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:
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...
At Faffy Quality Services, we understand the importance of dignity, respect, and independence in daily living. Our Personal Care service is tailored to support individuals who need assistance with essential daily routines...
Options for Senior America - Harrisburg, PA is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bayada Nurses Harrisburg is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Omni Home Care is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Maxim Healthcare Services Inc is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Cool Waters, our goal is to help our clients achieve the best quality of life possible. We understand that one solution does not fit every situation so we take the time to listen and learn about each client's needs and...
Pinnacle Health Home Care is a home care provider that services in Harrisburg, PA. 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...
Home Base Caregivers, LLC is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Blue Mountain Home Health Care, Inc of Harrisburg, PA is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or...
Xenial Home Care, LLC is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Welcome A little help could go a long way. We understand, and we are here to help with reliability, professionalism, and kindness. We send trained aides to the homes of our clients to provide support with activities of...
Why hire just one person to help at home when you can have an entire professional team at your service? From care planners, to schedulers, to multiple aides, we are all here to make sure your home care service is...
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...
Watching Over Us Home Care, LLC is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Activate And Aspire Home Care, LLC is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
DP Home Care Service LLC, PA is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Healing Spring Care Services is committed to being trustworthy and reliable. Owner, Haddy, is able to accomplish this by making sure she doesn't over extender her staff, fill in herself when there is a need and ensuring...
Kena Care Home Health Agency LLC is a provider of quality Home Health Services in Harrisburg, Pennsylvania. We specialized in Pediatric and Geriatric care for our patients. These services are provided in the comfort of...
Links2care is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
GRACE HOME HEALTHCARE, LLC is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ComForcare understands that today's busy lifestyles often deprive family members of the time necessary to provide hands on assistance and companionship for their loved ones. Therefore, we want every family we service to...
YAHCARE LLC is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Infinite Hearts Services, LLC is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We provide compassionate, quality healthcare services, to meet the needs of our fast-growing multicultural community, Planet Home Healthcare is committed to quality, individualized patient care and proudly dedicated to...
VNA of Central PA Inc is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Visiting Angels, we strive to make staying at home a positive experience. We do this by allowing you to select your caregiver from a group of skilled elderly home care providers, allowing you to maintain your schedule,...
TheKey of Harrisburg, PA is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our vision at Hilltop Home Care Agency, LLC, is to be the leading home care agency in Pennsylvania, renowned for our unwavering commitment to compassionate and innovative care. We aspire to set the standard for excellence...
All About You HomeCare Agency is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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,...
Integrity Support Coordination is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We Are Partners in This Community. The Griswold Team for Dauphin County is dedicated to supporting residents of our local community so they can live in the place they love. Our team lives locally, patronizes local...
You’re in Good Hands As a medical social worker, the founder established Guiding Hands Elder Care to respond to the need for caregiving services. We offer competitive pricing and have general and professional liability...
Home Remedy Skilled Nursing, Llc is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Right at Home - Harrisburg, PA is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Miracle Makers Home Care is a premium home care Agency licensed by the Pennsylvania Department of Health. It was founded by CEO Jack Ratigan with the mission to provide outstanding home care services to everyone who...
Homeland Home Care of Harrisburg, PA is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our Services, Our Passion. There comes a time in each of our lives when we or our loved ones need help or support. If you or your loved ones have any intellectual disabilities and need support from a provider agency,...
Relevant Home Care Incorporated is a unique and modern agency that envisions a world where care providers and care seekers fully understand the compassion of the services provided and get the best out of it. We have been...
Your Choice Home Health Care Services LLC is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Griswold Home Care of PA - Duplicate is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
HAND OF GRACE, LLC is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Psa Healthcare is a home care provider that services in Harrisburg, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At RTH Homecare LLC, we bring safe, loving, and caring services to those who desire to have a nursing home setting and treatment, in the comfort of their own home. We help with non-medical activities of daily living...
No matter the type of care your loved one requires, Senior Helpers provides the perfect services for any of their needs, all done from home. We’re giving better peace of mind for them. And you.
Momma Nan’s Home Care Services offers personal care services to the elderly and disabled community so they can remain safely cared for in the comfort of their own homes. Momma Nan’s Home Care Services is a licensed...
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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.