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.
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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:
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EPRINE COMMUNITY SERVICES is a premier, licensed healthcare agency that provides dignified and professional mental health and behavioral health services to children, adults, and families, around the states of New York and...
For over 15 years, Senior Helpers has been serving families across New York City with trusted, dependable in-home care services. From companionship and personal care to highly specialized support, our team is passionate...
If you need help for just a few hours each day or a couple of times a week, we can visit you in your home and provide as little or as much help as you need, with the aim of helping you to maintain your independence
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LifeWorx is a five-star rated, independently-owned private pay home care agency that brings personalized, compassionate elder care and lifestyle services to the Greater New York area. LifeWorx' Care Consultants are...
Today’s Homecare, Inc., is a New York Licensed Home Care Agency providing home health care services in the boroughs of the New York Metropolitan area. Our dedicated, compassionate caregivers provide personalized, services...
Alvita Care is a leading home care provider in New York City, Westchester, Long Island, and New Jersey. We’re best known for in-home senior care, but our caregivers are available to people of all ages, physical...
With over 25 years of experience, Alternate Staffing provides high-quality homecare tailored to patients with physical or mental challenges. Our staff collaborates with you, your family, and your physician to develop an...
Many of the seniors St. Nicks Alliance serves require regular assistance with daily activities. St. Nicks Alliance Home Attendants are certified Personal Care Aids (PCAs) who provide assistance with grooming, cooking,...
Marks Home Care, Compassionate In-Home Care Services At Marks Home Care, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort, dignity, and independence. Our mission is...
Affinity home care is a private concierge agency. We provide a selection of services based on expert-level care for your loved one. As a boutique agency, we are deeply committed to providing exceptional, elevated care...
Life at home becomes more challenging as we age. Care At Home of New York is dedicated to providing seniors, the differently abled, and those with special needs with the help and support they need so they can continue to...
Touching Hearts at Home of New York City, NY is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Graceland Homecare, Inc, Compassionate In-Home Care Services At Graceland Homecare, Inc, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort, dignity, and independence....
Center For Nursing and Rehabilitation Inc Lthhcp is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
CABS Home Attendants Service, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Acare Hhc, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
1St Choice Home Care Services, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Caring Professionals, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Benevolent Home Care is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Care at Home - Diocese of Brooklyn, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Alternate Choice Home Care is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Carewell Home Care, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
All Pro Home And Health Care Services is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Care Services We have Home Care Solutions to suit every family, situation, and budget. We work with you every step of the way to find the best solution. >CDPAP >Certified Home Health Aides >Private Pay Home...
Best Choice Home Health Care, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Alliance For Health, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We know how important choosing a quality care provider can be. The staff at Allborogh Personal Care Inc are special people. We take joy in our ability to make a difference in the lives of our patients and their...
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Anr Advance Home Care Services Inc is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
AAA Healthsource, Inc. - Brooklyn, NY is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Alternate Staffing, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Americare Of New York City is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Allhealth Home Care, Llc is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Amelia Home Care, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bhrags Home Care Corp. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Caring Angel Homecare Services LLC is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Big Apple Homecare Agency is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
All Heart Homecare Agency is dedicated to delivering compassionate, highest quality to our clients in the comfort of their homes. We strive to enrich as many lives as we can and constantly look for ways to add more value...
Best Professional Home Care Agency Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Galaxy Home Care is a company with deep roots in home health care. Our management team and staff have decades of home health care experience so that we can provide the full range of in-home care services to individuals...
All Care Home Health Services, Llc is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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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.