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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:
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 are...
Contact Aides & Companions today to schedule a consultation and discover the best home care solutions for you or your loved one. Our compassionate and experienced team is ready to listen to your unique needs and create a...
A & B Homecare Solutions - New Haven is a home care provider that services in Shelton, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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 Mission is to provide our clients with options, promote independence, embrace quality of life but more importantly provide a safe space for our seniors, veterans and people with disabilities to participate. With our...
Samash Holistic Home Care, located in Monroe, CT, offers comprehensive, holistic home care services designed to meet the physical, emotional, and mental well-being of their clients. They provide personalized care focused...
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...
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...
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...
With Nissi Agency you can entrust your loved ones to our experienced management and dedicated staff, who will go above and beyond to ensure that your loved one receive the best care.
Based in Waterbury, Connecticut, we specialize in providing personalized home care services designed to meet the unique needs of each individual. From compassionate personal care and fall prevention to friendly...
Hubcare Service LLC provides companion and homemaking services to seniors and individuals with disabilities in Fairfield and New Haven County Connecticut. The company founders/owners are experienced caring healthcare...
Our mission is to support individuals at risk in our community by providing the resources they need to find stable housing and non-medical services and ensuring they receive the care and assistance necessary for their...
Talem Home Care - New Haven, CT is a home care provider that services in Shelton, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We Are Your Caring Neighbors! The Infinity initiative is to provide our customers with convenient, reliable, healthcare, and custodial services in a setting that provides comfort, peace of mind, and results. We believe...
Hubcare Service is a home care provider that services in Shelton, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ELLMAK Personal Assistance Services LLC, CT is a home care provider that services Shelton, CT 06484. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Care Connect LLC of Shelton CT is a home care provider that services in Shelton, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Spending time with others is essential to a senior’s mental and emotional health. Keep your or a senior loved one’s mind engaged with meaningful social interaction from a dedicated companion. Seniors Helping Seniors®...
Elderly Caregivers LLC - Connecticut is a home care provider that services in Shelton, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Since 2007, we have been helping families in Fairfield and New Haven counties navigate their way through the difficult decision-making that makes elder care such a challenge. Caregiver’s Home Solutions provides...
Senior Helpers - Fairfield, CT is a home care provider that services in Shelton, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At SYNERGY HomeCare of Fairfield, we proudly provide nonmedical care to people of any age. We provide companionship,homemaking help, personal care, memory care and even respite care to individuals and their families in...
Giving Hearts Home Care provides assistance with activities of daily living such as bathing, dressing, meal preparation, housekeeping, laundry, med reminders, ambulation, appointment transportation, and other tasks. Our...
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...
Whether due to a temporary situation such as recovering from illness, injury or hospitalization or something longer-term such as the challenges of aging or a disability, including senior, elder or respite home care,...
Castle Group Home Care and Senior Advisors provides professional, affordable, and caring in-home living assistance and advice for seniors and their families. We dedicate our lives and our services to make the lives and...
Since 1984, the founders of Preferred Care at Home have had the privilege of assisting clients improve their quality of life while still recognizing and maintaining their dignity and independence. Preferred Care at Home...
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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.