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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:
At Lyfetyme Home Care, we prioritize your well-being and comfort in your home, the place where you have experienced a Lyfetyme of great memories and milestones. Our team is dedicated to delivering professional and...
Many Blessing Home Health LLC is a trusted non-medical home care agency proudly serving Portsmouth, Virginia, and surrounding communities. We are dedicated to enhancing the quality of life for seniors and individuals with...
PACE is designed to keep seniors independent and at home for as long as possible. InnovAge PACE – Program of All-inclusive Care for the Elderly – provides healthcare and social services to seniors without moving them...
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...
Prestige Home Health Care Agency and Services, LLC is a home care provider that services in Newport News, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance...
Families First Home Health Agency, LLC is a home care provider that services in Newport News, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Active Daily Living Home Care, LLC is a home care provider that services in Newport News, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Personal Touch Homecare Of Va is a home care provider that services in Newport News, VA. 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,...
We prioritize dignity, independence, and quality of life, ensuring that every individual receives the best possible care in a safe and supportive environment.
At Nurse Next Door of Hampton Roads, we do senior home care differently. We make it possible for seniors to live in their own home. Nurse Next Door’s extraordinary family of Caregivers can take care of your loved one so...
Rosetta Home Healthcare, LLC is a home care provider that services in Newport News, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our mission is to provide high-quality, cost-effective home care services to every client we serve; to give them peace of mind knowing that their needs are taken care of; and, to match them with caregivers who are...
Caring Touch,VA is a home care provider that services in Newport News, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Tama Home Health Care Services is a home care provider that services in Newport News, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Comfort Keepers of Newport News, VA is a home care provider that services in Newport News, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
By Grace Home Care is a home care provider that services in Newport News, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We are helping a growing population of older adults; their families and members of the healthcare community navigate a new era of transportation need. Our team of cheerful, conscientious and safety focused companions and...
Caring Touch,VA is a home care provider that services in Newport News, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Simply Amazing Services LLC is a home care provider that services in Newport News, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Hope In Home Care LLC is a home care provider that services in Newport News, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Riverside Home Health is a home care provider that services in Newport News, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Heavenly Home Care Services LLC is a home care provider that services in Newport News, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Guardian Light Home Health LLC is a home care provider that services in Newport News, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
I AM Companion Home Care is a Licensed & Bonded Virginia Limited Liability Company based in the City of Newport News offering home health care services. The company is locally owned and operated.
Community Home Health, LLC is a home care provider that services in Newport News, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Heartfelt Loving Private Care, LLC is a home care provider that services in Newport News, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Caring Hearts Telecare LLC is a dedicated home care agency committed to enhancing the quality of life for individuals who require assistance in the comfort of their own homes.
With Care Advantage in-home care locations across Virginia, we are poised to deliver the best possible services to all manner of clients in their home. We vow to make a positive contribution in the communities we serve...
The Home Instead® network is the world's largest provider of non-medical in-home care services for seniors, with more than 900 independently owned and operated franchises in 14 countries, spanning four...
Let Home Helpers & Direct Link of Hampton Create a Customized Home Care Plan to Fit Your Lifestyle! Meet Keith & Melissa Smith, Owners of Home Helpers of Hampton. The Smiths have been dedicated to the community for...
At Interim HealthCare, we've been helping our neighbors throughout Virginia improve their health and well-being since 1991. Our exceptional home health staff includes skilled nurses, physical, occupational, and speech...
At Progressive Healthcare Services, 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...
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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.