Elder Care Agreement

Elder Care Agreement

_______________ (hereafter "Care Provider") and the patient or their proxy, _______________ (hereafter "Patient"), hereby agree to the following:

Beginning {date}, the Care Provider will provide {residence/in-home} care for the Patient at {address} every {days of the week} from {time} to {time}. This agreement will last until {date}, at which time it may be renewed or renegotiated. Either party may end this agreement with {number} days' written notice.

The Care Provider confirms that the {Organization} is a licensed care facility and/or that all care providers have completed {training/certification}.

The Patient confirms that {he/she} consents to {residence/in-home care}. If the Patient is physically or mentally unable to communicate {his/her} needs, {Name}, the medical proxy, is legally equipped and permitted to make decisions on the Patient's behalf.

The Care Provider will administer {medication} every {day and time(s)} and ensure that the dosage has been successfully received.

The Care Provider will provide {number} meals every {day}, observing the following nutritional guidelines and dietary restrictions: {Nutrition and Diet}.

The Care Provider has been notified of the Patient's allergies to {allergens} and will ensure that the Patient is not exposed to said allergens.

The Care Provider will assist the Patient in {eating, bathing, using the toilet, exercising, etc.}.

The Care Provider will provide transportation of the Patient to and from {places} on {days} at {times}.

The Care Provider does NOT provide the following services: {services}.

The Patient will pay the Care Provider {amount} every {frequency}. This amount will cover all services rendered by the Care Provider except holiday hours, overtime, and additional services not outlined in this agreement. In the event that the Care Provider provides holiday hours, overtime, or additional services, {he/she} will be paid {amount} per hour for the duration of that work.

The Care Provider agrees to follow all legal and medical requirements as outlined by {his/her} medical training as well as state and federal law. Both parties agree to treat each other with mutual kindness and respect.

Emergency contacts for the Patient are as follows: {Contacts for family, doctor, etc.}.

In witness to their agreement to the terms of this contract, the parties affix their signatures below:

_____________________________________
(Care Provider signature and date)

_____________________________________
(Patient signature and date)

Index of Printable Contract Examples