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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:
Primewell Health Care Services delivers personalized, compassionate home and community-based care, helping clients maintain independence and dignity. Their trusted team offers services like personal care, companionship,...
We’re here to help you continue living independently. If you or a loved one is having trouble with activities of daily living, home safety or personal care, we can provide a specialized program to make life easier and...
Optimum Senior Care Optimum Senior Care offers in home senior care and caregiver services to the elderly population in the Chicago Metro area. Our mission is to cherish and protect the independence and dignity of our...
Cornerstone Caregiving is proud to provide exceptional in-home care in North Chicago and its surrounding areas. We offer a wide range of services including veteran’s care, palliative care, respite care, senior care,...
At Evanston CareNow Homecare it is our mission to provide our older adult with exceptional home care services and achieve the optimum wellness the older adult deserves.
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...
Perennial Home Care Services LLC is a home care provider that services Chicago, IL 60634. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with personal care...
At Caring Hands Home Nursing Care, we believe that caring is more than just a job – it’s a way of life. That’s why our caregivers mean so much more to the people, families, and organizations they serve. Caring Hands Home...
COMPASSIONATE & PROFESSIONAL HOME CAREGIVERS If you have a loved one who needs extra care, whether it be due to aging or lifelong challenges, trust the team at Home Helpers® Home Care! We are a professional and...
Resurrection Home Care LLC is a leading provider of in-home care services in the United States. Our mission is to provide compassionate and personalized care to seniors, individuals with disabilities, and those recovering...
Since opening the doors in 2011, our mission at Always Best Care Glenview and the North Shore has been to enable seniors to remain as independent and safe as possible wherever it is they call home. We do this through...
Guardian Angel Home Care, Inc is a home care provider that services in Niles, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Serenity Home Healthcare LLC provides compassionate and personalized in-home care services for seniors and individuals with disabilities. Our dedicated caregivers assist with daily activities, medical support, and...
Homeland Home Health Provider, Inc is a home care provider that services in Niles, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Alert Home Health Care, Inc is a home care provider that services in Niles, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Nurse Experts LLC is a home care provider that services in Niles, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Life Options Health Services is a home care provider that services in Niles, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Homehealth Of America, Inc is a home care provider that services in Niles, IL. 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,...
Seniors Choice Healthcare, Inc is a home care provider that services in Niles, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
OUR MISSION Letting our clients focus on what makes them happy. We’ll worry about the details! Does someone you love need home care? Caring professionals from Golden Heart Senior Care Chicago are available today to...
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...
Private Home Care - Niles, IL is a home care provider that services in Niles, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Jennifer Novy, owner of Amada Senior Care North Shore, has dedicated her professional and personal life to caring for seniors. As a life-long Chicagoan, she now uses her senior care experience to help neighbors in Lake...
At Senior Helpers of Elmwood Park, we are dedicated to providing exceptional in-home care services that promote independence, dignity, and a higher quality of life for our clients. Our compassionate and highly trained...
Vision & Mission At FirstLight Home Care, we envision a world in which all adults may age with comfort, dignity and independence in the place they call home. We exist to help people have their best day, every day. Our...
Jayron Home Care, Inc is a home care provider that services in Niles, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
North Shore Compassionate Care is the ideal solution for elderly or disabled individuals who want to maintain their independence and dignity by continuing to live in the comfort of their own homes. Our home health...
Senior Helpers North Side Chicago is a mother and daughter run business. We are proud to be 100% female owned. We come from a big family and love being part of a business that supports and promotes the well being of...
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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.