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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.
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I acknowledge and authorize
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I consent to the collection of my consumer health data.*
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I consent to the sharing of my consumer health data with qualified home care agencies.*
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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.
Share a few details and we will match you to trusted home care in your area:
All I did was have Moms doctor write a note. All it said was that I would not be able to serve because I was sole Caregiver for his patent who suffered from Dementia. I enclosed that letter with the form and sent them back. I was excused.
Like Glad said, Courts should be closed for COVID.
When I was caring for mom there was an option to simply notify the court if you were responsible for the care of another. I did not need a doctor's note. But, the first time only suspended the jury duty for six months, but then was not called again.
In my state all jury trials have been discontinued due to covid, but the summons continue to be sent. Have you checked the court website or called to find out the status of jury trials?
When I was called for jury duty, there was an opportunity to advise the clerk of reasons why jury service would be a hardship. It's been years, but best recollection is that you completed a questionnaire and returned it.
If that's not the situation, call the clerk of the court for the county and ask how to be excused b/c of medical obligations to your parent who is dependent on you. If you get any flack, gently ask how to arrange for a wheelchair to be available as you'll have to bring your mother with you, and she can't be left alone, needs a wheelchair to navigate and would need other special accommodations if you're selected, to include someone to stay with her while you're sitting in the courtroom.
If you're still getting flack, explain that she has stage 4 cancer and her oncologist has advised that she needs consistent care, almost 24/7.
I doubt if it goes that far though; my experience has been that there are so many selected from available jurors that it's easy to excuse someone for a good reason.
Your Mother's doctor can write an excuse for you. Send that in to the address on the form. Follow the instructions on your form. Your own doctor should even be able to write you a form letter. These are simple and all doctors have them. Basically it just is a trusted entity saying you cannot serve and why. I got out of it for years by sending a letter saying I had IBS (irritable bowel syndrome), which at the time was true. Said I would love to serve on a jury but got claustrophobic in enforced circumstances where I could not leave, and the judge would need to know I might have to go to the bathroom multiple times on any given day. They just sent back an excused notice. Don't know if that would work, but do know that claustrophobia, bad back and etc. letters do work. Not sure how your caregiver excuse would work. Is there a number to call to ask them what they need to excuse you? If not, just ask your Mom's doc for a letter; start there. Send that in.
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.
Like Glad said, Courts should be closed for COVID.
In my state all jury trials have been discontinued due to covid, but the summons continue to be sent. Have you checked the court website or called to find out the status of jury trials?
If that's not the situation, call the clerk of the court for the county and ask how to be excused b/c of medical obligations to your parent who is dependent on you. If you get any flack, gently ask how to arrange for a wheelchair to be available as you'll have to bring your mother with you, and she can't be left alone, needs a wheelchair to navigate and would need other special accommodations if you're selected, to include someone to stay with her while you're sitting in the courtroom.
If you're still getting flack, explain that she has stage 4 cancer and her oncologist has advised that she needs consistent care, almost 24/7.
I doubt if it goes that far though; my experience has been that there are so many selected from available jurors that it's easy to excuse someone for a good reason.
Is there a number to call to ask them what they need to excuse you? If not, just ask your Mom's doc for a letter; start there. Send that in.