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.
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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:
Kevin Manuel and Greg Hines are the owners of Amada Senior Care in Farmington Hills, and they have hand-picked each of the caregivers on their team to ensure that each of our clients receives the highest level of...
Acti-Kare is a leading in-home senior care company that has been trusted for over a decade. Our caregivers are insured, bonded, and trained which means you will receive a trusted and professional caregiver every time....
Our in-home care services empower seniors to continue to live independent lives by taking care of day-to-day tasks that become more challenging as you age. As your health and personal requirements change, we’re here to...
SYNERGY HomeCare of Northville - Livonia, MI is a home care provider that services in Plymouth, MI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
As Operating Director of Cornerstone Caregiving Dearborn, I focus on delivering high-quality support to the Geriatric and Veteran communities in Dearborn/Dearborn Hts., Westland, Garden City, Livonia, and Plymouth/Canton...
We are Brian and Breanne Stuart, parents to two boys and owners of Homewatch CareGivers of Ann Arbor, serving Washtenaw and Livingston counties. We have a deep passion for caring and serving others and feel blessed that...
Get the Help You Need. Without the Burden & Fuss! Senior Key Care focuses exclusively on elderly clients that wish to live in their own home. Senior Key Care has deep experience in working with Alzheimer's and...
With a whole-wellness approach, we address not only medical needs but also the emotional and personal well-being of each client. Whether you need ongoing care or short-term support, we are committed to helping you and...
BrightStar Care of Novi, MI provides home care and support services for seniors, including 24-hour in-home care, and support in independent and assisted living communities. We provide all levels of home care from...
Caregiving Experts takes a customized approach to working closely with clients and families to design and deliver personalized care plans that are adaptable and flexible to address individual needs. We foster client's...
Classic Home Care, Inc is a home care provider that services in Plymouth, MI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Diamond Home Health Care, Inc is a home care provider that services in Plymouth, MI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
L & L Quality Homecare LLC is a trusted home care agency dedicated to providing compassionate, high-quality support to individuals in need of companion and personal care services. With a focus on dignity, respect, and...
Family Home Health Services is a home care provider that services in Plymouth, MI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Homewatch CareGivers, we are driven by our Mission to preserve dignity, protect independence and provide peace of mind for our clients and their loved ones by providing exceptional home care; by our Vision to be...
At Legacy Place Senior Living Community, we envision a world where every person has access to the resources they need to live a healthy, happy, and fulfilling life. We strive to create a world where everyone has the...
Duplicate-Comfort Keepers of Plymouth, MI is a home care provider that services in Plymouth, MI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Omni Home Care, Inc is a home care provider that services in Plymouth, MI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Esther & Judale Senior Care Services is a home care provider that services in Plymouth, MI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A-1 International Homecare, Inc is a home care provider that services in Plymouth, MI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our care plans are designed to help you preserve your independence and quality of life and our caregivers are dedicated to you. Our number one goal at ComForCare is to help you live your best life. Sometimes you just need...
Companionship is key to a trusted relationship with our caregivers. We not only strive to help you with everyday tasks but want to develop a caring relationship with you. We provide one-on-one attention and care that...
SYNERGY HomeCare of Plymouth, MI is a home care provider that services in Plymouth, MI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Eminent Home Care is a home care provider that services in Plymouth, MI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
WellsBrooke, as a provider of premium home health care services, is dedicated to helping those individuals who, as a result of injury, illness, or aging, need some level of assistance to live a full, safe, comfortable...
Friends of the Family Home Health Care is a home health care company which offers a variety of services to allow your loved one to remain at home in the most comfortable environment. We offer in-home, in-facility,...
Comfort Care Home Care Assistance - Grosse Pointe is a home care provider that services in Plymouth, MI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
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...
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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.