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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:
Searching for a like-minded friend to help tackle chores and tasks? Do you seek a companion to join you in hobbies and activities? Our caregivers – seniors themselves – show up ready to exceed expectations – on a schedule...
"Our vision is to be the leading home care provider known for setting the standard in compassionate, personalized, and innovative care—where every individual feels valued, safe, and supported in living their best life at...
When seniors, or recovering individuals, need short or long-term care, home is always the best place for the healing to begin. With Cottage Caregivers, you can offer an aging care place for mom and dad that has the daily...
We are a recognized agency providing Home Health Care wherever a client lives in Eastern Massachusetts. We are also Alzheimer's specialists. The service can be a few hours or 24 hours. We offer Live-in, hourly,...
The Harbor Health Elder Service Plan offers a personalized healthcare program provided by our own geriatric professionals guided by a care plan developed and customized for the individual’s needs.
At Homily Care Agency, we offer a wide range of health care services for disabled and elderly individuals in the comfort of their own homes. Our dedicated team ensures that our clients receive the best care and attention...
Nesting Home Health Services is dedicated to enhancing the well-being of individuals through compassionate, tailored care delivered in the comfort of home. From personal care and companionship to transportation and...
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...
Since 2007 Right at Home South Shore has been providing superior non-medical in-home care services to seniors and disabled adults throughout the South Shore. Our trained caregivers offer round-the-clock care for seniors...
Impact Health Alliance is dedicated to improving community health through innovative, collaborative in-home care. We unite healthcare professionals to enhance access to quality care and promote wellness. Our mission is to...
Our Mission Our mission is to provide compassionate, high-quality, and personalized home health care services that promote independence, dignity, and improved quality of life for our clients. We are committed to...
Pointecare Home Health Agency is a home care provider that services in Brockton, MA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At To-Shankel Healthcare Services we offer a broad range of home health services tailored to meet your family’s unique needs - from personal care services to hospice care and many needs in between.
To improve quality of life for those we serve through the delivery of clinical excellence, extraordinary service and compassionate care, while being recognized as the leader in home health.
Vinona Group Services USA, LLC is a home care provider that services in Brockton, MA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Senior 1st Elevation Homecare Agency provides compassionate, personalized in-home care that promotes dignity, independence, and comfort. Based in Brockton, MA, we offer companionship, homemaker, home health aide, and...
"Informatix Health is committed to enhancing the well-being of our clients by providing innovative solutions that support and improve their Activities of Daily Living (ADLs). Our mission is to empower individuals and...
Our home health care agency is dedicated to providing top-notch in-home nursing care and personal care assistance. We understand the importance of maintaining dignity and independence while receiving care in the comfort...
Grace Health Care is a home care provider that services in Brockton, MA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Suzy Dream Home Care our commitment is to transform the way in-home care is experienced by blending compassion, excellence, and truly personalized support. Our mission is to help individuals live safely and...
Tru Caregiver Inc is a home care provider that services in Brockton, MA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Pediatric Services of America Home Healthcare is a home care provider that services in Brockton, MA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
To provide services and support that allow our clients to remain as independent as possible in their homes or residences while enabling a quality of life for our clients and their families which cannot be achieved on...
AB Home Healthcare is a home care provider that services in Brockton, MA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
LP Care Services, LLC provides compassionate and dependable personal care services designed to support individuals who need assistance with daily living activities while remaining in the comfort of their own homes. The...
Brockton VNA is a home care provider that services in Brockton, MA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Brockton Home health agency - Brockton MA is a home care provider that services in Brockton, MA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Premium Home Care Services LLC is dedicated to providing compassionate, reliable, and personalized in-home care tailored to meet the unique needs of each client. With a focus on dignity, independence, and comfort, our...
COMPASSIONATE CARE FOR YOUR LOVED ONES Are you seeking care services for an aging or differently-abled loved one who is struggling to live independently at home? Home Helpers Home Care of Plymouth is here to help. Our...
Torres House, INC is a dedicated provider of high-quality in-home care services, committed to enhancing the well-being and independence of individuals in need of personalized assistance.
Elderly Caregivers LLC - Connecticut is a home care provider that services in Brockton, MA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At it’s core, our in-home senior care service is about bringing warmth, friendship, and the highest quality of care right into the comfort of your home. More than just lending a hand, we’re here to share laughs,...
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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.