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.*
✔
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:
Options For Senior America - Cary is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Licensed for Hands on Care and Companion Services Fully Insured Licensed by the Department of Health and Human Services Division of Health Services Regulation Covering 14 counties out the Raleigh office: Wake, Alamance,...
Choosing the right in-home care team can be a daunting task. It’s important to make sure your caregiver is qualified, skilled, and trustworthy. This is why ComForCare offers the best Raleigh senior care in town. We...
Always Best Care - Raleigh, NC is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A1-Omega Health Services is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
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...
Horizons Home Care is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Tarheels Home Healthcare Services, LLC is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bright Home Care Services, LLC is a home care provider that services Raleigh, NC 27610. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with personal care and...
Home Care Services provides innovative solutions that improve health and quality of life for those in need of our services. We deliver care according to your plan of treatment to maximize independence while you remain...
Global Healthcare Resources, Inc. is a licensed Home Care Agency in the State of NC. We play a critical role in caring for seniors and bringing peace of mind to families in need.
At Home Quality Care Inc is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Broadway Home care, located in the scenic areas of North Carolina, we offer excellent home care services to our patients and clients. Our staff members and caregivers provide the highest level of professionalism in...
Vickie Shepherd Sanders is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Tar Heel Home Health is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Allied Home Health Care Services, Inc. is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
SAAR Homecare, LLC is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A and M Home Care is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Offering a wide range of services that are delivered by highly skilled professionals who are committed to meeting the emotional and physical requirements of clients and their families.
SYNERGY HomeCare of Raleigh, NC is a home care provider that services in Raleigh, NC. 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 Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Interim Healthcare is a leader in the home care industry with 50 years of experience. We provide supportive services to frail and disabled individuals allowing them to remain independent in their homes. Our care...
@Home Care is licensed by the state of North Carolina specifically for sitter/companion and respite care in the short term adding further licensing for hands-on home health care in mid-2016 when the statewide moratorium...
Lifeline Home Care LLC, NC is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Marywins Home Care Services is privately owned, licensed, certified by the North Carolina State, and established by seasoned professionals with years of patient care knowledge in hospitals, homes, and special home settings.
Intrepid USA Healthcare Services is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Angels that care and where love and healing is brought to your home. As dedicated care professionals we restore balance, order, and peace to your lives, by helping your love ones remain safe at home. We've been...
Welcome to Justheo Home Care, LLC, your trusted partner in providing compassionate and personalized home care services in Raleigh, North Carolina. At Justheo Home Care, we understand the importance of maintaining...
The Senior Care market is a rapidly expanding industry that continues to be competitive. We differentiate ourselves every day with the quality of our senior care services, how we speak and how we present ourselves. Our...
Hope of Solace Agency is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We have a variety of skilled services that are rendered and customized by our competent professionals. Trust us in providing you with only the best care that you deserve. Our mission is to provide the highest quality...
Royal Touch Home Care Agency is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Management Care Services, we are dedicated to providing quality behavioral health and healthcare services to individuals, families, and organizations in an effort to support better mental health and overall...
Omega Healthcare Services, LLC provides care for all age groups to include the elderly, adult and children in and around Wake, Johnston, Franklin, Durham, Person, and Orange, Vance, Granville, Chatham and Harnett counties...
Zion Home Healthcare LLC is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Right at Home of Durham, NC is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Phoenix Rising Home Care, LLC is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Heartland Home Health Care is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Care by Your Side & Services, NC is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Let us help you understand your home care options, including a full range of integrated care that meets the highest quality standards for compassion and reliability.
welcome to First Choice Home Health your first choice in quality home care. We provide one on one in home or in facility care to those requiring specialized help as a result of health issues or specific day...
Right at Home - Durham, NC - Duplicate is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Wakemed Home Health is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Romanus Uche Ani is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Whole Hearted Home Care, LLC is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Liberty Home Care, Llc is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
Our Services -Companion Care For our basic level of care, caregivers provide services such as companionship, meal planning and preparation, light housekeeping, laundry, medication reminders, and other general assistance....
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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.