{"id":2158,"date":"2017-07-17T19:28:46","date_gmt":"2017-07-17T23:28:46","guid":{"rendered":"\/?page_id=2158"},"modified":"2017-07-17T19:30:21","modified_gmt":"2017-07-17T23:30:21","slug":"home-care-leesburg","status":"publish","type":"page","link":"\/home-care-leesburg\/","title":{"rendered":"Leesburg"},"content":{"rendered":"<h1>\n\t\tLeesburg, VA<br \/>\n\t<\/h1>\n<p>\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"\/wp-content\/uploads\/2017\/07\/bigstock-cheerful-mid-age-woman-looking-93503669-1024x683.jpg\" alt=\"cheerful mid age woman looking at the camera\" itemprop=\"image\" height=\"683\" width=\"1024\" \/><\/p>\n<h3>Ready to find out more?<\/h3>\n<p>view our services<\/p>\n<p>\t\t\t<a href=\"\/services\" target=\"_self\" role=\"button\"><br \/>\n\t\t\t\t\t\t\tGo<br \/>\n\t\t\t\t\t<\/a><\/p>\n<h3>\n\tUse Form Below for Info &#038; Pricing<\/h3>\n<h3>\n\tOr Call 703-910-7081<\/h3>\n<h3>\n                <div class='gf_browser_gecko gform_wrapper' id='gform_wrapper_3' style='display:none'><form method='post' enctype='multipart\/form-data'  id='gform_3'  action='\/wp-json\/wp\/v2\/pages\/2158'>\n                        <div class='gform_body'><ul id='gform_fields_3' class='gform_fields top_label form_sublabel_below description_below'><li id='field_3_1'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_3_1' >Who Needs Care at Home?<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_1' id='input_3_1' class='medium gfield_select'   aria-required=\"true\" aria-invalid=\"false\"><option value='Select One' >Select One<\/option><option value='Myself' >Myself<\/option><option value='Spouse' >Spouse<\/option><option value='Parent' >Parent<\/option><option value='Grandparent' >Grandparent<\/option><option value='Other Relative' >Other Relative<\/option><option value='Friend' >Friend<\/option><option value='Other' >Other<\/option><\/select><\/div><\/li><li id='field_3_2'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_3_2' >How Old is the Person Who Needs Care?<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_2' id='input_3_2' class='medium gfield_select'   aria-required=\"true\" aria-invalid=\"false\"><option value='Select One' >Select One<\/option><option value='45-54' >45-54<\/option><option value='55-64' >55-64<\/option><option value='65-74' >65-74<\/option><option value='75-84' >75-84<\/option><option value='85 or older' >85 or older<\/option><\/select><\/div><\/li><li id='field_3_3'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_3_3' >Male or Female?<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_3' id='input_3_3' class='medium gfield_select'   aria-required=\"true\" aria-invalid=\"false\"><option value='Select One' >Select One<\/option><option value='Male' >Male<\/option><option value='Female' >Female<\/option><\/select><\/div><\/li><li id='field_3_4'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_3_4' >What is their current living situation?<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_4' id='input_3_4' class='medium gfield_select'   aria-required=\"true\" aria-invalid=\"false\"><option value='Select One' >Select One<\/option><option value='Living Alone at Home' >Living Alone at Home<\/option><option value='Living at Home with Family' >Living at Home with Family<\/option><option value='In the Hospital Needs a Sitter' >In the Hospital Needs a Sitter<\/option><option value='In the Hospital Discharging to Home' >In the Hospital Discharging to Home<\/option><option value='Assisted Living' >Assisted Living<\/option><option value='Independent Senior Living' >Independent Senior Living<\/option><option value='Nursing Home' >Nursing Home<\/option><\/select><\/div><\/li><li id='field_3_5'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_3_5' >Estimate How Much Care They Might Need<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_5' id='input_3_5' class='medium gfield_select'   aria-required=\"true\" aria-invalid=\"false\"><option value='Select One' >Select One<\/option><option value='A few hours per week' >A few hours per week<\/option><option value='More than 20 hours per week' >More than 20 hours per week<\/option><option value='40 or more hours per week' >40 or more hours per week<\/option><option value='Around-the-Clock Care' >Around-the-Clock Care<\/option><option value='Live-In Care' >Live-In Care<\/option><\/select><\/div><\/li><li id='field_3_7'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label'  >What Type of Care is Needed? (Check all that apply)<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_3_7'><li class='gchoice_3_7_1'>\n\t\t\t\t\t\t\t\t<input name='input_7.1' type='checkbox'  value='Light Meal Preparation'  id='choice_3_7_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_7_1' id='label_3_7_1'>Light Meal Preparation<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_3_7_2'>\n\t\t\t\t\t\t\t\t<input name='input_7.2' type='checkbox'  value='Light Laundry'  id='choice_3_7_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_7_2' id='label_3_7_2'>Light Laundry<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_3_7_3'>\n\t\t\t\t\t\t\t\t<input name='input_7.3' type='checkbox'  value='Light Housekeeping'  id='choice_3_7_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_7_3' id='label_3_7_3'>Light Housekeeping<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_3_7_4'>\n\t\t\t\t\t\t\t\t<input name='input_7.4' type='checkbox'  value='Companionship'  id='choice_3_7_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_7_4' id='label_3_7_4'>Companionship<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_3_7_5'>\n\t\t\t\t\t\t\t\t<input name='input_7.5' type='checkbox'  value='Transportation to Appointments'  id='choice_3_7_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_7_5' id='label_3_7_5'>Transportation to Appointments<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_3_7_6'>\n\t\t\t\t\t\t\t\t<input name='input_7.6' type='checkbox'  value='Grocery Shopping'  id='choice_3_7_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_7_6' id='label_3_7_6'>Grocery Shopping<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_3_7_7'>\n\t\t\t\t\t\t\t\t<input name='input_7.7' type='checkbox'  value='Errands'  id='choice_3_7_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_7_7' id='label_3_7_7'>Errands<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_3_7_8'>\n\t\t\t\t\t\t\t\t<input name='input_7.8' type='checkbox'  value='Bathing'  id='choice_3_7_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_7_8' id='label_3_7_8'>Bathing<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_3_7_9'>\n\t\t\t\t\t\t\t\t<input name='input_7.9' type='checkbox'  value='Toileting'  id='choice_3_7_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_7_9' id='label_3_7_9'>Toileting<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_3_7_11'>\n\t\t\t\t\t\t\t\t<input name='input_7.11' type='checkbox'  value='Medication Reminders'  id='choice_3_7_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_7_11' id='label_3_7_11'>Medication Reminders<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_3_7_12'>\n\t\t\t\t\t\t\t\t<input name='input_7.12' type='checkbox'  value='Respite Care'  id='choice_3_7_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_7_12' id='label_3_7_12'>Respite Care<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_3_7_13'>\n\t\t\t\t\t\t\t\t<input name='input_7.13' type='checkbox'  value='Hospice'  id='choice_3_7_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_7_13' id='label_3_7_13'>Hospice<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id='field_3_8'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label'  >How will care be paid for?<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_3_8'><li class='gchoice_3_8_1'>\n\t\t\t\t\t\t\t\t<input name='input_8.1' type='checkbox'  value='Private Funds'  id='choice_3_8_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_8_1' id='label_3_8_1'>Private Funds<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_3_8_2'>\n\t\t\t\t\t\t\t\t<input name='input_8.2' type='checkbox'  value='Long-Term Care Insurance'  id='choice_3_8_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_8_2' id='label_3_8_2'>Long-Term Care Insurance<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_3_8_3'>\n\t\t\t\t\t\t\t\t<input name='input_8.3' type='checkbox'  value='Medicaid'  id='choice_3_8_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_8_3' id='label_3_8_3'>Medicaid<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_3_8_4'>\n\t\t\t\t\t\t\t\t<input name='input_8.4' type='checkbox'  value='Other - (VA Aid and Attendance, Reverse Mortgage, etc)'  id='choice_3_8_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_8_4' id='label_3_8_4'>Other - (VA Aid and Attendance, Reverse Mortgage, etc)<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id='field_3_14'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label'  >Many Senior In-Home Care services and products are not covered by insurance, Medicare, Medicaid or public assistance. Most individuals and families often need to pay &quot;out-of-pocket&quot; for some or all services requested.  Are there other sources of financing available to you, such as Social Security benefits, VA benefits, or Private Funds?<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_14'><li class='gchoice_3_14_0'><input name='input_14' type='radio' value='Yes'  id='choice_3_14_0'    \/><label for='choice_3_14_0' id='label_3_14_0'>Yes<\/label><\/li><li class='gchoice_3_14_1'><input name='input_14' type='radio' value='No'  id='choice_3_14_1'    \/><label for='choice_3_14_1' id='label_3_14_1'>No<\/label><\/li><li class='gchoice_3_14_2'><input name='input_14' type='radio' value='I don&#039;t know'  id='choice_3_14_2'    \/><label for='choice_3_14_2' id='label_3_14_2'>I don't know<\/label><\/li><\/ul><\/div><\/li><li id='field_3_9'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_3_9' >Zip Code Where Care is Needed<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_3_9' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id='field_3_10'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex'  >Name of Person Submitting this Form<span class='gfield_required'>*<\/span><\/label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_3_10'>\n                            <span id='input_3_10_3_container' class='name_first' >\n                                                    <input type='text' name='input_10.3' id='input_3_10_3' value='' aria-label='First name'   aria-required=\"true\" aria-invalid=\"false\" \/>\n                                                    <label for='input_3_10_3' >First<\/label>\n                                               <\/span>\n                            <span id='input_3_10_6_container' class='name_last' >\n                                                    <input type='text' name='input_10.6' id='input_3_10_6' value='' aria-label='Last name'   aria-required=\"true\" aria-invalid=\"false\" \/>\n                                                    <label for='input_3_10_6' >Last<\/label>\n                                                <\/span>\n                            <div class='gf_clear gf_clear_complex'><\/div>\n                        <\/div><\/li><li id='field_3_13'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_3_13' >Your Email Address- We will send you information via email.<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_email'>\n          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