Elder Care Agreement Form 85 – Fill Out and Use This PDF

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:

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 __________, _________.