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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:
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...
A & B Homecare Solutions - New Haven is a home care provider that services in Waterbury, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We provide reliable homemaking services that help clients maintain independence where they feel most comfortable. Whether you need an extra hand a few times a week or daily support, our flexible plans make it easy to get...
To be the leading provider of compassionate, personalized home care services in Connecticut, enriching the lives of our clients and their families through exceptional care, innovative solutions, and unwavering commitment...
ElderCrew delivers the pinnacle of personalized care with our high-quality private duty aides, dedicated to enhancing lives both at home and in assisted living facilities.
Acti-Kare is a leading in-home senior care company that has been trusted for over a decade. Our caregivers are insured, bonded, and trained which means you will receive a trusted and professional caregiver every time....
Our vision at J & J Companions And Homemakers LLC is to be the leading provider of home care services in Connecticut, recognized for our commitment to excellence, compassion, and innovation. We aim to set the standard for...
Imperial Elderly Care and Nanny Services is a family owned and operated since 1988. We work with qualified coordinators and caregivers as a team to tailor services that fits the client's unique needs.
Quality Home Care, LLC is a home care provider that services in Waterbury, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Angel Care Companion offers compassionate home care services, including personal care, companionship, and specialized support. Our certified caregivers ensure clients feel valued while living safely and independently at home.
It is our mission here at Deeper View Homemakers and Companion Services to provide top-notch, affordable, and reliable home care services for you and your loved ones. We aim to continue to become your number one home care...
Horizon Homemaker and Companion provides a variety of PCA and home care services for the elderly in Waterbury, CT & the surrounding areas. Our personal care aides offer homemaking, companionship, chore completing, and...
Hamlett Home Care Services,LLC is a home care provider that services in Waterbury, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Salut Homecare is a home care provider that services in Waterbury, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
Quality Home Care, LLC is a home care provider that services in Waterbury, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Interim Healthcare is a leader in the home care industry with 50 years of experience. We provide supportive services to frail and disabled individuals allowing them to remain independent in their homes. Our care...
Friendly Companion and Homemakers LLC is a new home health and social agency. We are in our startup stage. When it comes to in-home health care and other services designed to help seniors age gracefully, Friendly...
Senior Helpers of Upper Fairfield, New Haven, and Central Connecticut is a home care provider that services in Waterbury, CT. Home care services allow seniors to remain safely in their own home while receiving medical...
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...
A & B Homecare Solutions - New Haven is a home care provider that services in Waterbury, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We provide reliable homemaking services that help clients maintain independence where they feel most comfortable. Whether you need an extra hand a few times a week or daily support, our flexible plans make it easy to get...
To be the leading provider of compassionate, personalized home care services in Connecticut, enriching the lives of our clients and their families through exceptional care, innovative solutions, and unwavering commitment...
ElderCrew delivers the pinnacle of personalized care with our high-quality private duty aides, dedicated to enhancing lives both at home and in assisted living facilities.
Acti-Kare is a leading in-home senior care company that has been trusted for over a decade. Our caregivers are insured, bonded, and trained which means you will receive a trusted and professional caregiver every time....
Our vision at J & J Companions And Homemakers LLC is to be the leading provider of home care services in Connecticut, recognized for our commitment to excellence, compassion, and innovation. We aim to set the standard for...
Imperial Elderly Care and Nanny Services is a family owned and operated since 1988. We work with qualified coordinators and caregivers as a team to tailor services that fits the client's unique needs.
Quality Home Care, LLC is a home care provider that services in Waterbury, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Angel Care Companion offers compassionate home care services, including personal care, companionship, and specialized support. Our certified caregivers ensure clients feel valued while living safely and independently at home.
It is our mission here at Deeper View Homemakers and Companion Services to provide top-notch, affordable, and reliable home care services for you and your loved ones. We aim to continue to become your number one home care...
Horizon Homemaker and Companion provides a variety of PCA and home care services for the elderly in Waterbury, CT & the surrounding areas. Our personal care aides offer homemaking, companionship, chore completing, and...
Hamlett Home Care Services,LLC is a home care provider that services in Waterbury, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Salut Homecare is a home care provider that services in Waterbury, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
Quality Home Care, LLC is a home care provider that services in Waterbury, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Interim Healthcare is a leader in the home care industry with 50 years of experience. We provide supportive services to frail and disabled individuals allowing them to remain independent in their homes. Our care...
Friendly Companion and Homemakers LLC is a new home health and social agency. We are in our startup stage. When it comes to in-home health care and other services designed to help seniors age gracefully, Friendly...
Senior Helpers of Upper Fairfield, New Haven, and Central Connecticut is a home care provider that services in Waterbury, CT. Home care services allow seniors to remain safely in their own home while receiving medical...
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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.