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A1 Senior Care Advisors LLC (“A1 Advisors”) is a referral, placement and advisory service that interviews, assesses and advises an elder person, vulnerable adult, or his or her representative, adult (hereafter, “Client”), helping them locate the appropriate care provider (“Provider”) who will meet their unique care needs, preferences, assistance and financial budgets. We meet with each Client to evaluate and discuss the Client’s needs. We will help you determine what level of supported care or housing is best for you or the Client, asking you questions and reviewing medical records. We will escort you to a number of facilities (“Providers”) and You will make the final decision on which provider will be chosen. Our commitment is to you and your family not a particular Provider. All Clients receive Disclosure of Services prior to the A1 Advisors and its Affiliates making a referral that includes information of compensation for services. A1 Advisors and its Affiliates operate in compliance with RCW 18.330.020.
– A1 Advisors does not charge a fee to their Client or representatives for referral services and are paid directly by the Provider. A1 Advisors plays a supporting role in helping you make the best choices and does not make direct recommendations – we make referrals and offer options. A Client may, without cause, stop using A1 Advisors without penalty or a cancellation fee. Also, A1 Advisors may, without cause, stop working with a Client with the appropriate notification.
– A1 Advisors does not require a Client to sign waivers of potential liability for losses of personal property or injury, we do not ask for waivers of any rights of the client established in state or federal law. A1 Advisors will not require the Client or their representative to work exclusively with one licensed individual or agency. Please notify us if you desire to work with more than one referral professional.
– A1 Advisors must receive the Client’s written authorization to obtain or disclose confidential health care information that includes identifying information. We will inform the Providers of details regarding the potential Clients housing and care needs.
– Contracted Provider facilities are typically visited, at a minimum, annually by A1 Advisors when Provider information is updated and maintained. At the time of providing referrals to the Client, A1 Advisors will inform the Client in writing or by electronic means if the referred supportive housing provider has been visited, and if so, the most recent date that a visit took place.
– A1 Advisors receive fees from the Provider or care Providers for making referrals. This fee is based on an agreement that A1 Advisors and the Provider have agreed upon.  The fee ranges as follows: 50% – 100% of one month’s rent and care charges which must be paid within 30-45 days from the financial Move-In date, for any referral fee not paid by the Provider within 30 – 45 days, a $100 per month charge will be applied to the total amount each month until the full amount is paid in full.  20% – 50% of the Clients daily rate up to 30 days for Respite or Short Stay, this amount is due 45 days from the financial Move-In date, if the Client changes their status from Respite or Short Stay to Permanent Move-In the provider will pay 50%-100% of the total rent and care due 30-45 days from the financial Move-In date under the new status. The Client will provide a copy of the closing/contract documents indicating the monthly charges when completed.
– Our contracts with the Providers state the referral fee cannot be passed on to the Client.
– If the Client move out, is hospitalized, passes away or is transferred to another Provider within 30-45 days, the referral fee amount will be pro-rated to the number of days the Client received care with the Provider, and A1 Advisors will receive 50%-75% of the daily rate for each day.
– A1 Advisors serves in a dual agency relationship, with responsibilities of offering information and guidance to the Client or their legal representative while receiving funding from the housing or care Provider for assisting the housing or care Provider with gaining a new resident or client.
– Occasionally A1 Advisors signs contractual agreements with Clients or their representative for private pay consulting, referral, placement or advisory services. Such agreement requires a $600 payment upfront retainer. This amount represents 6 hours of service to the client, billed at a rate of  $100 per hour and it is non-refundable. Every additional hour will be billed at$100 per hour and a statement with the remaining balance will be given to the Client or Client’s representative at the start of occupancy or end services to the Client. For any addition of a third party (ex: nurse, attorney, doctor, other advisors…etc.) the Client or their representative will be financially responsible for their services and will not impact in any way the agreement between A1 Advisors and the Client or their representative.
– A complaint of violations of the provisions in the “Elder and Vulnerable Adult Referral Agency Act” may be filed with the Attorney General’s office: Mon-Fri, 10am to 3pm, (360)753-6200, 1-800-551-4636 (WA state), 1-800-833-6384 (for hearing impaired) 1-206-464-6684 (outside WA), Address: 1125 Washington Street, PO Box 40100, Olympia, WA, 98504-0100.
– A1 Advisors will not solicit or accept payment from Medicaid clients.

Disclosure Form

Client's Printed Name
Client's Representative Printed Name
MM slash DD slash YYYY

Authorization: I certify that this request has been made freely, voluntarily and without coercion and that the information given above is accurate and complete to the best of my knowledge. I understand I can refuse to sign this authorization. I understand that I will receive a copy of this form after I sign it. I understand that I can revoke my authorization at any time in writing. Revocation will be effective immediately when received in writing by the Source Releasing the Information and A1 Senior Care Advisors LLC. I understand that the revocation will not apply to information that has already been released in response to this authorization. Without a revocation request this signed authorization will stay in effect until the needs for disclosure are satisfied. I have read this form, or it has been read and explained to me, and I understand its content.

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