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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:
Care Indeed provides non-medical home care services to seniors: personal care, support with mobility, help with household chores, companionship, and transportation. We also send our trained and experienced caregivers,...
On Lok PACE is a full-service healthcare program that provides the services you need to age at home. Our services include home care, medical, transportation and other senior services. On Lok PACE: Empowering you to live...
Providing care solutions in the comfort of your own home or place of residence. Residential Rehabilitation Facilities Assisted Living Facilities Board & Care homes Independent Living Facilities
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...
WelbeHealth is a Program of All-Inclusive Care for the Elderly (PACE), full-service healthcare provider that helps you live your life healthy and happy, in your own home.
Care Indeed Homecare Services are designed to meet the needs of families requiring personalized homecare for loved ones from qualified non-medical or medical caregivers as required. In addition to age-related issues,...
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 Griswold, care is personal, and we’ll work with you to create a care plan that best meets your needs, including companionship, homemaking, and personal care. We support those with certain conditions, illnesses, or...
Nurse Next Door - Santa Clara, CA is a home care provider that services over 40+ zip codes across Santa Clara County. Home care services allow seniors to remain safely in their own home while receiving medical care or...
At FirstLight Home Care of Sunnyvale, we provide exceptional care so that your loved one has the support they need to enjoy the quality of life they deserve in the place they call home.
HomeCare Professionals - South Bay Office, CA is a home care provider that services in Santa Clara, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Dedicated Care Living, Compassionate In-Home Care Services At Dedicated Care Living, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort, dignity, and independence. Our...
Arcadia Home Care - Campbell, CA is a home care provider that services in Santa Clara, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Nu Care is the perfect solution for seniors and others in need who are not ready to leave their home for an institutional setting, but need support to remain at home. We improve your life by providing compassionate,...
Care for Seniors is a home care provider that services in Santa Clara, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Ally Home Care is a home care provider that services in Santa Clara, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At EssentialCare we are passionate about providing the finest home care in Arizona, California, Nevada and Utah for your loved one. On our site you will learn what sets EssentialCare apart from standard care...
Located in Santa Clara, California, Caring With CARE is an in-home care agency providing affordable and quality in-home personal and respite care services to seniors and adult of any age who require extra care.
Living Angel is dedicated to providing compassionate and personalized non-medical in-home care services to the residents of Santa Clara. Our mission is to enhance the quality of life for our clients by fostering...
Pinnacle HR Solutions is a home care provider that services in Santa Clara, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Kaiser Foundation Hospitals Hha-Santa Clara is a home care provider that services in Santa Clara, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Right at Home helps seniors and disabled adults remain in the comfort of their own home. If you or a family member needs assistance with routine daily activities, Right at Home is the helping hand you seek. Our trained,...
TheKey of Santa Clara, CA is a home care provider that services in Santa Clara, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
EVERGREEN COMFORT CARE LLC is a home care provider that services in Santa Clara, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Entrusting your health and well-being to people you personally don’t know can be challenging. You need to ensure that they are capable of doing their job and meeting all of your expectations. At Samaria Elderly Care,...
Special Home Needs is a home care provider that services in Santa Clara, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
24 Hour Home Care - Santa Clara is a home care provider that services in Santa Clara, CA. 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...
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...
For over 15 years, Senior Helpers has been there to help anyway we can -- no matter how big or how small the task. Our owners, Shad Schidel and Alay Yajnik, know personally what it's like for the people in need of care...
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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.