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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:
Premier Senior Care is the leading in home senior care provider in California, specializing in Alzheimer's & Dementia Care. It is an established and respected senior care provider offering senior home care, personal...
Pacific Coast Homecare Caregivers are passionate about helping older adults live healthy and well in their own homes as they age, improving their quality of life and that of those who love them.
We proudly provide non-medical home care services to individuals with disabilities, injuries, difficulties with mobility, or illnesses. We are composed of highly trained and competent staff members who are dedicated and...
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...
As loved family members age, it can become increasingly difficult to provide them with the attention and care they require. Homewatch CareGivers of Northridge understands these challenges and has been providing...
Recently Awarded The Top 100 Leader in Experience with the highest Overall Satisfaction (OSAT) scores. We are #1 in Fresno and Kern Counties, and #2 Across the United States.
Home Instead - Simi Valley, Ventura County, CA - Duplicate is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or...
FirstLight Home Care of Santa Clarita, CA (353) is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Senior Home Care Living is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Craig and Joy Michayluk and Glen Schecter are the owners of Amada Senior Care Ventura County, a business based on their long-held belief that serving seniors and veterans is a great privilege and a lifelong...
Fidelity Home Health Care Inc is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Absolutely Able Home Care provides outstanding in-home care for seniors and for all people, regardless of age or medical condition. Our experienced caregivers provide a wealth of services and are extremely friendly and...
Home Instead - Simi Valley, CA is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Professional Care Home Health Services Inc is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Divine Care Home Health Services Inc is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Exceptional Home Health Services Inc is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Guardian Angel Home Health Agency Inc is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Jubilee Home Health Care Inc is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We have a genuine concern for the health and well-being of others and an incredible opportunity to help people live their best lives. By focusing on relationships, we create caring environments where people are encouraged...
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,...
Innerjoy Home Health Services Inc is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
AM-Swiss Elderly Care Inc. is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Adventist Health/Home Care Services is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Magnificent Healthcare Systems Inc is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Gibraltar Home Health Services, LLC is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A-1 Home Health Services Inc is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Summit Home Health, Inc is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Genesis Home Health, Inc is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ABSOLUTE COMFORT HOME HEALTHCARE, INC. is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A Flying Eagle Home Health is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Hearten Home Health Inc is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
AAA Home Health Care Inc is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
“EXCELLENT CARE IS OUR COMMITMENT ” Two Girls Home Care is an Independently-Owned Home Care provider. We provide non-medical home care services and personal care assistance. We provide an innovative and specialized...
Dependable Home Care Services Inc is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Since 1996, Always Best Care has helped thousands of families with non-medical in-home care and assisted living referral services. Our passion for helping people maintain a safe, independent and dignified lifestyle...
At Senior Helpers Westlake Village, we believe that getting the best care for your loved one should not be complicated. We are fully committed to delivering affordable, high-quality in-home care to seniors in the Orange...
All City Caregivers, Inc is a home care provider that services in Simi Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At our family-owned Homecare agency, we pride ourselves on providing exceptional, personalized care tailored to each individual's needs. Our compassionate and highly trained caregivers ensure the highest level of service,...
At Friends and Family Home Care, we understand the importance of comfort and familiarity. That's why we bring professional care right to your doorstep, ensuring your loved ones receive the support they deserve in the...
At Home Helpers we work with seniors that have reached the point in their lives where they need and deserve help to continue living independently at home or in a senior community. This help might include preparing meals,...
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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.