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:
We've been there. We understand. Neither giving nor receiving care is easy. Home Instead Senior Care® puts relationships first to support those giving care, to protect the dignity of those receiving care, and to enhance...
The challenges of having aging parents drew Chris Nieman to Senior Helpers as a life's work that he could be passionate about. His team is committed to delivering the best possible in-home care to seniors in the Northern...
The Senior Helpers West Chester office was opened in 2018 to match the growing need for in-home senior care in the surrounding community. We offer a wide range of services from companion care to chronic disease care. We...
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...
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...
Home Instead has been a trusted provider of in-home care for over 25 years, holding its 1,200 franchises to very high standards. The local office in Montgomery, Ohio is locally owned and operated and has been serving...
Sure Harvest Home Health Care is a dedicated provider home care services based in Ohio. We specialize in delivering personalized and compassionate care to seniors
Carobea Home Care Services offers compassionate, high-quality in-home care for individuals of all ages across Butler, Hamilton, Warren, and Clermont counties in Ohio. Specializing in senior care, post-hospital recovery,...
Nurse Sister Care offers: Personal Care Assistance-Bathing, grooming, and dressing Mobility and transfer assistance Toileting and incontinence care Feeding assistance Light housekeeping and meal...
What sets Private Home Care, Inc apart from other in home health agencies? It is our commitment to you. Our RN will come out and visit with you and your family to create a comprehensive care plan that addresses all of...
First Choice Home Health Ohio, Inc is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
If seniors are struggling to remain in their homes we provide non-medical services to help them stay there. We have an excellent reputation that we earn - EVERYDAY.
Parent Care Solutions is devoted to helping you care for your parents, grandparents, and loved ones in the comfort of their homes - or yours - for as long as they desire. We appreciate that the commitment to continue...
Through our unique system of in-home care that we call Interactive Caregiving™, our Comfort Keepers® engage clients in their care to enhance their independence and well-being. Interactive Caregiving™ includes four...
Children's Hospital Home Health is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Stay Well Home Health, Llc is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Through our unique system of in-home care that we call Interactive Caregiving™, our Comfort Keepers® engage clients in their care to enhance their independence and well-being. Interactive Caregiving™ includes four...
M J Nursing Registry Inc is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Despite the best intentions, caring for an elderly loved one can quickly become overwhelming. At Home Helpers of Cincinnati and Northern Kentucky, we would be happy to discuss your present situation and provide you with...
Alternate Solutions Home Care of Cincinnati is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
International Elderly Care Group is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Helping Hands Healthcare, Inc is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Tender Loving Care, an Amedisys Company is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Alternative Home Care Staffing is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Seniors Helping Seniors - Southeastern Hamilton County, OH is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or...
Home Care Partners Of Cincinnati, Inc is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
The mission of Homewatch CareGivers is to preserve dignity, protect independence, and provide peace of mind for our clients and their loved ones by providing exceptional home care. We provide service in the heart of the...
Deaconess Home Health Care is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Cardinal Home Healthcare Solutions, Inc is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Spirit Homecare, Inc is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Helpers of Butler, Clermont and Warren Counties of Southwestern Ohio provides unsurpassed quality of home care services from new mothers through the senior population. We have no minimum hours and no rate...
For over 30 years, Griswold Home Care has been referring the best Caregivers. We only refer Professional Caregivers that pass our stringent “CareAssure Screening System”. For your peace of mind, all of our Caregivers have...
Family Helping Families in Southwest Ohio & Northern Kentucky We Provide an Affordable and Caring Solution for the Busy FamilyTender Hearts At Home - Senior Care is the perfect solution for seniors and others who aren't...
At Your Service Because you value your independence and enjoy your home, we bring our special care to you. Non-medical in-home care improves your quality of life, gives you security and peace of mind, all in the privacy...
Home Healthcare By Black Stone Of Cincinnati Llc is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Interim Healthcare of Cincinnati is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Absolute Healthcare Services is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Cincinnati Home Care, Inc is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Care Connection of Cincinnati is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Amedisys of Cincinnati is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Superior Care Plus is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
"touching lives through personalized home health care" Caring Hearts has been locally owned and operating since 1988. We operate on the principle of teamwork with the main goal to offer the highest quality of service...
Visiting Nurse Association, The is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Care Network Inc is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Personal Touch Home Care of Ohio is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Instead has been a trusted provider of in-home care for over 25 years, holding its 1,200 franchises to very high standards. The local office in Milford, Ohio is locally owned and operated and has been serving...
Senior Independence is a home care provider that services in Cincinnati, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
HomeWell Care Services of Cincinnati, OH is a home care provider that services in Cincinnati, OH. 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.