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:
Home Helpers Home Care of Orange Coast is more than an in-home health care agency – we’re your extended family when family can’t be there. We’re a locally owned, trusted provider of quality, compassionate in-home care in...
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At Home Helpers® Home Care we offer personal care & companionship care. We assist with elderly care and the basic activities of daily living like hygiene, cooking, mobility, errands and light housekeeping to help your...
Premier Senior Care is the leading in home senior care provider in California, specializing in Alzheimer's & Dementia Care. It is an established and respected senior care provider offering senior home care, personal...
SYNERGY HomeCare of Huntington Beach, CA is a home care provider that services in Santa Ana, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Green Meadows In-Home Care is dedicated to providing compassionate, reliable, and personalized care for individuals who wish to remain in the comfort of their own homes. Our team focuses on promoting independence,...
If you are currently caring for a loved one that is having challenges living independently, we understand how difficult it can be. With the right kind of help, it’s possible to improve their quality of life so they can...
Exceptional Care for Your Loved Ones Our mission is to provide exceptional support to your loved ones in their golden years or those facing well-being challenges. Bella Vie Homecare LLC delivers premier care services...
Alpha Homecare LLC, Compassionate In-Home Care Services At Alpha Homecare LLC, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort, dignity, and independence. Our...
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Our in-home senior care starts with a clear understanding of who you are and what we can do to make your life a little easier and a little brighter. Whatever services you need and whenever you need them – for yourself or...
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...
Cornerstone Caregiving is proud to serve Huntington Beach and its surrounding areas, offering exceptional in-home care services. Our caregivers take the time to get to know each client individually, providing personalized...
Emerald Medical Management is a well established firm that has been in business for over seventeen years. We now provide Personalized In-Home Care and are in business to provide the best care possible for you or your...
Vna Of Orange County Llc is a home care provider that services in Santa Ana, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Whether you’re looking for help living independently or you’re wanting to help make sure someone you love has the support they need to stay in their home, Right at Home is here for you. We believe there’s more to...
Coastal Home Care LLC is a home care provider that services in Santa Ana, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Premier Healthcare Services, Llc is a home care provider that services in Santa Ana, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Gentiva Health Services is a home care provider that services in Santa Ana, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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CTSH OC, LLC is a home care provider that services in Santa Ana, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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CARE TO STAY HOME is a home care provider that services in Santa Ana, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Jm Homecare Solutions Inc is a home care provider that services in Santa Ana, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ATTENTIVE HOME CARE, INC is a home care provider that services in Santa Ana, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Costal Home Care is a home care provider that services in Santa Ana, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
TheKey Corporate - Santa Rosa, CA is a home care provider that services in Santa Ana, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Kind Care is a team of professional caregivers who strive continuously to deliver our commitment to our client’s needs. Our goal is to help our clients obtain their desires in order to improve the quality of their lives....
Care Dimensions LLC is a home care provider that services in Santa Ana, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Safe Guard Care Services, our mission is to provide compassionate, high-quality, and personalized care that enhances the well-being and dignity of every individual we serve. We are dedicated to fostering a safe,...
Entrust Senior Care helps keep your family member safe while living independently at home. We are entrusted with the gift and responsibility of caring. We provide high-quality personalized in-home care for aging loved ones.
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...
In Home-Care Overview – Description Tender Home Health aims to listen and provide clients with truly individualized care through their thoughtful approach. Increased Freedom Our caregivers assist clients with daily...
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About Us 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....
As a family owned, not for profit organization, Canaan Home Care is at the forefront of the home care industry. Canaan has been a partner of the State of California for over 25 years, together, raising the home care...
At Golden Years Home Care Solutions Inc – San Diego, our mission is to provide compassionate, personalized, and dependable home care services that empower seniors and individuals with disabilities to live safely,...
At Tandem Careplanning, our mission is to revolutionize home care by empowering seniors and uplifting caregivers, ensuring that together, we thrive. Our CEO, Joshua Greer, faced the same challenges and frustrations as...
Acti-Kare of Irvine provides quality in home care services to families and seniors in Irvine, Foothill Ranch, Trabuco Canyon, Rancho Santa Margarita, Las Flores, Coto De Caza, Costa Mesa, Fountain Valley, Huntington...
At Senior Helpers, we are here to help anyway we can -- no matter how big or how small the task. Our owners, Sandy and Hector Muñoz, know personally what it's like for the people in need of care and the toll it takes...
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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.