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.*
✔
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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Let our Reliable team of licensed caregivers provide the dedicated support your loved one needs, so you can handle your other responsibilities, and spend your free time making memories alongside them, rather than laboring...
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We are dedicated to providing exceptional in-home care for those who are in need. Our goal is to help our clients in achieving optimal health. We respect their independence and choices. We provide cost-effective home care...
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Senior Health Care - In Home Aides in Wilmington & Across Delaware Your Own Home LLC offers excellent Delaware in home senior care services. As you or your loved one gets older, maintaining a house can be a difficult...
Maxim Healthcare Services is a home care provider that services in Wilmington, DE. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Whether you're in an assisted living or rehab facility, a retirement community, or spending some time at your home, we can bring in-home care services right to your door!
At Senior Helpers, we are here to help anyway we can. No matter how big or how small the task. We are licensed, bonded and insured and have screened and continuously trained caregivers that are immediately available to...
Since 1987, Griswold Home Care, a non-medical home care office, has been referring caregivers to help people in Delaware stay safely and independently in their homes. The office is licensed with the State of Delaware as a...
For nearly three generations, Homewatch CareGivers has provided premier in-home care services to people of all ages. If your need is Senior Care, Elder Care, Child Care or non medical Home Care, we can provide it. Our...
We've been there. We understand. Neither giving nor receiving care is easy. Home Instead Senior Care® puts relationships first to support those giving care, to protect the dignity of those receiving care, and to enhance...
We ensure our caregivers are highly skilled and compassionate while giving attention to our clients. With them, you can be sure your loved ones are always safe and have the highest level of care. Since we maintain such a...
Aston Home Health, Inc is a home care provider that services in Wilmington, DE. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
"At Homecare Services, Inc., our mission is to enhance the quality of life for our clients through compassionate and personalized home care. We are dedicated to providing high-quality, professional services with...
Addus is proud to be a nationally recognized provider of high quality, in-home care services with over 30 years experience. Our breadth of services include Contractual Home Care, Personal Care, Homemaker, Respite, Care...
Nowcare is a home care provider that services in Wilmington, DE. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Angel Companions is a home care provider that services in Wilmington, DE. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Neighborly Home Care- Wilmington, DE is a home care provider that services in Wilmington, DE. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
BK Temp Home Care is a home care provider that services in Wilmington, DE. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
St. Francis Home Care is a home care provider that services in Wilmington, DE. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Generations Home Care, Inc is a home care provider that services in Wilmington, DE. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Carpe VITA Home Care PASA is a home care provider that services in Wilmington, DE. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Steph's Homecare Services, our mission is to provide compassionate, personalized, and high-quality care that enhances the well-being and independence of those we serve. We are dedicated to fostering a supportive and...
Bayada Home Health Care - Wilmington is a home care provider that services in Wilmington, DE. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Saints Home Healthcare, LLC is a home care provider that services in Wilmington, DE. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Heart 2 Heart Home Care Agency provides compassionate and personalized in-home care services for seniors and individuals with disabilities. Our dedicated caregivers assist with daily activities, medical support, and...
Right at Home - Wilmington, DE is a home care provider that services in Wilmington, DE. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Visiting Angels, we strive to make staying at home a positive experience. We do this by allowing you to select your caregiver from a group of skilled elderly home care providers, allowing you to maintain your schedule,...
Incredible Home Care, Inc. is a home care provider that services in Wilmington, DE. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Let our Reliable team of licensed caregivers provide the dedicated support your loved one needs, so you can handle your other responsibilities, and spend your free time making memories alongside them, rather than laboring...
Private Caregiver Solutions is a home care provider that services in Wilmington, DE. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Help at Home of Wilmington, DE is a home care provider that services in Wilmington, DE. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Haven Home Care is a home care provider that services in Wilmington, DE. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We are dedicated to providing exceptional in-home care for those who are in need. Our goal is to help our clients in achieving optimal health. We respect their independence and choices. We provide cost-effective home care...
Are you seeking assistance for an aging loved one in need of professional home care? Griswold caregivers are happy to help you. We are a provider of non-medical home care services in New Castle County, including respite...
Neighborly Home Care Wilmington is a home care provider that services in Wilmington, DE. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Radnon Home Care LLC is a home care provider that services in Wilmington, DE. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Since 1996, Always Best Care has helped thousands of families with non-medical in-home care and assisted living referral services. Our passion for helping people maintain a safe, independent and dignified lifestyle...
Macklyn Home Care is a home care provider that services in Wilmington, DE. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Southeastern Home Health Services Of Delaware, Llc is a home care provider that services in Wilmington, DE. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance...
Senior Health Care - In Home Aides in Wilmington & Across Delaware Your Own Home LLC offers excellent Delaware in home senior care services. As you or your loved one gets older, maintaining a house can be a difficult...
Maxim Healthcare Services is a home care provider that services in Wilmington, DE. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Open Heartz Care LLC is a home care provider that services in Wilmington, DE. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Whether you're in an assisted living or rehab facility, a retirement community, or spending some time at your home, we can bring in-home care services right to your door!
At Senior Helpers, we are here to help anyway we can. No matter how big or how small the task. We are licensed, bonded and insured and have screened and continuously trained caregivers that are immediately available to...
Since 1987, Griswold Home Care, a non-medical home care office, has been referring caregivers to help people in Delaware stay safely and independently in their homes. The office is licensed with the State of Delaware as a...
For nearly three generations, Homewatch CareGivers has provided premier in-home care services to people of all ages. If your need is Senior Care, Elder Care, Child Care or non medical Home Care, we can provide it. Our...
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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.