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:
We care for patients of all ages in different settings, be it at home, in a hospice facility, in a nursing home, or some other care facility. We believe that everyone should have access to quality care.
Our dedicated team provides heartfelt care, ensuring every senior feels valued and supported. Every individual is unique, so is our care. We tailor support to fit every senior's needs and lifestyle. Comfort and security...
Arcadia Home Care - Pleasant Hill CA is a home care provider that services in Pleasant Hill, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Senior Helpers Concord was opened by Jenny Lind in 2008. She was drawn to Senior Helpers because of their unique approach to in-home care and the continuing education they provide their caregivers. Jenny and her staff are...
With home care services, our office can provide personal care plans through an in-home evaluation and interviews between the client, family and the ComForCare team to help determine the best plan of action for the...
Home Helpers Home Care is a in-home care service that provides top quality in-home care. Our Cared-4℠ program is a holistic approach to meet the four primary areas of need, helping your loved one stay safe and independent...
Center For Elders’ Independence PACE (Program of All Inclusive Care for the Elderly) provides high-quality, affordable, integrated healthcare services to vulnerable seniors promoting autonomy, quality of life, and the...
Searching for a like-minded friend to help tackle chores and tasks? Do you seek a companion to join you in hobbies and activities? Our caregivers – seniors themselves – show up ready to exceed expectations – on a schedule...
At our home care agency, we provide non-medical home care services tailored to your needs, ensuring comfort and support in the familiar surroundings of home.
Senior care matters deeply here in the East Bay Area, where our senior population continues to grow and become more diverse. It's all about improving the lives of our older community members, ensuring their safety, and...
Thrive Home Care now serves the 7×7 city and county of San Francisco. We provide hourly and extended shifts with rates that are affordable and reasonable. Thrive Home Care is dedicated to serve and offer the best quality,...
We believe that care should feel like home — warm, personal, and grounded in love. Our Family-Style Live-In Non-Medical Care offers compassionate, around-the-clock support for seniors and individuals who need assistance...
Abundant Home Care - Pleasant Hill, CA is a home care provider that services in Pleasant Hill, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Partners In Care Services of Concord, CA is a dedicated provider of personalized, compassionate care solutions designed to enhance the quality of life for individuals and families in need. Located in Concord, California,...
Through our unique system of in-home care that we call Interactive Caregiving™, our Comfort Keepers® engage clients in their care to enhance their independence and well-being. Interactive Caregiving™ includes four...
Right at Home - Pleasant Hill, CA (Dupe) is a home care provider that services in Pleasant Hill, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We can help those in need not only by providing quality care at great value, but also by answering questions, offering advice, suggesting resources, or simply listening. Take a minute to look over the information on our...
ASSIST ON CALL, INC. is a home care provider that services in Pleasant Hill, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
JBEO INC. DBA ALL SEASONS HOMECARE is a home care provider that services in Pleasant Hill, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
WECARE HOME ASSISTANTS, LLC is a home care provider that services in Pleasant Hill, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Professional Healthcare at Home is a home care provider that services in Pleasant Hill, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
All Seasons Homecare provides assistance to those who need help with everyday tasks because of illness, surgery, or a chronic condition, yet treasure their independence and want to enjoy the comfort of their own homes. We...
Exceptional care begins with care professionals who feel truly valued and supported in their calling. Our care team is the heart and soul of our business. As a people-centric agency, we prioritize nurturing and equipping...
There is an incredible demand in our society for care professionals, and we are proud to be up to the task. And it's not just for seniors — if a member of your family needs help, we're the place to call. As we are a...
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.