Caregiver Agreement Template

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A caregiver contract agreement is a way to hire an individual or nurse to take care of someone else in exchange for payment. The caregiver can be a personal friend or family member, and determining the patient’s condition, is recommended to be a licensed nurse. The caregiver is generally required to provide balanced meals, clean the room/home, do housekeeping duties, running errands, and have personal care needs. If the patient is aware of their surroundings there is typically a companionship with trust that forms over time.

Table of Contents

What is a Caregiver?

A caregiver is someone who is paid to take care of another person, commonly an elderly individual or someone with special needs. A caregiver is paid to provide day-to-day care such as transportation, preparing meals, housekeeping chores, and any other needs of the individual. The caregiver will typically follow a weekly schedule outlined either in the agreement or that is set by the parties.

Caregiver Average Pay

  • Salary: $24,060/yr (source: BLS)
  • Hourly Rate: $11.57/hr (source: BLS)

Live-in (in the home) Caregiver

If the caregiver that is being hired is a family member or a friend that will be living in the same home, there may be tax advantages to the employer. Simply put, if the caregiver is there to “look after” the patient and spends no more than 20% of their daily living activities caring for him/her the caregiver may not be eligible for minimum wage.

Therefore, if someone is in the area that needs housing, and the patient needs only limited support, this can be an economical way to provide care for an elderly family member.

Is a Caregiver an Employee or an Independent Contractor?

Depending on the situation the caregiver may be considered an employee or independent contractor under State and Federal laws.

Employees

  • Paid directly by the patient;
  • Paid every payment interval;
  • Files IRS Form W-2; and
  • Files State and Federal unemployment insurance;

Independent Contractors

  • Paid by an entity (unless accepting payment as a sole proprietor);
  • Paid after an invoice is issued;
  • Files IRS Form 1099; and
  • Does not file any unemployment insurance;

Additional Recommended Forms

Durable (Financial) Power of Attorney – Gives a caregiver the power to pay bills, making deposits, and providing the assistance needed to handle financial responsibilities on someone else’s behalf.

Medical Power of Attorney – Gives the caregiver the right to make health care decisions on someone else’s behalf. This is common if the patient is not able to speak for themselves and a caregiver is assigned the duty of making decisions for the benefit of the patient. This form also includes a living will that allows the patient to make “end of life” decisions if they should be in a state of incapacitation for a longer period of time.

How to Write a Caregiver Agreement

1 – Save This Paperwork To Document The Contracted Services Of A Caregiver

When a Caregiver and Care Recipient enter a working relationship, it is often suggested to make sure the employment agreement is set on paper. This sort of documentation is available through the buttons captioning the image on this page. You may download any file version (Adobe PDF, Microsoft Word (.docx), or Open Document Text (.odt))of this template at your discretion.

2 – The Opening Statement Will Serve As A Documentation Of Each Concerned Party And His Or Her Role

Article I provides a method for naming both the participants of this agreement and identifying each one’s role in relation to the other. Before we begin we will need to document the Date of this contract by supplying the agreement Date’s Month and Calendar Day on the first blank space and the Year on the second blank space.  

Now, on the blank line labeled “Recipient,” produce the Full Name of the individual who will receive the services the Caretaker will provide. Finally, use the last blank line here to present the Caregiver’s Full Name. 

3 – A Definition To The Start Date And Caregiver Employment Status Is Required

The next task will be supplying the Calendar Date when both parties expect each other to fulfill the obligations this contract places upon them. This “Effective Date” should be supplied as a Calendar Month and Day on the first blank space in “II. Term Of Agreement” then supplying the Calendar Year of this Date on the second blank line.

4 – Caregiver Compensation And Scheduling Should Be Detailed

“III. Purpose” should be read and understood by both parties before signing. The next article that will require attention is “IV Employment Status.” Two checkbox definitions have been supplied to this section, so the Employment Status can be defined simply by marking the check box that corresponds to the best definition. If the Recipient will issue a W-2 to the Caregiver and fulfill an Employer’s obligations in this capacity, then mark the checkbox labeled “W-9 Employee.” Please note, that if the Caretaker is a “W-9 Employee,” you must fill out the page labeled “Exhibit A” which must be signed by both parties upon completion. If the Caregiver will perform his or her duties on a contractual basis, handle his or her own taxes, and the Recipient intends to fill out/issue Tax Form 1099 to the Caregiver at the end of the Tax Year, then mark the checkbox labeled “1099 Independent Contractor.” Article “V. Compensation” will seek a report on what the Caregiver will be paid for his or her services to the Recipient. Locate the blank space after the Dollar Sign then report the Hourly, Daily, Weekly, or Annual Salary the Caregiver will receive. Remember to place a mark in the box labeled “Hourly,” “Daily,” “Weekly,” or “Annually” to further define the previously reported Salary. A few more definitions will have to be supplied to “V. Compensation. Find the bold labels “Caretaker’s Commitment” and “Room And Board.” If the Caregiver will not be living with the Recipient, then mark the box labeled “Caretaker’s Commitment” then choose one of the two checkboxes under this label to record when the Caregiver must work for the Recipient. If there is a certain number of Hours per week, then mark the box attached to the statement “For At Least…” then fill in the minimum number of Hours/Week the Caregiver must work to satisfy this contract. If the Caregiver will only be expected to work when needed, then mark the checkbox attached to the choice “On An As-Needed Basis.”

If the Caregiver will live with the Recipient, then mark the box labeled “Room And Board.” You must also define this living arrangement by marking the “Provide Room And Board And Pay For All Related Expenses” checkbox or “Pay Caregiver…” checkbox. If the Caregiver will pay monthly rent, then make sure to record the Dollar Amount to be paid each Month to the Recipient when marking this checkbox. If the Recipient will reimburse the Caregiver for reasonable “Out-Of-Pocket Expenses” he or she must pay when performing duties for the Recipient, then mark the checkbox labeled “Reimbursement.” Otherwise, leave this checkbox unmarked. In some cases, the Recipient will pay a certain amount of money per mile the Caregiver drives when he or she must drive to fulfill his or her responsibilities. If so, then mark the checkbox labeled “Vehicle” then record the dollar amount the Recipient will pay the Caregiver on the blank space between the Dollar Sign and the words “Per Mile.” In Article “VI. Schedule” we shall handle when the Caregiver is expected to work for the Recipient. Two checkbox choices to choose from have been presented so this can be documented accurately. If the Caregiver shall not be subject to a specific schedule, then mark the first choice (“Shall Not Be Bound To A Schedule”). However, if the Recipient requires the Caregiver to follow a schedule then mark the “Shall Be Bound To The Following Schedule” then use the spaces supplied to define the Start Time and Finish Time for each day’s shift (Remember to mark “A.M” or “P.M.” when defining a Work Shift).

5 – The Services Expected Of The Caregiver Must Be Identified

“VII. Services To Be Performed” is the section where we will detail precisely what tasks the Caregiver will perform when employed by the Recipient. First, we will have to solidify the Physical Address where the Caregiver will work. Utilize the first blank space in this section to deliver the Building Number, Street Name, Unit Number, City, State, and Zip Code where the Caregiver must go when require supplying services to the Recipient. Typically, this is the home of the Caregiver.

The next three blank spaces should be used to present the Mailing Address where the Caregiver must work. This should be furnished as the Street Address, City, and State of the Mailing Address on the blank spaces placed after the terms “Mailing Address Of,” “City Of,” and “State Of” (respectively). Mark the checkbox labeled “Transportation And Errands,” if the Caregiver is expected to provide any of the services defined in the checklist below it. If so, then mark each description that should apply to the required duties the Caregiver must perform. Here, you may assign the Caregiver the task of “Driving Recipient To Medical, Dental, Adult Care, And Other Appointments And Activities,” “Shopping For Groceries And Other Items Needed…,” and “Running Other Errands For Recipient. If the first two selections do not accurately define all the driving tasks the Caregiver is responsible for, make sure to mark the third one and define each driving task on the blank lines presented. If the Caregiver will be given the task of supplying nourishment, then mark the checkbox labeled “Meals.” This subject will also need some additional details provided through a checklist. Make sure to place a mark in each checkbox statement describing each duty the Caregiver is obligated to deliver by marking the “Preparing…,” “Purchasing Or Assisting To Get Groceries,” and/or the “Acting As A Companion At Restaurants” checkbox. Note: If marking the first description, enter the Number of “Meals Per Day” the Caretaker must prepare for the Recipient on the blank space provided. If the Caregiver must perform “Housework” for the Recipient, the bold label “Housework” should be marked. In addition, place a mark in the box labeled “Cleaning Recipient’s Living Area” and/or “Laundry And Changing Linens” to hold the Caregiver responsible for satisfying these obligations. The Recipient may require some assistance to make sure his or her business accounts and bills. If so, then mark the “Financial” checkbox then select either or both definitions supplied to include them in the Caregiver’s required tasks. The first description will assign the task of “Paying Recipient’s Bills, Balancing Recipient’s Check Book, Making Deposits,” and handling other tasks such as dealing with the Recipient’s Health Insurance. The second selection will present an area where you may name specific tasks the Caregiver must fulfill in service to the Recipient. Many Caregivers will be required to administer Medication. If the Caregiver in this document will have such responsibility, then mark the bold label “Administration Of Medication.” Use the checkbox statements, “Ensuring The Recipient Is taking All Medications…” and “Assisting The Recipient With Living And Exercising Routines” to include one or both tasks to the Caregiver’s duties. Next, we will address the topic of Everyday Life. If the Recipient requires the Caregiver’s service during day-to-day activities, mark the checkbox labeled “Assistance With Everyday Life.” This subject will detail several duties the first checkbox will require the Caretaker to Transfer the Recipient From Bed, Chair, and Toilet in addition to helping him or her move around, bathe, and hygiene/personal maintenance. The second checkbox obligates the Caretaker to schedule tasks and manage the Recipient’s Calendar. The third statement will obligate the Caretaker to Monitor the Recipient’s Safety while the fourth statement requires the Caretaker to Monitor the Recipient’s Health and contact Health Care Providers when necessary. You may assign one, some, or all these duties to the Caregiver’s job requirements. Before we finalize the information, we set forth here, we must address one more issue in “VIII. Vehicle.” If the Caretaker will “…Be Provided With A Vehicle To Perform The Services” above, then mark the first checkbox in this article. If the Caretaker will not be supplied with a Vehicle, then mark the second checkbox. It should be noted the second checkbox will mean the Caregiver must Reimburse the Recipient “…In Accordance With The Internal Revenue Service (IRS) Reimbursement Rate Per Mile” and the Caregiver provide a Driving Log to the Recipient.

6 – A Report On Where And When The Effect Of This Agreement Is Executed Must Accompany The Party Signature

Once the information we have reported to define the Caregiver’s and Recipient’s responsibilities, we must solidify which State Government will govern this contract. Disclose the State that governs these terms on the blank line in “XII. Governing Law.”

Now, each party named in the first article must sign this document and print his or her Name. The Recipient must sign his or her Name on the “Recipient Signature” line then name the Calendar Date he or she signed this paperwork on the adjacent line (labeled “Date”).

The “Caregiver Signature” line must be signed by the Caregiver while the “Date” line to right.

If the Caregiver’s Employment Status is a W-9 Employee, then “Exhibit A” on the last page should be used to define the Caregiver Employee’s Benefits and to disclose some vital information when such an Employment Status is recorded. Once this page has been filled out and read by both parties, each must sign his or her Name then supply the Calendar Date when he or she signed this page.