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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:
We understand that choosing a home health care provider can be a difficult decision. That's why we are committed to providing the highest level of care and support to our clients and their families. Our team of skilled...
Home Instead® is a reliable source of home care for seniors in the West Baltimore and Howard County area. Services include companionship, meal preparation, light housekeeping, med reminders, shopping, errands, more. We...
Senior Helpers Baltimore is the premier provider of in-home senior care. We offer tailored home care services ranging from companion care for seniors who need daily assistance to in-depth specialized care for those with...
Shiloh Healthcare, LLC (Shiloh) is a Maryland State LLC based in Frederick, Maryland. Shiloh Healthcare provides dedicated, committed, and tailored sterling healthcare services for our clients at the comfort and pleasure...
Staffing on the Go was created to solve the complicated nature of hiring quality talent and finding quality jobs in the medical field. Our experienced staff goes through the critical process of verifying every job &...
Yad Lae Zeerah is a dedicated health care provider committed to offering affordable and comprehensive care solutions. Our mission is to ensure that high-quality health care services are accessible to all, regardless of...
A Homemade Plan is a hardworking and caring home care company that is dedicated to its patients, clients, care providers, and community. We are a locally owned and operated company based in Maryland. We help those who...
At Senior Helpers, we are here to serve families within the Howard, Carroll and Frederick areas in any way we can. No matter how big or how small the task. We our licensed, bonded and insured and have screened and...
AMITY Health Care Services is a registered domiciliary care provider serving the Baltimore area. We supply reliable, affordable, and personalized in-home care services tailored to you and your family-specific needs. The...
At AllCare Advanced Home Care, our mission is to provide compassionate and personalized home health care services to our clients. We strive to improve the quality of life for those we serve, while prioritizing their...
Options For Senior America Corp. started providing home care services in late 1989 to the residents of the Washington, DC metropolitan area. What started as a handful of customers grew substantially due to the personal...
Capital City Nurses - Columbia is a home care provider that services in Ellicott City, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Glorious Generation Home Health Care Agency is a home care provider that services in Ellicott City, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Friendly Senior Companion Home Care LLC is a home care provider that services in Ellicott City, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Engage, Enrich, Empower Care in the Home: Five simple but trans-formative principles 1. Learn and grow together. Loved ones with Alzheimer’s or other forms of dementia, can continue to take pleasure in their favorite...
Access Home Health Care Services, Inc is a home care provider that services in Ellicott City, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Feel better in the comfort of your own home. We specialize in care and daily living assistance to an array of individuals. Whether you need daily or weekly assistance due to aging, illness, recovery, or rehabilitation,...
Carebridge, Inc is a home care provider that services in Ellicott City, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ABOUT US Touching Angels Healthcare is a trusted, State Licensed home health agency that has been providing quality, professional and reliable home healthcare services to the residents of Maryland. Our caregivers are...
We at Griswold Home Care Referral Service realize that every home-care situation is unique and that having the correct type and amount of care for your loved one is what provides our clients with peace of mind. Whether it...
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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.