Elder Care Agreement Form 85 PDF Details

As the US population continues to age, the need for comprehensive caregiving arrangements has become increasingly important. The Elder Care Agreement 85 form provides a structured way for older adults and caregivers to outline the terms of caregiving services. This legal document covers a wide range of services including daily living assistance, nutrition, cleaning, housekeeping, personal care, and even companionship. It specifies the nature of services to be provided by the caregiver, such as preparing balanced meals, performing household chores, assisting with personal care needs, and providing transportation. Moreover, it addresses compensation, stating how and when the caregiver will be paid. The agreement also ensures both parties understand the commitment to maintain a clean and orderly living environment for the older adult. Key legal elements, like governing law and severability, ensure the document holds up in court, emphasizing its significance as a legally binding contract. By signing the agreement, both the older adult and the caregiver acknowledge their understanding and acceptance of its terms, making the Elder Care Agreement 85 an essential tool in formalizing the caregiver relationship.

QuestionAnswer
Form NameElder Care Agreement Form 85
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namescaregiver home contract printable, elder care agreement template, elder care contract template, elder care form 85

Form Preview Example

CARE AGREEMENT

This agreement made this____ day of ___________, _____), by and between [name of older adult]

(hereafter referred to as “_____________”), and, ___________________, Caregiver (hereafter referred

to as “Caregiver”).

1.Purpose. The purpose of this agreement is to set forth the terms and conditions under which Caregiver will provide assistance with day to day living for ________________ in his/her home in exchange for reasonable compensation.

2.Services to be performed by Caregiver. Caregiver shall furnish ___________ with the services and incidentals specified herein, provided that _____________ remains in his/her house and performs his or her obligations under this contract. In consideration of the mutual promises contain herein, the parties intent to be legally bound, agree as follows:

3.Nutrition.

a.Balanced meals- Caregiver hereby agrees to prepare three (3) nutritionally balanced meals per day when such assistance is requested. One such meal shall be served in the morning, one at mid-day, and one in the evening for ____________.

b.Special Diet- Special diets will be provided only upon order of a licensed physician.

c.Additional Duties- Caregiver agrees to grocery shop for _______ with nutritious meals in mind. Following the preparation of meals, Caregiver shall assist with feeding, if necessary, and cleaning the kitchen which included washing dishes.

4.Cleaning. Caregiver agrees to provide cleaning services on a weekly basis as follows:

a.General cleaning

b.Make bed

c.Wash Laundry/ change sheets

d.Wash dishes

e.Empty waste containers

f.Sweep and mop all uncarpeted floor, stairs and hallways

g.Scrub floors

h.Disinfect all bathroom

i.Replace bathroom supplies

j.Maintain bedroom in a neat and orderly condition

5.Housekeeping. _____ shall maintain the home in a clean and sanitary and orderly condition. Caregiver shall make available to _____ all supplies necessary for ______ to perform the usual housekeeping in order to maintain his or her accommodations. Caregiver shall perform all ordinary and heavy housekeeping as set forth in detail above.

6.Assistance outside the Home. Caregiver shall run daily errands for______. These may include but are not limited to, picking up dry cleaning, grocery shopping, shopping for necessities and, if applicable, maintaining ___’s car.

7.Personal Care Needs. Caregiver shall observe ______’s physical and mental states on a regular basis, and shall make arrangements, as necessary, to meet health needs by arranging transportation to the physician of _______’s choice. Caregiver shall provide assistance to ________ in carrying out the instructions of physicians including storing, distributing and reminding ______ to take prescribing medications.

Caregiver shall also provide _______ with personal assistance with bathing, dressing, toileting, hair care, shaving, eating, care of clothing, personal shopping and incidental services, as needed.

8.Transportation. Caregiver shall assist with transportation needs by arranging for public transportation or help with specially provided elderly transportation.

9.Companionship and Entertainment. Caregiver shall provide companionship and support for ______.

10.Compensation. ______________ shall pay Caregiver:

___________ Weekly

___________ Monthly

On each ___ of the week/month

$________ per hour.

11.Governing Law, Entirety of Agreement and Severability. This agreement shall be governed by the laws of state of ______. It constitutes the entire agreement between the parties regarding its subject matter. If any provision in this contract is held by any court to be invalid, void or unenforceable, the remaining provisions shall nevertheless continue in full force and effect.

THIS IS A LEGALLY BINDING CONTRACT. EACH PARTY HAS READ THE ABOVE AGREEMENT BEFORE SIGNING IT. EACH PARTY UNDERSTANDS THE AGREEMENT THAT HE OR SHE IS MAKING.

We, __________ and Caregiver having read this agreement, agree to its terms and sign it as our free act

on the ____ Day of __________, _________.

__________________________________

_______________________________

[name of older adult]

Caregiver

Witness

 

_______________________________

___________________________________

Signature

Address

How to Edit Elder Care Agreement Form 85 Online for Free

Creating the get the elder care agreement form 85 pdf file is a breeze with this PDF editor. Follow these particular actions to create the document right away.

Step 1: The initial step is to press the orange "Get Form Now" button.

Step 2: As you get into the get the elder care agreement form 85 pdf editing page, you will see all the functions it is possible to undertake regarding your form within the top menu.

Create the particular sections to fill in the file:

step 1 to writing elder care agreement template

You should insert your data within the field b Special Diet Special diets will, c Additional Duties Caregiver, mind Following the preparation of, Cleaning Caregiver agrees to, a General cleaning b Make bed c, and Housekeeping shall maintain the.

elder care agreement template b Special Diet Special diets will, c Additional Duties Caregiver, mind Following the preparation of, Cleaning Caregiver agrees to, a General cleaning b Make bed c, and Housekeeping shall maintain the blanks to insert

Identify the important details in the Assistance outside the Home, Personal Care Needs Caregiver, Caregiver shall also provide with, and Transportation Caregiver shall section.

elder care agreement template Assistance outside the Home, Personal Care Needs Caregiver, Caregiver shall also provide with, and Transportation Caregiver shall fields to insert

The Companionship and Entertainment, for, Compensation shall pay Caregiver, Weekly, Monthly, On each of the weekmonth per hour, Governing Law Entirety of, THIS IS A LEGALLY BINDING CONTRACT, and We and Caregiver having read this area can be used to point out the rights and responsibilities of both sides.

Filling in elder care agreement template step 4

Finish by checking all of these fields and completing the proper information: We and Caregiver having read this, name of older adult, Caregiver, and Witness Signature Address.

step 5 to entering details in elder care agreement template

Step 3: Press the "Done" button. Now, it is possible to export your PDF document - download it to your electronic device or deliver it via email.

Step 4: To prevent yourself from any challenges in the future, try to have up to a couple of copies of your form.

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