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:
I don't believe it is required. However, if you need to communicate directly with Medicare or with the insurance supplement company, they will require the POA document. And I'm not sure if the POA document alone would suffice for Medicare as they also have their own form(s). Medicare has an "authorization to disclose information" form that I remember my husband had to sign to allow me to act on his behalf for Medicare when he was in rehab, even though we each have POA for the other. Even if you have no need to be in touch with either outfit now, it can't hurt to get the POA document, and other needed forms, on file with them. I assume you have the POA in your mother's records at the LTC facility. You also want to make sure that any correspondence from Medicare or the insurance supplement comes to your mother at your address rather than being sent to her at the LTC facility. Same for social security correspondence.
If you’re helping a family member or friend with a Medicare claim or appeal, your loved one will need to fill out an Appointment of Representative form (in addition to the POA document), which authorizes you to legally represent him or her in Medicare decisions. This form should be sent to the same organization handling your loved one’s Medicare claim or appeal. If you have questions about this form or aren’t sure where to submit it, call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week; for TTY assistance, call 1-877-486-2048. If your loved one is enrolled in a Medicare Advantage or Medicare prescription drug plan, he or she will need to contact the Medicare plan.
Well, likely too late on some levels if she has dementia. I was POA for my brother per his request when he was diagnosed with early Lewy's and moved to assisted living, asking me to take over paying all bills, including supplemental, getting all records from his supplemental insurance, keeping files on everything and etc. What a job. The Medicare and Social Security required his permission to send any documents to me, including what portion of hospital bills were paid by medicare. So did his supplemental insurance and his credit cards. I had to sign that I was responsible for telling the credit card companies, as his POA, if his mental acuity was not good enough to manage the cards I was getting in my mail and paying as his POA. EACH ENTITY will have their own rules and will be glad to tell you about it as long as you are glad enough to hold online for one to two hours. It was a mess getting things set up. Start with the banks, to be certain you are on the account as POA so that you sign correctly on the checks, her name, with you as POA. After a year I got it all together pretty well with the occ. glitch of Spectrum turning off his phone for no good reason and etc. We were at opposite ends of our state. What a trip that all was. I sure do wish you good luck. Do know that medicare will send you documents if you Mom agrees, but SS is different in that if you are not prepresentative payee (two doctor letters that Mom is no longer competent and all the other papers as well as yearly documentation, SS will do little for you. IRS is a whole other barrel of monkeys and I stress monkeys.
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.
https://www.ehealthmedicare.com/blog/caregiver/power-of-attorney-for-family/.
Do know that medicare will send you documents if you Mom agrees, but SS is different in that if you are not prepresentative payee (two doctor letters that Mom is no longer competent and all the other papers as well as yearly documentation, SS will do little for you. IRS is a whole other barrel of monkeys and I stress monkeys.