Disclosure and Advisory

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                                                                             Long-Term Care Referral Agent

                                                                              Disclosure and Advisory Form

Agent’s Business Name: LiveWell Senior Living Advisors, LLC

Address: 22220 Salamo Rd. #215, West Linn, OR.  97068     Telephone: (503) 344-4431  Fax: (503) 907-8591

Email: info@LiveWellAdvisors.com Website: www.LivewellAdvisors.com

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General Information for Oregon Consumers: Oregon law requires all Long-Term Care Referral Agents conducting business in Oregon to be registered with the Oregon Department of Human Services (DHS) and provide the following required disclosures. 

Mandated Disclosures

Oregon law requires a Long-Term Care Referral Agent to make the following disclosures to a client: 

1) Description of the referral:  The referral(s) being provided to you includes the following: 

☒Adult Foster Home ☒Resident Care Facility ☒Assisted Living Facility 

☒Memory Care  ☒Independent Living  ☐Medicaid Contracted 

☒Continuing Care Retirement Community (CCRC) ☐Other:

2) Limitations on referrals: You will only be referred to care facilities/homes with which Livewell Senior Living Advisors, LLC has a business-to-business contract. 

3) Referral fees: Any referral fees paid to LiveWell Senior Living Advisors, LLC will be paid by the admitting care facility. There is no cost to the client for referrals, hidden or disclosed. 

4) Length of contract:  The Referral Agent’s right to a referral fee expires if the client does not move into a referred facility within 12 months from the time of the referral. 

5) Privacy Policy: Our privacy policy can be found at www.LivewellAdvisors.com 

6) Facility Complaint History:  

· The State agency website listing complaints concerning communities is found at: https://ltclicensing.oregon.gov 

· Long Term Care Referral Agent Disclosure and Advisory Form Aging and People with Disabilities 

                                                                            Additional Disclosures

The following additional disclosures are not required by law to be made to consumers, but are provided to assist the consumer in understanding Oregon laws regarding Senior Referral Agents: 

A Referral Agent Must: 

1.   Discontinue providing services to a client who notified the referral agent in writing that the client no longer wishes to use the services of the referral agent. If the referral agent has received compensation from the facility for a referral that has been made, the client may notify the referral agent in writing that he/she wish to use the services of another referral agent in the future for referral to another facility in a subsequent move.  The client’s written notice shall identify the name of the facility and the move-in date of the original referral made by the referral agent. LiveWell Senior Living Advisors LLC accepts text, email, mail and/or phone calls to discontinue services.

2. Provide the required disclosures to the client in writing in a conspicuous and clear manner. The disclosure may be made orally first if the agent makes an audio recording with the consent of the client and thereafter provides the client a written disclosure. 

A Referral Agent May Not: 

1. Provide a referral to a long-term care facility/home for compensation unless registered with DHS. 

2. Refer a client to a facility in which the Referral Agent or an immediate family member has an ownership interest. 

3. Contact a client or authorized representative who has requested in writing that the Referral Agent stop contacting them. Discontinuing services If the Referral Agent has received compensation from the facility for a referral that has been made, you or your representative may notify the referral agent in writing that you, or your representative, wish to use the services of another Long-Term Care Referral Agent/Agency in the future for referral to another facility in a subsequent move.

4. Share a client’s placement information with or sell a client’s placement information to a facility or marketing affiliate without obtaining affirmative consent from the client or his/her authorized representative for each instance of sharing or selling such information.

Authorization to Share Placement Information

I have read, understand the disclosures herein and authorize LiveWell Senior Living Advisors, LLC agents to share my placement information with the facilities and/or service providers to which I will be referred or with this agent’s marketing affiliates that provide services relevant to me.

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Receiving Individual (electronic) Signature                             Date

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Receiving Individual – Printed Name 

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LiveWell Advisor  

                                                                                                Agreement

By agreeing to work with LiveWell Senior Living Advisors, LLC, you consent to the following:

LiveWell Senior Living Advisors, LLC will not be held liable for any illness, injury or death that may occur from a referral, visit or placement.  You agree that you are making use of our services at your own risk. 

LiveWell Senior Living Advisors, LLC and its staff will be held harmless from any injury or harm from being voluntarily transported in an Advisors vehicle or an arranged transportation company, as well as any risk or harm from the spread of infection, virus, or diseases.

Our service creates a sole and exclusive agency relationship with LiveWell Senior Living Advisors, LLC and the client. We ask that we remain your first point of contact with any senior living options for you.