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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:
United Home Care of Newark, NJ is a trusted home care agency dedicated to providing compassionate, high-quality support to seniors in the comfort of their own homes. With a focus on personalized care, the agency offers a...
Welcome To Boikin Health Care Services We are dedicated to providing comprehensive, high-quality healthcare services to individuals and families. Our mission is to deliver personalized care that meets the unique needs of...
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...
Home Helpers® Home Care is a in-home care service that provides top quality in-home care. Our Cared-4℠ program is a holistic approach to meet the four primary areas of need, helping your loved one stay safe and...
We understand that reliable home care is where our clients feel most comfortable. Therefore, we work tirelessly to make sure that they continue to live independently while receiving the care they need. Whether it's...
Angel Home Care LLC is a home care provider that services in Edison, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Joy Bringers Home Care LLC is a home care provider that services in Edison, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Instacare Home Health Solutions is a home care provider that services in Edison, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Stanford Angels Home Health Care is a home care provider that services in Edison, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We treat every client like royalty. We ensure that our clients' voices are heard and that they are treated with the respect they deserve. We ensure that each client’s caregiver is handpicked by our team to see that they...
At Helping Wings, we provide compassionate self-care assistance, reliable household support, and friendly companionship—giving you and your loved ones peace of mind. Our caregivers undergo rigorous evaluations, ongoing...
Sunrise Community Services is established with the goal of providing a safe and nurturing environment for our clients and individuals with developmental disabilities.
Innovative Helping Hands Home Health Inc. is a home care provider that services in Edison, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ALERT HOME SERVICES CORPORATION of West Orange, NJ is a home care provider that services in Edison, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Care Services Tailored to Meet Your Needs Since 1995, ComForcare Senior Services has delivered compassionate and superior home care services to thousands of clients across the country. ComForcare provides services...
Dabhi Hands Of Hope LLC is a home care provider that services in Edison, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Everjoy Home Care Services LLC is a home care provider that services in Edison, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Instacare Home Health Solutions, located in Edison, NJ, provides personalized home health care services aimed at improving the quality of life for individuals in need of compassionate in-home support. They offer a range...
na Cares Senior Service is a reputable and compassionate senior care agency dedicated to providing exceptional care and support to elderly individuals. With a team of highly trained and experienced caregivers, Ana Cares...
Central New Jersey’s finest Home Care Services - At Assisting Hands Home Care, our mission is to offer our clients the very finest personalized senior home care assistance allowing them to live safely and comfortably in...
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.