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:
At BrightStar Care of Lake County, we believe in giving more. Not only to the people we serve, but also to our community. We do it through a variety of high-quality, compassionate care and unparalleled support for our...
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Whether you're a new client, a family member, or part of our caregiving team, we are committed to providing exceptional, personalized support that enhances the quality of life for every senior we serve. As a locally owned...
At BrightStar Care of Lake County, we believe in giving more. Not only to the people we serve, but also to our community. We do it through a variety of high-quality, compassionate care and unparalleled support for our...
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Helping Hearts is a trusted home care agency in Indiana dedicated to providing compassionate, personalized in-home support for seniors and individuals with special needs. Our trained caregivers assist with daily living...
Senior Helpers of Crown Point takes great pride in being a part of the community and helping to improve the lives of senior citizens. Since our opening in 2008 we have assisted over 1000 Northwest Indiana families. We...
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Here at Senior Home Care LLC, we provide reliable and affordable home care, structured family care and adult daycare services to clients in the counties of Lake, Porter, Elkhart, Hamilton, Marion, Hendricks,...
JONESZZZ COMPASSION CARE LLC is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Choosing Abundant Home Care in Merrillville, Indiana ensures compassionate, professional support tailored to your unique needs, fostering a nurturing environment where you or your loved ones can thrive in the comfort of home.
Home Care Services of Northwest Indiana is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
SAFE CARE SPOT LLC is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
CARE FOR ALL, LLC is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A FAMILY THAT CARES PERSONAL CARE CPR CLASSES CO is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance...
Caring Hands Loving Heart LLC delivers compassionate, personalized in-home care services for seniors and individuals with disabilities. Our dedicated caregivers provide support with daily tasks, medical care, and...
Healing Hearts And Home Inc is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
GOD'S HELPING HANDS PERSONAL SERVICES NWI LLC is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Options For Senior America - Lake County is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Abode Home Care, we are passionate about providing personalized care to individuals who require assistance with daily activities while remaining in the comfort of their own homes. Our dedicated team is committed to...
LIFE BUILDERS HOMECARE SERVICES LLC is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Serenity At Home, LLC is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Comforting Hands Home Care Services is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Atlas Home Health Services, Inc is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
"To provide compassionate care & improve the quality of life of those we serve" Having the right caregiver is essential to your loved one's caregiving. Kindred Spirits Home Care highly trained, background checked,...
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CORPORATE COMPANIONS OF INDIANA LLC is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
The Agency’s mission is to provide paraprofessional services to clients in their place of residence thereby assisting them to realize his or her highest level of independence and quality of life. We are committed to...
LIFE AT HOME SENIOR CARE, LLC is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Interim Healthcare is a leader in the home care industry with 50 years of experience. We provide supportive services to frail and disabled individuals allowing them to remain independent in their homes. Our care...
Prime Care Home Health Services Inc is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Unlimited Love and Care, we provide exceptional, non-medical in-home care services to clients in Merrillville and Northwest Indiana counties. Our dedicated caregivers offer personalized support to enhance the quality...
CARING CAREGIVERS PERSONAL CARE LLC is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
J&J Heavenly Blessed Services LLC is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Divine Family Care LLC is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bright Path Support Service provides compassionate and personalized in-home care for seniors and individuals with disabilities. Our dedicated caregivers offer assistance with daily tasks, medical care, and companionship,...
Option Healthcare Inc is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Addus is proud to be a nationally recognized provider of high quality, in-home care services with over 30 years experience. Our breadth of services include Contractual Home Care, Personal Care, Homemaker, Respite, Care...
Ripple Effect Home Care, LLC is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Christian Home Health Services is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ELITE CARE PSA, LLC is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Lmr Indiana Home Care Inc is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Adarna Home Health Care Services Inc is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Residential Clinical Services Inc is a home care provider that services in Merrillville, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Quality Home Care for Northwest Indiana Area Seniors RightCare is our comprehensive approach to delivering the care your loved one needs. It starts by having the right people delivering the right services the right way....
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...
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.