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:
I just saw an obit yesterday (day before St. Patrick's day!) that said "in true form, John opted for an Irish exit and did not wish for funeral services)" 🍀
The funeral home will ask for anbobit and postbit to their site. As said, if person had a Facebook page, it could be posted there. Where I live, their are no local papers so someone set up a condolence page for our town.
I may send out note cards saying that... My father, John Doe, passed away on March 1st. His obituary can be seen at the Jones Funeral home site, (site addy). Upon his request, services were private.
We did not have a funeral for my FIL, for a number of reasons.
On HIS Facebook page, as well as the Facebook page of his son and daughter, myself and SIL's DH - we posted basically the following statement and linked his "official" obituary, which ended with a similar statement.
"As many of you know, FIL went to be with the Lord on
As many of you know, FIL went to be with the Lord on (date). Because the grandchildren are spread out across the country, we will not be having a public service. We will have a private memorial when we are able to get all of the immediate family here to do so. Your thoughts and prayers are appreciated."
If family is close and aware he is ill, then I am certain they are AWARE. You would, in updating his condition form a phone tree if there's lots of relatives. A sort of thing where you pick one person you are comfortable with.
As to services? Neither my brother, nor either of my parents wanted services. My partner and I do not wish to have services either.
Simply tell all: "My beloved Dad ___________died on ___________with family at his side; he has requested no services. Hold him in your hearts."
I have as well. Many say "no services". As to me, I didn't even allow his death to be published in OB or anywhere else. It just these days serves as a scammer's entrance. In fact robbers and scammer's watch for people, SS numbers, empty homes, et al to run their scams.
No need for obituary if decedent didn't want one. I'm a no fuss 'n feathers girl and prefer to make my Final Exit unobtrusively. I've prepaid for my immediate cremation post-death--no service, no obit. Ashes scattered in the ocean or a nice outdoor site that's convenient for the family.
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 may send out note cards saying that... My father, John Doe, passed away on March 1st. His obituary can be seen at the Jones Funeral home site, (site addy). Upon his request, services were private.
On HIS Facebook page, as well as the Facebook page of his son and daughter, myself and SIL's DH - we posted basically the following statement and linked his "official" obituary, which ended with a similar statement.
"As many of you know, FIL went to be with the Lord on
As many of you know, FIL went to be with the Lord on (date). Because the grandchildren are spread out across the country, we will not be having a public service. We will have a private memorial when we are able to get all of the immediate family here to do so. Your thoughts and prayers are appreciated."
As to services? Neither my brother, nor either of my parents wanted services. My partner and I do not wish to have services either.
Simply tell all: "My beloved Dad ___________died on ___________with family at his side; he has requested no services. Hold him in your hearts."
Good luck and my condolences.