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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:
A Place At Home – Reston provides compassionate, professional, and dependable in-home care for seniors and families in Reston, VA, and throughout the surrounding areas of Chantilly, VA | Sterling, VA | Herndon, VA |...
At Amada, quality care is our priority. We look for ways to make simple, everyday tasks special. Amada’s in-home caregivers not only take care of daily essentials like cooking, cleaning and grocery shopping, but they also...
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...
Abby’s Home Care Service in Virginia offers dependable, in-home support for individuals facing age-related challenges, health conditions, or disabilities. We help clients remain safe and comfortable in the place they know...
BG HealthCare Services is a trusted non-medical in-home care agency dedicated to supporting seniors and individuals who need daily living assistance. The agency provides personalized services such as companionship, meal...
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...
Empowering Independence with Trusted In-Home Care and Companionship Sencura brings compassionate support and trusted companionship to seniors and adults with disabilities. Our reliable, in-home caregiving services are...
We know from first-hand experience with our parents, in-laws and children, how stressful both caregiving to those that need it, and picking a quality home care provider, can be. We are here to help with the worry, fear...
Better Days Home Healthcare Professionals, LLC, Compassionate In-Home Care Services At Better Days Home Healthcare Professionals, LLC, we are committed to providing high-quality, non-medical in-home care services that...
Green Life Home Care, LLC is a home care provider that services Springfield, VA 22150. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with personal care and...
More than just a caregiver, we assign each client a care team. Our thoroughly-vetted and qualified caregivers are there to provide care to clients, with the support of a remote Care Team
The Executive Home Care Mission We work in a unique industry with unique opportunities to provide meaningful improvement in seniors’ lives. We also realize that this comes with great responsibility.
Tamela Fletcher opened the Senior Helpers Fairfax office to provide high-quality personalized senior care in the Fairfax and surrounding communities. Tamela recognizes the positive impact that Senior Helpers has on the...
Home Helpers Home Care of Northern VA is more than an in-home health care agency – we help make life easier and more enjoyable for you and your family. We’re a locally owned, trusted provider of quality, compassionate...
My Privilege Home Care, LLC is a home care provider that services in Fairfax, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Obioma Health Care Services, we believe that everyone deserves to experience the comfort and familiarity of home while receiving compassionate and personalized care. With a devoted team of healthcare professionals, we...
Our mission is to provide compassionate, personalized care to individuals who need assistance with daily living activities. We understand that aging, illness, or disability can be challenging, and our goal is to help our...
Safe and Happy : That is what we all want to be. At Senior Care Safe at Home, our mission is to enable all adults to remain in the most desirable place of all: their own homes. Our goal is to offer the help and...
At For Better Home Healthcare our commitment is to transform the way in-home care is experienced by blending compassion, excellence, and truly personalized support. Our mission is to help individuals live safely and...
Home Helpers Home Care of Springfield, VA is a home care provider that services in Fairfax, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Hope Home Healthcare Agency, LLC is a home care provider that services Fairfax, VA 22031. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with personal care...
Ajir Homecare of Fairfax, VA is a home care provider that services in Fairfax, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
An In Home Supportive Care Agency provides services in the patient?s home with the goal of enabling the patient to remain at home. The services provided may include personal care services such as hands-on assistance with...
Inova Vna Home Health is a home care provider that services in Fairfax, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Apollo Home Healthcare, LLC is a home care provider that services in Fairfax, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Ayaan Home Healthcare, LLC is a home care provider that services in Fairfax, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Hope Home Care Services, LLC is a home care provider that services in Fairfax, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A Brighter Day Home Care, Inc. is a home care provider that services in Fairfax, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Alliance Nurses For Home Health And Wellness, LLC is a home care provider that services in Fairfax, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
HomeCentris Healthcare is a home care provider that services in Fairfax, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Empire Home Health Services, LLC is a home care provider that services in Fairfax, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Home Care DMV, we started with a simple idea: to provide reliable and compassionate home health care services to those in need. Over the years, we have grown into a trusted provider of quality care, serving the needs...
Ready 2 Serve Home Healthcare LLC is a locally-operated home health care agency servicing Alexandria, Virginia, and the surrounding counties. We specialize in rendering medical and non-medical care to our patients who are...
At HomeWell Care Services, we provide hourly at-home care for seniors and others who are struggling to manage day-to-day activities like grooming, bathing, cooking or even running errands. Our knowledgeable Care Managers...
Maxbel Home Health Inc. provides Waiver Services to clients at all stages of their lives. Our experts are dedicated to providing care of the utmost quality, consistently advocating for autonomy, respect, and...
ElderOptions Senior Care is a family-owned and operated business dedicated to making in-home living safe and comfortable for aging adults — and worry-free for their families. At ElderOptions, providing reliable,...
Dignity Home Care of VA is a home care provider that services in Fairfax, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Hallmark Home Care -Northern Virginia, Compassionate In-Home Care Services At MedPro Solutions DBA Hallmark Homecare, we are committed to providing high-quality, non-medical in-home care services that prioritize...
Home Caregivers provides non-medical home care services to individuals in the comfort of their own home. We also serve as a resource company for you, your loved ones, or other persons involved in your support and...
Butters Home Health Care is a professional in-home care provider, assisting individuals and families who need one-on-one care of their loved ones. As a team of highly experienced, motivated, and dedicated associates,...
Our Values - At FirstLight HomeCare, a leading home care agency, the genuine health and well-being of others is our greatest concern. We vow to provide first-class personal service for our clients so that they may enjoy...
Our clients love our expanded services – all with the same level of high touch service, responsiveness and attention-to-detail you’ve come to depend on and the reliability of a single care coordinator managing all your...
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.