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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:
We offer our clients personalized non-medical support services in their homes, assisting the elderly, disabled and others needing assistance to maintain quality of life. Our services support the individual’s choices and...
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Home Helpers is more than an in-home health care agency. We are your extended family when family can’t be there. We offer compassionate in-home care assistance and will work with you to provide exceptional support for you...
Feel better in the comfort of your own home. We specialize in care and daily living assistance to an array of individuals. Whether you need daily or weekly assistance due to aging, illness, recovery, or rehabilitation,...
We have been providing specialized care for seniors in their homes for over 25 years in Northwest Indiana. FirstCare Home Care can help ease some of the difficulties people encounter when life presents its challenges. We...
Senior Helpers of Chesterton takes great pride in being a part of the community and helping to improve the lives of senior citizens. Since our opening in 2008 we have assisted over 1000 Northwest Indiana families. We are...
Adair Home Health Professionals is a home care provider that services in Valparaiso, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
An Anchor nurse will perform an in-home or in-hospital assessment and, in conjunction with the physician, determine the client’s individual home care needs. A detailed plan of care will be developed based on the...
Loving Care Agency, Inc is a home care provider that services in Valparaiso, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Back Home Again Inc is a home care provider that services in Valparaiso, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our specialized in-home care is uniquely designed to meet your needs and support your family. We track quality of care to be sure your concerns are quickly addressed. Our highly-trained staff are always available, 24...
First Choice Home Health Services Inc is a home care provider that services in Valparaiso, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Finding the right in-home care can be overwhelming. We simplify the journey, guiding you every step of the way to ensure you receive the compassionate care you deserve.
Associated Homecare Inc is a home care provider that services in Valparaiso, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
TEAM SELECT HOME CARE - Valparaiso is a home care provider that services in Valparaiso, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
BUTTERCUP PERSONAL CARE AGENCY LLC is a home care provider that services in Valparaiso, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Visiting Nurse Association of Porter County is a home care provider that services in Valparaiso, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
FirstLight Home Care provides quality, affordable, non-medical in-home care for seniors, mothers just home from the hospital, those recovering from surgery and other clients with need for companionship or personal care....
FirstLight Home Care is the choice provider in a range of caregiving services for seniors, new mothers, those healing from surgery, and much more. We custom build our Valparaiso home care and caregiver services for the...
Pediatric Nursing Specialists of Indiana is a home care provider that services in Valparaiso, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Help at Home of Valparaiso, IN is a home care provider that services in Valparaiso, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Quality Home Care for Northwest Indiana Area Seniors RightCare is our comprehensive approach to delivering the care your loved one needs. It starts by having the right people delivering the right services the right way....
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...
BrightStar of Valparaiso is a nationally accredited (The Joint Commission) home care company servicing Porter, LaPorte, Starke, Jasper, and Marshall counties in Northwest Indiana. We provide the full continuum of medical...
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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.