www.agingcare.com Open in urlscan Pro
18.239.94.62  Public Scan

Submitted URL: https://em.agingcare.com/MzA1LVpYWi00NjYAAAGVmhF2wWuq9hwgJVv5dQH_ohEbatQUctJntlfebbUnZdXvD7AGq08rp_-oFsygibZfjfGzPEA=
Effective URL: https://www.agingcare.com/local/assisted-living?%20utm_source=specialoffer&utm_medium=email&utm_campaign=20240916&mkt_tok=...
Submission: On September 16 via api from US — Scanned from DE

Form analysis 10 forms found in the DOM

GET /search

<form id="searchboxform" searchform="" class="searchform" action="/search" method="get" novalidate="novalidate"><input type="text" name="term" class="ac-field field-text fancy-rounded__regular field1" placeholder="Search AgingCare"
    data-uw-rm-form="fx" aria-label="Search AgingCare" data-uw-hidden-control="hidden-control-element"> <button type="button" class="ac-button button-nav-blue fancy-rounded__regular field2 ladda-button" data-submit="true" data-style="zoom-out"
    navsubmitsearch="" aria-label="button" data-uw-rm-empty-ctrl=""> <span> <svg onclick="return false" class="icon-magnifier" style="margin-left:0" data-uw-rm-kbnav="click">
        <use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="/Content/www/images/svg/spritesheet.svg?ver=041dcd79ecaba3fffbe11e563172281b#HeaderMagnifier"></use>
      </svg> </span> </button></form>

GET /search

<form id="searchboxform" searchform="" class="searchform" action="/search" method="get" novalidate="novalidate"><input type="text" name="term" class="ac-field field-text fancy-rounded__regular field1" placeholder="Search AgingCare"
    data-uw-rm-form="fx" aria-label="Search AgingCare" data-uw-hidden-control="hidden-control-element"> <button aria-label="Right Align" type="submit" class="ac-button button-nav-blue fancy-rounded__regular field2 ladda-button" data-submit="true"
    data-style="zoom-out" menusubmitsearch=""> <span> <svg onclick="return false" class="icon-magnifier" style="margin-left:0" data-uw-rm-kbnav="click">
        <use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="/Content/www/images/svg/spritesheet.svg?ver=041dcd79ecaba3fffbe11e563172281b#HeaderMagnifier"></use>
      </svg> </span> </button></form>

POST /local/lead/saveseniorhousinglead

<form action="/local/lead/saveseniorhousinglead" class="find-senior-housing-form" data-ajax="true" data-ajax-failure="OnSeniorHousingFormFailure(data, this.id)" data-ajax-success="OnSeniorHousingFormSuccess(data, this.id)"
  data-formname="LF-ALFLocalLP" id="findSeniorHousingForm" method="post" novalidate="novalidate" onsubmit="TrackWizardFormSubmit(this)"><input id="Url" name="Url" type="hidden"
    value="/local/assisted-living?%20utm_source=specialoffer&amp;utm_medium=email&amp;utm_campaign=20240916&amp;mkt_tok=MzA1LVpYWi00NjYAAAGVmhF2wfrHsFGoBzl-QRnYgQYcXyEv-kxyKNZvTFB_vzwm-Avq7wc5rCnsbWm9fYqZitCu3e1zWDfmKjVTt9gn38y1B_a6LW2nD2TL5oyQDVM"><input
    id="FormUsed" name="FormUsed" type="hidden" value="LF-ALFLocalLP"><input id="CampaignKeyWord" name="CampaignKeyWord" type="hidden" value=""><input id="CampaignGroup" name="CampaignGroup" type="hidden" value=""><input data-val="true"
    data-val-number="The field CategoryId must be a number." data-val-required="You can't leave this empty." id="CategoryId" name="CategoryId" type="hidden" value="2">
  <div class="form form-blue findCare-wizardForm seniorHousing white pad-top-xl pad-leftright-l" data-hero="LF-ALFLocalLPStep1Show2018">
    <div class="c-heading large bold pad-btm-m">Find Assisted Living Communities Near You</div>
    <div class="pad-btm-m"><span class="twitter-typeahead" style="position: relative; display: inline-block;"><input autocomplete="off" class="ac-field field-text fancy-rounded__regular typeAhead tt-hint" data-currentcategory="2" data-val="true"
          data-val-required="You can't leave this empty." type="text" readonly="" spellcheck="false" tabindex="-1"
          style="position: absolute; top: 0px; left: 0px; border-color: transparent; box-shadow: none; opacity: 1; background: none 0% 0% / auto repeat scroll padding-box border-box rgb(255, 255, 255);" dir="ltr" data-uw-rm-form="fx"
          aria-label="Text field"><input autocomplete="off" class="ac-field field-text fancy-rounded__regular typeAhead tt-input" data-currentcategory="2" data-val="true" data-val-required="You can't leave this empty." id="Location" name="Location"
          placeholder="City, ST" type="text" spellcheck="false" dir="auto" style="position: relative; vertical-align: top; background-color: transparent;" data-uw-rm-form="fx" aria-label="City, ST">
        <pre aria-hidden="true"
          style="position: absolute; visibility: hidden; white-space: pre; font-family: &quot;Nunito Sans&quot;, Arial, Helvetica, sans-serif; font-size: 18px; font-style: normal; font-variant: normal; font-weight: 400; word-spacing: 0px; letter-spacing: 0px; text-indent: 0px; text-rendering: auto; text-transform: none;"></pre>
        <div class="tt-menu" style="position: absolute; top: 100%; left: 0px; z-index: 100; display: none;">
          <div class="tt-dataset tt-dataset-locations"></div>
        </div>
      </span></div>
    <div class="pad-btm-m"><input class="ac-field field-text fancy-rounded__regular" data-val="true" data-val-length="Full Name may not be longer than 100 characters" data-val-length-max="100"
        data-val-regex="Enter your first name separated by a space and then your last name." data-val-regex-pattern="^[a-zA-Z'-]{2,} [a-zA-Z'-. ]*[a-zA-Z'-]{2,}$" data-val-required="You can't leave this empty." id="FullName" name="FullName"
        placeholder="Your Full Name" type="text" data-uw-rm-form="fx" aria-label="Your Full Name"></div>
    <div class="pad-btm-m"><input class="ac-field field-text fancy-rounded__regular" data-val="true" data-val-length="Email Address not be longer than 90 characters" data-val-length-max="90"
        data-val-regex="Enter your full email address, including the '@'" data-val-regex-pattern="^[A-Za-z0-9]+([-+_.']?[A-Za-z0-9]+)*@(?:[A-Za-z0-9-]+\.)+[A-Za-z]{2,6}$" data-val-required="You can't leave this empty." id="EmailAddress"
        name="EmailAddress" placeholder="Email Address" type="text" data-uw-rm-form="fx" aria-label="Email Address"></div>
    <div class="fancy-container horizontal pad-btm-l phoneNextToButton">
      <div class="pad-right-m phone-number"><input class="ac-field field-text fancy-rounded__regular" data-val="true" data-val-length="Phone number may not be longer than 15 characters" data-val-length-max="15"
          data-val-required="You can't leave this empty." id="PhoneNumber" name="PhoneNumber" placeholder="Phone Number" type="text" usphonenumber="True" maxlength="14" data-uw-rm-form="fx" aria-label="Phone Number"></div>
      <div><button type="submit" class="ac-button button-blue fancy-rounded__regular" data-submit="" data-style="zoom-out">Find Care</button></div>
    </div>
    <div class="text small pad-btm-l">Talk to an Advisor now <a href="tel:888-848-5698" class="white" aria-label="call 888-848-5698" uw-rm-vague-link-id="tel:888-848-5698$call 888-848-5698" data-uw-rm-vglnk="">888-848-5698</a></div>
    <div class="text xxsmall disclaimer pad-btm-l">By clicking <span data-dynamic-html="buttontext">Find Care</span>, you agree to our
      <a href="/aboutus/policy" rel="noopener" target="_blank" data-uw-rm-brl="PR" data-uw-original-href="https://www.agingcare.com/aboutus/policy" aria-label="Privacy Policy - open in a new tab" data-uw-rm-ext-link="" uw-rm-external-link-id="https://www.agingcare.com/aboutus/policy$privacypolicy">Privacy Policy</a>.
      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
      <a href="/aboutus/termsofuse" rel="noopener" target="_blank" data-uw-rm-brl="PR" data-uw-original-href="https://www.agingcare.com/aboutus/termsofuse" aria-label="Terms of Use. - open in a new tab" data-uw-rm-ext-link="" uw-rm-external-link-id="https://www.agingcare.com/aboutus/termsofuse$termsofuse.">Terms of Use.</a>
      for information about our privacy practices.</div>
  </div>
</form>

<form style="display:none" id="mktoForm_1089"></form>

POST /lead/savelongformcarequizz

<form action="/lead/savelongformcarequizz" data-ajax="true" data-ajax-failure="OnLongFormCareQuizzFormFailure(data)" data-ajax-success="OnLongFormCareQuizzFormSuccess(data)" id="LFCQForm" method="post" novalidate="" role="form"><input
    name="__RequestVerificationToken" type="hidden" value="25DfQI-oycZPTC4r-fNeuW1GRZaDIORVQPMZoxQpb-XnuPqt9tM0VAsADrRNifx9Wg9alyBOyGv0yQRJAhMkf8thaoU1"><input id="Relation" name="Relation" type="hidden"><input data-val="true"
    data-val-number="The field MedicationAssistance must be a number." data-val-required="The MedicationAssistance field is required." id="MedicationAssistance" name="MedicationAssistance" type="hidden" value="0"><input data-val="true"
    data-val-number="The field MemoryImpairment must be a number." data-val-required="The MemoryImpairment field is required." id="MemoryImpairment" name="MemoryImpairment" type="hidden" value="0"><input data-val="true"
    data-val-number="The field HygieneImpairment must be a number." data-val-required="The HygieneImpairment field is required." id="HygieneImpairment" name="HygieneImpairment" type="hidden" value="0"><input data-val="true"
    data-val-number="The field SocialImpairment must be a number." data-val-required="The SocialImpairment field is required." id="SocialImpairment" name="SocialImpairment" type="hidden" value="0"><input data-val="true"
    data-val-number="The field MobilityImpairment must be a number." data-val-required="The MobilityImpairment field is required." id="MobilityImpairment" name="MobilityImpairment" type="hidden" value="0"><input data-val="true"
    data-val-number="The field LivingEnvironmentRisk must be a number." data-val-required="The LivingEnvironmentRisk field is required." id="LivingEnvironmentRisk" name="LivingEnvironmentRisk" type="hidden" value="0"><input id="FormName"
    name="FormName" type="hidden"><input id="SeeListings" name="SeeListings" type="hidden"><input id="OriginalUrl" name="OriginalUrl" type="hidden"><input data-val="true" data-val-required="The QuizzSubmited field is required." id="QuizzSubmited"
    name="QuizzSubmited" type="hidden" value="False">
  <div class="outcome-form">
    <div class="outcome-form-row">
      <div class="form-field">
        <div class="appender">Your Full Name</div>
        <div class="form-control-item"><input aria-invalid="false" class="form-control bp-lp-par-textbox" id="FullName" maxlength="100" name="FullName" placeholder="First Name &amp; Last Name" type="text" data-uw-rm-form="fx"
            aria-label="First Name &amp; Last Name" data-uw-hidden-control="hidden-control-element">
          <div class="form-input-error-text" style="display:none" data-validation-for="FullName"><span>​Please enter your full name</span></div>
        </div>
      </div>
      <div class="form-field">
        <div class="appender">Your Phone Number</div>
        <div class="form-control-item"><input aria-invalid="false" class="form-control bp-lp-par-textbox" data-val="true" data-val-phonenumber="Invalid Phone Number" data-val-required="Phone Number is required" id="Phone" maxlength="50" name="Phone"
            placeholder="(XXX) XXX-XXXX" type="tel" data-uw-rm-form="fx" aria-label="(XXX) XXX-XXXX" data-uw-hidden-control="hidden-control-element">
          <div class="form-input-error-text" style="display:none" data-validation-for="Phone"><span>​Please enter your phone number</span></div>
        </div>
      </div>
    </div>
    <div class="outcome-form-row">
      <div class="form-field">
        <div class="appender">Your Email Address</div>
        <div class="form-control-item"><input aria-invalid="false" class="form-control bp-lp-par-textbox" data-val="true" data-val-email="Invalid Email Address" data-val-required="Email Address is required" id="EmailAddress" maxlength="100"
            name="EmailAddress" placeholder="sample@email.com" type="text" data-uw-rm-form="fx" aria-label="sample@email.com" data-uw-hidden-control="hidden-control-element">
          <div class="form-input-error-text" style="display:none" data-validation-for="EmailAddress"><span>​Please enter your email</span></div>
        </div>
      </div>
      <div class="form-field">
        <div class="appender">Your ZIP Code</div>
        <div class="form-control-item location-zip"><span class="twitter-typeahead" style="position: relative; display: inline-block;"><input autocomplete="off" autocorrect="off" class="typeAhead tt-hint" data-currentcategory="4" data-val="true"
              data-val-required="ZipCode is required" data-zipcodeonly="True" spellcheck="false" type="text" typeaheadlongform="" readonly="" tabindex="-1" dir="ltr" data-uw-rm-form="fx"
              style="position: absolute; top: 0px; left: 0px; border-color: transparent; box-shadow: none; opacity: 1; background: none 0% 0% / auto repeat scroll padding-box border-box rgb(255, 255, 255);" aria-label="Text field"
              data-uw-hidden-control="hidden-control-element"><input autocomplete="off" autocorrect="off" class="typeAhead tt-input" data-currentcategory="4" data-val="true" data-val-required="ZipCode is required" data-zipcodeonly="True"
              id="Location" name="Location" placeholder="" spellcheck="false" type="text" typeaheadlongform="" dir="auto" style="position: relative; vertical-align: top; background-color: transparent;" data-uw-rm-form="fx" aria-label="Text field"
              data-uw-hidden-control="hidden-control-element">
            <pre aria-hidden="true"
              style="position: absolute; visibility: hidden; white-space: pre; font-family: sans-serif; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; word-spacing: 0px; letter-spacing: 0px; text-indent: 0px; text-rendering: auto; text-transform: none;"></pre>
            <div class="tt-menu" style="position: absolute; top: 100%; left: 0px; z-index: 100; display: none;">
              <div class="tt-dataset tt-dataset-postalcodes"></div>
            </div>
          </span>
          <div class="form-input-error-text" id="zipCodeError" style="display:none"><span>Please enter a valid zip code</span></div>
        </div>
      </div>
    </div>
  </div>
  <div class="outcome-submission"><button see-listings="" submission="" data-submit="true" data-style="zoom-out">SEE LISTINGS</button> <button call-me="" submission="" data-submit="true" data-style="zoom-out">CALL ME</button></div>
</form>

POST /local/search

<form action="/local/search" class="find-care-widget-form" data-formname="LF-FindCareSearchWidget-ALFLocalMiddleC-LoggedOut" method="post" novalidate="" onsubmit="TrackFindCarePanel(this)" role="form">
  <div class="find-care-widget pad-leftright-m pad-top-l pad-btm-l">
    <div class="fancy-container horizontal m-btm-m"><label class="c-heading large bold white">Find</label> <select class="dropdown field field-dropdown field-white wide" id="Cname" name="Cname" data-uw-rm-form="fx" aria-label="Find"
        data-uw-hidden-control="hidden-control-element" style="display: none;">
        <option value="4">In-Home Care</option>
        <option selected="" value="2">Assisted Living</option>
        <option value="6">Independent Living</option>
        <option value="11">Memory Care</option>
        <option value="7">Nursing Homes</option>
        <option value="1">Adult Day Care</option>
        <option value="5">Hospice</option>
      </select>
      <div class="nice-select dropdown field field-dropdown field-white wide" tabindex="0"><span class="current">Assisted Living</span>
        <ul class="list">
          <li data-value="4" class="option">In-Home Care</li>
          <li data-value="2" class="option selected">Assisted Living</li>
          <li data-value="6" class="option">Independent Living</li>
          <li data-value="11" class="option">Memory Care</li>
          <li data-value="7" class="option">Nursing Homes</li>
          <li data-value="1" class="option">Adult Day Care</li>
          <li data-value="5" class="option">Hospice</li>
        </ul>
      </div>
    </div>
    <div class="fancy-container horizontal wide"><label class="c-heading large bold white">In</label> <label> <span class="twitter-typeahead" style="position: relative; display: inline-block;"><input autocomplete="off"
            class="ac-field field-text fancy-rounded__regular zipcode typeAhead join-button-right tt-hint" data-currentcategory="2" type="text" readonly="" spellcheck="false" tabindex="-1"
            style="position: absolute; top: 0px; left: 0px; border-color: transparent; box-shadow: none; opacity: 1; background: none 0% 0% / auto repeat scroll padding-box border-box rgb(255, 255, 255);" dir="ltr" data-uw-rm-form="fx"><input
            autocomplete="off" class="ac-field field-text fancy-rounded__regular zipcode typeAhead join-button-right tt-input" data-currentcategory="2" id="seachterm" name="SearchTerm" placeholder="City, ST" type="text" spellcheck="false" dir="auto"
            style="position: relative; vertical-align: top; background-color: transparent;" data-uw-rm-form="nfx">
          <pre aria-hidden="true"
            style="position: absolute; visibility: hidden; white-space: pre; font-family: &quot;Nunito Sans&quot;, Arial, Helvetica, sans-serif; font-size: 18px; font-style: normal; font-variant: normal; font-weight: 400; word-spacing: 0px; letter-spacing: 0px; text-indent: 0px; text-rendering: auto; text-transform: none;"></pre>
          <div class="tt-menu" style="position: absolute; top: 100%; left: 0px; z-index: 100; display: none;">
            <div class="tt-dataset tt-dataset-locations"></div>
          </div>
        </span> <span
          style="color: #ffffff!important;background: #000000!important;clip: rect(1px, 1px, 1px, 1px)!important;clip-path: inset(50%)!important;height: 1px!important;width: 1px!important;margin: -1px!important;overflow: hidden!important;padding: 0!important;position: absolute!important;"
          class="" data-uw-reader-element="" data-uw-rm-ignore="">Text field</span></label> <button type="submit" class="ac-button button-green fancy-rounded__regular join-input-left" data-submit="true" data-style="zoom-out">Go</button></div>
  </div>
</form>

POST /local/lead/saveleadrightsidebarform

<form action="/local/lead/saveleadrightsidebarform" class="lead-form-sidebar" data-ajax="true" data-ajax-failure="OnSideBarLeadFormFailure(data)" data-ajax-success="OnSideBarLeadFormSuccess(data)" id="leadFormSidebar" method="post" novalidate="">
  <input name="__RequestVerificationToken" type="hidden" value="dTuyEP1w23U-9V82c85yFzY4QcbFD60h1Z2mkBOQY5ZAEwd3K1us9dEfy60OJZhGmdIMtDf-w80NOeNsfGPuV1buOYA1"><input id="FormName" name="FormName" type="hidden"><input id="OriginalUrl"
    name="OriginalUrl" type="hidden" value="/local/assisted-living"><input id="OverrideWACheck" name="OverrideWACheck" type="hidden">
  <div class="container">
    <div class="logo-img">
      <a data-uw-rm-kbnav="anohref" tabindex="0"> <img src="https://ac-cdn.azureedge.net/resources/Content/www/images/betterpathlpparents/ac_logo_2.png" alt="Aging Care Logo" data-uw-rm-alt-original="Aging Care Logo" data-uw-rm-alt="ALT"> </a></div>
    <div class="header-text">Free, No Obligation <br role="presentation" data-uw-rm-sr=""> Care Finder</div>
    <div class="settings">
      <div class="txt">What type of care do you need?</div>
      <div class="option"><label class="black"><input data-val="true" data-val-required="The InHomeCare field is required." id="InHomeCare" name="InHomeCare" type="checkbox" value="true" data-uw-rm-form="nfx"><input name="InHomeCare" type="hidden"
            value="false">In-Home Care</label></div>
      <div class="option"><label class="black"><input data-val="true" data-val-required="The SeniorHousing field is required." id="SeniorHousing" name="SeniorHousing" type="checkbox" value="true" data-uw-rm-form="nfx"><input name="SeniorHousing"
            type="hidden" value="false">Senior Housing</label></div>
    </div>
    <div class="form-fields">
      <div class="form-control-item"><input aria-invalid="false" data-val="true" data-val-required="First Name is required" id="FirstName" maxlength="100" name="FirstName" placeholder="First Name" type="text" data-uw-rm-form="fx"
          aria-label="First Name">
        <div class="form-input-error-text" style="display:none" data-validation-for="FirstName"><span>​Please enter a valid first name.</span></div>
      </div>
      <div class="form-control-item"><input aria-invalid="false" data-val="true" data-val-required="Last Name is required" id="LastName" maxlength="100" name="LastName" placeholder="Last Name" type="text" data-uw-rm-form="fx" aria-label="Last Name">
        <div class="form-input-error-text" style="display:none" data-validation-for="LastName"><span>​Please enter a valid last name.</span></div>
      </div>
      <div class="form-control-item"><input aria-invalid="false" data-val="true" data-val-email="Invalid Email Address" data-val-required="Email Address is required" id="EmailAddress" maxlength="100" name="EmailAddress" placeholder="sample@email.com"
          type="text" data-uw-rm-form="fx" aria-label="sample@email.com">
        <div class="form-input-error-text" style="display:none" data-validation-for="EmailAddress"><span>​Please enter a valid your email address.</span></div>
      </div>
      <div class="form-control-item"><input aria-invalid="false" data-val="true" data-val-phonenumber="Invalid Phone Number" data-val-required="Phone Number is required" id="Phone" maxlength="12" name="Phone" placeholder="(XXX) XXX-XXXX" type="tel"
          data-uw-rm-form="fx" aria-label="(XXX) XXX-XXXX">
        <div class="form-input-error-text" style="display:none" data-validation-for="Phone"><span>​Please enter a valid phone number.</span></div>
      </div>
      <div class="form-control-item location-zip"><span class="twitter-typeahead" style="position: relative; display: inline-block;"><input autocomplete="off" autocorrect="off" class="typeAhead tt-hint" data-currentcategory="4" data-val="true"
            data-val-required="ZipCode is required" data-zipcodeonly="True" spellcheck="false" type="text" typeaheadlongform="" readonly="" tabindex="-1"
            style="position: absolute; top: 0px; left: 0px; border-color: transparent; box-shadow: none; opacity: 1; background: none 0% 0% / auto repeat scroll padding-box border-box rgb(243, 243, 243);" dir="ltr" data-uw-rm-form="fx"
            aria-label="Text field"><input autocomplete="off" autocorrect="off" class="typeAhead tt-input" data-currentcategory="4" data-val="true" data-val-required="ZipCode is required" data-zipcodeonly="True" id="Location" name="Location"
            placeholder="Enter ZIP code" spellcheck="false" type="text" typeaheadlongform="" dir="auto" style="position: relative; vertical-align: top; background-color: transparent;" data-uw-rm-form="fx" aria-label="Enter ZIP code">
          <pre aria-hidden="true"
            style="position: absolute; visibility: hidden; white-space: pre; font-family: Nunito; font-size: 14px; font-style: normal; font-variant: normal; font-weight: 400; word-spacing: 0px; letter-spacing: 0px; text-indent: 0px; text-rendering: auto; text-transform: none;"></pre>
          <div class="tt-menu" style="position: absolute; top: 100%; left: 0px; z-index: 100; display: none;">
            <div class="tt-dataset tt-dataset-postalcodes"></div>
          </div>
        </span>
        <div class="form-input-error-text" id="zipCodeError" style="display:none"><span>Please enter a valid ZIP code.</span></div>
      </div>
    </div>
    <div class="privacy-policy">By calling APFM, you are availing yourself of our core service, which is providing customized referrals to assisted living and home care facilities, who will contact you by phone (including text, which may be
      auto-dialed), to help you decide which facility best meets your needs, or the needs of your loved one. Your consent is not a condition to using our services, but we cannot provide you with our core service – a customized referral – without
      sharing your contact information with the facilities to which you have asked to be referred. By clicking, you agree to our
      <a class="outcome-link" href="/aboutus/policy" rel="noopener" target="_blank" data-uw-rm-brl="PR" data-uw-original-href="https://www.agingcare.com/aboutus/policy" aria-label="Privacy Policy - open in a new tab" data-uw-rm-ext-link="" uw-rm-external-link-id="https://www.agingcare.com/aboutus/policy$privacypolicy">Privacy Policy</a>.
      Please visit our
      <a class="outcome-link" href="/aboutus/termsofuse" rel="noopener" target="_blank" data-uw-rm-brl="PR" data-uw-original-href="https://www.agingcare.com/aboutus/termsofuse" aria-label="Terms of Use - open in a new tab" data-uw-rm-ext-link="" uw-rm-external-link-id="https://www.agingcare.com/aboutus/termsofuse$termsofuse">Terms of Use</a>
      for information about our privacy practices.</div>
    <div class="submission"><button data-submit="true" data-style="zoom-out">REQUEST INFO</button></div>
  </div>
</form>

POST /signup/signupentry

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AgingCare Assessment

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Who are you caring for?
Parent Spouse Myself Someone Else
Which best describes their mobility?
Independent with no difficulty moving around Needs occasional mobility
assistance but can manage most tasks alone Needs constant assistance from
another person Bedbound or has significant mobility limitations
How well are they maintaining their hygiene?
Independent, with no difficulty staying clean and groomed Needs occasional
reminders or assistance to stay clean and groomed Requires significant help or
supervision to stay clean & groomed Unable to stay clean and groomed without
help from others
How are they managing their medications?
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Requires daily reminders to take their medications correctly Unable to manage
their medications without support
Does their living environment pose
any safety concerns?
Fall risks, spoiled food, or other threats to wellbeing
Yes No
Are they experiencing any memory loss?
Not at all Sometimes Often
Which best describes your loved one's social life?
Regularly engages with friends or family Occasionally engages with friends or
family, but would benefit from more Almost no social interaction and feels very
isolated
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.
SUBMIT
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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communities. Your consent is not a condition to using our service. Please visit
our Terms of Use for information about our privacy practices.
 We Do Not Sell
Personal Information.



ASSISTED LIVING (ALF)

Assisted living is a senior residential setting with varied levels of services
and housing configurations to address increasing care needs. Assisted living
facilities are designed to provide residents with personal care and assistance
with activities of daily living (ADLs) so that they’re able to continue to live
as independently as possible. Assisted living provides:

 * Individual apartments that promote independence.
 * An increased level of assistance to those who can no longer live safely at
   home, but want to maintain some autonomy.
 * 24 hour/day staff trained to provide assistance with activities of daily
   living such as bathing, dressing, grooming and toileting.
 * Group dining, on-site activities and amenities.
 * Supportive services such as medication management, personal safety
   monitoring, transportation, and housekeeping.


ASSISTED LIVING ARTICLES


 * CHOOSING A LONG-TERM CARE FACILITY: TIPS FROM A CERTIFIED NURSING ASSISTANT
   
   On senior living tours, guides often direct your attention to the shiny
   features they’re proudest of. These amenities may be great, but this
   checklist of essentials can clue you in to the subtler indicators of a
   quality community.
   
   5 Comments
   
   --------------------------------------------------------------------------------


 * INDEPENDENT LIVING VS. ASSISTED LIVING: EVERYTHING YOU NEED TO KNOW
   
   Differences between assisted living and independent living include supportive
   and medical care, amenities, costs, and residential spaces.
   
   9 Comments
   
   --------------------------------------------------------------------------------


 * WHAT TO DO WHEN ELDERLY PARENTS REFUSE ASSISTED LIVING
   
   What's a caregiver to do when their elderly parent refuses assisted living or
   nursing home care but isn’t safe at home? In some cases, guardianship may be
   an option.
   
   59 Comments
   
   --------------------------------------------------------------------------------


 * METHODS OF PAYMENT AND FINANCING OPTIONS FOR ASSISTED LIVING
   
   Most seniors cover assisted living costs with savings, Social Security,
   retirement funds, and home equity. Some government programs and financial
   tools may help, too.
   
   38 Comments
   
   --------------------------------------------------------------------------------

More Assisted Living Articles





ASSISTED LIVING QUESTIONS


 * DOES ANYBODY HAVE ADVICE ON NEGOTIATING WITH A MEMORY CARE FACILITY?
   
   3 Answers
   
   B
   brandee Answered 10 hours ago
   
   --------------------------------------------------------------------------------


 * MOM AND DAD MOVED INTO AL AND ARE REFUSING CARE. HOW DO I HANDLE THIS?
   
   10 Answers
   
   B
   Beatty Answered 12 hours ago
   
   --------------------------------------------------------------------------------


 * MOTHER RUNNING OUT OF MONEY PAYING HER ASSISTED LIVING FACILITY. I WILL START
   USING MY MONEY TO PAY HER BILL. HOW DO I GET HER SS DEPOSIT?
   
   25 Answers
   
   A
   AlvaDeer Answered 13 hours ago
   
   --------------------------------------------------------------------------------


 * MOVED 85 YEAR OLD DAD WITH STAGE 5 LEWY BODY DEMENTIA INTO ASSISTED LIVING
   MEMORY CARE ON AUGUST 30TH, 2024. QUESTION ABOUT EXPECTATIONS!
   
   3 Answers
   
   F
   funkygrandma59 Answered 15 hours ago
   
   --------------------------------------------------------------------------------

More Assisted Living Questions


ASSISTED LIVING DISCUSSIONS


 * HUMANA HMO: ANY EXPERIENCE WITH FINDING DOCTORS?
   
   7 Comments
   
   G
   glasgowgirl48 Commented Sep 7, 2024
   
   --------------------------------------------------------------------------------


 * YOUTUBE CHANNEL LINDSAY KELLY
   
   3 Comments
   
   A
   AlvaDeer Commented Aug 5, 2024
   
   --------------------------------------------------------------------------------


 * ASSISTED LIVING AND VISITING HOME.
   
   10 Comments
   
   F
   funkygrandma59 Commented Aug 1, 2024
   
   --------------------------------------------------------------------------------


 * UPDATE ON IN-LAWS GOING TO AL.
   
   5 Comments
   
   D
   Dawn88 Commented Jul 28, 2024
   
   --------------------------------------------------------------------------------

More Assisted Living Discussions
Find In-Home CareAssisted LivingIndependent LivingMemory CareNursing HomesAdult
Day CareHospice
Assisted Living
 * In-Home Care
 * Assisted Living
 * Independent Living
 * Memory Care
 * Nursing Homes
 * Adult Day Care
 * Hospice

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POPULAR CITIES FOR ASSISTED LIVING

 * Anchorage, AK
 * Baltimore, MD
 * Chicago, IL
 * Cincinnati, OH
 * Cleveland, OH
 * Denver, CO
 * Fort Lauderdale, FL
 * Hialeah, FL
 * Los Angeles, CA

 * Miami, FL
 * Milwaukee, WI
 * Minneapolis, MN
 * Mission Viejo, CA
 * Phoenix, AZ
 * Portland, OR
 * Sacramento, CA
 * Saint Louis, MO
 * Saint Paul, MN

 * Saint Petersburg, FL
 * San Diego, CA
 * San Francisco, CA
 * San Jose, CA
 * Seattle, WA
 * Tampa, FL
 * Tucson, AZ


ASSISTED LIVING BY STATE

 * Alabama
 * Alaska
 * Arizona
 * Arkansas
 * California
 * Colorado
 * Connecticut
 * Delaware
 * Florida
 * Georgia
 * Hawaii
 * Idaho
 * Illinois
 * Indiana
 * Iowa
 * Kansas
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 * Louisiana
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 * Massachusetts
 * Michigan
 * Minnesota
 * Mississippi
 * Missouri
 * Montana
 * Nebraska
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 * New Hampshire
 * New Jersey
 * New Mexico
 * New York
 * North Carolina
 * North Dakota

 * Ohio
 * Oklahoma
 * Oregon
 * Pennsylvania
 * Rhode Island
 * South Carolina
 * South Dakota
 * Tennessee
 * Texas
 * Utah
 * Vermont
 * Virginia
 * Washington
 * West Virginia
 * Wisconsin
 * Wyoming



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Acknowledgement 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 & 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.
Continue