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ELDER Placements Disclosure of Services and Agency Agreement

ELDER Placements Disclosure of Services

This is an Agreement between ELDER Placements and the Client (individual, family and/or entity requesting placement service), and is effective immediately with acknowledgment of this Disclosure. ELDER Placements refers clients to senior housing and care options, and is therefore in subjection to RCW 18.330 under Washington State’s “Elder & Vulnerable Adult Referral Agency Act”. ELDER Placements provides personalized services to clients, their family members or legal representatives who are looking for senior housing and/or care options. The relationship is at-will, and the client may terminate the relationship with written notice at any time.  We make referrals to Independent Living, Assisted Living, Memory Care, and Adult Family Homes options.  The referrals are based on information from the intake form and client/family history and includes health history, personal preference, care needs, and financial abilities.  Intake form information is covered by the Washington State health care information confidentiality law. This document will act as a medical release and will only be shared with providers related to admission and or care services. 

ELDER Placements partners are not considered providers and will not be liable or responsible for the acts or omissions of a housing and/or care provider. Clients will not be asked to sign waivers of potential liability for losses of potential property or injury or to sign waivers of any rights of clients established by state or federal laws.

ELDER Placements represents both the Resident and the Senior Housing and Care Provider. Senior Housing and Care Provider pays us a referral fee for clients that choose to use their services.  Referral fees are charged according to individual contracted terms with Senior Housing and Care Provider and are due from providers after the client takes financial responsibility. Referral fees cannot be passed onto the client. This is stated in the contract we have with Senior Housing and Care Provider. Refunds to Senior Housing and Care Provider are given if a client passes away, is hospitalized, or is transferred to a setting with a more appropriate level of care within the first 30 days of admission as agreed upon in the contract. 

ELDER Placements partners will refer only to facilities that have been toured and contracted. The Senior Housing and Care Providers are required per our contract to update us regularly on the status of their facility license and state inspections outcomes.

ELDER Placements Agency Agreement

We appoint ELDER Placements to represent us in the search of long-term care, housing, and services. This agreement creates an agency relationship with ELDER Placements and the Client. This agreement supersedes any and all other agreements that might have been implied verbally, in writing or with an internet search. 

Terms. This agreement will expire at the time of the client’s acceptance of 3rd party services or by written notice.  Client shall be under no obligation to ELDER Placements except for those obligations existing at the time of termination or completion of securing long term care and/or housing. Warranties. ELDER Placements makes no warranties or representation regarding the suitability or care of any referrals to Senior Housing and Care Provider.  The client agrees to be responsible for conducting all investigations necessary to satisfy the suitability of said services.  Fees.  Placement and Referral Services are free to all seniors and their families. Additional consulting services are available for clients at their request for $250/hr.

Medicaid Clients. ELDER Placements partners cannot collect a referral fee for Medicaid clients, only for the private-pay portion of the stay and care, and/or for services requested by client’s family or representative based on prior arrangements for services for private pay. Complaints. Complaint of violations of the “Vulnerable Adult Referral Agency Act” can be filed by client with the Attorney General’s office 1125 Washington Street SE, PO Box 40100, Olympia, WA 98504-0100   Attorney General Phone: Mon-Fri, 10 am to 3 pm, (360) 753-6200 1-800-551-4636 (in-state only) 1-800-833-6384 (for hearing impaired) 1-206-464-6684 (out of state callers). Authorization: I certify that this request has been made freely, voluntarily and without coercion and that the information provided to ELDER Placements partners is accurate and complete to the best of my knowledge. I understand that I can revoke my authorization at any time in writing. I hereby accept the Disclosure of Services and I Agree with all terms above, and I acknowledge receiving the ELDER Placements Disclosure of Services and Agency Agreement.

Client's Name: _________________


Client's Signature: _________________


Date: _________________


Client's Representative Name: _________________


Client's Representative Signature: _________________


Date: _________________