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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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...
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St. John The Baptist Human Services, Inc. is a home care provider that services in Baton Rouge, LA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Home Health Solutions, LLC is a home care provider that services in Baton Rouge, LA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Homewatch CareGivers, we pride ourselves on being one of the oldest and most trusted providers of customized in-home care services. We know that inviting someone into your home is an important and complex decision,...
Audubon Home Health is a home care provider that services in Baton Rouge, LA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Always There Healthcare is your trusted partner in senior care services in Liberty, MS. We are a dedicated team of professionals committed to providing exceptional care and support to seniors in our community.
Moore Care - Baton Rouge, LA is a home care provider that services in Baton Rouge, LA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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South Regional Personal Care Services is a home care provider that services in Baton Rouge, LA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Woman's Home Care is a home care provider that services in Baton Rouge, LA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
1st Home Health Kare is a home care provider that services in Baton Rouge, LA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Right at Home - Baton Rouge, LA is a home care provider that services in Baton Rouge, LA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Beyond Measures Healthcare,LLC is a home care provider that services in Baton Rouge, LA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Chase Health Care Inc is a home care provider that services in Baton Rouge, LA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Diversity Health Services, LLC is a home care provider that services in Baton Rouge, LA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Southern Nursing Home Health is a home care provider that services in Baton Rouge, LA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Metro Preferred Home Care, an Amedisys CO is a home care provider that services in Baton Rouge, LA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Autumn Lake was created to build stronger communities through providing quality personal care services. We plan to accomplish this by providing assessments, community support, individualized plans of care, individual...
Psa Healthcare is a home care provider that services in Baton Rouge, LA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Charter Home Health is a home care provider that services in Baton Rouge, LA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Greater Fellowship, LLC is a home care provider that services in Baton Rouge, LA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Sunset Total Care LLC- Baton Rouge, LA is a home care provider that services Baton Rouge, LA 70809. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We offer private pay companionship care with no contracts or commitments. Our experienced team provides PRN services with a 6-hour minimum per day. We provide peace of mind for families in need of last-minute...
Professional Hhs Of Baton Roug is a home care provider that services in Baton Rouge, LA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Pinnacle Personal Care is proud to be Licensed by the Louisiana Department of Health and Hospitals. We strive to provide the best private care in the region. Providing personal services is exactly that, personal. We work...
At Home Care of Louisiana is a home care provider that services in Baton Rouge, LA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bethesda Adult Day Care, LLC is a home care provider that services in Baton Rouge, LA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Unique Home Healthcare, Inc is a home care provider that services in Baton Rouge, LA. 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...
Griswold Home Care of Baton Rouge is a referral service that takes a unique and innovative approach to home care. Griswold matches you with a fully screened, independent professional caregiver based on your preferences....
Seniors Helping Seniors® Baton Rouge recognizes the value of aging in place. So, we offer a range of elder care services that can empower seniors to live more comfortably and safely, extending the time they can remain in...
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.