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:
If you apply to Medicaid, your state will require information from you to show that you are "at need" to be eligible for whatever Medicaid program you are applying for. Medicaid has specfic medical & financial requirement to show that you are "at need" & just what depends on which Medicaid program.
For financials, this is done by an up to 5 year look-back at your financial history. What documents vary by state as each state administers its medical program uniquely but within an overall federal guidelines. In general, 5 years of banking including statements, safe deposit info, any CDs / Tbills; details on any real property ownership (& it's sale or transfer within the past 5 years & where the proceeds went); type of life insurance; your current awards letters from SS & other retirements; information on any trusts, annuities....basically all info on the applicant to make sure they are at-need (basically impoverished) and that no $ gifted to others during the 5 year period. Look back starts the day of the Medicaid application and not the date something was gifted.
Just how deep of a lookback depends on your states rules and how involved the applicants finances were in the past. If your parents has been private pay in IL or an AL for several years, the lookback period could be less.
I dealt with NH Medicaid applications for my mom & mil, and my experience is that it's pretty detailed review - both in looking at what you submitted as well as caseworker running a matchup with tax assessor & state databases; and all the documents required must be turned in with the inital applicatioowing ASAP. If not, the application will be suspended or denied. If this is is a NH application, the NH should have a list of documents needed for the States review & "look back" and also for the NH to themselves review in order to have them admitted as a "Medicaid Pending" resident. My experience was each NH reviews the documents to see if there are any obvious issues with the documents & "look back" period, & if so they may not take then as "pending". Afterwards the NH turns in all documents, application and their initial NH room & board bill to Medicaid via the caseworker assigned to their facility. If there is a problem, state sends out a transfer penalty inquiry letter for finances to the family or a medical history review inquiry to the NH if it's a medical issue.
To me there is no way to get around the 5 year requirement for an individual medicaid application unless they started planning on needing Medicaid 7 years before, worked with an atty to move assets all legal and above board. Not a DIY project.
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.
For financials, this is done by an up to 5 year look-back at your financial history. What documents vary by state as each state administers its medical program uniquely but within an overall federal guidelines. In general, 5 years of banking including statements, safe deposit info, any CDs / Tbills; details on any real property ownership (& it's sale or transfer within the past 5 years & where the proceeds went); type of life insurance; your current awards letters from SS & other retirements; information on any trusts, annuities....basically all info on the applicant to make sure they are at-need (basically impoverished) and that no $ gifted to others during the 5 year period. Look back starts the day of the Medicaid application and not the date something was gifted.
Just how deep of a lookback depends on your states rules and how involved the applicants finances were in the past. If your parents has been private pay in IL or an AL for several years, the lookback period could be less.
I dealt with NH Medicaid applications for my mom & mil, and my experience is that it's pretty detailed review - both in looking at what you submitted as well as caseworker running a matchup with tax assessor & state databases; and all the documents required must be turned in with the inital applicatioowing ASAP. If not, the application will be suspended or denied. If this is is a NH application, the NH should have a list of documents needed for the States review & "look back" and also for the NH to themselves review in order to have them admitted as a "Medicaid Pending" resident. My experience was each NH reviews the documents to see if there are any obvious issues with the documents & "look back" period, & if so they may not take then as "pending". Afterwards the NH turns in all documents, application and their initial NH room & board bill to Medicaid via the caseworker assigned to their facility. If there is a problem, state sends out a transfer penalty inquiry letter for finances to the family or a medical history review inquiry to the NH if it's a medical issue.
To me there is no way to get around the 5 year requirement for an individual medicaid application unless they started planning on needing Medicaid 7 years before, worked with an atty to move assets all legal and above board. Not a DIY project.