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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:
Our vision is simple: we aim to be the leading provider of home care services. By providing personalized, compassionate support, we help our clients live with dignity and peace of mind. Reach out to us today to discuss...
Homewatch CareGivers of Windsor was founded on the idea that your loved one deserves to be treated with kind, compassionate care that is tailored to their unique needs, and in their preferred surroundings. That’s why we...
Greenwich HomeCare is a locally owned and operated non-medical home health care agency dedicated to providing the highest quality home health aides. We are a licensed, bonded, and insured agency serving Greenwich,...
AFI Healing Hands International LLC is a dedicated home care agency committed to providing compassionate and high-quality care to individuals in need of assistance with daily living.
The mission of CareCo Shoreline is to provide comprehensive, compassionate, and customized in-home services designed to help individuals remain in their homes, safe and strong.
Our family owned company was established in 1989 in New Britain, CT as Bright Cleaning Services with the intentions of providing housecleaning services in central Connecticut – Newington, Middletown, Avon, Glastonbury and...
Care At Home by JFS, LLC, Compassionate In-Home Care Services At Care At Home by JFS, LLC, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort, dignity, and...
A & B Homecare Solutions - New Haven is a home care provider that services in West Hartford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
There’s a reason why Unity Home Care LLC, is a leading provider of homecare in Farmington, Connecticut, and that’s simply because we truly care for you! Elderly, injured, ill, and the disabled—we make every high-quality...
Mercy Home Health Inc. is a home care provider that services in West Hartford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At H0PE ALIVE HOME CARE AND COMPANION, we’re dedicated to providing the support needed to ensure your loved ones receive the quality care and quality of life they deserve.
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...
HomeWell is committed to helping people live life more fully. With a highly personalized care management approach, our agencies strive to provide exceptional care in the place where clients feel most comfortable.
At Senior Helpers, we are here to help anyway we can. No matter how big or how small the task. We are licensed, bonded and insured and have screened and continuously trained caregivers that are immediately available to...
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...
BrightStar Care® offers a wide variety of high-quality in-home companion services. If you are looking for a trustworthy companion services provider in the Central Connecticut, CT area, please contact us. We’re here 24/7...
Specializing in full time live-in care, HomeAide is the highest quality provider of non-medical home care for senior citizens throughout the state of Connecticut.
Elizabeth Manor is a non-medical homecare agency providing a wide range of services at the lowest rates for over 25 years. Over the years, professional referrals and word of mouth have lead Elizabeth Manor to become the...
BrightStar Care bda CareAll LLC is a home care provider that services in West Hartford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
The mission of American Homemakers & Companions is to provide our clients with convenient and reliable services in the comfort of their homes. Our stringent hiring standards and ongoing supervision ensure our clients...
American Home Health, Inc is a home care provider that services in West Hartford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Mercy Community Home Care Serv is a home care provider that services in West Hartford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
EldersChoice of Connecticut, LLC services are very focused: 24/7 non-medical home support through a qualified dedicated caregiver. Caregivers live in for one to three months before taking a break. We conduct a detailed...
There is no place your loved one would rather be than in the comfort of their own home. Being placed in a residential facility can cause depression and withdrawal. Care Given At Home provides affordable and...
Advanced Home Health Care Agency, Inc is a home care provider that services in West Hartford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At CareHaven, we believe that home is where the heart is, and where healing happens best. Our story began with a simple yet profound mission: to deliver high-quality, patient-centered home healthcare services, empowering...
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...
Companions & Home Helpers was established in 2002, is locally owned and operated. We provide quality home care services to help you maintain your independence. As the population of America’s seniors continue to grow, more...
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...
Enavi LLC is a trusted home care agency based in Hartford, CT, dedicated to providing compassionate and personalized care for individuals in the comfort of their own homes. We specialize in a wide range of services,...
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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.