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:
We specialize in providing value-based, comprehensive care and coverage for older adults with significant needs so they can thrive in the homes they love and in the communities they cherish. Our high-touch, team-based...
At MK Home Health, our experienced team of caregivers is committed to delivering the highest standard of care, whether it's assisting with daily activities, offering companionship, managing medical needs, or providing...
Founded in 2020 by industry veterans. After 16 years of combined home care nursing experience across different aspects of the home care field, Prestige Home Care Angels' founders decided to start their own home care...
A&K Blissful Home Care offers tailored in-home care services that prioritize the well-being and independence of seniors and individuals with disabilities. Our experienced caregivers provide assistance with daily tasks,...
When choosing Homewatch CareGivers, take to heart that extensively trained and compassionate employees strive to preserve dignity while enriching quality of life and empowering independence as much as possible.
Our core mission is to provide the best personal care to our clients. We focus exclusively on personal care, assisting our patients in facing their daily challenges and undertaking their tasks comfortably. We help people...
AJAC Homecare Inc. is a healthcare service provider specializing in offering personalized and compassionate in-home care for individuals needing assistance with daily living activities. The company is dedicated to...
Premier Senior Care is the leading in home senior care provider in California, specializing in Alzheimer's & Dementia Care. It is an established and respected senior care provider offering senior home care, personal...
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,...
The main goal of Calming Palm's Home Care LLC is to provide services that prioritize comfortability, least-restrictive setting, and a piece of mind. We want to make a significant difference in your life by being there for...
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.
Always Best Care Senior Services combines national strength and standards with local accessibility and personal service in Pasadena, Altadena, Serra Madre, San Marino, Arcadia, Temple City, and parts of North El Monte....
At Senior Helpers we are here to help anyone we can. No matter how big or how small the task-- our goal is to keep your loved ones safe, maintaining or enhancing their quality of life.
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...
Home Care of America is a home care provider that services in San Marino, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
San Marino Home Health is a home care provider that services in San Marino, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
One of our friendly representatives will introduce our family-owned company and will meet with you privately at your home or the service location to evaluate your needs and customize services to best serve you and your...
Project Senior Care is a home care provider that services in San Marino, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Ease of Mind Hospice is a home care provider serving Tarzana, CA 91356. Our services enable seniors to stay safely in their own homes while receiving medical care or assistance with personal tasks. We offer a range of...
In memory of our mom, Livewell Private Care continues to provide the loving, professional and tender care that families have come to expect from our Livewell brand. Our focus is on hiring and placing the most qualified...
In Home-Care Overview – Description Tender Home Health aims to listen and provide clients with truly individualized care through their thoughtful approach. Increased Freedom Our caregivers assist clients with daily...
We specialize in providing value-based, comprehensive care and coverage for older adults with significant needs so they can thrive in the homes they love and in the communities they cherish. Our high-touch, team-based...
At MK Home Health, our experienced team of caregivers is committed to delivering the highest standard of care, whether it's assisting with daily activities, offering companionship, managing medical needs, or providing...
Founded in 2020 by industry veterans. After 16 years of combined home care nursing experience across different aspects of the home care field, Prestige Home Care Angels' founders decided to start their own home care...
A&K Blissful Home Care offers tailored in-home care services that prioritize the well-being and independence of seniors and individuals with disabilities. Our experienced caregivers provide assistance with daily tasks,...
When choosing Homewatch CareGivers, take to heart that extensively trained and compassionate employees strive to preserve dignity while enriching quality of life and empowering independence as much as possible.
Our core mission is to provide the best personal care to our clients. We focus exclusively on personal care, assisting our patients in facing their daily challenges and undertaking their tasks comfortably. We help people...
AJAC Homecare Inc. is a healthcare service provider specializing in offering personalized and compassionate in-home care for individuals needing assistance with daily living activities. The company is dedicated to...
Premier Senior Care is the leading in home senior care provider in California, specializing in Alzheimer's & Dementia Care. It is an established and respected senior care provider offering senior home care, personal...
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,...
The main goal of Calming Palm's Home Care LLC is to provide services that prioritize comfortability, least-restrictive setting, and a piece of mind. We want to make a significant difference in your life by being there for...
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.
Always Best Care Senior Services combines national strength and standards with local accessibility and personal service in Pasadena, Altadena, Serra Madre, San Marino, Arcadia, Temple City, and parts of North El Monte....
At Senior Helpers we are here to help anyone we can. No matter how big or how small the task-- our goal is to keep your loved ones safe, maintaining or enhancing their quality of life.
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...
Home Care of America is a home care provider that services in San Marino, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
San Marino Home Health is a home care provider that services in San Marino, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
One of our friendly representatives will introduce our family-owned company and will meet with you privately at your home or the service location to evaluate your needs and customize services to best serve you and your...
Project Senior Care is a home care provider that services in San Marino, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Ease of Mind Hospice is a home care provider serving Tarzana, CA 91356. Our services enable seniors to stay safely in their own homes while receiving medical care or assistance with personal tasks. We offer a range of...
In memory of our mom, Livewell Private Care continues to provide the loving, professional and tender care that families have come to expect from our Livewell brand. Our focus is on hiring and placing the most qualified...
In Home-Care Overview – Description Tender Home Health aims to listen and provide clients with truly individualized care through their thoughtful approach. Increased Freedom Our caregivers assist clients with daily...
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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.