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.
✔
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:
I used Legal Zoom for free. They ask questions along the way, which personalizes it for your situation. I downloaded the form and took my mom to a notary to sign it. You can have just 2 signatures but if you will need to do any property transactions, such as selling a house, you will need to have it notarized. This is a Durable POA. Health Care requires a separate Durable POA for Health Care.
Your state bar association website may also have free DPOA, Health Care Surrogate, and Advance Directive forms.
However, as mentioned above, you might be better off spending a few bucks to make sure you have it done right.
I am not a lawyer but I am sure I have examined over 1,000 DPOA's in my career. I would not hesitate to do one myself because I know what I am looking for and what I am doing.
You probably have little experience with such documents and you may be surprised by the "little things" that can trip you up once you try to put the power in effect.
If you shop carefully you should be able to find qualified counsel to do a complete set of estate planning documents (Revocable Trust, Pour-Over Will, DPOA, Health Care Surrogate, Living Will, Advance Directives) for under $700 for a couple ($400 individual).
In the end, though, some form of document is better then NO document (usually).
I went to my local library and they had a book i could copy one out of that was relevant to my states laws. after having it signed my lawyer said it was the correct one.
Our county Department on Aging gave us the correct form for our state for free. It was very easy to fill out and just needed to be signed in front of a notary for $3 per signature. I think it cost us $9 total. We have needed to use it several times in the last few months and haven't had any problems.
Remember the POA consent must be signed by someone deemed competent. If you can afford it, an attorney is your best bet. The money spent to dot the i's and cross the t's could save you time, money, headache and heartache in the future.
Yes, but you might also want to look up your own state's general statutes concerning POA and refer to those sections and paragraphs in the POA.
If someone fills it in and prints it out, it really needs to be witnesses by two people and stamped with a nortary. Many counties in various states really like for people to file the Durable POA with the register of deeds, but you don't have to. There are times when a business or financial group will require a certified copy of the Durable POA and that's when having it on file with the register of deeds comes in handy for they can make a certified copy. I've only had to do this one time.
You should be able to download -- or at least print -- a free durable power of attorney form from Google, Ask.com, or any other search engine. There's no advertising allowed in this forum, and any specific link I provide you with will be deleted.
The main thing is that the POA include and agree with the state general statutes concerning Durable and Medical POAs. Oftten a regular lawyer can do that.
There are many sites out there. After searching several, I chose "Legacy Writers." The cost was minimal. You can print out as many copies as you need and they keep your original docs. on file. They also had up-to-date state forms (this is very important) and instructions on how to use them. (some states require witnesses for signatures, notarization, court filing, etc...) I would recommend printing out several copies of both your medical and financial PoAs and have them notarized.
I have used LegalZoom for my business docs. They are very professional.
Carol had a good point...if your situation is more complicated, a good elder attorney is the way to go.
I can't recommend one, though someone may know of a site. However, if you want something to stand up in court (and you never know if this could happen), it's generally best to have an attorney draw one up. They aren't really that expensive (at least mine wasn't). Good luck, Carol
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.
However, as mentioned above, you might be better off spending a few bucks to make sure you have it done right.
I am not a lawyer but I am sure I have examined over 1,000 DPOA's in my career. I would not hesitate to do one myself because I know what I am looking for and what I am doing.
You probably have little experience with such documents and you may be surprised by the "little things" that can trip you up once you try to put the power in effect.
If you shop carefully you should be able to find qualified counsel to do a complete set of estate planning documents (Revocable Trust, Pour-Over Will, DPOA, Health Care Surrogate, Living Will, Advance Directives) for under $700 for a couple ($400 individual).
In the end, though, some form of document is better then NO document (usually).
If someone fills it in and prints it out, it really needs to be witnesses by two people and stamped with a nortary. Many counties in various states really like for people to file the Durable POA with the register of deeds, but you don't have to. There are times when a business or financial group will require a certified copy of the Durable POA and that's when having it on file with the register of deeds comes in handy for they can make a certified copy. I've only had to do this one time.
You should be able to download -- or at least print -- a free durable power of attorney form from Google, Ask.com, or any other search engine. There's no advertising allowed in this forum, and any specific link I provide you with will be deleted.
-- ED
I have used LegalZoom for my business docs. They are very professional.
Carol had a good point...if your situation is more complicated, a good elder attorney is the way to go.
Carol