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:
At Always Best Care of Greater Boston, we specialize in providing personalized, non-medical care for seniors who wish to remain in the comfort of their own homes. With a team of over 300 Certified Nursing Assistants, our...
At Homily Care Agency, we offer a wide range of health care services for disabled and elderly individuals in the comfort of their own homes. Our dedicated team ensures that our clients receive the best care and attention...
We are a recognized agency providing Home Health Care wherever a client lives in Eastern Massachusetts. We are also Alzheimer's specialists. The service can be a few hours or 24 hours. We offer Live-in, hourly,...
As loved ones age, their daily needs may change in ways that make living alone more difficult. Many families consider home care as a way to offer support while helping seniors remain in familiar surroundings. Choose...
At JJ Homecare & staffing, we are a beacon of compassion and excellence in homecare and staffing solutions. Our journey began with a profound commitment to making a difference in the lives of those in need, guided by the...
Welcome to Golden Hands Healthcare, where every touch is golden and every patient is cherished. Come home to care that feels like family. At GHHC, we believe in treating every individual with LOVE, DIGNITY and...
Quality Private Home Care Services is a trusted and compassionate home care agency dedicated to enhancing the lives of individuals in need of personalized assistance.
We are a senior home care service that allows your loved ones to stay where they feel most comfortable: at their home in Woburn. Our trusted Woburn staff can’t wait to meet your loved one. We want to know how many times...
We provide a range of non-medical support services to enable seniors to remain safely at home as long as possible. Our caregivers are carefully screened (background and references checked), trained, insured and bonded. We...
Impact Health Alliance is dedicated to improving community health through innovative, collaborative in-home care. We unite healthcare professionals to enhance access to quality care and promote wellness. Our mission is to...
Visiting Nurse & Community Care provides compassionate, non-medical home care services designed to help seniors and individuals maintain independence in the comfort of their own homes. Our trained caregivers assist with...
CARE PLANS PERSONALIZED TO YOUR LOVED ONES NEEDS Home Helpers is a trusted and reliable provider of home care services in Burlington, MA and the surrounding areas. Our team of highly trained Caregivers are dedicated to...
From nursing homes to in-home healthcare, we offer a comprehensive recruitment plan that truly bridges the gap between prospective professionals and agency or facility managers.
Greater Medford Visiting Nurse Assoc is a home care provider that services in Medford, MA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
NIZHONI HEALTH SYSTEMS is a home care provider that services in Medford, MA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Together In Care, LLC is dedicated to providing compassionate, reliable in-home care that helps seniors and individuals maintain independence and comfort where they feel most at home.
Nationwide Home Healthcare Services is a local home healthcare agency that was built on integrity, love, kindness, and compassion. We are fully committed to being involved in the care of your loved one, by providing the...
At Visiting Angels, we strive to make staying at home a positive experience. We do this by allowing you to select your caregiver from a group of skilled elderly home care providers, allowing you to maintain your schedule,...
We are a private pay agency. We do accept long term care insurance and veteran's benefits. I am looking to service the elderly population who suffer from Alzheimer's disease and related dementias. Our staff is very...
Ameriken Caring Services - Medford is a home care provider that services in Medford, MA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We have a professional, process-oriented staff ready to serve our clients and their families. When a prospective client contacts a Senior Helpers office, they set up a complimentary initial assessment at the client’s...
It is our vision to be the best support system that eases pain for families going through the challenges of caring for their declining loved ones. We also work to facilitate opportunities for compassionate caregivers...
Elderly Caregivers LLC - Connecticut is a home care provider that services in Medford, MA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
FirstLight Home Care of Boston Northwest provides private home care services that allow seniors and other adults to receive the support they deserve in a comfortable, familiar setting. To learn how a compassionate in-home...
Your Extended Family When Family Can’t Be There At Home Helpers Home Care, we’re here to do exactly what our name says: help. We’re more than an in-home health care agency – we’re your extended family when family can’t...
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.