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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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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:
Usually, when a patient moves to assisted living or a nursing home, the primary physician is no longer in the picture. Most times the facility physician takes over the oversight and care, working with nursing and PT/OT and the facility social worker. Look at the questions on the FL2, most of it contains items that the family doctor would have no information on. Bring the form to the facility and ask for a care meeting to help fill it out.
If you are having to explain a form to a medical office, perhaps you need to find a doctor's office who knows what you are talking about or tell the doctor you are having trouble with his/her staff about a form you need filled out. Even though a person who goes into a facility can be seen by their doctor, the patient can also have a personal doctor to follow their care.
Angelsxs2, I see you are in NC. So am I. I obtained an FL2 online and took it to my cousin's Primary when we needed it for her entrance into AL. Also, the AL facility should have the form on hand. Everyone that I spoke with said the Doctor had to complete it for the person to be admitted. Pam suggest that the facility may be able to prepare it. That's a thought. You can always inquire about that.
To admit anyone to assisted living, nursing home, memory care the primary care doc must make aome sort of assessment stating level of care needed. We needed a something from my mom's doc before she was admitted to memory care. After she was admitted then she started seeing the facility's doc.
As a retired RN, when ever I have a form that required an MD signature, I always fill out the information that I know easily, on the form for the doctor. I have never had a doctor become upset that I did this to help. I noticed early on, that they go through these forms and they ask you what they should write down anyhow....so I just start it for them. I do not write in vital signs, or diagnoses or anything that WOULD require the doctor to assess or know or check before filling out a line....just the stuff I know. Who is going to know more than you, how well your LO can walk, or what they can do for themselves daily, or what kinds of assistance they would need....like help bathing or dressing or doing their hair?
Thanks so much for all of your suggestions. I think the problem I'm having has to do with the fact that the doctor I have requested complete the form is a Psychiatrist and not a Primary Care doctor. The person I am working with has a primary diagnosis of mental illness. He has actually moved out of an institution into a community based setting. Although, the community based setting does not qualify as "home" as the FL2 has it listed, it is also not an institution or an Assisted Living facility. The office that is following this patient is aware of his circumstances and the program he is in. Hopefully when the patient goes for his appointment with the doctor on 12-12-16 I will be able to get it signed and the doctor knows what the form is. I have the form completed except for height/weight, etc. The diagnosis and other information is documented with the doctor as well as other organizations. The patient doesn't even have a Primary Care doctor. He refuses to go to one. However, he will see his Psychiatrist as it is required for his participation in tbe program that assisted him in getting into a community based setting. Again, thank you all for your suggestions and comments!
Just a tip about the FL2. As soon as the doctor completes and signs it, have the facility you are looking into review it to make sure it's correctly completed. I had to take mine back to the doctor and have it corrected, according to the feedback I got from the facility. It was simple enough, though, I had to runaround the county to get it done.
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 see you are in NC. So am I. I obtained an FL2 online and took it to my cousin's Primary when we needed it for her entrance into AL. Also, the AL facility should have the form on hand. Everyone that I spoke with said the Doctor had to complete it for the person to be admitted. Pam suggest that the facility may be able to prepare it. That's a thought. You can always inquire about that.
Daltjie