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:
Go to the Acorn Stairlift website (acornstairlifts.com) and click on Why Buy From Us? on the red banner across the top and then click on FAQs. They report that it is not covered by Medicare but lists several states that offer financial aid. Your state may be listed.
For a veteran, I found this info on the Ameriglide website:
Veterans Seeking Assistance from the VA: The Department of Veterans Affairs has three programs that give cash grants to qualified veterans with disabilities for safety improvements in the home. •The Home Improvements and Structural Alterations (HISA) grant can be used for improvements such as wheelchair ramps and door widening, lowering kitchen and bathroom counters and sinks, installing elevators and stair lifts, and many more. Maximum grants are currently $4,100 for veterans with a 50 to 100 percent service-connected disability, or $1,200 for veterans with disabilities that are not service related. •The Specially Adapted Housing (SAH) grant can be used to make significant changes to housing that will assist eligible veterans in functioning independently in their own homes. The maximum grant, currently $50,000, is available to veterans who have a permanent and total disability (blindness or loss of limbs) as a result of military service. •The Special Home Adaptation (SHA) grant can be used for any home improvement that can help veterans with service-connected disabilities increase mobility throughout their homes. Maximum grants are currently $10,000 and are available to veterans who have permanent and total disability (blindness or loss of limbs) as a result of military service.
A qualified veteran can receive both an HISA grant and either an SAH or SHA grant. To apply for the HISA grant, you should complete VA form 10-0103 and send it to your local VA medical center. To apply for an SAH or SHA grant, complete VA form 26-4555 and send it to your VA regional office. For more information, call 1-800-827-1000 or go to the websites on HISA and on SAH/SHA.
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.
Veterans Seeking Assistance from the VA: The Department of Veterans Affairs has three programs that give cash grants to qualified veterans with disabilities for safety improvements in the home.
•The Home Improvements and Structural Alterations (HISA) grant can be used for improvements such as wheelchair ramps and door widening, lowering kitchen and bathroom counters and sinks, installing elevators and stair lifts, and many more. Maximum grants are currently $4,100 for veterans with a 50 to 100 percent service-connected disability, or $1,200 for veterans with disabilities that are not service related.
•The Specially Adapted Housing (SAH) grant can be used to make significant changes to housing that will assist eligible veterans in functioning independently in their own homes. The maximum grant, currently $50,000, is available to veterans who have a permanent and total disability (blindness or loss of limbs) as a result of military service.
•The Special Home Adaptation (SHA) grant can be used for any home improvement that can help veterans with service-connected disabilities increase mobility throughout their homes. Maximum grants are currently $10,000 and are available to veterans who have permanent and total disability (blindness or loss of limbs) as a result of military service.
A qualified veteran can receive both an HISA grant and either an SAH or SHA grant. To apply for the HISA grant, you should complete VA form 10-0103 and send it to your local VA medical center. To apply for an SAH or SHA grant, complete VA form 26-4555 and send it to your VA regional office. For more information, call 1-800-827-1000 or go to the websites on HISA and on SAH/SHA.