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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.
✔
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:
Giving Hearts Home Care provides assistance with activities of daily living such as bathing, dressing, meal preparation, housekeeping, laundry, med reminders, ambulation, appointment transportation, and other tasks. Our...
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...
Prestige Companion & Homemakers, LLC is a home care provider that services in Bridgeport, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
A & B Homecare Solutions - New Haven is a home care provider that services in Bridgeport, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
Our programs enable individuals to receive the care they need in their homes and communities that reduces the need for an out-of-home placement or living in traditional nursing facilities. With the use of strength-based...
Trustworthy Home Care Agency will effectively oversee and deliver quality care, cost effective non medical home care services, geriatric care management and oversight for critical care needs of each client and family in...
Seven Stars Home Services is a home care provider that services in Bridgeport, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Precise Care , LLC is a home care provider that services in Bridgeport, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Alexander Home Care LLC believes in promoting independence and safety, we offer excellent care to individuals and families in Fairfield county. We are committed to providing high quality, patient centered services to...
At Chosen Homecare, LLC, our mission is to deliver compassionate, high-quality, and personalized home care services that empower individuals to live with dignity, independence, and comfort in their own homes.
The Agency’s mission is to provide paraprofessional services to clients in their place of residence therby assisting them to realize his or her highest level of independence and quality of life. We are committed to...
Able 2 Care is a home care provider that services in Bridgeport, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our caregivers help your loved ones turn the little things into big accomplishments. Give your loved one the confidence to achieve the simple goals meaningful to them. We Make Home Care Easy. Care You Can Count On!
Bethel Home Care of CT is your one stop services center for all home care services for seniors and those that need assistance with ADLs. In Home Care is care that allows a person with special health needs to stay in...
Vicarah Private Duty Agency - Bridgeport, CT is a home care provider that services in Bridgeport, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
4 Nurses at Work LLC is committed to providing Non-Medical quality care to all our clients. We provide the highest quality In-home care services for the elderly and to all that may be in need of assistance. We...
BECK N CALL HOMECARE is an in-home service provider that assists individuals and families. We are dedicated to helping our clients lead dignified, independent lifestyles in the comfort and safety of their own homes by...
Unicare, LLC is a home care provider that services in Bridgeport, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Zuma Caring Services is a home care provider that services in Bridgeport, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Visiting Nurse Services of CT is a home care provider that services in Bridgeport, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Happier At Home-Bridgeport is a home care provider that services in Bridgeport, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We are on the border of Trumbull, Shelton, Stratford and Bridgeport. We serve Fairfield and New Haven Counties. We have been in business for 20 years. We are a CT Licensed Homecare Agency. We are not a registry, we...
Seniors Helpers of Fairfield was established in 2017 by Katie Vanovitch and her husband Joel. This business is truly personal, as Katie and Joel watch their own parents grow older and struggle with maintaining their...
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...
Since 1984, the founders of Preferred Care at Home have had the privilege of assisting clients improve their quality of life while still recognizing and maintaining their dignity and independence. Preferred Care at Home...
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,...
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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.