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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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Thanks again I have a specific timeline. For me. I Just want to see mom. I know she is not well, for my brother it's about isolation, control, and abuse. I am going to APS but I believe my brother is to smart and shrewd for APS to be effective. I hope I am wrong.
Why do you think your sister cut off communication with you five months ago?
Suppose you succeeded in removing your mother from your brother/sister's care: what alternative arrangements do you have in mind?
When you speak to the authorities, which everyone is correctly urging you to do, you will find them much more receptive if you are very clear on the details. Your mother was moved into your sister's house, correct? And your brother lives near to them, lives with them, or what? Or are you talking about a sister and brother-in-law? I know this will sound like nit-picking, but it makes it very hard to get a clear picture of what's going on when we can't understand easily who is doing what exactly.
How have you seen your brother's large investments? What has he invested in?
I think you will find that APS will respond if you tell them that neither you nor her doctor has been able to get near your mother for five months to check on her wellbeing; give them the doctor's name and contact number for back-up, if you like; and tell them why you suspect your brother is spending your mother's money other than for her benefit. But when you speak to them slow down, answer their questions carefully, and try not to get upset - it weakens your credibility and will make them less likely to raise the alarm.
Mom was living alone up to a year ago. Sister moved mom in about a year ago into her house. I have seen mom sick and sister did not get mom medical care. I was visiting mom up to about 5 months ago when sister shut down all communications and visits
When I was seeing mom, she had bronchitis and sister refuses to take her to the dr. Brother also refuses dental care, and mom also has diabetes. I spoke with moms dr and he told me he wanted to see mom. He called to set up an appointment with no answer. I have also seen that my brother recently has purchased large investments all of a sudden
I have a complete diary of isolation, lack of medical care, and financial abuse
Where is your mother living? How is your brother preventing you from seeing her? What reason does he give for refusing to let you see her? How long has it been since somebody other than your brother saw your mother to speak to? If you haven't been able to see your mother, how has the lack of medical care come to your attention? What involvement have you had with her care before now? - what needs does she have that you believe are not being met? Does your brother have financial POA? What leads you to believe there is financial mismanagement?
I'm sorry to lead with all these questions; but if you need to report your concerns they are the sorts of things you will be asked - so best to get your ducks in a row, then you're more likely to get something done.
There must be a reason behind your brother's refusal. Have you tried asking him why he does so?? And if you are sure that she is being abused in any way, report it to local authorities. But if you think that she is being abused because your mom tells you so, you should do some research ,because usually such patients are very unpredictable and often say things that aren't true. Just don't take sides
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.
Suppose you succeeded in removing your mother from your brother/sister's care: what alternative arrangements do you have in mind?
When you speak to the authorities, which everyone is correctly urging you to do, you will find them much more receptive if you are very clear on the details. Your mother was moved into your sister's house, correct? And your brother lives near to them, lives with them, or what? Or are you talking about a sister and brother-in-law? I know this will sound like nit-picking, but it makes it very hard to get a clear picture of what's going on when we can't understand easily who is doing what exactly.
How have you seen your brother's large investments? What has he invested in?
I think you will find that APS will respond if you tell them that neither you nor her doctor has been able to get near your mother for five months to check on her wellbeing; give them the doctor's name and contact number for back-up, if you like; and tell them why you suspect your brother is spending your mother's money other than for her benefit. But when you speak to them slow down, answer their questions carefully, and try not to get upset - it weakens your credibility and will make them less likely to raise the alarm.
When I was seeing mom, she had bronchitis and sister refuses to take her to the dr. Brother also refuses dental care, and mom also has diabetes. I spoke with moms dr and he told me he wanted to see mom. He called to set up an appointment with no answer. I have also seen that my brother recently has purchased large investments all of a sudden
I have a complete diary of isolation, lack of medical care, and financial abuse
How is your brother preventing you from seeing her?
What reason does he give for refusing to let you see her?
How long has it been since somebody other than your brother saw your mother to speak to?
If you haven't been able to see your mother, how has the lack of medical care come to your attention?
What involvement have you had with her care before now? - what needs does she have that you believe are not being met?
Does your brother have financial POA? What leads you to believe there is financial mismanagement?
I'm sorry to lead with all these questions; but if you need to report your concerns they are the sorts of things you will be asked - so best to get your ducks in a row, then you're more likely to get something done.