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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:
Senior Serenity Home Care, is not only our name, but it stands as our way of service. We bring safe, loving, and caring services to those that desire to have a nursing home setting and treatment, in the comfort of their...
Bella Home Care, LLC is committed to providing compassionate and personalized care. We operate with integrity and a genuine heart for service, ensuring that each individual receives the support they need to live...
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...
The most qualified professionals in the health and wellness community. Our mission is to provide the most qualified, experienced and compassionate nurses and specialists to healthcare institutions, hospices, government...
The Cassagnol Agency, based in Connecticut, provides home health care, senior care, and financial planning services. They assist with daily activities like bathing, dressing, meal prep, and medical appointments, alongside...
Anchored Care LLC is a compassionate home care service dedicated to providing personalized, high-quality care for seniors in the comfort of their own homes. Our trained caregivers offer assistance with daily activities,...
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...
Advanced Home Care Agency LLC is a dedicated home care provider committed to delivering high-quality, compassionate, and personalized care services to individuals in need.
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.
Efficient Aids Agency is a trusted Homemaker Companion Agency committed to providing compassionate and professional care to individuals who need assistance in their daily lives. Our experienced team offers a range of...
At Absolute Best Home Care, our vision is to be a meaningful contributor to the communities we serve making a lasting impact in the lives of the seniors and giving back to the community.
TheKey Corporate - Fairfield, CT is a home care provider that services in Stratford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Hope Home Care, LLC is a home care provider that services in Stratford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We are a New England-based agency providing 21 years of assisted living care services to the elderly in your community. As a full service home care agency, FCP Live-In is committed to providing a unique customized...
I would like to introduce myself and my family. I am Michael Savoie, and with my mom, Camille, and my sister Robin, we own Executive Home Care. We began our journey as business owners together in the community, way back...
Equinox Home Care, LLC is a home care provider that services in Stratford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Mission Statement Our caring and capable non-medical home care services for seniors help our clients stay safe, independent, and happy in their own home with the respect and privacy they deserve. Who We Are HOME...
Stratford VNA is a home care provider that services in Stratford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Forever Home Care is owned by a local family, committed to improving the needs of the elderly and special needs in our community. Our goal is to provide you a peace of mind, maintain dignity and treat you with respect...
Caring Nest Homecare, LLC provides personalized, compassionate in-home care services designed to promote independence, dignity, and well-being. Our experienced caregivers offer personal care, companionship, respite...
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,...
Executive Home Care is a home care provider that services in Stratford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
Elderly Caregivers LLC - Connecticut is a home care provider that services in Stratford, 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®...
At SENIOR HELPERS of Upper Fairfield, New Haven, and Central Connecticut, we are dedicated to supporting families in our community with personalized care, no matter how big or small the task. Our mission is simple: to...
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...
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,...
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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.