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Caregiver Agreement

Sample Caregiver Agreement

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Following is a Personal Care Contract which the Missouri courts decided did not provoke a Medicaid penalty period. On September 3, 2003, the time the contract was entered into, Eileen Reed was in a nursing home. The personal care contract was with her daughter, Sandra Teson. Under the terms of the contract, Reed paid $11,000 to her daughter two weeks before submitting her application for Medicaid benefits.

The agreement was contained in an article written by Vincent G. Rapp, Esq. and Michael C. Weeks, Esq., attorneys practicing in the state of Missouri.

NOTE: Just because this agreement was upheld in Missouri, does not mean it will be in your state. Check with an experienced lawyer before modifying the agreement to your circumstances and executing it. 

Personal Care Contract

This agreement is entered into by and between Eileen Reed (CARE RECIPIENT) and Sandra Teson (CARE PROVIDER). It sets forth the terms under which CARE PROVIDER will provide personal assistance to CARE RECIPIENT.

1. DUTIES OF CARE PROVIDER. CARE RECIPIENT contracts to receive and CARE PROVIDER agrees to provide the following services for the lifetime of the CARE RECIPIENT on an "as needed" basis: 
a. Attend to needs of CARE RECIPIENT, including preparation of nutritious, appropriate meals and snacks; house cleaning; laundry;
b. Assist CARE RECIPIENT with grooming, bathing, dressing, laundry, and personal shopping, as needed;
c. Purchase, with funds made available by CARE RECIPIENT, or assist CARE RECIPIENT in purchasing clothing, toiletries, and other personal items for CARE RECIPIENT as needed, taking into account CARE RECIPIENT's ability to pay for such items;
d. Purchase, with funds made available by CARE RECIPIENT, or assist CARE RECIPIENT in purchasing hobby, entertainment or other goods for CARE RECIPIENT's use and enjoyment, as needed, taking into account CARE RECIPIENT's ability to pay for such items;
e. Monitor CARE RECIPIENT's physical and mental condition and nutritional needs on a regular basis in cooperation with health care providers;
f. Arrange for transportation to health care providers and to the physician of CARE RECIPIENT's choice. CARE PROVIDER will also arrange for assessment, services and treatment by appropriate health care providers, including but not limited to, physicians, nurses, nursing home services, physical therapists, and mental health specialists as needed for CARE RECIPIENT;
g. Assist CARE RECIPIENT in carrying out the instructions and directives of CARE RECIPIENT's health care providers;
h. Arrange for social services by social service personnel as needed by CARE RECIPIENT;
i. Even if additional services are not needed, visit at least weekly with CARE RECIPIENT and encourage social interaction;
j. Arrange for outings and walks in keeping with CARE RECIPIENT's lifestyle, if reasonable and feasible for CARE RECIPIENT;
k. Interact with and/or assist any agent of CARE RECIPIENT in interacting with health professionals, long-term care facility administrators, social service personnel, insurance companies, and government workers in order to safeguard CARE RECIPIENT's rights, benefits, or other resources as needed.
l. The privacy of CARE RECIPIENT shall be preserved and respected as to visitors, telephone conversations and personal mail. Family members shall be permitted to visit CARE RECIPIENT.

2. DURATION. The services indicated above shall be provided to CARE RECIPIENT by CARE PROVIDER for the lifetime of CARE RECIPIENT.

3. COMPENSATION. The parties stipulate that as of the execution of this Agreement, CARE RECIPIENT is 76 years of age. CARE RECIPIENT agrees to pay, and CARE PROVIDER agrees to accept, in payment for the aforesaid services to be rendered by CARE PROVIDER, the compensation set forth below, which compensation the parties stipulate and agree to be fair and reasonable and commensurate with the quality and extent of the services and their fair market value.

Professional geriatric care managers typically receive $20.00 per hour for performance of the services noted above. The parties stipulate and agree that the CARE PROVIDER shall receive $12.00 per hour.

The parties agree and stipulate that CARE PROVIDER shall furnish the services set forth over the lifetime of CARE RECIPIENT on an "as needed" basis. Therefore, the parties understand that the hours expended in performance of said services will fluctuate over said lifetime according to CARE RECIPIENT's needs. There may be periods where more than 20 hours per week may be required. Conversely, there may be intervals when the services require less time. The parties agree that over the lifetime of CARE RECIPIENT, CARE PROVIDER will expend, on average, 4 hours per week or more.

The parties agree and stipulate that CARE RECIPIENT is 76 years of age. Based on the actuarial tables published by the National Center for Health Statistics, the life expectancy of CARE RECIPIENT is 11.3 years. This Agreement is for the duration of CARE RECIPIENT's life, regardless of its length. Although CARE RECIPIENT may live beyond said life expectancy or survive for a shorter duration, the parties agree and stipulate that compensation to the CARE PROVIDER be based upon said life expectancy of 11.3 years.

The parties, therefore, agree and stipulate that compensation to the CARE PROVIDER shall be computed as follows: $12.00 per hour, multiplied by 4 hours, multiplied by 11.3 years, multiplied by 52 weeks equals $28,204.80.

Thus, the maximum reasonable fair market value compensation is $28,204.80.

The parties recognize that CARE RECIPIENT does not possess sufficient assets to pay the maximum compensation. Therefore, the parties agree that as full compensation for the services contemplated hereunder, CARE RECIPIENT shall pay to CARE PROVIDER in cash and/or other assets of equivalent value the amount of $11,000.

The parties agree that the agreed upon compensation of $11,000.00 is less than the reasonable and fair market value of the services contemplated hereunder; nonetheless, CARE PROVIDER agrees to accept such amount as full compensation.

4. NON-ASSIGNABILITY. This Agreement is for services unique to CARE RECIPIENT. CARE PROVIDER agrees to personally perform the above services. CARE PROVIDER shall have no obligation to render services or otherwise be liable to any other person or entity.

5. LIABILITY. Medical care is to be provided at the expense of CARE RECIPIENT. CARE PROVIDER shall not be liable for the cost of CARE RECIPIENT's care. CARE RECIPIENT agrees to reimburse CARE PROVIDER for any reasonable out-of-pocket expenses incurred on CARE RECIPIENT's behalf.

6. EFFECTIVE DATE. This Agreement shall take effect and be binding on the parties hereto upon payment of the agreed upon compensation set forth above for CARE PROVIDER.

7. ARBITRATION CLAUSE. The parties agree that any dispute between them regarding the services under this Agreement or any other aspect of this Agreement, will be determined by submitting it to arbitration under the laws of the State of Missouri, rather than by a lawsuit through the court process.

8. This Agreement contains the entire Agreement and understanding between the parties, surpassing all prior communications, either written or oral, concerning the subject matter of this Agreement. This agreement may be changed only by a written instrument executed by both parties hereto.

9. This Agreement shall be governed by and construed in accordance with the laws of the State of Missouri.


(Presumably the agreement also included space for both parties to sign as well as the date of signature)

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