...
We understand that when it comes to choosing a homecare company for yourself or to care for a loved one, it is a very personal choice. Understanding that one size does not fit all and designing innovative care solutions...
Welcome to Stanford Senior Care, where compassionate care meets the comfort of home. We are dedicated to providing exceptional homecare services that enhance independence and well-being. Whether it’s assistance with daily...
At Home Helpers Home Care, we’re here to do exactly what our name says: help. We’re more than an in-home health care agency – we’re your extended family when family can’t be there. From our initial free in-home...
Cloverleaf Care is a home care provider that services in San Jose, 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...
There is an incredible demand in our society for care professionals, and we are proud to be up to the task. And it's not just for seniors — if a member of your family needs help, we're the place to call. As we are a...
Absolute Senior Solutions is a home care provider that services San Jose, CA 95117. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with personal care and...
At Senior Helpers, we understand the importance of maintaining independence and dignity while receiving the care you need. Our home care services are designed to support individuals of all ages who require assistance with...
Home—there’s no place like it. It’s where your memories are. Where you raised your family and where friends have gathered for life’s celebrations. It’s been your basecamp through good times and bad. And it’s where you...
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,...
On Lok PACE is a full-service healthcare program that provides the services you need to age at home. Our services include home care, medical, transportation and other senior services. On Lok PACE: Empowering you to live...
Care Indeed Homecare Services are designed to meet the needs of families requiring personalized homecare for loved ones from qualified non-medical or medical caregivers as required. In addition to age-related issues,...
Arcadia Home Care - Campbell, CA is a home care provider that services in San Jose, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We support people to do the extraordinary everyday. ReachPoint Home Care is a local provider of home care and staffing services with over 10 years of experience and dedication to enhancing quality of life for...
Built with love in San Francisco, New York and Miami, by a team that has experienced the pain of finding and managing care ourselves, we’re committed to delivering better health outcomes for seniors, and peace of mind to...
Nurse Next Door - Santa Clara, CA is a home care provider that services over 40+ zip codes across Santa Clara County. Home care services allow seniors to remain safely in their own home while receiving medical care or...
Bonita Springs Home Care provides compassionate and personalized in-home care services. Our dedicated caregivers assist with daily tasks, promoting independence, comfort, and safety while enhancing the quality of life for...
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...
Nu Care is the perfect solution for seniors and others in need who are not ready to leave their home for an institutional setting, but need support to remain at home. We improve your life by providing compassionate,...
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...
Aging, disability, illness or injury can make living at home a challenge. We believe that no one should have to face the long list of complex decisions and unforeseen changes alone. We are experts, providing not just...
WelbeHealth is a Program of All-Inclusive Care for the Elderly (PACE), full-service healthcare provider that helps you live your life healthy and happy, in your own home.
Mother's Nest Home Care is a home care provider that services in San Jose, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
KIWI ASSOCIATES INC. DBA A1CARE is a home care provider that services in San Jose, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Prohealth Home Care, Inc is a home care provider that services in San Jose, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Right at Home helps seniors and disabled adults remain in the comfort of their own home. If you or a family member needs assistance with activities of Daily Living. Right at Home is the helping hand you seek. Our...
At Homewatch CareGivers of West San Jose, we believe in caring for the whole person, not just their condition. That’s why we offer a variety of services to ensure their overall health and emotional well-being, as well as...
Are you searching for exceptional home care, senior care, or respite care? Please do not stress or worry any longer. FirstLight Home Care of Silicon Valley offers leading home care and elderly caregiver services in Los...
When seeking a care service for seniors, those with disabilities, illness or recovering from injury or surgery, there are many factors to consider. You undoubtedly have many concerns and reservations. This is perfectly...
Focus Health is a home care provider that services in San Jose, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
National Home Health Services, Inc is a home care provider that services in San Jose, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Gentiva Health Services is a home care provider that services in San Jose, CA. 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,...
ComForCare Home Care - San Jose, CA is a home care provider that services in San Jose, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Professional HealthCare At Home, our goal is to facilitate your speedy recovery from illness, injury, or surgery in the privacy and comfort of your own home. Our committed staff provides you with comprehensive, skilled...
Royal Providence is a 3rd generation, family owned elderly care company with over 20 years of industry experience. Branching out to the Silicon Valley from Hawaii in 2011, Royal Providence is raising the standards of...
VN Home Health Care is a home care provider that services in San Jose, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Alegre Home Care is a home care provider that services in San Jose, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
With over 40 years in healthcare, the Companion Access Care (CAC) team provides services to seniors, and physically challenged adults. Because every moment counts in people’s lives, CAC ensures that our clients receive...
HELPING HANDS HOME CARE INC is completely devoted to excellence in providing non-medical care to enhance and improve the quality of lives of those entrusted to our care with respect and dignity. Client is our first...
Senior Helpers Greater San Jose is a premier provider of non-medical in-home care services for the elderly. Senior Helpers provides the highest level of care to our clients, helping them live independently and with...
FAMILY CARE PROVIDER is a home care provider that services in San Jose, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Harmonious Living Homecare is a BBB certified non-medical in-homecare agency. We are locally owned and have been in business since 2009. Our agency office is located in West San Jose, we provide service to clients in...
With home care services, our office can provide personal care plans through an in-home evaluation and interviews between the client, family and the ComForCare team to help determine the best plan of action for the...
California Seniors Care is a home care provider that services in San Jose, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
HOME CARE NETWORK was created to serve the changing needs of our society while maintaining the traditional values of the home and family. In recent years we have witnessed an increase of women in the work force, more...
We understand that when it comes to choosing a homecare company for yourself or to care for a loved one, it is a very personal choice. Understanding that one size does not fit all and designing innovative care solutions...
Welcome to Stanford Senior Care, where compassionate care meets the comfort of home. We are dedicated to providing exceptional homecare services that enhance independence and well-being. Whether it’s assistance with daily...
At Home Helpers Home Care, we’re here to do exactly what our name says: help. We’re more than an in-home health care agency – we’re your extended family when family can’t be there. From our initial free in-home...
Cloverleaf Care is a home care provider that services in San Jose, 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...
There is an incredible demand in our society for care professionals, and we are proud to be up to the task. And it's not just for seniors — if a member of your family needs help, we're the place to call. As we are a...
Absolute Senior Solutions is a home care provider that services San Jose, CA 95117. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with personal care and...
At Senior Helpers, we understand the importance of maintaining independence and dignity while receiving the care you need. Our home care services are designed to support individuals of all ages who require assistance with...
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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.