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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.
✔
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:
Our mission is to provide our clients with the best healthcare assistance available in a family-home atmosphere. We believe that the comfort and compassion our team provides can boost the wellness and well-being of our...
At Amada Senior Care in Hastings, Minnesota, providing exceptional in-home care is our top priority. Our caregivers and expert administrative team offer dedicated support to your aging loved ones, both in their own homes...
Welcome to Anytime Home Care LLC, your trusted provider of compassionate and reliable home care services in Minnesota. At Anytime Home Care, we understand the importance of maintaining independence and dignity while...
We’ve been there, and we get it—caregiving is tough, whether you’re giving or receiving. That’s why at Home Instead®, we prioritize real, meaningful relationships. We support those providing care, honor the dignity of...
At All Scope Health, we believe exceptional care covers every aspect of well-being. Our caring team provides individualized support from help with daily routines to meaningful companionship and condition-specific...
When seeking a care service for seniors, those with disabilities, illness or recovering from injury or surgery, there are many factors to consider. You undoubtedly have many concerns and reservations. This is perfectly...
Connection Care Services LLC is a trusted home care provider dedicated to enhancing the quality of life for seniors and individuals in need of daily living support. With compassionate caregivers and personalized care...
Our in-home care services brighten the lives of seniors, who can benefit from a helping hand and a friendly smile. Our caregivers, who are seniors themselves, make your life easier through compassionate support,...
Senior Helpers of Stillwater, MN is a home care provider that services in St Paul, MN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We’ve been there, and we get it—caregiving is tough, whether you’re giving or receiving. That’s why at Home Instead®, we prioritize real, meaningful relationships. We support those providing care, honor the dignity of...
Honesty Home Care LLC is a Minnesota-based in-home care agency committed to helping seniors and adults remain independent and comfortable in their own homes.
Our mission here at Leophane Care: To enhance the health and well-being of our community by providing compassionate, high-quality healthcare services through dedicated professionals and advanced medical practices.
Joyful Hearts Homecare is committed to helping seniors and their families during the aging process. While services differ between clients, our goal is to ensure all seniors receive high-quality, joyful care. We treat...
We’ve established ourselves as a leader in trustworthy, experienced care for children, chronic patients, and those aging in place with a team with the skills and know-how to deliver on our promise.
We provide a variety of needed in-home senior care services, like general companionship, light housekeeping, cooking, shopping, transportation to / from appointments or events, medication reminders, fall prevention...
We’ve been there, and we get it—caregiving is tough, whether you’re giving or receiving. That’s why at Home Instead®, we prioritize real, meaningful relationships. We support those providing care, honor the dignity of...
Senior Helpers of Minneapolis–St. Paul and Surrounding Areas provides compassionate, reliable in-home care to seniors across the Twin Cities. Locally owned and operated by Paul and Laurie Barthol, who bring more than 15...
Senior Helpers Burnsville is committed to a customized plan of senior care for your aging loved one. Supervised by Kristie Beaudet, RN, our caregivers provide quality care and personal assistance with a long history of...
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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.