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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:
My Mom gave me pushback about being in the exam room with her. I told her my job was just to "take notes" because the docs talk fast. I also had her create a list of questions for the doc, so I was basically the "secretary". I sat behind her so that if the doc asked a question and she didn't give an accurate answer, I would nod or shake my head. The doc got it. They've seen it all. I did this for both my MIL and Mom. For my MIL I wrote a note in advance saying who I was and the concerns I had about my MIL (which was memory impairment) and that she was not recognizing her own symptoms. I discretely handed the note to the staff before hand. It worked great.
You can go with them to the appointment and ask for the HIPAA Medical Representative form. Have your Dad fill in your name so that the medical staff can legally discuss your Dad's private health information with you without his further consent or presence.
My older siblings one who lives on the Upper west side of NYC and One who lives in DC think that I use my father's medical appointments as a means to tattle on my father. They don't understand what I have been going through as caregiver to my father for the past 13 years. Nor do they understand the day to day functioning of my father.
It all depends on Dad. If he wants you in the room too, then there is no reason why you can't be. Even if he signs a HIPAA form, he can ban you when he wants to. Is Moms proxy in effect? Sometimes its worded a doctor has to invoke it saying the principle is not competent to make decisions. The main purpose of a Medical proxy is to carry out the principles wishes concerning their heath.
If Dad is competent to make informed decisions, he can request that neither you nor Mom be in the exam room with him. The doctor will abide by what Dad wants.
If Dad doesn't give you permission to be in the room, it is his right to keep you out. Doesn't matter if you are caregiver or not. Even if Mother is healthcare proxy, if Dad says you can be in the room, you can be in the room. Read the proxy paperwork, it will give you the specifics. If Dad is cognitive, he can sign a HIPAA waiver giving you access to his medical records, and the ability to speak to his medical care team.
My Sister and I have found it helpful for one of use to be in the room. Ask your Dad if it's OK with him that you're there. You can be a Health Care Proxy too, most states allow that, I did that with a friend who had a terminal diagnosis. Her Sister and I could attend appointments. Your Dad would have to sign the form. Explain it will help your whole family if you are included. Especially both parents, it will allow you to ask questions as his caregiver. They will be different questions than your Dad's or Mom's. I always feel it's best to have two sets of ears than one, being your Mom, so there isn't confusion. My Dad is always grateful I'm there because he doesn't always know what questions to ask and thanks me for helping. I do same for Mother who's memory isn't as sharp as it used to be. Best wishes as you navigate this family dynamic!
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.
You can go with them to the appointment and ask for the HIPAA Medical Representative form. Have your Dad fill in your name so that the medical staff can legally discuss your Dad's private health information with you without his further consent or presence.
If Dad is competent to make informed decisions, he can request that neither you nor Mom be in the exam room with him. The doctor will abide by what Dad wants.
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