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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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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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DNH = Do Not Hospitalize order (or Do No Harm?) Are they the same as a DNR, or included in a DNR? I've not come across this term before... thanks for clarifying.
This is a form ordinarily used in a nursing home setting to post; it is akin to advance directive and it is an order not to hospitalize. If you mean WHO can get this, anyone can get it for him or herself from the MD and it is much like a POLST; it will dictate what may be done and what may not by MD order.
I note you have posted this under "depression"? Can you tell us a bit more about this form and why now you prefer to have it?
By asking "who can get" this form are you saying you want one for yourself? If this is the case, speak with your MD who should have these available and will make one out with you at an appointment.
"Do Not Hospitalize order (“DNH”). There are 2 types of DNH orders: 1) one is an absolute prohibition against hospitalization under any circumstances; and 2) a general recommendation to avoid hospitalization, but allowing the health care proxy to make the decision on a case by case basis."
If you are the Medical Proxy then the Hospital Mom frequests needs to be made aware and have a copy on file with your info. You need to make all her doctor's aware too.
Can I add a question to a question as this pertains to my situation/ my dad too What happens if the LO's will, health care proxy and POLST etc were all written some time ago, during times of mental competency, and written to be essentially "full treatment/ full code". However now the LO is not competent, and has signed a financial and health care POA, with myself and my brother as POAs. Are we now essentially stuck with this full code status? If my dad went to PCP and said that he now wants to dramatically change things, including to a Do Not Hospitalize level, would they allow him too since invoked his POA ?
If your Dad is not competent he cannot change a thing. Funny, I just had this conversation with my DD, RN. You as heathcare proxy has the responsiblility to to follow the of wishes the principle. Now is this proxy was written when Dad was younger and in better health and was still in good health, then if he wanted to be resuscitated then you would need to go along with it. But if years have passed, Dementia and illness have set in and elderly and Dad stops breathing, you can override his former wishes and let him go. My daughter says she sees it all the time but in reverse. Family won't let LO go. You make the best judgement for Dad not u.
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 note you have posted this under "depression"? Can you tell us a bit more about this form and why now you prefer to have it?
By asking "who can get" this form are you saying you want one for yourself? If this is the case, speak with your MD who should have these available and will make one out with you at an appointment.
If you are the Medical Proxy then the Hospital Mom frequests needs to be made aware and have a copy on file with your info. You need to make all her doctor's aware too.
What happens if the LO's will, health care proxy and POLST etc were all written some time ago, during times of mental competency, and written to be essentially "full treatment/ full code". However now the LO is not competent, and has signed a financial and health care POA, with myself and my brother as POAs. Are we now essentially stuck with this full code status? If my dad went to PCP and said that he now wants to dramatically change things, including to a Do Not Hospitalize level, would they allow him too since invoked his POA ?