Disclosure and Advisory

                                                                             Long-Term Care Referral Agent

                                                                              Disclosure and Advisory Form

Agent Business Information

Business Name: LIVEWELL SENIOR LIVING ADVISORS LLC

Agent Name Ronda Lovely

Address: PO Box 215, West Linn, OR. 97068

Telephone: 503-344-4431

FAX: 503-907-8591

Email: info@livewelladvisors.com

Website address: www.LivewellAdvisors.com

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General information for Oregon consumers 

Oregon Long-Term Care Referral Agents are required to provide consumers and clients seeking assistance finding long-term care options the following information.

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 types of facilities being referred to the client, include 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:  The client will be referred only to facilities with which the Referral Agent has a business-to-business contract:      ____Yes X_ No 

3) Referral fees:  Any fees paid to the Referral Agent for services will be paid by the admitting home/facility:  X_ Yes ____No 

4) Length of contract:  This Referral Agent’s right to a referral fee expires if the client does not move into a referred facility within a specified period from the time of the referral:  X _Yes ____No

a. If yes, what is the range of the expiration periods specified in this Referral Agent’s business-to-business facility agreements? 12 months.

5) Privacy Policy:  A copy of the Referral Agent’s privacy policy is attached to this advisory form. A copy can be found at the following web link https://livewelladvisors.com/privacy-policy. 

6) Facility Complaint History:  The Oregon Department of Human Services (ODHS) website listing complaints concerning facilities/care communities is found at: https://ltclicensing.oregon.gov 

                                                                            Additional Information

  The following additional information beyond the mandatory disclosures is provided to assist the consumer in understanding Oregon laws regarding referrals. 

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 wishes 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.

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 ODHS.

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.

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, and consent to this agreement and I authorize this Referral Agent to share my placement information with the facilities to which I will be referred or with this Referral Agent’s marketing affiliates.

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Receiving Individual (electronic) Signature                             Date

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Receiving Individual – Printed Name 

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LiveWell Advisor  

This form must include a copy of the agent’s current certificate of registration. The certificate shows the agent is registered with the state and has met state requirements, including insurance and a criminal background check.

                                                                                                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.