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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Happier At Home provides in-home care in many settings throughout Southeast North Carolina & the surrounding areas. Our team of experienced caregivers can assist with laundry, household cleaning, meal preparation,...
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Senior care services from Home Instead® of Wilmington, NC help to enhance the aging experience by providing practical support at home with a human touch. Our professional CAREGivers℠ immerse themselves into wherever home...
Home Instead enables the elderly to live independently. It’s at home where quality of life is enhanced without the stress of interrupted routines and changes in daily habits. Our non-medical CAREGivers provide...
In 2012 we opened the Wilmington NC office of Griswold Home Care. What began as a simple desire to start a business together that made a difference in Wilmington turned into an opportunity to do far more. It has been our...
We provide you with options so you can continue to maintain your life while staying in your home on your terms. We desire to create a relationship that allows you the opportunity to make your own decisions about your...
Synergy HomeCare in Wilmington, NC is fully prepared to work with clients with these illnesses. Our in-home caregivers have been trained to work with memory function and can provide relief care, respite care, or anything...
Quality Home Staffing - Wilmington is a home care provider that services in Wilmington, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
AssistedCare, Inc. is a home care provider that services in Wilmington, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
SYNERGY HomeCare of Wilmington, NC is a home care provider that services in Wilmington, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Well Care Home Health is a home care provider that services in Wilmington, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We know that your loved ones need our support to help them live as independently as possible. From providing help with lifestyle choices to doctor’s appointments, personal care, shopping, or household management, we take...
Care Alternatives is the People’s Choice for quality home care in Southeastern North Carolina. Established in 2002, Care Alternatives has been serving seniors and their families for over 8 years. Quality in home care is...
Visiting Angels - Wilmington, NC is a home care provider that services in Wilmington, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We all need a little help sometimes. The caregivers at CB HomeCare understand that you want to preserve your loved one’s independence without compromising their safety. If you’ve noticed that you or your loved one is...
Our mission is to build trusting relationships, with patients, families, physicians and all others devoted to patient care in the home. We are working as a team to provide you with quality home care to improve your...
Interim Healthcare is a leader in the home care industry with 50 years of experience. We provide supportive services to frail and disabled individuals allowing them to remain independent in their homes. Our care...
Our caregivers are committed, highly qualified and carefully selected individuals who are personally and thoroughly screened. Most importantly, they are dependable and extraordinarily caring of others. They have lots of...
Hire an Independent Caregiver to Provide Personalized Senior Care in Brunswick County & Wilmington, NC Our Recruiters & Matchmakers connect seniors with professional, independent caregivers at affordable rates.
Maybe you've recently had surgery or suffered an injury, or you're adapting to a new challenge, such as life after a stroke. Perhaps you need assistance caring for a loved one with Alzheimer's, or you live apart and...
Wilmington's Premier Provider of Home Care Services. A specialized and unique home care company providing high quality and customized home care services to loved ones.
We understand that not one care plan fits all. Daily services can include anything from meal preparation, hygiene, cleaning, and supervision. We will take the time to get to know you and develop an individualized care...
Well Care Home Care is a home care provider that services in Wilmington, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Caregivers You Can Trust Feel better in the comfort of your own home. We specialize in care and daily living assistance to an array of individuals. Whether you need daily or weekly assistance due to aging, illness,...
Liberty Home Care is a home care provider that services in Wilmington, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Visiting Angels, we strive to make staying at home a positive experience. We do this by allowing you to select your caregiver from a group of skilled elderly home care providers, allowing you to maintain your schedule,...
We've been there. We understand. Neither giving nor receiving care is easy. Home Instead® puts relationships first to support those giving care, to protect the dignity of those receiving care, and to enhance the quality...
Senior Helpers Wilmington has been providing dependable and affordable in-home care with their well trained staff of professional caregivers to the seniors and families of the Coastal Carolina community since 2011....
Through our unique system of in-home care that we call Interactive Caregiving™, our Comfort Keepers® engage clients in their care to enhance their independence and well-being. Interactive Caregiving™ includes four...
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.