Home Care Service Agreement Form

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Depending on the situation, the caregiver may be considered an employee or independent contractor under state and federal laws. Article I provides a method for naming the two participants in this Agreement and identifying the role of each individual in relation to the other. Before we begin, we must document the date of this contract by specifying the month and calendar day of the contract in the first empty field and the year in the second empty field. The following three spaces should be used to indicate the mailing address where the supervisor is to work. This must be indicated as the mailing address, city and state of the postal address in the spaces after the terms « postal address of », « city of » and « state of ». Check the « Transportation and shopping » box if the caregiver is expected to provide one of the services defined in the checklist below. If so, select each description that you want to apply to the required tasks that the supervisor needs to perform. Here you can assign the caregiver the task « Drive the recipient to medical, dental, adult care and other appointments and activities », « Buy food and other necessary items… »  » and « Perform other errands for the recipient ». If the first two selections do not precisely define all the driving tasks for which the supervisor is responsible, be sure to select the third and define each driving task in the displayed blank lines. If the caregiver is responsible for providing food, check the « Meals » box.

This topic also requires additional details provided by a checklist. Be sure to check a box that describes each task that the caregiver is required to do by checking the « Prepare.. « , « Shop or help with groceries » and/or « Act as a companion in restaurants ». Note: When marking the first description, enter the number of « meals per day » that the caretaker must prepare for the recipient in the empty field provided. If the caregiver needs to do « household chores » for the recipient, the bold label « household chores » must be marked. In addition, place a marker in the box that reads « Clean the beneficiary`s living space » and/or « Do the laundry and change the bedding » so that the caregiver is responsible for meeting these obligations. The recipient may need help ensuring that their business accounts and invoices are in place. If so, check the « Finance » box and select one or both definitions to include them in the caregiver`s required tasks. The first description assigns the task of « paying the recipient`s bills, balancing the recipient`s checkbook, making deposits » and managing other tasks such as processing the recipient`s health insurance. The second selection represents an area where you can name certain tasks that the supervisor must perform in the recipient`s department.

Many caregivers need to administer medication. If the caregiver has such a responsibility in this document, mark the label in bold « Medication Administration. » Use the instructions in the « Make sure the recipient is taking all medications… »  » and « support the beneficiary with life and exercise routines » to include one or both tasks in the caregiver`s tasks. Next, we will address the topic of everyday life. If the recipient needs the caregiver`s services during daily activities, check the « Support in daily living » box. This section will describe several tasks that the first checkbox requires the caretaker to transfer the receiver from the bed, chair and toilet and help him move, wash and perform hygienic/personal maintenance. The second checkbox requires the custodian to schedule tasks and manage the recipient`s calendar. The third statement requires the caregiver to monitor the recipient`s safety, while the fourth statement asks the custodian to monitor the recipient`s health and contact health care providers if necessary. You can assign one, some or all of these tasks to the caregiver`s work requirements. Before we finish the information we present here, we need to address another issue in « VIII. Vehicle ». If the guardian « .

Be supplied with a vehicle to perform the services » above, and then select the first check box in this article. If the guard does not receive a vehicle, check the second box. It should be noted that the second checkbox means that the maintainer has the recipient. » In accordance with the Internal Revenue Service (IRS) reimbursement rate per mile and caregiver, provide the recipient with a driving log. Now, in the blank line labeled « Recipient, » enter the full name of the person receiving the services provided by the custodian. Finally, use the last blank line here to display the full name of the maintainer. A caregiver is a person who is paid to care for another person, usually a senior or a person with special needs. A caregiver is paid to provide daily care such as transportation, meal preparation, household chores, and any other needs of the person. The caregiver usually follows a weekly schedule, which is set out either in the agreement or by the parties.

If the caregiver lives with the beneficiary, check the « Room and board » box. You must also define this housing arrangement by checking the box « Provide accommodation and meals and pay for all related expenses » or « Pay caregivers… » » Checkbox. If the caregiver pays monthly rent, be sure to record the dollar amount to be paid to the beneficiary each month if you check this box. If the beneficiary reimburses the caregiver for the reasonable « expenses » that the recipient must pay for the recipient in performing the tasks, check the « Reimbursement » box. Otherwise, do not leave this check box selected. In some cases, the recipient pays a certain amount of money per kilometre travelled by the caregiver when they have to drive to fulfill their responsibilities. If this is the case, check the box labeled « Vehicle » and note the dollar amount that the recipient will pay to the caregiver in the empty field between the dollar sign and the words « Per kilometre ». In the article « VI. Schedule, » we`ll see if the caregiver is supposed to work for the beneficiary. Two checkboxes have been displayed for selection so that this can be accurately documented. If the caregiver is not subject to a specific schedule, check the first choice (« Should not be tied to a schedule »). However, if the recipient requires the manager to follow a schedule, select « Should be linked to the next schedule, » and then use the fields provided to set the start time and end time for each shift (remember to mark « A.M » or « P .M. » when setting a shift).

So if there is someone in the area who needs accommodation and the patient needs limited support, this can be a cost-effective way to care for an elderly family member. If the caregiver hired is a family member or friend who will live in the same house, there may be tax benefits for the employer. Simply put, if the caregiver is there to « take care » of the patient and does not spend more than 20% of their daily activities to care for them, the caregiver may not be entitled to the minimum wage. « III. Purpose » must be read and understood by both parties before signing. The next article that requires special attention is « IV Employment Status ». Two checkbox definitions have been provided for this section, so that employment status can be set simply by checking the box that fits the best definition. If the recipient issues a W-2 to the supervisor and fulfills an employer`s obligations as such, select the W-9 Employee check box. Please note that if the custodian is a « W-9 employee », you will need to complete the page entitled « Exhibit A », which must be signed by both parties at the end. .