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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.
✔
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:
A Helping Hand at Home: Reliable and Compassionate Care for Your Loved Ones When your loved one needs extra support to thrive in the comfort of their own home, look no further than CT Health Care Services. Our team of...
Best Home Care in Bergen County At SYNERGY HomeCare of Bergen County, NJ our mission is to be your premier provider of in- home care services by always striving to offer your senior parent or family member the highest...
Homewatch Caregivers of Jersey City is dedicated to providing compassionate, personalized care to individuals in need of assistance with daily living activities. Whether you're seeking support for an aging loved one,...
Comfort Keepers of Montclair, NJ is a home care provider that services in Jersey City, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Senior Helpers, we are here to help anyway we can. No matter how big or how small the task. We are licensed, bonded and insured and have screened and continuously trained caregivers that are immediately available to...
NJHHC is proud to be designated as a Minority Women Owned Business, exemplifying our commitment to diversity and empowerment. We are dedicated to supporting women entering the workforce by providing a higher standard of...
Faith Home Healthcare LLC is a home care provider that services in Jersey City, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We understand that a leap of faith is often involved when family members consider home care for their love ones. While many families hope for the best, we do not believe in leaving home care to chance. Best Home Care is...
Promise Care Nj, LLC is a home care provider that services in Jersey City, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
By Your Side Home Health Services is an agency built on integrity, love, kindness, and compassion. We are dedicated to being involved in the care of your loved one and fully committed to improving the lives of our...
St. Bernadine Home Care Services, LLC is a home care provider that services in Jersey City, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Since its founding in 2010, New Jersey’s home care agency The Alexander Club’s goal has always been simple- to serve the ever- growing community of people who wish to remain independent in the place they call home, but...
Angel Care is a home care provider that services in Jersey City, NJ. 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,...
Loving Care Agency is a home care provider that services in Jersey City, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bestcare Homecare of NJ is a home care provider that services in Jersey City, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Optimus Homecare LLC is a home care provider that services in Jersey City, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Liberty Home Care, Inc is a home care provider that services in Jersey City, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Pedro's Home Care Agency, located in Jersey City, NJ, is dedicated to providing exceptional and compassionate home care services to individuals and families in need. Our team of highly trained and experienced caregivers...
Welcome To Holistic Touch Homecare Tailored Home Care Services For Every Need Holistic Touch Homecare was founded with a clear vision: to provide exceptional homecare services that not only address physical health but...
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...
Synergy HomeCare prides itself on credibility and compassion by providing the best caregivers to our clients of all ages in their time of need. Our services are geared to meet a variety of real life challenges. Whether...
A Helping Hand at Home: Reliable and Compassionate Care for Your Loved Ones When your loved one needs extra support to thrive in the comfort of their own home, look no further than CT Health Care Services. Our team of...
Best Home Care in Bergen County At SYNERGY HomeCare of Bergen County, NJ our mission is to be your premier provider of in- home care services by always striving to offer your senior parent or family member the highest...
Homewatch Caregivers of Jersey City is dedicated to providing compassionate, personalized care to individuals in need of assistance with daily living activities. Whether you're seeking support for an aging loved one,...
Comfort Keepers of Montclair, NJ is a home care provider that services in Jersey City, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Senior Helpers, we are here to help anyway we can. No matter how big or how small the task. We are licensed, bonded and insured and have screened and continuously trained caregivers that are immediately available to...
NJHHC is proud to be designated as a Minority Women Owned Business, exemplifying our commitment to diversity and empowerment. We are dedicated to supporting women entering the workforce by providing a higher standard of...
Faith Home Healthcare LLC is a home care provider that services in Jersey City, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We understand that a leap of faith is often involved when family members consider home care for their love ones. While many families hope for the best, we do not believe in leaving home care to chance. Best Home Care is...
Promise Care Nj, LLC is a home care provider that services in Jersey City, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
By Your Side Home Health Services is an agency built on integrity, love, kindness, and compassion. We are dedicated to being involved in the care of your loved one and fully committed to improving the lives of our...
St. Bernadine Home Care Services, LLC is a home care provider that services in Jersey City, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Since its founding in 2010, New Jersey’s home care agency The Alexander Club’s goal has always been simple- to serve the ever- growing community of people who wish to remain independent in the place they call home, but...
Angel Care is a home care provider that services in Jersey City, NJ. 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,...
Loving Care Agency is a home care provider that services in Jersey City, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bestcare Homecare of NJ is a home care provider that services in Jersey City, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Optimus Homecare LLC is a home care provider that services in Jersey City, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Liberty Home Care, Inc is a home care provider that services in Jersey City, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Pedro's Home Care Agency, located in Jersey City, NJ, is dedicated to providing exceptional and compassionate home care services to individuals and families in need. Our team of highly trained and experienced caregivers...
Welcome To Holistic Touch Homecare Tailored Home Care Services For Every Need Holistic Touch Homecare was founded with a clear vision: to provide exceptional homecare services that not only address physical health but...
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...
Synergy HomeCare prides itself on credibility and compassion by providing the best caregivers to our clients of all ages in their time of need. Our services are geared to meet a variety of real life challenges. Whether...
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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.