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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:
HomeWell is committed to helping people live life more fully. With a highly personalized care management approach, we strive to provide the highest quality of care in the place where clients feel most comfortable.
Sterling Care is a locally owned and operated home health care agency based in Greenwich, Connecticut. Our service area includes all of the towns and cities in lower Fairfield County. We are the only full service home...
A & B Homecare Solutions - New Haven is a home care provider that services in Stamford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Senior Helpers Fairfield County is owned and operated by Hal Zerman. Thrilled to be in an industry that gives back to the community, Hal is passionate about providing affordable, high-quality home care to both seniors and...
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...
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 Stamford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Visiting Angels, we strive to make staying at home a positive experience. We do this by allowing you to select your caregiver from a group of skilled elderly home care providers, allowing you to maintain your schedule,...
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...
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...
Greenwich HomeCare is a locally owned and operated non-medical home health care agency dedicated to providing the highest quality home health aides. We are a licensed, bonded, and insured agency serving Greenwich,...
At personalized Care at Home LLC, we are committed to helping our clients in the comfort of their home environment with personalized home care services that suit their needs and create a positive experience for our...
Personalized Home Care Ltd of CT is a home care provider that services in Stamford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Grace Home Care LLC is a home care provider that services in Stamford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At NCHC, our Care Team is family centered and family focused. We recognize that the demands and responsibilities of busy life can be challenging and providing the desired level of supervision and attention to your loved...
Patient Care, Inc. has been providing home care services for more than twenty-five years. Our office is licensed as a Homemaker-Home Health Aide Agency by the State of Connecticut Department of Public Health. We are also...
We are a non-medical home care agency based in Norwalk, Connecticut. We are dedicated to providing the best quality home care for you or your loved ones. Whether you are an aging individual who is in need of a little more...
Both Non medical and Medical services. Private pay and Medicare certified enabling us to provide the full range of services under one roof. Companion / homemaker services to seniors, those recovering from surgery, and...
Grace Home Care, LLC is a home care provider that services in Stamford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ComForCare Home Care - Stamford, CT is a home care provider that services in Stamford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our Approach to Concierge Home Care Founded by Cornell-trained, world-renowned experts in Geriatrics, Gerontology, and Hospitality, we believe that as we age, one size does not fit all when it comes to care. We...
Vn Hospice Care Of Southwest is a home care provider that services in Stamford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
SYNERGY HomeCare of Stamford, CT is a home care provider that services in Stamford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Dawn to Dusk Home Health Care, Inc. offers a unique combination of premier home health care and community-based social services to Fairfield County, CT and the surrounding areas. Consumers of our services are those...
We understand the challenges of our Senior Citizens, Disabled, Vulnerable and Sick ones in the community. That is why we customize and personalize your Home Care experience with high quality care and passion using very...
OUR FOCUS: • Dependability of Service • Continuity of Caregivers • Peace of Mind for the Family • Quality of Life for the Client • Independent Living in the Home OUR SERVICES: • Companion Care - For our basic...
ComForcare understands that today's busy lifestyles often deprive family members of the time necessary to provide hands on assistance and companionship for their loved ones. Therefore, we want every family we service to...
Welcome to BAYADA Home Health Care. Every day, our expert team of BAYADA Nurses, Therapists, Home Health Aides, and Medical Social Workers provide quality care to people of every age and stage of life. We believe our...
We offer independent living home care services built on four tenets: trust, skill, compassion, empathy. This holistic approach to the care needs of our clients strives to meet and exceed the needs of the whole person....
At BrightStar Care of Stamford, our local home care team is available to you and your family 24 hours a day, 7 days a week no matter what care you need. We pride ourselves on providing the highest quality of in-home care...
Tender Loving Care Health Care Services of Ne, LL is a home care provider that services in Stamford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Elderly Caregivers LLC - Connecticut is a home care provider that services in Stamford, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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,...
Acti-Kare of Stamford is a home care provider that services Connecticut. Home care services allow seniors to remain safely in their own home while receiving assistance with personal care and other daily tasks.
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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.