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:
Is this a quarterly care conference? Each discipline at the nursing home will report their observations of your mother. Dietary will say if she is eating well or not, PT will report on the progress of her physical therapy (if any), Nursing may talk about any sleep problems, rashes, etc. Activities will tell you if Mom is participating in activities and maybe what her favorites are, etc.
You may have questions based on any of the reports.
Here are some of the questions my sisters and I have asked: We have found Mom without her teeth in 3 times this month. What is happening to correct that problem?
Mom is really enjoying the musical entertainment. Thank you for bringing her to these events.
Mom's rash seems to be getting worse. Is there something else that can be tried?
In other words, ask any questions that have occured to you in the last few weeks, and also offer comments.
Mom has not been long in the nursing home? The most important thing is to listen. They are telling you their observations and expressing concerns. They want to get to know your mom and you are an important tool to reach the goal of providing her the best care. Your lifetime of knowledge is very valuable to them. You are part of the team. Ask any questions that come to your mind, even the questions asked will help them get to know her.
I will just add, if there are outside services that come in to see your mom (podiatry, dentistry, audiology, behavioral health) please ask for WRITTEN reports that result from those visits.
The most difficulty that we've had over the past three years with mom in the NH have been the result of lack of communication between us and those services, because they report their results to the NH, who report them to us. In the process, important information was left out, which WAS in the written reports.
As an example, the dentist, who started seeing mom three years ago recommended pulling all of her teeth and doing complete upper and lower dentures. We were unable to contact this person directly and we did not pursue the issue. Recently, some of mom's teeth broke off. I persisted and after three months of calling and cajoling, finally got the dentist on the phone. It turns out that when he initially saw mom, nearly all of her teeth had cavities; he recommended extraction for a very good reason!
Not that we would have done it, but it would have been good to know what road we were going down at the outset.
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.
You may have questions based on any of the reports.
Here are some of the questions my sisters and I have asked:
We have found Mom without her teeth in 3 times this month. What is happening to correct that problem?
Mom is really enjoying the musical entertainment. Thank you for bringing her to these events.
Mom's rash seems to be getting worse. Is there something else that can be tried?
In other words, ask any questions that have occured to you in the last few weeks, and also offer comments.
The most difficulty that we've had over the past three years with mom in the NH have been the result of lack of communication between us and those services, because they report their results to the NH, who report them to us. In the process, important information was left out, which WAS in the written reports.
As an example, the dentist, who started seeing mom three years ago recommended pulling all of her teeth and doing complete upper and lower dentures. We were unable to contact this person directly and we did not pursue the issue. Recently, some of mom's teeth broke off. I persisted and after three months of calling and cajoling, finally got the dentist on the phone. It turns out that when he initially saw mom, nearly all of her teeth had cavities; he recommended extraction for a very good reason!
Not that we would have done it, but it would have been good to know what road we were going down at the outset.