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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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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.
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Please bear with the long post, but I feel like I need to give the back story. My Mom has been through a lot. She has severe COPD. In the summer of 2023 she was placed on hospice while at a skilled nursing facility. Due to unforeseen circumstances she had to switch facilities. The events that followed the next 10 days at the second facility almost killed her. The staff at the facility stated they weren’t comfortable with the amount of medication hospice prescribed. They decided to cut her Ativan dose in half and take her completely off of her morphine for over a week. It sent her into severe withdrawal with full on psychosis. She was hitting herself, believed a man in her head was telling her to hurt herself. Drs believed this all stemmed from the withdrawal. She had never hallucinated before. She spent 5 days in an acute care hospital and then was placed in a hospice house. The hospice house was amazing. They adjusted all her medication and she was able to graduate off of hospice and into the second nursing home. That was in January. She was doing great. When she entered the nursing home she was still on Ativan. I expressed my concern with administration about her meds and the importance of not taking them away from her, they agreed. So, the end of August, without talking to family, they screwed with her meds again. They again cut her Ativan in half, and made two other major changes all within just a couple of weeks. So, guess what happened? It sent her into a full blown withdrawal, psychotic episode again. This time she wasn’t violent to herself , but she was convinced a demon was in her head telling her she was going to hell. She was terrified. I’m a RN and work at a hospital and have never seen anything like it. She was sent to an inpatient psychiatric facility for 3 weeks to get it figured out. She was doing better. They were giving her meds to stop the hallucinations and klonopin for her withdrawals and anxiety. Then the nursing home made them take her off the klonopin before they would take her back. So now she’s getting nothing for anxiety. I’m upset because she only went there because of their incompetence in the first place! She was on Ativan before she went. I’m just so sick about this whole situation. I know SNFs have to be careful because of state regulations, but I also know that they can give their patients what they need with proper documentation. I have a meeting to discuss the events of the last few weeks with administration scheduled for next week. I don’t want her to go through this again. She deserves quality of life and basic respect .
Have you spoken to the in house doctor who manages and writes Mom’s med orders at her SNF ? I’d have a chat with that person as well .
I’d also tell admin you want to be notified of any medication changes same day the new order is written . ( I have dealt with facilities that automatically did this in the beginning , but would slack off as time went by ). This way if you don’t agree you ask them to have the doctor call you to discuss.
I would check weekly with the charge nurse what Mom’s meds are , in case they forget to tell you of a change.
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’d also tell admin you want to be notified of any medication changes same day the new order is written . ( I have dealt with facilities that automatically did this in the beginning , but would slack off as time went by ). This way if you don’t agree you ask them to have the doctor call you to discuss.
I would check weekly with the charge nurse what Mom’s meds are , in case they forget to tell you of a change.
Go to or call into every care meeting ,
I’m assuming you have POA.