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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:
Home Nursing And Home Services is a home care agency locally-based and privately-owned. Our founders are caregiving professionals who have been in this line of work for years. With their experience, they inspire the rest...
We are committed to providing high quality, client-centered and affordable Home Care services to our clients to assist them to lead dignified and independent lives in the comfort and safety of their own homes. Their...
Vision & Mission At FirstLight Home Care, we envision a world in which all adults may age with comfort, dignity and independence in the place they call home. We exist to help people have their best day, every day. Our...
Optimum Senior Care Optimum Senior Care offers in home senior care and caregiver services to the elderly population in the Chicago Metro area. Our mission is to cherish and protect the independence and dignity of 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...
GYC Senior Care Services is a home care provider that services in Northbrook, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Recognized For Our Devotion To Clients and Caregivers Our goal is not to be the biggest home care company, it's to be the best home care company. The most accurate way to measure that standard is comparing ourselves to...
Senior Helpers of Greater Chicagoland 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...
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...
At Care Advocate of Illinois, Inc. your safety is ensured while your health is kept in check. We believe that bringing quality home care is where healing starts and ends. You can experience this when you become one of our...
With home care services, our office can provide personal care plans through an in-home evaluation and interviews between the client, family and the ComForCare team to help determine the best plan of action for the...
PROVIDING CARE BEYOND COMPARE ALMOND HOMECARE LLC is a dedicated and compassionate organization that aims to provide exceptional and quality in-home care services for the elderly.
Open Arms Solutions of Northbrook, IL is a home care provider that services in Northbrook, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Anytime Home Care of Northbrook, IL is a home care provider that services in Northbrook, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Americhoice Health Care, Inc is a home care provider that services in Northbrook, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Wellcare Home Health, Inc is a home care provider that services in Northbrook, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Welcome to Live In Caregivers! Personalized Care Solutions. We understand the importance of providing round the clock care to our clients while ensuring cost effectiveness and quality service. We take pride in...
Brightstar Care of Northbrook IL is a home care provider that services in Northbrook, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
"COMPASSIONATE, SUPPORTIVE CARE IN THE HOME." At Sienna Home Care, Inc. we strongly believe that the best place to be is at home. We understand the importance of personal care, and are dedicated to providing the highest...
For many people, our in-home senior care is the best solution for maintaining a healthy lifestyle and loving relationships. Whether a family member needs a little extra help around the house, assistance recovering from a...
Elite Home Health Care, Inc is a home care provider that services in Northbrook, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
BG Home Health Providers, LLC is a home care provider that services in Northbrook, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Providence Home Health Care, I is a home care provider that services in Northbrook, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Mafolux Healthcare understands what it takes to ensure that your loved ones have access to exceptional healthcare services while staying in a familiar environment. That is why we make every effort to provide tailored...
Vita Health Care Inc is a home care provider that services in Northbrook, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
WHY LIFECARE? At LifeCare we listen… Our highly trained personnel will ensure continuity of care by working closely with the health care professionals and your family to develop and provide the care plan tailored to your...
Advanta Home Health Care, Inc is a home care provider that services in Northbrook, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Cardinal Homehealth, Inc is a home care provider that services in Northbrook, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
NorthShore FamilyCare is the premier non-medical home care agency providing a wide range of in-home care services to the 14 north suburban communities along Chicago's north shore. NorthShore FamilyCare is a locally-owned...
At Open Arms, our caregivers are inspired to make a difference in their clients’ lives every day. Our caregivers receive specialized training in caring for people with chronic and degenerative disorders and through skills...
Jennifer Novy, owner of Amada Senior Care North Shore, has dedicated her professional and personal life to caring for seniors. As a life-long Chicagoan, she now uses her senior care experience to help neighbors in Lake...
North Shore Compassionate Care is the ideal solution for elderly or disabled individuals who want to maintain their independence and dignity by continuing to live in the comfort of their own homes. Our home health...
BrightStar Healthcare is a full service, private duty healthcare and medical staffing company. We provide a full range of medical and non-medical services to private patients in their homes or assisted living facilities,...
Our home care agency provides home health care services ranging from 24/7 live-in home care to 1 hours of senior care companionship. That is important when you or a loved one are struggling with daily activities because...
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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.