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:
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Queenmine Homehealth, LLC, is your premier destination for top-notch home healthcare services in Fort Washington, Maryland, and surrounding areas. Founded by a dedicated registered nurse with 24 years of extensive...
Prospect Nursing and Home Care Services is a trusted provider of compassionate home health and professional healthcare staffing solutions in Frederick, MD. We proudly serve patients and clients of all ages — from babies...
Providing quality in-home care at affordable rates since 1989. Assistance in personal care including help in bathing, showering, dressing, grooming, meal preparation, medication reminders, companionship, transportation to...
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Caring Touch Agency LLC is a non-medical home care agency built on a foundation of love, compassion, and dependable support for every individual we serve. We provide personalized services, including safe and reliable...
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Gracie Care LLC is a Silver Spring, Maryland–based home care agency providing compassionate, non-medical in-home support. Services include personal care and companionship designed to help individuals maintain...
Leap Homecare offers caregiving services for almost any family and practically any circumstances. We care for your loved ones to enjoy healthy lives in the comfort of anywhere they call home.
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Experience a happier, healthier life at home. We know there’s no place like home. That’s why HomeWell brings you the highest quality of care so you can maintain your independence and experience life to the fullest.
Active Participant LLC is a compassionate home care agency dedicated to empowering individuals to remain actively engaged in their daily lives while aging in place. We provide personalized, non-medical home care services...
Allied QualityCare LLC is a trusted provider of compassionate and reliable home care services, dedicated to supporting individuals and families with personalized care solutions. Our mission is to enhance the quality of...
Blessed Angels Home Healthcare Services extends a warm welcome to you our client and to your family and friends. Your medical treatment, safety and happiness are most important to us as we will do our best to answer any...
At Sarah’s Peace and Love, we are committed to providing high-quality, customized and affordable home care services to our clients to assist them in the comfort and safety of their homes.
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Cornerstone Care Nursing is a provider of healthcare services to the clients in the comfort of their homes. As our company has grown, we have maintained a commitment to high performance and unsurpassed knowledge about the...
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Gifted Hands Home Care LLP is a compassionate and reliable home care agency dedicated to providing exceptional in-home care services for individuals in need of assistance with daily activities.
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Serving You Home Care is a home care provider that services in Upper Marlboro, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Prestige Healthcare Resources provides personalized in-home care services to seniors at their own home or various settings; including hospitals, assisted living, independent living facilities, or where ever the individual...
Welcome to Pleasant Care and Nurse Staffing! Pleasant Care and Nurse Staffing is your local source for reliable care. Our company is proudly a part of the community in Maryland, Washington, D.C. and Virginia. We serve...
TruGrace Healthcare is a reliable home care service agency dedicated to providing exceptional care and support for your family. We offer a wide range of personalized home health services, including skilled nursing,...
Community Support Health Services, LLC, we put our clients first in providing home health care services in Maryland. Our extensive array of services guarantees your loved ones’ optimum health while remaining in the...
At Freedom Home Care, we are dedicated to providing the highest quality of care in the Home Care Profession. We are a bonded and insured non-medical home care agency serving the Anne Arundel County Area. We provide...
Founded in 1966, Interim HealthCare is the nation’s first home care company and a trusted provider of home healthcare, personal care and support, hospice care and medical staffing services.
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One of our advisors will contact you soon to connect you with trusted sources for care in your area.
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.