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.
✔
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:
Does your family member qualify for any of the various financial assistance programs, or will this be private pay? That makes a difference to how you go about finding someone.
Many older or disabled adults live at home but need daily assistance with a broad range of activities such as bathing, dressing, eating and taking their medications. They may also need assistance with household chores, such as cooking, cleaning and laundry. As a friend or relative, you may find it difficult to provide all of that help on your own. If you are providing care on a daily, weekly or even monthly basis, you may find that you need help or need a break. A variety of services are available to assist you and your family member.
Generally, two types of care in the home are available: home health care services and in-home care services. If your family member requires regular assistance with health care needs, home health care organizations and skilled nursing agencies may be the best choice for you. They can provide a range of medical services, such as medication assistance, nursing services, physical therapy and medical social services to coordinate care among health care providers. Medicare, Medicaid and a number of private insurance policies pay for some home health care services, with certain restrictions. For example, Medicare will cover limited home health care for homebound beneficiaries who need intermittent skilled nursing or therapy services as prescribed by a physician. Many families, however, have to pay out of pocket for home health care services. If your family member needs help with daily activities and personal care, such as household chores, meal preparation or bathing, or is just in need of companionship, you likely are seeking in-home care services , rather than home health care. In-home care services offer assistance with everyday activities. The costs for these services and the eligibility requirements vary. Often, you will have to hire someone from an agency or someone you know and pay out of pocket. In some communities volunteer organizations may be able to help. While Medicare will not pay for these services, Medicaid (government health insurance for low-income people - this program may go by a different name in your state) covers limited in-home care or chore services for those who qualify. If your family member is age 60 or older, he/she may also be eligible for other government programs administered through the local department on aging such as transportation services, meals programs (i.e., Meals on Wheels) and limited in-home personal care and chore services.
Used with permission of Family Caregiver Alliance, National Center on Caregiving. For more information, visit www.caregiver.org or call (800) 445-8106.
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.
Generally, two types of care in the home are available: home health care services and in-home care services. If your family member requires regular assistance with health care needs, home health care organizations and skilled nursing agencies may be the best choice for you. They can provide a range of medical services, such as medication assistance, nursing services, physical therapy and medical social services to coordinate care among health care providers. Medicare, Medicaid and a number of private insurance policies pay for some home health care services, with certain restrictions. For example, Medicare will cover limited home health care for homebound beneficiaries who need intermittent skilled nursing or therapy services as prescribed by a physician. Many families, however, have to pay out of pocket for home health care services.
If your family member needs help with daily activities and personal care, such as household chores, meal preparation or bathing, or is just in need of companionship, you likely are seeking in-home care services , rather than home health care. In-home care services offer assistance with everyday activities. The costs for these services and the eligibility requirements vary. Often, you will have to hire someone from an agency or someone you know and pay out of pocket. In some communities volunteer organizations may be able to help. While Medicare will not pay for these services, Medicaid (government health insurance for low-income people - this program may go by a different name in your state) covers limited in-home care or chore services for those who qualify. If your family member is age 60 or older, he/she may also be eligible for other government programs administered through the local department on aging such as transportation services, meals programs (i.e., Meals on Wheels) and limited in-home personal care and chore services.
Used with permission of Family Caregiver Alliance, National Center on Caregiving. For more information, visit www.caregiver.org or call (800) 445-8106.