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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:
Let her know that one of the worst things you can imagine is getting a phone call notifying you that she's been in an accident. Focus on how much she means to you and how you want her to be safe. Tell her that if she was injured in an accident, even if it wasn't her fault, recovery is a long slow process for people in their eighties. Point out that there are a lot of bad drivers on the road and you are concerned that she may not be quick enough with defensive driving skills to avoid an accident if she encounters one of "those other drivers". Ask her if she has any doubts about her own driving abilities. Tell her you are concerned about both her safety and her independence. Be prepared to help her understand resources that are available to help her get around (including offering to drive her to Dr. appointments, weekly shopping, etc.), so that she can begin to imagine her life without driving. Point out the advantages to not owning a car (no repairs and maintenance, no auto insurance, no registration, etc.).
If she will not have this conversation with you, share your concerns with her physician and enlist his/her help in assessing her driving abilities. Physicians regularly advise the DMV that an elderly driver is not safe to drive.
Tell her about my mother, younger than her and a good careful driver. Once when she was tired and driving slowly, a bad driver tail-gated her aggressively to speed her up. She got flustered, tried to draw into the curb, over steered and drove head on into a lamp post. She was very lucky to escape with minor injuries, and all the clean-up work with the car and the police was a trial for me. She never drove again. Tell her that it may not be her bad driving that causes a problem, but some-one else’s bad driving that her reflexes aren’t quick enough to cope with now. It’s completely true, and it might be easier for her to hear than criticisms of her own driving.
I had that talk with my dad. It didn't make a bit of difference. After weeks of having this discussion over and over I thought maybe his doctor could help me. I called the doctor's office and explained the situation. After some back and forth the doctor said he would help me. I got my dad to the doctor under false pretenses (dad needed a check up or something of the sort). I went into the doctor's office with my dad. The doctor gave him a thorough exam and began talking to my dad about his life, his eating habits, etc. Then the doctor brought up driving. He asked my dad if my dad was still driving and my dad confirmed that yes, he was. The doctor told my dad he didn't think it was safe for my dad to drive anymore. The doctor was very compassionate about it. After a 10 minute conversation our visit was over and my dad never drove again.
Most elderly parents aren't going to listen to us. We're their children. But our parents are of the generation that obey doctors and place great faith in what doctors say. I had been talking to my dad for months about not driving anymore and he wouldn't budge. One word from his doctor and the issue was resolved.
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.
Let her know that one of the worst things you can imagine is getting a phone call notifying you that she's been in an accident. Focus on how much she means to you and how you want her to be safe. Tell her that if she was injured in an accident, even if it wasn't her fault, recovery is a long slow process for people in their eighties. Point out that there are a lot of bad drivers on the road and you are concerned that she may not be quick enough with defensive driving skills to avoid an accident if she encounters one of "those other drivers". Ask her if she has any doubts about her own driving abilities. Tell her you are concerned about both her safety and her independence. Be prepared to help her understand resources that are available to help her get around (including offering to drive her to Dr. appointments, weekly shopping, etc.), so that she can begin to imagine her life without driving. Point out the advantages to not owning a car (no repairs and maintenance, no auto insurance, no registration, etc.).
If she will not have this conversation with you, share your concerns with her physician and enlist his/her help in assessing her driving abilities. Physicians regularly advise the DMV that an elderly driver is not safe to drive.
Most elderly parents aren't going to listen to us. We're their children. But our parents are of the generation that obey doctors and place great faith in what doctors say. I had been talking to my dad for months about not driving anymore and he wouldn't budge. One word from his doctor and the issue was resolved.