Pair with Care

Interested in getting in touch with a licensed care provider for your loved one but don’t know how to begin or who to call?

We work to ensure that kūpuna are provided with the right care for their situation. Please complete the below form and we'll guide you through the process of finding an appropriate care service/facility.

Your Name

First Name

Last Name

Phone

(###)

###

####

Interested In

Type of care for your kupuna

Age of your kupuna in need of care

Height of your kupuna in need of care

Weight of your kupuna in need of care

Gender of your kupuna in need of care

Preferred neighborhood for care

Anticipated time frame for placement/care

How long does your kupuna need care?

COVID-19 vaccine status of your kupuna

Current living/care arrangement of your kupuna

Please provide a description of your kupuna

Include relevant diagnoses & health history, daily care needs, any other important information. The more detailed, the better we can assist you.

Required language for care (besides English)

Monthly budget for care

(for the next 2-4yrs assuming no change in condition)

Funding sources (select all that apply)

Medicaid only

SSI

Medicare

LTC insurance

Out of pocket

Other

Please let us know anything else important and/or if you have any questions

Our Elderly Care Marketplace's Terms of Use and Privacy Policy can be found at kupunacarepair.com/terms-use and kupunacarepair.com/privacy-policy

I agree to the Elderly Care Marketplace's Terms of Use and Privacy Policy

I would like to receive occasional emails from Kupuna Care Pair (I can opt out any any time)

Pair with Care

© 2022 Kupuna Care Pair

hello@kupunacarepair.com