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:
Griswold is an award-winning pioneer in the home care industry, with over four decades of experience and a storied legacy of compassion and integrity. We believe Care Professionals are the foundation of our success, and...
Licensed for Hands on Care and Companion Services Fully Insured Licensed by the Department of Health and Human Services Division of Health Services Regulation Covering 14 counties out the Raleigh office: Wake, Alamance,...
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...
Life moves in one direction – forward. No matter what each person’s circumstances are, SYNERGY HomeCare steps in with effective, comforting, life-affirming care that moves people, and their loved ones, emotionally and...
It doesn’t matter if you’re here because you’re looking for help living independently, or if you want to make sure someone you love has the support they need to stay in their home. We believe there’s more to caring for...
Home Instead has been serving Tarheel families for over a decade. We provide the extra help that is sometimes needed so that seniors may continue to live as safely and independently as possible.
Mary's Amazen Homecare, LLC is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Right Time is a provider of home care and staffing services with many years of experience and dedication to enhancing quality of life for others. We are proud of our compassionate home care program designed to help people...
Welcome to Active At Home Senior Services. We are excited to show you all that we have to offer! Our goal is to enrich the lives of older adults in our community through a variety of personalized services designed to...
You Share We Care Inc, NC is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Liberty Home Care, Llc is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Discover Cherished Non-Medical Homecare, where we prioritize the well-being and happiness of your loved ones. With our compassionate and dedicated team, we provide exceptional care that brings comfort, joy, and peace of mind.
Beautiful Remissions, LLC-Durham-NC is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Carrington Home Care, LLC is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Peaceful Home Care, our unwavering commitment lies in offering dedicated home care and support to the elderly, disabled, and unwell individuals throughout the state of North Carolina. Our goal is to ensure that...
Amedisys Home Health is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Mercy's Home Care Agency-Durham-NC is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Pleasant Health Agency, we help seniors and older adults with non-medical activities of daily living including meal preparation, assistance with bathing, dressing, toileting, light housekeeping, medication reminders,...
Health Care Options of the Triangle, Inc is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Caring Souls Home Health, Inc. is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Gentiva Health Services is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Visiting Nurse Service of Durh is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Home Eldercare of Durham NC is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Nurse Care of North Carolina provides professional in-home care with compassion. We specialize in matching the right caregiver to each client. We are devoted to keeping our clients safe and secure in their own homes.
CareSource, LLC is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Mount Zion Home Health Care, Inc. is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Inspired Home Healthcare Services, LLC is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Love Has Come Homecare LLC is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Stand-Out Stand-In Specialist is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
Seniors Helping Seniors - Durham and Chapel Hill, NC is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Did you know that personal care services from Aryzen Health & Wellness can make your home health episodes more profitable, improve the likelihood of return patients, and improve the frequency of return patients? Here’s...
Located in Durham, North Carolina, Tower of Blessing Home Care Agency is dedicated to providing compassionate and personalized home care services to individuals in need. Our team of experienced caregivers is committed to...
Senior Care in Durham, NC is a lifestyle. Our professional team come from the fields of geriatric and nursing care or are nurses, certified nurse assistants, certified nurses and domestic helpers. All are well trained...
Hands From Heaven, LLC is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Tar Heel Home Health is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Prestige Home Care, LLC-Durham-NC is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Duke Home Health is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Albertacare - Durham, NC is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Recovery Healthcare Agency is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Innovative Senior Care Home Health is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
One You Love Home Care Chapel Hill NC is a home care provider that services in Durham, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Cornerstone Caregiving stands apart in offering compassionate, authentic assistance for your loved ones. We are senior care professionals with 20+ years of experience in the caregiving field who are willing and ready to...
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...
First Watch Homecare LLC is a home care provider that services in Durham, NC. 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...
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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.