Are you sure you want to exit? Your progress will be lost.
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.*
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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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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...
Home Matters Caregiving is compassionate care you can depend on. Discover the benefits of professional caregiving in the comfort of your home. Learn how a Professional Caregiver can help create great days for your...
Some services we offer: Companionship Homemaking Personal Care Respite Care Hourly Care Live-in Care Nursing Assessment & Visits Essential Transportation & Transition Care Concierge
Care With Passion LLC is a home care provider that services Clifton, NJ 07013. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with personal care and other...
To provide compassionate and exceptional home care services that empower individuals to live with dignity and independence. We are committed to delivering high-quality, personalized care tailored to the unique needs of...
Seniors Helping Seniors® Essex County can help you empower your loved one. We know taking care of a senior family member sometimes presents challenges. Don’t go it alone. Give your loved one the independence they deserve,...
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Exceptional Home Healthcare and Long-Term Care Insurance Advocacy. Welcome to Amada Senior Care of North Central New Jersey (Westfield / Morristown) the premier home healthcare provider headquartered in Cranford, NJ....
Our goal is to promote independence for our clients by providing compassionate care in the comfort of their homes. patient Often individuals require assistance with one or more of their activities of daily living such...
Our values are simple. Silver Fox Home & Health Care strives to offer excellent and affordable home health care services to individuals and families of in our community. Most seniors prefer to stay at home where their...
Maxim Home Care Services South Orange, NJ is a home care provider that services in West Orange, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
GOHEWEC HEALTHCARE PROVIDERS CONNECT, INC. is a home care provider that services in West Orange, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Preferred Care At Home of Northeast New Jersey is a home care provider that services in West Orange, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Green Hill, located in West Orange, New Jersey, is among the most experienced senior living communities providing over 140 years of compassionate personal care. Green Hill offers a catered lifestyle for the more...
When Family Can't Be There, We Can Be There. We believe in providing a pro-active approach to the delivery of care and services to our aging clients, thus the management and continued overall monitoring is an important...
Right at Home - Essex County, NJ is a home care provider that services in West Orange, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We provide a wide range of services, including in-home care, companionship, personal assistance, and specialized support for seniors with Alzheimer’s, dementia, and other health conditions. Our team of trained caregivers...
Jersey Care Home Health Program is a home care provider that services in West Orange, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Wellpath Home Health Services offers personalized in-home healthcare services that assist with daily activities. Their mission is to provide compassionate, high-quality care that enhances the well-being of patients in the...
Precious Hands has been serving the community for years. Our agency strives to provide you or your loved one with outstanding care. We provide service seven days a week, from a few hours to twenty-four hours a day....
Premier Home Health Care - West Orange is a home care provider that services in West Orange, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Patient Care Medical Services, Inc is a home care provider that services in West Orange, NJ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ComForcare understands that today's busy lifestyles often deprive family members of the time necessary to provide hands on assistance and companionship for their loved ones. Therefore, we want every family we service to...
We help seniors with the different routine activities of daily living from the comfort of their own homes through our senior care in New Jersey. Our services can be personalized to suit your specific care needs, including...
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.