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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:
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Home is where you feel most comfortable. And it’s where you want to be when you or a loved one need high-quality, compassionate care for your companionship and personal care needs.
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Affordable Home Care Associates is a trusted provider of compassionate, reliable, and personalized in-home care services designed to support seniors and individuals with special needs in maintaining their independence and...
Little Bit of Help provides all manner of care for Elders across Marin County. Our team of experts deliver personalized support for individuals and couples. Our service ranges from a few hours a week to 24-hour care as...
At First Light Home Care in Napa, California, and the surrounding areas, we are led by twins Jonathan and Felipe De Souza, whose lives have been shaped by a deep commitment to helping others. Born in Argentina to...
At Interim HealthCare of Vacaville, CA, we know how important it is to be in a comfortable, familiar environment. We all value our independence, however, sometimes the best way to maintain our autonomy, or preserve that...
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.
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...
Atlas Home Health specializes in long-term, private duty home care for both adult and pediatric clients. Each client receives one-on-one support from a dedicated caregiver or care team, with services ranging from basic...
Grace Dairo Care Home is a home care provider that services in Vallejo, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Wellness Home Health Agency, Llc is a home care provider that services in Vallejo, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
PASIFIKA HOME CARE LLC is a home care provider that services in Vallejo, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Mary's Help Home Health Services, Inc is a home care provider that services in Vallejo, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Lifeline In-Home Care Staffing is a leading provider of home care services in Vallejo, California. We specialize in delivering personalized assistance and support to individuals in the comfort of their own homes. Our...
ComForCare Home Care - Vallejo, CA is a home care provider that services in Vallejo, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Mare Island Home Health Inc is a home care provider that services in Vallejo, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Kaiser Foundation Hospital Home Health - Vallejo is a home care provider that services in Vallejo, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
At Gentlehands Home Care in Dixon, California, our mission is to provide compassionate and personalized care that enhances the well-being and quality of life for our clients and their families. We are dedicated to...
Q & R Home Care Services LLC is a trusted provider of personalized home care solutions dedicated to enhancing the quality of life for individuals and families.
Comprehensive Home Health Care & Hospice, Inc., your neighborhood health partner, was founded in 2013 with the idea that health care is at its best when people who deliver it are from the community. We are not a chain or...
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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.