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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Edison Home Health Care DBA Help at Home of Buffalo, NY is a home care provider that services in Buffalo, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance...
MAXIM HEALTHCARE SERVICES, INC. - Buffalo, NY is a home care provider that services in Buffalo, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Buffalo Homecare Inc. is a home care provider that services in Buffalo, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Aftercare Nursing Services, Inc. is a home care provider that services in Buffalo, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Interim Health Care Of Buffalo is a home care provider that services in Buffalo, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Aurora Home Care, Inc. is a home care provider that services in Buffalo, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
People Home Health Svs CHHA is a home care provider that services in Buffalo, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
WESTERN REGION HEALTH CORPORATION is a home care provider that services in Buffalo, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Amak Health Care Agency of Buffalo, NY is a home care provider that services in Buffalo, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our Mission TRANSFORMING HOME CARE Caring for Neighbors like Family. Dedicated to Compassion, Innovation, Trust, Patience, and Honesty. Inspiring Hope, Healing, and Recovery. Encouraging our patients that God has a...
Assisting Angels was founded 10 years ago when the company's Chief Operating Officer was in need of some non-medical assistance for his dad. His father was living by himself and finding it more difficult each day to...
GOOD SAMARITAN HOME HEALTH AGENCY, INC is a home care provider that services in Buffalo, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Caregivers homecare - Homemakers Upstate Group Inc of Buffalo, NY is a home care provider that services in Buffalo, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or...
AccordCare - Buffalo, NY is a home care provider that services in Buffalo, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Caring Hearts Home Care, Inc is a home care provider that services in Buffalo, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Willcare Buffalo CHHA is a home care provider that services in Buffalo, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Maxim Of New York, Llc is a home care provider that services in Buffalo, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
The CareGiver's Choice is a non-medical home care agency for the elderly. Our goal is to provide in-home, non-medical assistance to the elderly who wish to remain independent in their own homes.Our CareGivers provide...
Catholic Health Home Care of Buffalo, NY is a home care provider that services in Buffalo, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Good Samaritan CareGivers was founded to alleviate the major concerns of aging - running out of money and needing to move out of the home. We provide in-home, non-medical services so seniors may remain in their own home...
Schofield Home Health Care Services, Inc. is a home care provider that services in Buffalo, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
VNA of Western NY CHHA is a home care provider that services in Buffalo, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Mcauley Seton Home Care Corp is a home care provider that services in Buffalo, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Allcare Family Services, Inc. of Buffalo, NY is a home care provider that services in Buffalo, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Happier at Home is the perfect solution for seniors that need support to maintain independence in their place of residence, no matter where they call home. We are dedicated to improving the lives of our clients by...
All Metro Health Care is a home care provider that services in Buffalo, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
OasisCCS is Western New York's most premier care agency. We offer a full service of care giving support. So, why not feel better in the comfort of your own home? We specialize in care and daily living assistance to an...
When you or your loved one need help at home, turn to FirstLight Home Care of Buffalo. We offer complete companion and personal care services for seniors, new mothers, those recovering from surgery, or anyone who just...
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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.