Agreement For Home Care

Many families reach a point where they realize that a sick or elderly relative needs help. There are usually warning signs: difficulties with daily activities; storage problems; banking and financial problems; several falls; driving problems; Forget about medications. Sometimes an elderly or sick loved one needs more than occasional help – they need full-time care. Family Caregiver AllianceNational Center on Caregiving (415) 434-3388 | (800) 445-8106 Website: www.caregiver.org e-mail: [email protected] FCA CareJourney: www.caregiver.org/carejourney Family Care Navigator: www.caregiver.org/family-care-navigator 5 Non-payment is made to our lawyer for the ordinary legal process of attention and confiscation. _____ (initial). TERMINATOR OF THE SERVICES. In the event that the undersigned wishes to terminate the services provided under this contract, the undersigned undertakes to inform the Agency seven (7) days in advance. _____ (initial). CUSTOMER. In case of termination caused by the death of the customer within seven (7) days of the start of the SERVICE, a refund of 50% of the payment is made. _____ (initial).

OPT-OUT CLAUSE. Signature: _____ Signature: _____. SERVICE Invoices are sent to: (address, location, state, zip code). _____. _____. Wishes to enter into a service contract with _____ (Agency). The following non-medical and home care services: SERVICES TO BE PROVIDED. Meal preparation and feeding Bath and body care and care Light household Bedside Care for minor temporary illnesses Groceries and food Medication control and distribution Day and night shifts Long-term care and acute care Price: $ _____ per hour (at least 6 hours per day).

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