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 Amada Eastern North Carolina, we provide non-medical in-home care for seniors. We know how important it is for our clients to continue to do the things they love at home, so we help make life easier and more enjoyable.
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...
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...
At Home Eldercare is the perfect solution for seniors who wish to remain independent in their own homes, but may need assistance because of the normal occurrences of aging such as reduced eyesight, arthritis, and...
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...
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,...
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...
Rex Home 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...
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,...
Through our unique system of in-home care that we call Interactive Caregiving™, our Comfort Keepers® engage clients in their care to enhance their independence and well-being. Interactive Caregiving™ includes four...
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...
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...
Griswold Home Care was founded by the late Jean Griswold in 1982 and we are celebrating our 35th anniversary as the oldest non-medical senior care franchise organization in the country. While we operate in a growing...
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...
GG’s Home Care Services LLC is named after my late grandmother Gonnie Gorham. As she was in her late age of 80 when her health declined. In years prior to her health declining, she advised in laughter (lol) not to put her...
Good Health Services, a North Carolina licensed home care agency based in Raleigh is a family owned business in operation since 1989. Good Health Services provides a full range of personal care assistance and nursing...
Arcadia Home Care & Staffing 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...
Pinnacle Healthcare 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...
Trinity Staffing, Inc. is licensed by the State of North Carolina to provide in-home care services. Our goal is to help our clients maintain their independence and dignity in the comfort of their own home. Our employees...
Welcome to Helping Hands of America!We are the perfect solution for seniors who wish to remain in their own homes, but may need assistance because of the normal occurrences of aging such as Dementia , Arthritis, and...
Caring Hands Health 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...
Americare Alliance of Wake County 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...
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...
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...
AlbertaCare 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...
Medi Home Health 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...
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...
Home Choice Companions provides non medical companion / homemaker services for seniors, those recovering from surgery, new and expectant mothers, and the disabled throughout the triangle and surrounding communities....
Our Family At Elite Care One we are a family oriented Home Care Agency that believes in keeping families together. We believe that people work hard to get a good place to call home so we do everything we can to help you...
Above The Horizon 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...
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...
AccordCare - 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...
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...
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...
Vantage HealthCare 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...
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...
Whitney Home Care 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...
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.
Are You Looking for Peace of Mind Homecare Services for You and/or Your Loved One? Then you look no further!!!ACCESS HOME HEALTHCARE INC (AHHC) is here for you! AHHC Inc. is a Home Care Agency incorporated in the state...
Absolute Care Staffing Health Agency, Inc. is independently owned and operated. It was founded because we saw the need to provide compassionate and caring professionals to treat home care clients with the care, the...
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...
Perpetual Home Care is a NC State licensed home care agency and the only home care agency in the Triangle to be Certified through the Caregiver Quality Assurance program. Our 9 step hiring process offers you and your...
At Home Eldercare of E Wake County 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...
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...
From our family to yours, we are not just caregivers, we are an extension of your family. Our One You Love Homecare North Raleigh, North Carolina location delivers senior in-home care to the greater North Raleigh region....
Classic Home Healthcare and Counseling Services is driven by the philosophy of commitment to our patients, leadership and excellence. We recognize the unique physical, emotional and spiritual needs of each person. Our...
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.