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:
We had a Durable POA, Healthcare POA, Advance Medical Directive or Living Will, HIPPA Consent Form, done all the same time, and a Last Will and Testament, for a flat fee of 1,000. It was worth it for the peace of mind to get it all done, and done before my mother got any worse. It was hard enough to get her to agree to these, since she was reaching the phase where she was convinced I only wanted control over her. No matter how often I told her it was so I could protect and speak and act for her best interests.
My wife downloaded the forms for Minnesota from the internet and gave them to my friend's second cousin to use when she came to visit them. She went through the forms with them line by line marking the boxes the way they wanted them marked and writing their desires in the open ended question areas. Another friend took them to their bank to have them notarized. The bank people knew them well and knew it was time to get them positioned for help. It was then that I learned that I was their first POA with all sorts of authority vested in me since they had no children nor close relatives. It cost nothing and covered everything. We had been friends for 40 some years, worshipped together, vacationed together, and there was no one else in their life they trusted more than me. The cousin that went through the forms with them was from out of state and was the second POA, while the friend who took them to the bank was the third. It has worked well with this approach and I have learned a lot in this role and gotten a lot of good advice on what to do as their dementia increased and memory worsened.
First of all, the elder must understand what they are signing. Then they must present photo ID to a notary public after the document is filled out. Then keep it on file at elder's doctor and hospital.
I am not a big fan of internet POA and having you fill it out. All it takes is one misplaced word or one word left out to create a landmine of problems later down the road.
With using an Elder Law Attorney you would be asked questions that you never would have thought about which would be important. And you can ask questions to the Attorney.
While cheap forms from the office supply store are certainly available, and probably better than nothing, the small fee that a good elder law attorney charges for his or her preparation of a durable power of attorney for financial and legal matters would be money well spent. The cost for just that one document can be between $75 and $200, most likely, depending on the needs of the client. However, you will certainly also need a durable power of attorney for health care and probably a living will.
If the individual for whom you are seeking the POA has any assets and you think that nursing home care may become needed at some point in the future, the attorney will include some necessary clauses in the POA to facilitate certain types of Medicaid planning. Without those clauses, such planning may be impossible to accomplish.
I include a section on durable powers of attorney in my book, Medicaid Secrets, which you may find helpful.
It all depends on who the POA is covering. Documents can be downloaded free online with your state secretary of state website. The person signing must be present to sign, under no duress, and be competent. Notaries do not have medical licenses so cannot make a medical determination as to competency, but will ask the signor who he/she is, date of birth, and ask what document they are signing (perhaps). A bank's notary cannot sign a power of attorney attesting to competency (at least Wells Fargo will not). Why does this person need a POA? If you are a caregiver, this is a bad idea.
Often the attorney will also prepare the Durable POA, Healthcare POA, Advance Medical Directive or Living Will, HIPPA Consent Form, all the same time, if the client wants them. They can also prepare Last Will and Testament, if that is requested. Often, it's for a flat fee, based on the size of the estate and complexity of the issues.
One of the most valuable things one may obtain is advice on your particular situation. There are laws and consequences that may apply to your situation, that you may not be aware of, unless you consult with an attorney. That's why they will have you complete a questionaire and get details from you.
The biggest question is whether or not the patient has the capacity to understand what they are signing. If the notary public is not convinced the patient fully understands the document, you may have to seek Guardianship. That gets expensive. You can get a blank DPOA form anywhere online for free. Notaries are very cheap and sometimes free at your bank. Lawyers expect about $300 per hour.
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.
With using an Elder Law Attorney you would be asked questions that you never would have thought about which would be important. And you can ask questions to the Attorney.
If the individual for whom you are seeking the POA has any assets and you think that nursing home care may become needed at some point in the future, the attorney will include some necessary clauses in the POA to facilitate certain types of Medicaid planning. Without those clauses, such planning may be impossible to accomplish.
I include a section on durable powers of attorney in my book, Medicaid Secrets, which you may find helpful.
One of the most valuable things one may obtain is advice on your particular situation. There are laws and consequences that may apply to your situation, that you may not be aware of, unless you consult with an attorney. That's why they will have you complete a questionaire and get details from you.
You can get a blank DPOA form anywhere online for free. Notaries are very cheap and sometimes free at your bank.
Lawyers expect about $300 per hour.