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:
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...
Choosing the proper home care agency for yourself or a senior loved one is something most people are not prepared for, but Amada Senior Care of West Charlotte is here to show you the way. Korey Sixbury, owner of Amada...
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...
Superior Home Care Agency, LLC is a trusted provider of in-home supportive care services based in Gastonia, North Carolina. Located at 2020 Remount Road, Suite E106, this agency is dedicated to enhancing the quality of...
We are a senior home care service that allows your loved ones to stay where they feel most comfortable: at their home in West Charlotte or in surrounding areas like Belmont, Stanley, or Bessemer City.
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...
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...
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...
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...
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...
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...
Better Living Home Health Care of Charlotte provides a wide range of homecare services including adult and pediatric skilled nursing, non-medical companion and personal care, as well as medical staffing.
Choosing a reliable Home Care Agency is a crucial step to ensure your family members will have the level of care they deserve. The needs of your family are always in our focus and everything we do is dedicated to your...
Since 1996, Always Best Care has helped thousands of families with non-medical in-home care and assisted living referral services. Our passion for helping people maintain a safe, independent and dignified lifestyle...
Alternative Living Solutions of North Carolina is a Non-Profit outpatient home health company founded by Stephanie Shine-Morrison. We aim to make sure that all of our patients needs are thoroughly taken care of. We offer...
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...
Better At Home 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...
Alliance Home Health Services, LLC or Carolina Family Alliance 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...
Advanced 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...
AADAX HOMECARE INC 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...
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...
Access Healthcare 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...
A Lot of Luv Homecare, 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...
Along with our excellent home care, A New Pathway LLC eliminates the stress and worry family members are experiencing over the care of their loved ones.
Aroga 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...
ARS HOME 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...
Abundant Love Home Care Services, LLC provides in-home personal care services in Charlotte, North Carolina, and the surrounding areas. Our assisted living services give any homebound individual the help they need to...
Ally Home Care 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...
A Tranquil Care Home Agency is an accredited provider of Skilled Nursing and non-skilled services in Charlotte, North Carolina. Endorsed by the Accreditation Commission for Health Care (ACHC) to provide professional Home...
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,...
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...
Blessed Beyond Expectations, 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...
Live in/ Companion/Home Keeper Live-ins can provide the following services: Bedside monitoring for patients in a facility or in the home. Assistance with personal care activities (bathing, grooming, etc. Reminding...
Alexander vaults 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...
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...
Adon 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...
Angela's Helping Hands 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...
A Healing Touch Home Care Services, 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...
Angels by Surprise 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...
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...
Who are we 1st Serenity Healthcare Registry is locally operated in the Charlotte metro area. Our team of well qualified healthcare professionals and in partial partnership with Home Care Seminars (one of the oldest...
Empowering you to live independently at home. If you love your home and plan to stay right where you are, Aldersgate At Home is the perfect solution for seniors. Created by the most respected Life Plan Community in...
We’re always there when you need us – ready to provide care in all ways. When faced with the decision to provide care, you need a trusted partner. One who has the knowledge gained from years of providing quality home care...
We create sustainable solutions for our seniors and nurturing them in their daily lives in the comfort of their homes is what we envision. We position ourselves to help seniors live happily in the comfort of their homes...
Polite Touch Home Care is dedicated to offering personalized, compassionate non-medical home care services to individuals in the Charlotte, NC area. We strive to provide the highest quality of care to our clients in the...
A New Beginning Community Care LLC is a dedicated and compassionate provider of community-based healthcare services. The organization is committed to delivering high-quality, personalized care to individuals in need,...
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...
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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.