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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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I consent to the collection of my consumer health data.*
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I consent to the sharing of my consumer health data with qualified home care agencies.*
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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.
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Sign the principal’s name first, not your own. This eliminates any confusion that you’re acting in your own interests or assuming any personal liability for what you’re signing. The principal is actually the one engaging in the transaction. Sign your own name after the principal’s name, after including the word “by.” This indicates that the principal is engaging in the transaction through you. For example, you would write, “Sally Smith, by Samuel Smith.” End the signature by indicating that you’re acting under power of attorney. You can do this in one of several ways. After your name, you can write in the words “agent,” “attorney in fact,” “power of attorney” or simply, “POA.” Your final signature should read similar to "Sally Smith, by Samuel Smith, power of attorney." Direction from a different source
It is also good form for the attorney-in-fact to write the principal’s name the same way it appears in the document. For example, if the document names Sally E. Smith as the signer and John Doe is signing under a power of attorney for Sally, then ideally John would write, John Doe, Attorney-in-Fact for Sally E. Smith, or Sally E. Smith by John Doe, Attorney-in-Fact, or Sally E. Smith by John Doe, Power of Attorney.--\
Then there is this very different I instruction
If you have been named as “Attorney in Fact” by the Grantor of a Power of Attorney, you should sign YOUR OWN NAME, followed by the words “Power of Attorney.” Do NOT sign the Grantor’s name EVER.
Only if you signed her in without writing "POA" or "Guardian" on the admitting papers after your signature. Read everything you signed. Medicaid applications take a long time and Medicaid will want 5 years of financial records for her. Start digging them out.
+1 on what "Pam" said....also, in our case, several years ago, the first application was denied for some reason, at the end of the 45 day application process window....then we reapplied after fixing the "error" or whatever, and the approval came in another 45 days and was retroactive money-wise, all the way back to the date of the first application. During the application period we paid the monthly fee and then the nursing home gave all that back once she was approved..
Be-careful when asked by a medical or similar organization. Do Not accept responsibility for bill paying unless you as an individual plan to pay the bills.
The person driving some one to the hospital and signs the documents can get a nasty surprised when they get billed I refuse to sign and I refuse to sign any form that has blank sections and has not been filled out completely.
Personal experience at ER. The admissions brought me a form to sign and I said please fill this out before I sign. The admissions guru showed up and said I understand you will not sign. I said I complete the form and then I'll sign. She came back with 90% of the form crossed out and the blanks filled,
I found this on TechByter Worldwide. It works for me:) {edited to fit}
I really need to say this: I participate and post for informational purposes only. I assume no responsibility for accuracy. Any actions you take based on my posting information are entirely at your own risk. Products and services are mentioned for informational purposes only and their various trademarks and service marks are the property of their respective owners.
I must disagree with others who have posted. I do not believe you are legally responsible for your mother's bills of any kind no matter what or how you signed, unless perhaps if you expressly signed something saying you would pay the nursing home. Sure, the nursing home may try to get the money from you, but that doesn't mean you have to pay it. If Mom does go on medicaid, they will take her income and assets, so if you want to contact an elder care lawyer to protect as much as you can, go ahead. If she doesn't get medicaid and can't afford to pay [up to $15.000 a month] they will probably want to discharge her, but a nursing home can't just throw someone out into the street. As noted, medicaid is retroactive so there is no reason to pay the nursing home anything now, and it does take up to three months. I assume the nursing home has helped with the process and you've given them all the documentation they need. Give it time -- there probably won't be a problem. Good luck, and sorry your Mom had to go into a home. I know that nowadays the thinking is to keep people at home as long as possible, but sometimes our elderly loved ones really need more care than we can provide, and not everyone has the time or ability and so on to be a caregiver. Feel no guilt. Best of luck.
First make sure placing Mother is a nursing home is absolutely the only option for her. Consider paying a home health aide to be with her in her home. Make sure you have visited an elder care lawyer, let him advise you on how to use her existing financial assets to best care for her. Medicaid will examine all of her assets and all "gifts" or transfers of her money for the past 5 years (If she is 85 now any financial moves since turning 80 will be questioned). This takes lots of time, meanwhile most nursing homes in this area run $9,000 to $10,000 a month. It will not take long for her to dent or eliminate her life savings. If she does require a nursing home, make the placement, see the lawyer, get busy constructing paperwork to show her assets to the lawyer and let him assist you with the Medicaid application.
I agree with Lizann. I took my mother home from the nursing home that was supposed to wean her off a ventilator, and get her up and walking. They did neither except take her money. Her health has improved 500%. She is now off the ventilator without being weaned. Medicaid will pay for long term home care if you want to go that way. Nursing homes that are for-profit, are the ones to stay away from. They are more concerned about getting as much money as they can get out of the patient. I just took my mother to the ER recently. The ER nurse heard my story, and told me that nursing homes are not great options anymore. She said being at home is the best. I also advise an elder care lawyer or a company that handles Medicaid applications. I had a company handle the medicaid application. One mistake and you will be denied. Also, when you get medicaid, the application needs to be renewed every year.
Judge nursing homes on their own merits. There are good and bad non-profit homes as there are for-profit homes. Don't confuse the term "non-profit" with the idea of charity. All charitable institutions are non-profit, but not all non-profits are charitable institutions.
Virginia50, I really took note of your statement to be aware of for-profit homes. Would you happen to know how to quickly find non-profits? Everyone else, thanks for de-mystifying things like signing for another. Our lawyer never gave us these nuts and bolts.
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.
Sign your own name after the principal’s name, after including the word “by.” This indicates that the principal is engaging in the transaction through you. For example, you would write, “Sally Smith, by Samuel Smith.”
End the signature by indicating that you’re acting under power of attorney. You can do this in one of several ways. After your name, you can write in the words “agent,” “attorney in fact,” “power of attorney” or simply, “POA.” Your final signature should read similar to "Sally Smith, by Samuel Smith, power of attorney."
Direction from a different source
It is also good form for the attorney-in-fact to write the principal’s name the same way it appears in the document. For example, if the document names Sally E. Smith as the signer and John Doe is signing under a power of attorney for Sally, then ideally John would write, John Doe, Attorney-in-Fact for Sally E. Smith, or Sally E. Smith by John Doe, Attorney-in-Fact, or Sally E. Smith by John Doe, Power of Attorney.--\
Then there is this very different I instruction
If you have been named as “Attorney in Fact” by the Grantor of a Power of Attorney, you should sign YOUR OWN NAME, followed by the words “Power of Attorney.”
Do NOT sign the Grantor’s name EVER.
The person driving some one to the hospital and signs the documents can get a nasty surprised when they get billed
I refuse to sign and I refuse to sign any form that has blank sections and has not been filled out completely.
Personal experience at ER. The admissions brought me a form to sign and I said please fill this out before I sign. The admissions guru showed up and said I understand you will not sign. I said I complete the form and then I'll sign. She came back with 90% of the form crossed out and the blanks filled,
I found this on TechByter Worldwide. It works for me:) {edited to fit}
I really need to say this: I participate and post for informational purposes only. I assume no responsibility for accuracy. Any actions you take based on my posting information are entirely at your own risk. Products and services are mentioned for informational purposes only and their various trademarks and service marks are the property of their respective owners.
Good luck.
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