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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:
AHC is a trusted and dependable non-medical home-care provider. Our priority is to provide our clients with continuity of care and preserve the Our top priority is to provide our clients with continuity of care and to...
At Gentiva Personal Care, our Personal Home Care Assistance can assist with personal care, daily living necessities, and help around the home. If you or a loved one is struggling with prolonged illness, recovery from...
At Interim HealthCare of San Bruno, CA, we know how important it is to be in a comfortable, familiar environment. We all value our independence, however, sometimes the best way to maintain our autonomy, or preserve that...
At Always Best Care, we believe it’s a good feeling to be included in our clients' lives. Subtle smiles and long talks, showing kindness and humor during difficult times, providing the right levels of care – these are the...
Senior Helpers of San Mateo was founded in 2007 and purchased by Nicholas Magnusson in 2014. He is passionate about providing quality senior care and decreasing hospital readmissions through the high standards he sets for...
Aunt Ann’s is the Bay Area’s premier Home Care Agency. Aunt Ann’s has been serving local families with affordable, competent, trustworthy, reliable Home Care Aides since 1958. We take the worry out of hiring help...
HomeCare Professionals - Daly City, CA is a home care provider that services in Daly City, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
You deserve to have the optimum level of health and comfort. Whenever life’s difficulties hinder you from achieving wellness, then we are here to provide you with home care services that are specifically structured to...
Accent Care of Daly City, CA will provide senior citizens quality home health care. Whether is is companion services, personal needs care, meal preparation or assistance with bathing and grooming, their staff is available...
Fully Compliant Staff Background ChecksSuperior Client and Staff MatchingWe Offer Excellence in Senior Care ManagementWe Offer Flexible Hourly In-Home Care SchedulingWe Offer Flexible Scheduling for Live In-Home CareWe...
SERVING SENIORS CARE (duplicate) is a home care provider that services in Daly City, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
New Haven Home Health & Hospice, Inc is a home care provider that services in Daly City, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Brightlife In-Home Care Services LLC is a home care provider that services in Daly City, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Serving Seniors Care is a home care provider that services in Daly City, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
West Bay Home Health & Community Services is a home care provider that services in Daly City, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Anx Home Healthcare is a home care provider that services in Daly City, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Highly Skilled Individuals At Personal Home Care our professional home caregivers treat our clients with the utmost respect and compassion. Each member of our staff are selected to meet our high standards of providing...
Allied Care Bay Area is a home care provider that services in Daly City, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Health Professionals, Inc. is a home care provider that services in Daly City, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Professional Healthcare at Home is a full service home health agency providing in-home skilled nursing and rehabilitation, extended care, and private duty services. Locally owned and operated, the company has been serving...
Help in Need LLC We combine comfortable living with high-quality care services. For seniors living alone, having someone to talk to is crucial. They require them somebody to assist with their daily routines. As a...
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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.