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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:
As a provider of home care services in Bloomingdale, Illinois, we are committed to providing compassionate home health care rooted in the values of doing what is right and noble. Inspired by the Hebrew word “Mishle,”...
APEX Health Services comprises a team of experts who redefine the continuum of health care model for optimal patient outcomes. We are committed to innovative care models that provide a full spectrum of services evolving...
CareDiem Home Care is a licensed and bonded home care agency that provides companion, sitter, personal, respite, dementia care, sitter services, overnight care, transitional care and onsite-catered care. Our mission is...
Samaritan Senior Care is a licensed elderly home care provider with over ten years of experience. Our compassionate caregivers assist elders in maintaining independence and offer comfort to family members who might...
We replace nursing homes with in-home care. We ensure your parent or loved one is taken care of; from grocery trips, home chores and nutrition planning all the way to non-medical administration. We're your 'eyes and ears'...
We all need help, be it little or big, from time to time. And, while a lot of seniors or elderly individuals or seniors seek support from their family and friends, there may be many situations when and where it is...
Harvest In-HomeCare Inc. - Plainfield, IL is a home care provider that services in Oak Brook, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We understand the difficult feelings, when life has changed your loved ones ability to live independently. Amazing Care offers help ranging from occasional light housekeeping to continuous live-in support to those who are...
At 2nd Family Home Care of Glen Ellyn, IL we believe that care begins with compassion. As a trusted provider of non-medical home care services, our mission is to bring comfort, dignity, and independence to every...
We are a dedicated homecare services provider committed to delivering exceptional care to those in need. Our goal is to enhance the lives of our patients and their families by providing comfort, support, and dignity.
Private Home Care - Niles, IL is a compassionate and reliable provider of in-home care services, dedicated to supporting individuals in the comfort of their own homes. Specializing in personalized care plans, they offer a...
Our mission is to keep families or individuals content in their own homes, to maintain the quality of life they have come to expect. Give all our clients of all ages and their families compassionate care that encompasses...
Cornerstone Caregiving stands apart in offering compassionate, authentic assistance for your loved ones. We are senior care professionals with 20+ years of experience in the caregiving field who are willing and ready to...
Home Instead, Inc. began franchising in 1995. Today, the Home Instead® network has grown to include more than 1,200 franchises around the world. While our franchise network is international, our office is local. And to...
Senior care services from Home Instead® help to enhance the aging experience by providing practical support at home with a human touch. Our professional caregivers immerse themselves into wherever home is to assist with...
BrightStar Care of Oak Brook, IL is a home care provider that services in Oak Brook, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Apex Home Health Care, Inc is a home care provider that services in Oak Brook, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We believe that providing professional and compassionate home care will help increase a person’s overall wellness, dignity, and confidence. For this reason, our caregivers are dedicated to supporting our clients’...
Supreme Home Health, Inc is a home care provider that services in Oak Brook, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Delta Home Health Care, Inc is a home care provider that services in Oak Brook, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Best Care Home Health, Inc is a home care provider that services in Oak Brook, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Healthcare Partners At Home, Llc is a home care provider that services in Oak Brook, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Amazing Medical Care, Inc is a home care provider that services in Oak Brook, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Alc Home Health is a home care provider that services in Oak Brook, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Independence Plus Inc. is a home care provider that services in Oak Brook, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
In-Home Care Provider Your Care Is Our Responsibility Bringer of Joy is committed to providing high quality, client-centered and affordable Home Care services to its clients to assist them to lead dignified and...
Summit Home Health is a home care provider that services in Oak Brook, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Growing up in the house “on the corner” was truly special. Mom cared not only for our family, but for the whole neighborhood. When Alzheimer’s knocked at her door, our family answered the call to care for her the way she...
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...
Senior Helpers of Greater Chicagoland is the premier provider of in-home senior care. We offer tailored home care services ranging from companion care for seniors who need daily assistance to in-depth specialized care for...
Home & Hearth Caregivers is available 24/7 for you or your loved one. We serve Cook, DuPage, Kane, Kendall, Lake, McHenry and Will counties. Our experienced Care Plan Managers will be happy to provide a complimentary home...
Home Helpers Home Care, serving the Western Suburbs of Chicago, provides compassionate care for those that need a little extra help to remain safe and independent in their own home. We are licensed by the State 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.