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.
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I acknowledge and authorize
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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.
Share a few details and we will match you to trusted home care in your area:
Are you POA? The POA should sign, if she is incompetent to do so. If she is competent then SHE should sign even if to make a mark. YOU DO NOT SIGN unless you are POA, guardian, conservative, legal fiduciary, etc. If she has assets the they should be disclosed. But if you are not her POA then I don't think you have the power to disclose them.
Ask for Social Services at the facility. They can help you negotiate all this and make your way through and can also discuss discharge planning with you.
If asking for moms info, I see no problem. If you are POA make sure you sign everything with POA after your name. You are a representative for Mom, so when u sign, you are signing for her if she is not competent to sign for herself. Your finances don't matter. Your not paying for her care,
I'm not sure if she's going into rehab or a nursing home? I think it's pretty standard to have to disclose financials of the patient. Facility wants to know if she can self pay or if medicaid is imminent.
How long have you been caring for her? Are your burnt out? If you are done being her caregiver, then it is time to look at facilities. If she is in rehab now, have go directly to a facility. It is sooo much easier to do it that way as opposed to trying to get her to cooperate with leaving her home to go to a facility.
Is she going into a facility for Medicare-paid rehab after a hospitalization? And the transitioning to LTC?
When my mom was released to rehab after a stroke and broken hip, we knew she was being admitted to the NH/rehab forever. We disclosed mom's assets to them so they could see that she had enough to pay privately for several years before she would need Medicaid.
It's MOM'S assets you are disclosing, not yours. Do not sign as "responsible party". Mom signs that.
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 signed everything the day before my mom entered the facility. The next day they transported mom straight from the hospital to the facility.
Medicare pays for it. If you stay longer than the maximum amount of time, the cost is out of pocket.
My mom was in her 90’s so I signed POLST paperwork too.
I see in your profile that your mom is 88.
The POA should sign, if she is incompetent to do so.
If she is competent then SHE should sign even if to make a mark.
YOU DO NOT SIGN unless you are POA, guardian, conservative, legal fiduciary, etc.
If she has assets the they should be disclosed. But if you are not her POA then I don't think you have the power to disclose them.
Ask for Social Services at the facility. They can help you negotiate all this and make your way through and can also discuss discharge planning with you.
How long have you been caring for her? Are your burnt out? If you are done being her caregiver, then it is time to look at facilities. If she is in rehab now, have go directly to a facility. It is sooo much easier to do it that way as opposed to trying to get her to cooperate with leaving her home to go to a facility.
Best of luck.
Is she going into a facility for Medicare-paid rehab after a hospitalization? And the transitioning to LTC?
When my mom was released to rehab after a stroke and broken hip, we knew she was being admitted to the NH/rehab forever. We disclosed mom's assets to them so they could see that she had enough to pay privately for several years before she would need Medicaid.
It's MOM'S assets you are disclosing, not yours. Do not sign as "responsible party". Mom signs that.