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.
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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:
Happier at Home helps maintain independence, avoiding problems from becoming crises. We improve the lives of our clients by providing compassionate, one-on-one senior care in the comfort of their home or wherever they...
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...
Licensed for Hands on Care and Companion Services Fully Insured Licensed by the Department of Health and Human Services Division of Health Services Regulation Covering 14 counties out the Raleigh office: Wake, Alamance,...
Latita's Helping Hands LLC is a home care provider that services in Rocky Mount, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Stacy Johnson Companion Services, LLC is a home care provider that services in Rocky Mount, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Amada Eastern North Carolina, we provide non-medical in-home care for seniors. We know how important it is for our clients to continue to do the things they love at home, so we help make life easier and more enjoyable.
Our mission is to provide compassionate, personalized care to individuals who need assistance with daily living activities. We understand that aging, illness, or disability can be challenging, and our goal is to help our...
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...
Open-Minded Developmental Services, Inc. (OMDS) in Rocky Mount N.C. offers professional home health care services. The services include a broad range of care and support services for those who are recovering from a...
Tar Heel Home Health Sub Unit is a home care provider that services in Rocky Mount, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Automatic Home Care, LLC is a home care provider that services in Rocky Mount, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Nash County Home Health Agency is a home care provider that services in Rocky Mount, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Innerlogic Health and Home Care Agency is a full-service health clinic, offering primary care, mental health, and addiction services to patients in Raleigh, North Carolina, and the surrounding communities. Our home care...
Amazing Life Home Healthcare, Inc. is a home care provider that services in Rocky Mount, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
All In One Home Care is a home care provider that services Nash and Edgecombe counties. Home care services allow seniors to remain safely in their own home while receiving assistance with personal care and other daily tasks.
LifeSaver Resources, Inc is a home care provider that services in Rocky Mount, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance 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...
Good Shepherd Home Health Care Inc. is a home care provider that services in Rocky Mount, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Ashley's Home Care Agency, LLC is a home care provider that services in Rocky Mount, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We aim to provide the highest quality of care and compassion to all of the clients we encounter. Our focus will be on helping our clients to live a dignified and productive life all while living in the comfort of their...
Quality Home Staffing is part of the CBHomeCare Family of Providers. For over twenty years, we have been the premier local resource dedicated to providing high quality, reliable Personal Care Services, Private Duty,...
Options For Senior America - Cary is a home care provider that services in Rocky Mount, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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.