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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.*
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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:
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Exceptional Care for Your Loved Ones Our mission is to provide exceptional support to your loved ones in their golden years or those facing well-being challenges. Bella Vie Homecare LLC delivers premier care services...
When you and a loved one in your life require care assistance, Executive Home Care is ready to lend a hand. Find out more about the expert and compassionate senior living care that is offered in the comfort of one’s own...
We know there’s no place like home. That’s why we bring the highest quality of care right to your front door. With a personalized care management approach and a dedicated team of compassionate caregivers, you can expect...
At Friends and Family Home Care, we understand the importance of comfort and familiarity. That's why we bring professional care right to your doorstep, ensuring your loved ones receive the support they deserve in the...
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...
Premier Senior Care is the leading in home senior care provider in California, specializing in Alzheimer's & Dementia Care. It is an established and respected senior care provider offering senior home care, personal...
Est 2008, Caregiver Provider in California. We provides in-home senior care, helping older adults continue to live well and independently at home and anywhere.
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Home Helpers Home Care of Orange Coast is more than an in-home health care agency – we’re your extended family when family can’t be there. We’re a locally owned, trusted provider of quality, compassionate in-home care in...
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At Emieric, we are proud to offer you and your loved ones the highest quality home care services. Our mission is to go beyond the industry standard by caring for you the way we would care for our own...
Alpha Homecare LLC, Compassionate In-Home Care Services At Alpha Homecare LLC, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort, dignity, and independence. Our...
Green Meadows In-Home Care is dedicated to providing compassionate, reliable, and personalized care for individuals who wish to remain in the comfort of their own homes. Our team focuses on promoting independence,...
Unlike in-home care franchises, Care for SoCal is owned and operated by two nurses-an RN and an LVN-with experience in multiple specialties of nursing and in-home care, for people of all ages and circumstances. Whether...
Basic self-care tasks of bathing, dressing, personal hygiene, and grooming. Our services also include assistance with toileting, incontinence care, and mobility.
OC HOMECARE SERVICES is a home care provider that services in Lake Forest, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Lake Forest Home Care is a home care provider that services in Lake Forest, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We're the best in our field, and it's all thanks to the incredible relationships we've formed with our clients. We're invested in developing a personal connection with each and every one of our customers, by providing...
CARE FIRST HOME CARE, INC. is a home care provider that services in Lake Forest, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Lake Forest Quality Health Care is a home care provider that services in Lake Forest, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Looking for someone to take care of your elderly parent? Need help at home while you’re out of action due to an injury or illness? Care Art Homecare has you covered. We offer customized services for home care in Lake...
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Tender Loving Care is a home care provider that services in Lake Forest, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Top Quality Health Care - Lake Forest, CA is a home care provider that services in Lake Forest, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Griswold Home Care for Laguna Hills, we offer compassionate in-home care for those who want support to live where they love. With over four decades of experience and a storied legacy of compassion and integrity, we...
At Gentle Breeze Home Care, we provide compassionate, personalized in-home care services designed to meet the specific needs of each client, we prioritize their welfare and comfort. Our commitment is to go above and...
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PARISIAN HOMECARE, INC. is a home care provider that services in Lake Forest, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
LFQ SENIOR CARE DBA LAKE FOREST SERVICES is a home care provider that services in Lake Forest, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Safe Guard Care Services, our mission is to provide compassionate, high-quality, and personalized care that enhances the well-being and dignity of every individual we serve. We are dedicated to fostering a safe,...
Since 1996, Always Best Care has helped thousands of families with non-medical in-home care and assisted living referral services. Our passion for helping people maintain a safe, independent and dignified lifestyle...
As a family owned, not for profit organization, Canaan Home Care is at the forefront of the home care industry. Canaan has been a partner of the State of California for over 25 years, together, raising the home care...
With Koda Caregiver personal care services, we help your relative or loved one with intimate non-medical care needs. Our companion care services provide daily companionship and assistance with daily living activities (ADLs).
At Senior Helpers, we are here to help anyway we can -- no matter how big or how small the task. Our owners, Sandy and Hector Muñoz, know personally what it's like for the people in need of care and the toll it takes...
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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.