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Acknowledgement of Disclosure

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Disclosure of Services and Agency Agreement

This Agreement made, effective immediately with acknowledgment of Disclosure. Senior Housing Specialists makes referrals to senior housing and care options and can provide for Real Estate services. And is therefore in subjection to RCW 18.330 under Washington State’s “Elder & Vulnerable Adult Referral Agency Act”.

We provide a personalized service 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.  Referrals are made to Independent Living, Assisted Living, and Memory Care, Adult Family Homes or Home Care options.  Referrals are based on information gathered during the intake process which includes health history, personal preference, care needs, and financial abilities.  Information gathered in the intake form 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. 

Senior Housing Specialists and their employees, owners, and officers are not considered providers and will not be liable or responsible for the acts or omissions of a housing 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.

Senior Housing Specialists and its affiliates act as Dual Agents representing the Resident and Senior Housing.  We are paid by senior providers a referral fee for clients that choose to use their services.  Referral fees are charged according to individual contracted terms with Senior Housing providers. Exact charges will be disclosed upon request.  Referrals fees are due from providers after the client takes financial responsibility. According to the contract, these costs cannot be passed onto the client.  Refunds to providers 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. The refund is a prorated portion of the fees based upon a per diem calculation. 

Referrals are made only to senior housing providers that have been toured and meet the personal standards set forth.  Profiles are maintained on every property to include the type of license held by the provider; the provider's authority to care for individuals with mental illness, dementia, or developmental disabilities; accepted payment sources; the level of medication management services and personal care services provided; cultural accommodations; primary languages are spoken; activities provided; behavioral conditions that can and cannot be met; and food preference accommodations. Profiles are updated annually.  State survey is checked at the time of referral and all findings are disclosed to clients within 30 days, either verbally or electronically. 
1. Agency.  We appoint Senior Housing Specialists, LLC to represent us in the search of long term care, housing, and services. This agreement creates an agency relationship with Senior Housing Specialists, LLC, and the client. This agreement supersedes any and all other agreements that might have been implied verbally, in writing or with an internet search such as A Place For Mom or 

2. Terms of Agreement. 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 Senior Housing Specialists, LLC except for those obligations existing at the time of termination or completion of securing long term care and or housing.

3. No Warranties or Representation. Senior Housing Specialists, LLC make no warranties or representation regarding the suitability or care of any referrals to Long Term Care Providers.  The client agrees to be responsible for conducting all investigations necessary to satisfy the suitability of said services. 

4. Compensation.  Placement and Referral Services are free to all seniors and their families! 

Medicaid or Medicare Clients: Referral Agents cannot collect a referral fee for clients who are beneficiaries of Federal or State health care programs like Medicaid or Medicare.  Should the client become a Federal or State funded consumer, then the referral fee will be prorated to cover only the private-pay portion of the stay. 

**Agents can work on a private pay basis with family or friends of the senior. 

Clients may at any time file a complaint of violations of the “Vulnerable Adult Referral Agency Act” with the Attorney General’s office

1125 Washington Street SE, PO Box 40100, Olympia, WA 98504-0100  

Monday - Friday: 10 am to 3 pm

Attorney General Phone: (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)

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