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:
Most of the time the facility will have a list of items that will be needed to accompany the LTC Medicaid application. It may be the Social Worker or billing department that has the “list”.
If TN does a full 5 yr look back, then it’s 5 years of all bank statements, any paperwork on real property assets sold or transferred past 5 years (like a home, land or car in thier name), your DPOA, perhaps a copy of their will, info on life insurance policies, and their “awards letter” for 2021 from SSA and any other pension or retirement $ they get. ((For SSA this usually gets mailed out in Nov in a single trifold from SSA that states to the penny the amount of $ SS will pay each month, the other retirements do something similar right abt end of each year)). Btw the awards letters will determine what the required copay to the facility will be and what $ amount thier PNA / personal needs allowance will be. Most states have PNA of $50 or $60 a mo and that’s all they will have to spend from here on out once on MedicAID. The PNA can go into a trust acct at the NH for mom so you as POA can go & draw from or if mom is having her income go into her old bank acct and you as POA are writing a check for the copay, then the PNA stays in her bank account. But remember once on individual LTC Medicaid they cannot have over 2k in assets so you have to keep either their bank account or at the NH trust account under 2k.
Yeah it’s quite a bit of paperwork, so ask for the list & start gathering stuff up. Sometimes you may have to see a bank officer to get old statements. & Sometimes if they are already in a facility- IL, AL, etc. - and private pay the lookback may just be 3 years, as assumption is made that they did a spend down of assets to pay for their care, so no need for full 5 years.
Also the states will do some sort of annual renewal for LTC Medicaid, so to make your life easier, start a binder for 2021 so it’s all at the ready to be xeroxed and sent when you get the renewal request. I had no idea this happened and had put stuff into bins & in storage. Nothing but fun there. I was totally ready for year 2 renewal tho’! Good luck in your search.
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.
If TN does a full 5 yr look back, then it’s 5 years of all bank statements, any paperwork on real property assets sold or transferred past 5 years (like a home, land or car in thier name), your DPOA, perhaps a copy of their will, info on life insurance policies, and their “awards letter” for 2021 from SSA and any other pension or retirement $ they get. ((For SSA this usually gets mailed out in Nov in a single trifold from SSA that states to the penny the amount of $ SS will pay each month, the other retirements do something similar right abt end of each year)). Btw the awards letters will determine what the required copay to the facility will be and what $ amount thier PNA / personal needs allowance will be. Most states have PNA of $50 or $60 a mo and that’s all they will have to spend from here on out once on MedicAID. The PNA can go into a trust acct at the NH for mom so you as POA can go & draw from or if mom is having her income go into her old bank acct and you as POA are writing a check for the copay, then the PNA stays in her bank account. But remember once on individual LTC Medicaid they cannot have over 2k in assets so you have to keep either their bank account or at the NH trust account under 2k.
Yeah it’s quite a bit of paperwork, so ask for the list & start gathering stuff up. Sometimes you may have to see a bank officer to get old statements. & Sometimes if they are already in a facility- IL, AL, etc. - and private pay the lookback may just be 3 years, as assumption is made that they did a spend down of assets to pay for their care, so no need for full 5 years.
Also the states will do some sort of annual renewal for LTC Medicaid, so to make your life easier, start a binder for 2021 so it’s all at the ready to be xeroxed and sent when you get the renewal request. I had no idea this happened and had put stuff into bins & in storage. Nothing but fun there. I was totally ready for year 2 renewal tho’! Good luck in your search.