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:
For most of us, the top questions for any new and unfamiliar idea are: "Do I really need to spend money and time on this?" and "Can't I save myself some money by not doing this?"
If you answer the money questions properly, you help the person begin to see the many reasons to protect themselves with power of attorney:
"You'll be saving a lot of money and time if you have a Power of Attorney document. With Power of Attorney, you won't need to have us go to Probate Court to get permission to manage things for you if something happens. That would be very expensive, and your important decisions would end up going public, in front of a judge. Not having Power of Attorney would waste a great amount of money and time."
After the money saving benefits are understood, you can reassure the person with many more benefits:
"You can have your own lawyer prepare the Power of Attorney document the way you want it. Have the lawyer explain the powers that you are considering, and tell you how you can limit or expand the powers, depending on your needs."
Many elder law attorneys make house calls. I bring the laptop and printer to the home appointment, so the client can make changes as we talk about what's important.
Take her dirty clothes away, lay out clean ones.. This works for Dad! If he can;t find them he can;t wear them. Coax her into the nice warm tub or shower, and give her a nice body spray. Mom loves these! The notory at the bank she uses can do the POA, if you have the form (look on line) Our bank does not charge for this . If she is clean and smells good, you may be able to get her to sign. Promise her a nice lunch after? I am becoming very good at distraction and bribes!
Maybe Mom doesn't want to go because she fears losing her independence. At the doctor's visit, get her to sign a health care proxy and they witness it. Keep a copy. One step at a time. Get a durable POA form at an office supply store, and have it signed and notarized during a visit to the bank, or get two independent witnesses to sign it as well. In our case the lawyer came to our house, you might get lucky and find one who will do the same.
Is a durable POA form on line tried SUZY ORMAn but not sure legal enough in this case because mom on meds. for depression and anxiety need a lawyer ?? Any body actually have experience with this kind of situation?
thanks our public library has notary for free. just worried about someone contesting her signature because of her mental state with mental illness . trying to get free consultation with young lawyer a block from her house if she will only go and stop stressing about not wanting to be alive.Yes she is on meds. after surgery for rectocele last week she just is not feeling up to anything. And says look what I've gotten her into. Poor brother is doing the best he can living with her. I go over half the week or more and I can usually only handle 2 days at a time before having chest pains or getting angry with the craziness. My brother is bi-polar and my mom has been his support all these years and he says he has had to survive with much worse in his history of mental illiness treatment thru the system. He actually seems to not get as emotionally drained as I do dealing with my mom....
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.
If you answer the money questions properly, you help the person begin to see the many reasons to protect themselves with power of attorney:
"You'll be saving a lot of money and time if you have a Power of Attorney document. With Power of Attorney, you won't need to have us go to Probate Court to get permission to manage things for you if something happens. That would be very expensive, and your important decisions would end up going public, in front of a judge. Not having Power of Attorney would waste a great amount of money and time."
After the money saving benefits are understood, you can reassure the person with many more benefits:
"You can have your own lawyer prepare the Power of Attorney document the way you want it. Have the lawyer explain the powers that you are considering, and tell you how you can limit or expand the powers, depending on your needs."
Many elder law attorneys make house calls. I bring the laptop and printer to the home appointment, so the client can make changes as we talk about what's important.
her signature because of her mental state with mental illness . trying to get free consultation with young lawyer a block from her house if she will only go and stop stressing about not wanting to be alive.Yes she is on meds. after surgery for rectocele last week she just is not feeling up to anything. And says look what I've
gotten her into. Poor brother is doing the best he can living with her. I go over
half the week or more and I can usually only handle 2 days at a time before having
chest pains or getting angry with the craziness. My brother is bi-polar and my mom has been his support all these years and he says he has had to survive with
much worse in his history of mental illiness treatment thru the system. He actually
seems to not get as emotionally drained as I do dealing with my mom....