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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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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.
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My father was in tears today. He hasn’t been feeling 100%. Today, he went over his funeral arrangements (again). My mother died 6 months ago. She had dementia, but otherwise healthy. Everyone has always assumed Dad would pass first—since his heath is more fragile (cardiovascular). Needless to say, her death was a surprise to all. She went from healthy to what seemed a bad cold to death within a week or so. My dad has heard of these stories and is realizing he is “at the 6 month mark”. It is almost as if he is fearing that he will go “any minute”. As lovely/romantic as these stories are…I feel badly that my dad is burdened with this narrative. We had a good talk today. He has a strong faith and knows his life is in God’s hands…and this narrative is not everyone’s reality.
I became a widow at 59. We were married for 35 years - very very happily married. My husband and I owned a business and worked side by side all those years. Our's was a wonderful love story. When Bill died - after a truly awful cancer battle - I was lost and just wanted to be with him - did not want to live without him. The day after his funeral, I woke up in severe pain - total back spasm. (Like a leg cramp - every single muscle in my body). Non stop. No relief. The ER doctor told me that I had been functioning with very high levels of adrenaline throughout my husbands final months. Also, dehydrated during that time (you don't even think about yourself when the love of your life is suffering).
After his funeral -my surging adrenaline stopped suddenly - causing a violent reaction - full back spasm. Laying in the hospital in pain I really wanted to go and be with Bill. But I saw pain in our dear children's eyes......they didn't need me to add to their grief. At 59, I recovered quickly. But I was amazed at how violently my body reacted to sweet Bill's death. Grief is emotional torture but there's physical issues too. I've always been super healthy.......... but losing Bill took me right down - flat on my back. I adored my husband...............nobody should think that our's wasn't a fabulous marriage because I'm still here. It's in the Good Lord's hands.
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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.
2 Comments
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First
Why So Many Long-Married Couples Die Close Together
We were married for 35 years - very very happily married. My husband and I owned a business and worked side by side all those years. Our's was a wonderful love story. When Bill died - after a truly awful cancer battle - I was lost and just wanted to be with him - did not want to live without him. The day after his funeral, I woke up in severe pain - total back spasm. (Like a leg cramp - every single muscle in my body). Non stop. No relief. The ER doctor told me that I had been functioning with very high levels of adrenaline throughout my husbands final months. Also, dehydrated during that time (you don't even think about yourself when the love of your life is suffering).
After his funeral -my surging adrenaline stopped suddenly - causing a violent reaction - full back spasm.
Laying in the hospital in pain I really wanted to go and be with Bill.
But I saw pain in our dear children's eyes......they didn't need me to add to their grief.
At 59, I recovered quickly. But I was amazed at how violently my body reacted to sweet Bill's death. Grief is emotional torture but there's physical issues too.
I've always been super healthy.......... but losing Bill took me right down - flat on my back.
I adored my husband...............nobody should think that our's wasn't a fabulous marriage because I'm still here. It's in the Good Lord's hands.