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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:
Greenwich HomeCare is a locally owned and operated non-medical home health care agency dedicated to providing the highest quality home health aides. We are a licensed, bonded, and insured agency serving Greenwich,...
Our in-home care services brighten the lives of seniors who can benefit from a helping hand and a friendly smile. Our caregivers, who are seniors themselves, make your life easier by providing compassionate care in the...
Caring for your loved ones can be challenging, especially if they have special needs, illnesses, or injuries. Fortunately, Homewatch CareGivers of Norwalk is here to help you provide the best care and support to your...
Prestige Companion & Homemakers, LLC is a home care provider that services in Norwalk, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Sterling Care is a locally owned and operated home health care agency based in Greenwich, Connecticut. Our service area includes all of the towns and cities in lower Fairfield County. We are the only full service home...
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...
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...
There’s a reason why Unity Home Care LLC, is a leading provider of homecare in Farmington, Connecticut, and that’s simply because we truly care for you! Elderly, injured, ill, and the disabled—we make every high-quality...
HomeWell is committed to helping people live life more fully. With a highly personalized care management approach, we strive to provide the highest quality of care in the place where clients feel most comfortable.
A & B Homecare Solutions - New Haven is a home care provider that services in Norwalk, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Senior Helpers Fairfield County is owned and operated by Hal Zerman. Thrilled to be in an industry that gives back to the community, Hal is passionate about providing affordable, high-quality home care to both seniors and...
In Home Care for Fairfield County, CT - FirstLight Home Care of FairField County is the business to turn to when you or a family member needs help at home. Our home care services, available to Norwalk and surrounding...
We provide home care services in Connecticut. Whether you need 24 hour live-in care or hourly care, we can meet your needs and exceed your expectations. Our aides will help your loved one with shopping, meal...
BrightStar Care of Norwalk, CT is a home care provider that services in Norwalk, CT. 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 Norwalk, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our caregivers can provide personal care, homemaking services, and companion care. These services include bathing, dressing, continence care, meal planning/preparation, cleaning, laundry, and running errands.
Visiting Nurse & Hospice Of Fairfield County, Inc is a home care provider that services in Norwalk, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Nova HomeCare is a home care provider that services in Norwalk, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Sovereign Home Health of Connecticut provides in-home care that makes a difference in the lives of seniors and other adults. Our clients and their families trust their care to us. Whether part-time companionship services...
At Caring For You Home Care, our mission is to ensure you or your loved one are able to remain at home and be cared for and assisted in the ways that you need. Our team, staff and caregivers are patient, kind and eager to...
CONSTELLATION IN HOME CARE Our compassionate caregivers provide excellent care and support for you in the comfort of your home. Our goal is to create a happy, secure and nurturing environment while helping you...
BrightStar Care of Fairfield, CT is a home care provider that services in Norwalk, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Caring People is a family-owned and operated home care agency with more than 25,000 clients served over the past 20 years. We provide a wide range of care-based services, including Alzheimer’s and dementia care, companion...
Stellar Homecare is a home care provider that services in Norwalk, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
My name is Steven and after a long career on Wall Street working at Cantor Fitzgerald, the firm that lost 658 souls on 9/11, I decided to leave the industry and build a home care business. The loss of so many friends had...
Since 1996, Always Best Care has helped thousands of families with non-medical in-home care and assisted living referral services. Our passion for helping people maintain a safe, independent and dignified lifestyle...
McKesson Health Solutions is a home care provider that services in Norwalk, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Elderly Caregivers LLC - Connecticut is a home care provider that services in Norwalk, CT. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
After nearly 20 years of care, HomeWell has helped tens of thousands of families with millions of hours of assistance and compassion. We provide quality in-home care for seniors across the United States and Canada. Since...
Since 1984, the founders of Preferred Care at Home have had the privilege of assisting clients improve their quality of life while still recognizing and maintaining their dignity and independence. Preferred Care at Home...
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,...
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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.