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:
Seniors Helping Seniors® in-home care services brighten the lives of seniors who can benefit from a helping hand and a friendly smile. Our caregivers, who are seniors themselves, make your life easier by providing...
Home—there’s no place like it. It’s where your memories are. Where you raised your family and where friends have gathered for life’s celebrations. It’s been your basecamp through good times and bad. And it’s where you...
PACE of the Southern Piedmont is here to help you continue living in the home and community you love. The Program of All-Inclusive Care (PACE) is a Medicare not for profit, Medicaid State option program. We serve...
Why Affordable Family Care Services? • RN Assessments and Follow up Visits • Caregiver Match • 24-Hour On-Call • Alzheimer’s/Dementia Care Specialists • Licensed-Bonded-Fully Insured • Family Owned and...
Experience our Nurse Guided Care approach that distinguishes us as leaders in the caregiving industry. Our clinical leadership team, composed of experienced nurses, empowers clients and families by providing knowledge and...
The Synergy HomeCare Difference... Synergy HomeCare, the most trusted name in non-medical in-home care, stands out from the rest because we provide in-home care and services to all ages from senior adults to children....
At Agape Love Home Care in Charlotte, NC, compassion isn’t just a word — it’s a way of life. Founded on the principles of kindness, respect, and genuine care, Agape Love provides top-tier non-medical home care with a...
HomeWell Care Services of Huntersville, NC serves Charlotte, NC and surrounding areas. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with personal care and...
Welcome to Home Care Freedom. As a home care provider, we want you to trust us with your personal and health needs. We proudly provide non-medical home care services to individuals with disabilities, injuries,...
Angela's Helping Handz inc is a committed community based organization providing dedicated in-home supportive services for our undeserved retired service members, seniors and to our disabled clients who prefer their...
If you or someone you love needs in-home assistance, contact FirstLight Home Care Greater Charlotte. Whether you’re a senior, a new mother, someone recovering from surgery or you just need extra help, FirstLight Home Care...
Anjie’s Home Care in Charlotte, NC provides personalized non-medical in-home support for seniors and adults. They offer services such as personal care, meal preparation, companionship, and light housekeeping. Their...
BlueDot Cares is a family-owned and operated, in-home care company that provides personalized senior living solutions for people of all ages. BlueDot Cares makes it easy for you or your loved ones to stay safe and...
Share Care Home Care Services, Compassionate In-Home Care Services At Share Care Home Care Services, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort, dignity, and...
Since 1984, the founders of Preferred Care at Home have had the privilege of assisting clients improve their quality of life while still recognizing and maintaining their dignity and independence. Preferred Care at Home...
At the heart of our home care agency is a deeply personal journey-caring for our beloved mother following her dementia diagnosis. Through that experience, we came to understand the emotional and physical challenges...
Trusted Care At Health Assured Home Care, compassion and trust guide our personalized services. We are committed to delivering dependable care in the comfort of your home.
Always 4Ever Young Homecare is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Visiting Angels, we strive to make staying at home a positive experience. We do this by allowing you to select your caregiver from a group of skilled elderly home care providers, allowing you to maintain your schedule,...
Acti-Kare of Charlotte, NC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Blake Home Health Care LLC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Total Care Home Health is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Visiting Angels, we strive to make staying at home a positive experience. We do this by allowing you to select your caregiver from a group of skilled elderly home care providers, allowing you to maintain your schedule,...
Better Together Home Care is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
AccordCare -Charlotte, NC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bayada Nurses - Charlotte is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Victorious Health Services is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
University Care Services is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bayada Nurses is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
BrightStar Care of SW Mecklenburg County, NC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Total Care of North Carolina is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Assurance Home Care Service, LLC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Partners in Care, LLC provides non-medical in-home care to those in need who wish to remain independent in their own homes for as long as possible. Our caregivers provide assistance with errands, incidental...
Family First Healthcare, LLC of Charlotte, NC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Seniors Helping Seniors - Charlotte, NC - Duplicate is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance...
A Better Day Home Care Services, Inc. is dedicated to delivering quality patient care and service to maintain the highest possible level of independent living for our clients. Our approach to quality care focuses on a...
Hendrick Home Care is the leading provider of Home Care Services including skilled nursing and Home Aides. Our mission is to provide top quality home care to all of our clients. We strive to make every client feel like...
Interim Healthcare is a leader in the home care industry with 50 years of experience. We provide supportive services to frail and disabled individuals allowing them to remain independent in their homes. Our care...
Covenant In Home Care is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Carepoint, inc is a Charlotte-based Home Care agency offering personal care, companion, homemaker, and transportation services to those adults and seniors wishing to remain independent. Exceptional care is truly our...
Living Ease Home Care, Inc. was established in 2014 in Charlotte, NC as a care management company. Later in 2019 the company started doing business as “Living Ease Home Care.” In addition, we provide in-home aides,...
Since 1975, Bayada Nurses has helped people have a safe home life with comfort, independence, and dignity. Bayada Nurses provides skilled, rehabilitative, therapeutic, and personal home health care services to children,...
Outstanding Care Of Charlotte LLC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Top Notch Nursing & Staffing Home Care - Charlotte, NC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance...
Affordable HomeCare was formed by a team of seasoned professionals with a combined experience of more than sixty years, in the field of healthcare.We are dedicated to bringing quality home care services to our clients,...
Senior Helpers Charlotte is the premier provider of in-home senior care. We offer tailored home care services ranging from companion care for seniors who need daily assistance to in-depth specialized care for those with...
Experience a Better Way to Age with Gentle Shepherd Care. Gentle Shepherd Care provides At Home Care services in the Charlotte Metro Area, and Eldercare Management and Lifecare Planning services nationwide. Our support...
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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.