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.*
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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:
Since 2007, we have served the seniors in our community with the highest quality caregivers in the field. We take the screening and selecting of our CNAs and HHAs seriously and hire 1-2% of applicants on average. All...
For over 15 years, Senior Helpers has been serving families across New York City with trusted, dependable in-home care services. From companionship and personal care to highly specialized support, our team is passionate...
Affinity home care is a private concierge agency. We provide a selection of services based on expert-level care for your loved one. As a boutique agency, we are deeply committed to providing exceptional, elevated care...
7 Day Home Care provides the same level of care that we demand for our own family. We are family-owned and have helped hundreds of clients since our inception. Our compassionate team of skilled professionals develops...
Kindred Path Supportive Care, Compassionate In Companion Care Services At Kindred Path Supportive Care, we are committed to providing high-quality companionship services that prioritize dignity and independence. Our...
LifeWorx is an independently-owned private pay home care agency providing concierge elder care & lifestyle services in your community. Founded 20 years ago, our goal remains the same: to provide the best in-home care and...
If you need help for just a few hours each day or a couple of times a week, we can visit you in your home and provide as little or as much help as you need, with the aim of helping you to maintain your independence
When we started LifeWorx in 2004, we wanted to build more than caring, empathetic care services. We wanted to build a community of giving. A place you join as an individual, ‘me’, but where you become part of a greater...
Right at Home - Lower Manhattan, NY is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Alvita Care is a leading home care provider in New York City, Westchester, Long Island, and New Jersey. We’re best known for in-home senior care, but our caregivers are available to people of all ages, physical...
Touching Hearts at Home of New York City, NY is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Village Center For Care Lthhcp is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Dignacare is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Extended Home Care is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Village Center For Care CHHA is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Selfhelp Special Fam Home Care is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Chinese-American Planning Council Home Attendant is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Concerned Home Managers for the Elderly (COHME) is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Advanced Monitored Caregiving, Inc. is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Isabella Home Care is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Avalon Nurses Registry, Inc. is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Yai Home Health Services is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
First Step Registered Nursing, Pc is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
HHC Health & Home Care is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Priority Homecare is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
American Outcomes Management Inc. Of New York is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Cabrini Care At Home is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bayada Nurses, Inc. is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Fedcap Rehabilitation Services, Inc is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Affable Home Care, Inc. is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
First Chinese Presbyterian Comm Affairs Hac is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
All Season Home Attendant is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Better Helpers, Inc. is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bestcare, Inc. is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Access Nursing Services is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Vns of NY Home Care CHHA is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Jewish Home/Hosp Lifecare Comm Svcs Manhattan Lthh is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Elderserve Of Manhattan is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Cabrini Center For Nursing & Rehabilitation Lthhcp is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Empire State Home Care Services Inc CHHA is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bioscrip Nursing Services Llc is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
When we started LifeWorx in 2004, we wanted to build more than caring, empathetic care services. We wanted to build a community of giving. A place you join as an individual, ‘me’, but where you become part of a greater...
Our services cover many everyday tasks and can be adjusted and customized to meet the unique needs of your loved one. Our referred caregivers want to make sure you are always getting the exact care you need. If something...
SYNERGY HomeCare of New York, NY is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
Sara Companion HomeCare Services is a New York State Licensed Home Care Agency dedicated to providing client and family centered home care services. Our goal is to provide quality continuity of care. Our business...
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,...
In 2002, Christian Steiner (a former attorney and nurse) opened the Manhattan office of Home Instead and has been serving the elderly in Manhattan diligently day after day, night after night year after year. Home Instead®...
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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.