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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:
Greenwich HomeCare is a locally owned and operated non-medical home health care agency dedicated to providing the highest quality home health aides. We are a licensed, bonded, and insured agency serving Greenwich,...
At SENIOR HELPERS of Stamford, CT we are dedicated to supporting families in our community with personalized care, no matter how big or small the task. Our mission is simple: to keep your loved ones safe while maintaining...
For 24 years, TheKey has earned the trust of more than 120,000 clients by delivering 12 million hours of personalized home care each year using our science-backed Balanced Care Method® that actively supports well-being....
Ann's Helping Hands With Warm Heart Where Compassion Meets Care – Right at Home. Our Services Our comprehensive suite of professional services caters to a diverse clientele, ranging from homeowners to commercial...
Our team will be able to assist with your loved one’s non-medical care and can help them avoid having to go to a nursing care facility. We believe that your family member should live their remaining years with dignity and...
FirstLight Home Care of Western Ct. is the business to turn to when you or a family member needs non-medical homemaker or companion care services at home. Our homemaker services include assistance with activities of daily...
Founded on the principles of dignity, respect, and personalized care, we provide high-quality non-medical assistance to seniors, individuals with disabilities, and those recovering from illness or surgery. Operating from...
We live our values authentically. Every action we take supports the best outcomes for our clients, each member of our team takes ownership in delivering on the care and commitments we have made and we build meaningful and...
Our Mission is to provide our clients with options, promote independence, embrace quality of life but more importantly provide a safe space for our seniors, veterans and people with disabilities to participate. With our...
There’s a reason why Unity Home Care LLC, is a leading provider of homecare in Farmington, Connecticut, and that’s simply because we truly care for you! Elderly, injured, ill, and the disabled—we make every high-quality...
Amada caregivers are compassionate individuals trained to provide personal assistance to seniors and other individuals in need. They offer physical and emotional support, ensuring the well-being and comfort of their...
Way Home Care is more than just a home care provider—we’re your trusted partner in caring for your loved ones. Our team is made up of trained, compassionate, and reliable caregivers who treat every client like family.
Our team of caregivers assists with age-related duties that grow increasingly challenging for those who prefer to stay in their homes. No other home care service in the region gives the same degree of individualized and...
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 by providing compassionate care in the...
Reliable Home Care - Westport, CT is a home care provider that services Westport, CT 06880. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with personal care...
Comfort Keepers Home Care is a leading provider of home care services. Our expert caregivers provide customized care plans that may include personal care and companionship-homemaker services. We help seniors and other...
Elshaddai Home Care, Compassionate In-Home Care Services At Elshaddai Home Care, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort, dignity, and independence. Our...
Quality Care is a home care provider that services in Westport, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Absolute Best Home Care, our vision is to be a meaningful contributor to the communities we serve making a lasting impact in the lives of the seniors and giving back to the community.
We are more than just a homecare provider, we are a dedicated team of compassionate professionals whose mission is to help individuals live longer, healthier and happier lives by delivering exceptional services to our...
Elderly Caregivers LLC - Connecticut is a home care provider that services in Westport, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Viera Homecare is your leading provider of world-class homecare services in Connecticut. We specialize in helping seniors maintain their independence while providing peace of mind to their families and loved ones. We also...
Our Goals at Future At Home Care is to elevate the standard of home healthcare by providing exceptional, client-focused services tailored to each individual's unique needs.
At SYNERGY HomeCare of Fairfield, we proudly provide nonmedical care to people of any age. We provide companionship,homemaking help, personal care, memory care and even respite care to individuals and their families in...
Endurance Home Care is a non-medical Home Care Agency in Connecticut. Our mission is to improve the quality and duration of life for our clients while providing enriching opportunities for our Care Professionals. We...
Whether due to a temporary situation such as recovering from illness, injury or hospitalization or something longer-term such as the challenges of aging or a disability, including senior, elder or respite home care,...
Established in 2004, Task Home Care Services, is a Home Health Care company that provides services to clients throughout the state of Connecticut. Our mission is to provide qualified staff to support the right of each...
Through our unique system of in-home care that we call Interactive Caregiving™, our Comfort Keepers® engage clients in their care to enhance their independence and well-being. Interactive Caregiving™ includes four...
WHY US? Love and Care LLC offers quality homecare including homemakers, health aides and companions. We screen compassionate and capable caregivers who can play a critical role in delivery of exceptional home health...
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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.