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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:
Welcome to Right at Home Pearl City! How can we help you? Whether a family member needs a little extra help around the house, assistance recovering from a hospital stay or someone to check in on them throughout the week,...
Always Best Care combines national strength and standards with local accessibility and personal service. Your local Always Best Care team will be helping families throughout Oahu, Hawaii or Island to provide non-medical...
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Kokua Nurses Inc is a home care provider that services in Honolulu, HI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Kokua Home Health Agency is a home care provider that services in Honolulu, HI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Prime Care Services Hawaii Inc is a home care provider that services in Honolulu, HI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ISLAND TEMPORARY NURSING is a home care provider that services in Honolulu, HI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
The American population is getting older. Baby boomers are reaching retirement age in larger numbers than any generation before them. This generation is hard working and knows what they want. Many do not want to lose...
LEGACY HOME CARE is a home care provider that services in Honolulu, HI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
HAWAII SENIOR CARE LLC is a home care provider that services in Honolulu, HI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Lilikoi Homecare LLC is a home care provider that services in Honolulu, HI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Kaiser Home Health Agency - Oahu is a home care provider that services in Honolulu, HI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Griswold is an award-winning pioneer in the home care industry, with over four decades of experience and a storied legacy of compassion and integrity. We believe Care Professionals are the foundation of our success, and...
HOLISTIC CARE IN HOME SERVICES LLC of HI is a home care provider that services in Honolulu, HI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
St. Francis Home Care Services is a home care provider that services in Honolulu, HI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Affordable Homecare Services - Honolulu is a home care provider that services in Honolulu, HI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
FirstLight provides non-medical home care in Honolulu for elders, people with disabilities, those recovering from illness, injury or surgery, mothers just home from the hospital, veterans, and anyone who needs some extra...
Careresource Hawaii is a home care provider that services in Honolulu, HI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
All Care Hawaii’s continued success hinges on practicing Aloha with a commitment to each individual client, as well as a commitment to each Caregiver. Combining those commitments with her expertise, and utilizing hands-on...
All Care Hawaii’s continued success hinges on practicing Aloha with a commitment to each individual client, as well as a commitment to each Caregiver. Combining those commitments with her expertise, and utilizing hands-on...
Interim Healthcare is a leader in the home care industry with 50 years of experience. We provide supportive services to frail and disabled individuals allowing them to remain independent in their homes. Our care...
Kokua Care Homewatch CareGivers is a home care provider that services in Honolulu, HI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
BrightStar Care of Honolulu, HI is a home care provider that services in Honolulu, HI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
B Homecare offers in home care services for adults, injured, elderly or anyone needing help with personal care in Hawaii. With an array of care options and their unmatched reputation, B-Homecare is the best and only...
MARIANAS HOME CARE SERVICES is a home care provider that services in Honolulu, HI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Visiting Caregivers is a home care provider that services in Honolulu, HI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Attention Plus Care is a home care provider that services in Honolulu, HI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
HMC Home Care offers families seeking assistance for an aging or ill adult experienced, trained care that is not only task-oriented. We strive to engage with those we care for. Our caregivers are here to ease the concerns...
Senior Helpers® is the nation's premier provider of in-home senior care, with locations all across the country. Our services range from specialized care for those with chronic diseases to companion services for seniors...
It can be challenging to decide whether to place a family member in long-term care or assisted living facility. Homecare services may be the best alternative for providing their needed care.
Senior Helpers® is the nation's premier provider of in-home senior care, with locations all across the country. Our services range from specialized care for those with chronic diseases to companion services for seniors...
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...
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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.