Personal Care Agreements & Contracts: The Complete Guide

Putting together a caregiver contract for a family member or loved one is often an afterthought, rather than something that is planned for in advance. Unfortunately, it’s an unpleasant reality of life that someday we may have to face the responsibility of caring for someone we love. Being prepared for that reality can help us navigate life in a way that’s best for both the caregiver and person that needs assistance.

It is usually an adult child of a sick parent that takes on the role of caregiver, or in case of no heirs, a close friend or spouse. The signs of ailing health in the elderly usually point towards dementia symptoms: difficulties with short-term memory, trouble navigating previously well-known journeys, problems concentrating, forgetting words, a higher tendency to trip up or fall, and generally, more vulnerability concerning everyday tasks. Sometimes, these symptoms take time to build up, providing the caregiver a false sense of control over the situation. As caregiving becomes more challenging with the increasing needs of the ill person, organizing a personal care agreement is the first step towards simplifying the lives of everyone involved.

The main care provider may often find themselves having to make large sacrifices to meet the time commitments and demands necessary for quality care. It may cause them to cut down on hours at work, give up employment benefits, and completely reorganize their lifestyle. While there may be other relatives or caregivers in the picture, a formal agreement could help to better set boundaries and prepare for any future financial need, while providing a way to compensate the caregiver.

Putting the care relationship in writing is a binding agreement and called a personal care agreement. It can also be called elder care, caregiver, family care, or long-term care personal support services contract. The contract offers both caregivers and the person they are looking after a secure framework of how things should be done financially as the illness progresses. The agreement also provides peace of mind in terms of who will advocate on the loved one’s behalf, in accordance with their wishes.

About Personal Care Agreements

A caregiver contract or personal care agreement are contracts that tend to be drawn up between a family member, most often an adult child or adult grandchild, and the person receiving care. Other relatives may also be included in the contract, or indeed close friends or other nominated, paid caregivers.

A caregiver contract is designed to define all the tasks required for giving care and the amount of money that should be compensated in return. It’s a useful tool in preventing conflict between family members and the main caregiver about the amount of care provided and where the financing should come from. With that in mind, the agreement should be discussed with all involved to examine all possibilities and concerns before it is written up.

Treating the contract as a legal document is a good idea, as it will show the state authorities where the money is being spent and for what products or services. This is especially important if your loved one is in receipt of state-supported home care. Additionally, a personal care agreement could help to clear any potential misunderstandings over inheritance later on, with the caregiver’s compensation clearly laid out.

The Three Basic Requirements 

A personal care agreement comprises three basic requirements that outline the contract between a caregiver and the person paying for the care.

• Requirement one: Any agreement or contract must be in writing.
• Requirement two: Any payments or compensation must be for services or care that are to take place in the future, not for any that have already come to pass.
• Requirement three: Compensation must match the same as the type of care services already offered in your local area or state. Fees and tasks performed should be “reasonable” and in line with costs offered by other 3rd parties.

Here is what a sample caregiver agreement should contain:

• The starting date of the commencement of care
• A detailed list of tasks/services that the caregiver will undertake, such as grocery runs, errands, transportation to and from medical appointments, medical care, accompaniment to adult daycare, preparing meals, cleaning, etc.
• How much time will be dedicated to providing services over a certain period, e.g. up to 30 hours a week, or 120 hours a month.
• How often and how much the caregiver will receive their compensation (weekly, biweekly, monthly, bimonthly, a lump sum payment, or whatever is decided)
• The set agreement time. How long is the contract going to last, over the person’s lifetime, or only a few years? How many exactly? Will a new agreement need to be created for future care?
• A declaration by all contract parties agreeing to modification in writing only by mutual agreement.
• Locations where the caregiving services will be provided, e.g. the person’s home, caregiver’s home, nursing home, or another place. 
• Date of the completed agreement with signatures of all parties involved.

Providing Room for Additional Agreement Details 

As mentioned in the previous section, there is always room for leeway or modifications to the agreement if all the contract parties allow. Sometimes, there may be a need for flexibility, e.g. if the caregiver themselves become ill or other circumstances prevent them from taking on the main role.

Another event that may occur is that one party may want to withdraw from the contract and terminate their involvement. In this case, you will need to include a clause that allows parties to do so as long as they state their intentions in writing. You may also want to include a backup plan for the next designated carer, in case they need to take over for a while or permanently.

In terms of allowances for extra expenses, perhaps consider whether the caregiver should receive some sort of provisions for sharing boarding costs (if they live with the care recipient), including utilities, rent, etc. You’ll also need to include specific details about what will happen if the person is moved into a care facility and whether a health insurance policy will cover the needs of the caregiver as well.

Depending on the illness the person has, you may need the assistance of a healthcare professional to determine the level of care anticipated for the future. Consult with a physician or local service provider to conduct a home care assessment. You may be charged a fee for this service, however, it is very helpful to get an expert opinion to avoid any pitfalls in the future.

Caregiving can be defined as any one of the following acts of support: helping with banking and finance management, transportation (factor in distances for gas costs), grocery shopping, cooking, general cleaning, assistance with taking medications/injections, keeping track of medical markers (blood pressure, blood glucose, etc), liaising with physicians and hospitals, plus personal hygiene.

As you draft your contract, define each caregiving activity with specific tasks needed to be done within each, and the time it will take for the caregiver to complete them. This will result in a more accurate presentation of the responsibilities undertaken.

Like other jobs closely related to health and safety, caregivers should write a daily log of what they have done and keep the activity list up to date. Any details and documentation journaled will support your activities should they need to be proved at a later time.

The contract being drafted between the care recipient and the giver is viewed exactly the same as the relationship between an employer and employee. For this reason, you’ll need to consider whether to factor in caregiver benefits such as vacation pay, or health insurance. In this instance, it’s best to consult an attorney to help you apply exactly what is needed for your particular circumstance.

Organizing Personal Care Agreements With Others

Family caregivers often have the uncomfortable task of consulting with others when it comes to discussing what will happen with an ill relative and who will take on the role of the main carer. One way to make this process a lot easier for everyone is to organize a dedicated family meeting, with all documents and information ready to digest and talk about. Include distant family members via video call as well, to speed up the decision-making.

One important element to consider when organizing the personal care agreement is whether to include the person in receipt of the care. Depending on their current condition, they may or may not have the cognitive capacity to advocate for themselves. You’ll also need to be wary of any potential areas of discussion that may be sensitive to your loved one, or private. Perhaps they may only need to attend some part of the meeting, or at the very end to ensure they feel comfortable with the plans.

To ensure your meeting goes as smoothly as possible, schedule a date and time that everyone can attend. Write out an agenda and share documents/materials beforehand so that everyone is on board with the information, and ready to start at the same point. Here are just some examples of the documents you may need:

• Research showing the fees and quotes of caregivers in your location. Try to gather as much information as you can from nursing homes and other professional caregiving services.
• The patient’s medical records that’ll detail caregiving tasks needed
• A care assessment completed at the patient’s home with care recommendations
• Medicaid planning: Your state’s rules in terms of eligibility for covered long-term care
• Legal documents that may include: the Power of Attorney, a will, finance agreements, insurance policies, and other relevant documents.

Nominate a family member to take notes, just as you would have in an office environment. This will help you ensure all points have been covered and everyone’s input is considered. You may even want to share the meeting notes for future reference or use it to create a shared folder where everyone can access information related to the personal care agreement. If you can anticipate the meeting getting out of control, it may be a good idea to enlist the help of a professional mediator or trusted community member, such as a pastor to facilitate. A few meetings might have to take place before everyone is on board with the final decisions.

To keep the discussions on track, here are some points you may want to go over during the meeting:

• The start and end of the agreement/contract
• The exact role of the caregiver, with tasks listed and defined
• The caregiver’s compensation and how often it shall be paid out
• Who will serve as a deputy caregiver and step in when necessary?
• If not the main caregiver, who holds Power of Attorney?
• Estate planning and managing financial assets: are all areas covered in the patient’s will?
• Who is the main physician or healthcare worker to contact in case of any questions?
• What are the wishes of the family member with the illness?
• What happens if caregiving needs to be moved to a 24/7 care home?
• Does the patient have an advance health care directive to ensure their end-of-life wishes will be carried out? 
• What could be considered as an asset “spend down” if needed to qualify for Medicaid?

If you find that the meeting is still not having the desired conclusion, contacting the National Care Planning Council may be your best resource for seeking adequate family mediation with an eldercare expert.

Hiring An Attorney

It may not always be necessary, but when there are more than 2-3 people involved in the financial and caregiving decisions of the patient, it may be wise to hire an attorney to iron out the details and make sure the contract is seamless. Depending on the complexity of your contract and unique situation, the professional services of a lawyer will help you avoid any potential family conflict in the future. You may consider drawing up a lump-sum contract for your caregiver, however, it may be difficult to track expenses especially if needed for Medicaid later on. A regular salary, e.g. monthly, for the caregiving services is easier for this reason.

Another situation you may need legal intervention for is if the patient is unable to participate in or sign the contract. The conservator or Power of Attorney may sign on their behalf.

Personal Care Agreements and Medicaid

Medicaid is a joint state and federal government program that helps those with low income or assets access health care for free. It covers the costs of doctor visits, hospital stays, and long-term care such as for Alzheimer’s disease and dementia patients, as well as those who are terminally ill. They may also cover the costs of in-home caregiving services, though this does not include custodial care, i.e. personal care (help with bathing, eating, using the bathroom, getting in and out of chairs, etc).  

In terms of qualifying for Medicaid as part of a personal care agreement, the patient’s assets and spending habits are assessed for the past 5 years. This is called a “look-back” period, and the assets subject to liquidation to go towards care, a “spend down.” Before entering a facility that Medicaid may cover for the patient, the program will “look-back” at the patient’s expenditure and judge how much care they are entitled to accordingly. Having a personal care agreement is a good way to show authorities that assets have not been hidden or given away to family members or caregivers as gifts, but rather used towards legitimately caring for their loved one.

Without having a caregiver agreement in place, the patient’s Medicaid eligibility may be questioned, as well as face delays with processing. You may be penalized, when all along you have been taking care of your family member as much as a professionally-employed caregiver. This is why personal care agreements and contracts are so important, as regulations can be very complex and vary according to state. To be on the safe side, always consult an elder law attorney or your local Medicaid office to check the rules pertaining to your state. Based on federal requirements, the general program rules for Medicaid eligibility and what services are financed have some flexibility on how they may work, meaning that you’ll likely find the experience of others may differ from yours.

Personal Care Agreements: A Saving Grace

A care contract may be just the saving grace you and your loved one may need at the end of an arduous, yet rewarding journey. Relying on social security services like Medicaid isn’t an ideal circumstance for providing care, but for many people may be the only option. A written agreement, such as that of your care plan, will not only help you factor in long-term care costs, but also protect you and your loved one from future financial difficulties when needing more specialized care.

To start with, why not look up one of the several sample caregiver contract forms offered online, which give you the option of saving formats for free in Word or PDF.

There are also many free resources on the subject of personal care services and caregiving on the following websites:

• Medicaid
• Family Caregiver Alliance
• National Academy of Elder Law Attorneys (NAELA)
• You can also hire qualified help through Care As One.