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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.
✔
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:
Cleaning the house everyday is becoming a frown.I need a break.I cleaned the house last night so I wouldn't have to do it today.I sleep my day away sleeping till noon from cleaning all nite last nite.I wish a could afford a maid lol.
Capt you do feel strongly about cleaning or should I say not. Have you found your fork yet? Maybe it's under a pile off dirt. Can't you whittle a new one
ike is 30 yrs old this year . happy birthday you hor'in , cop chasin , cop flee'in , fire startin , troublemakin sob .. har . that state trooper didnt have s*it under his hood , eh ike ? me and ike got busted in marion IN a few years ago . the police report was two paragraphs of " nice guy but he was trashed " then 3 pages of pics of ike .. marion has two bible colleges in their town . the poor repressed b*stards needed ike .. hes the only exitement theyve had since the last black lynching in the usa took place on their courthouse lawn . yea, hang your heads in shame you turds .. its a better era . a stranger female gave me a ride to the next town to reunite with impound boy ( ike ) .. we crammed it towards home f those losers .. WE AINT GOIN BACK ..
i did get my teeth cleaned tho but only cause i plan to bite " diana " square on the behind .. she cleaned my teeth , they should be completely to her satisfaction ..
cleaning ? wth is that ? if i put on clean clothes , the minute i get to work and fire up a stone or woodsaw i wonder ; why in the hell did i put on clean clothes this am ? if a girl ever comes to visit i figure ill leave a bucket of soapy water and a sponge in the kitchen and if theres something that bothers her -- feel free to wipe it up . just dont wash ike . that greasy film keeps my bolts from seizing in the aluminum cases .. ike has class , he dont need chrome and pretty paint .. ike has dam near 5 inch pistons . he could hold his own against a 1000 hp rail dragster ..
Cleaning every day? Good heavens, I am so emotionally drained from dealing with two very stubborn 90+ year old parents, who still live in their own home by choice, that at the end of my work day or weekends the last thing I want to is become Martha Stewart. Laundry I will do because I need clothes for work.... groceries I will do because I have to eat.... but cleaning, forgetaboutit. No one better ring my doorbell, because I won't answer it :P
I do volunteer work Saturday mornings [I call that my vacation day], but the rest of the time I am either napping or spending hours on the computer researching elder care. This isn't how I planned my retirement years !!
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.
Have you found your fork yet? Maybe it's under a pile off dirt. Can't you whittle a new one
har . that state trooper didnt have s*it under his hood , eh ike ?
me and ike got busted in marion IN a few years ago . the police report was two paragraphs of " nice guy but he was trashed " then 3 pages of pics of ike .. marion has two bible colleges in their town . the poor repressed b*stards needed ike .. hes the only exitement theyve had since the last black lynching in the usa took place on their courthouse lawn . yea, hang your heads in shame you turds ..
its a better era . a stranger female gave me a ride to the next town to reunite with impound boy ( ike ) ..
we crammed it towards home f those losers ..
WE AINT GOIN BACK ..
if a girl ever comes to visit i figure ill leave a bucket of soapy water and a sponge in the kitchen and if theres something that bothers her -- feel free to wipe it up . just dont wash ike . that greasy film keeps my bolts from seizing in the aluminum cases .. ike has class , he dont need chrome and pretty paint ..
ike has dam near 5 inch pistons . he could hold his own against a 1000 hp rail dragster ..
I do volunteer work Saturday mornings [I call that my vacation day], but the rest of the time I am either napping or spending hours on the computer researching elder care. This isn't how I planned my retirement years !!