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Sample Adult and Senior Care Contract

Julia Quinn-Szcesuil
March 19, 2018

Include these house rules in your contract and then discuss them in person with your new caregiver.

Hiring an adult or senior caregiver to help your aging loved one is a big step for your family. You found someone you think is a good match, and you want to be as professional as you can to make sure everything goes well. To help both you and your caregiver figure out all the details and expectations, a contract tailored to your situation will help a lot. It also helps you cover all of your duties as an employer and makes your wishes and requirements as clear as possible.

We have created a sample Adult and Senior Care Contract that you can personalize to ensure your loved one receives the exact care you want. Also check out our planning documents on Adult and Senior Caregiver Rules and Daily Schedule that go along with this contract.

Next Steps:

  • Copy the text below and paste it into a Word document or download a pdf
  • Look it over and figure out what details you should include for your family and situation
  • Go over the contract with your caregiver and let her ask questions
  • Print out two copies of the contract, sign both and ask your caregiver to do the same -- then you each keep a copy
  • Create a payroll account to make handling payment and caregiver taxes easier


CLICK HERE TO DOWNLOAD A PDF VERSION OF THIS ADULT AND SENIOR CARE CONTRACT

Sample Adult and Senior Care Contract

 

Dear ________________,

Thank you for providing this much-needed care! The following contract is to make sure we are all on the same page about responsibilities, vacation days, taxes, payments and schedules. The attached "Adult and Senior Care Rules" and "Daily Schedule" offer a little more information about how our family works and how we are hoping you can assist our loved one, written down so it can be clear. While the below contract is very black and white, the addendum will be an agile document and we know things might change.

This contract, executed on ____DATE_____, between __________EMPLOYER_____________ and _____________EMPLOYEE_______________, has the following terms of employment:

  1. START DATE
    Employee will start employment on ________DATE________ and continue until either party elects to terminate the relationship.
     
  2. WORKSITE ADDRESS
    Work will be performed at ____________WORKSITE ADDRESS_________________.
     
  3. WORK SCHEDULE
    The following represents a typical schedule. Employer will limit fluctuations as much as possible and provide as much notice as possible.

  Sat

Begin: ______ am/pm 

End: ______ am/pm 

 

 

Begin: ______ am/pm

End: ______ am/pm

Daily Hours ___

  Sun

Begin: ______ am/pm

End: ______ am/pm

 

 

Begin: ______ am/pm

End: ______ am/pm

Daily Hours ___

  Mon

Begin: ______ am/pm

End: ______ am/pm

 

 

Begin: ______ am/pm

End: ______ am/pm

Daily Hours ___

  Tue

Begin: ______ am/pm

End: ______ am/pm

 

 

Begin: ______ am/pm

End: ______ am/pm

Daily Hours ___

  Wed

Begin: ______ am/pm

End: ______ am/pm

 

 

Begin: ______ am/pm

End: ______ am/pm

Daily Hours ___

  Thurs  

Begin: ______ am/pm

End: ______ am/pm

 

 

Begin: ______ am/pm

End: ______ am/pm

Daily Hours ___

  Fri

Begin: ______ am/pm

End: ______ am/pm

 

 

Begin: ______ am/pm

End: ______ am/pm

Daily Hours ___

      Total Weekly Hours _____

 

  1. NOTES ABOUT THE PERSON REQUIRING CARE
    The person you will care for, ____NAME AND DOB________________, has been diagnosed with ______________________________________________________________________________, which can cause these changes in his or her behavior: __________________________________
    ______________________________________________________________________________

    (Include any essential information about dementia, Alzheimer’s, food allergies, chronic pain or other chronic conditions).

    The person you will care for can/cannot be left alone.

    Caregiver’s initials _____________
     
  2. JOB RESPONSIBILITIES
    Here are some of the things you will be responsible for during this job:
     

     

    YES

    NO

     

     

     

    Health Care

     

     

    [These services should be provided by a licensed therapist or nurse. It is advised to ask to see the current license and make a copy.]

    Speech therapy

    _____

    _____

    Wound care or bandaging

    _____

    _____

    Rehabilitative or therapeutic physical therapy

    _____

    _____

    Occupational therapy

    _____

    _____

     

     

     

    Medications

     

     

     

    Medication prompting

    _____

    _____

     

     

     

    Bedroom

     

     

     

    Help with transfers (getting in and out of bed)

    _____

    _____

    Change bed sheets

    _____

    _____

    Straighten room, make bed

    _____

    _____

     

     

     

    Personal Care

     

     

    Assist with transfers (going from chair to bed, using the toilet, getting in and out of the bath, etc.)

    _____

    _____

    Assist with bathing

    _____

    _____

    Assist with toileting

    _____

    _____

    Assist with dressing

    _____

    _____

    Assist with walking

    _____

    _____

    Assist with exercises

    _____

    _____

    Assist with shaving

    _____

    _____

    Assist with personal grooming (brushing hair or teeth, clipping fingernails or toenails)

    _____

    _____

    Observe and record any health or behavior changes

    _____

    _____

     

     

     

    Meals and Nutrition

     

     

    Plan ____ meals and ____ snacks a day

    _____

    _____

    Prepare food

    _____

    _____

    Serve food

    _____

    _____

    Provide company at mealtime

    _____

    _____

    Assist with feeding

    _____

    _____

    Clean dishes or put in dishwasher

    _____

    _____

    Put away clean, dry dishes

    _____

    _____

    Wipe surfaces of counters and stove

    _____

    _____

    Activity of daily living

    _____

    _____

     

     

     

    General Duties

     

     

    Clean tub, toilet, sink

    _____

    _____

    Care for pets

    _____

    _____

    Empty trash in kitchen, bathrooms and bedroom

    _____

    _____

    Sort recycling items

    _____

    _____

    Secure home when leaving

    _____

    _____

    General/thorough house cleaning

    _____

    _____

    Wash, dry, fold and put away laundry

    _____

    _____

    Water plants

    _____

    _____

    Vacuum carpets and floors or sweep hard floors

    _____

    _____

    Shovel or de-ice steps

    _____

    _____

    Garden maintenance

    _____

    _____

    Keep home surfaces clean, clutter-free and dusted

    _____

    _____

     

     

     

    Grocery Shopping, Errands and Activities

     

     

    Errands may include stops at the grocery store, drug store or gas station to purchase food and supplies

    _____

    _____

    Put items away in the home

    _____

    _____

     

     

     

    Transportation

     

     

    Arrange for alternate transportation (like a senior van) or public transportation

    _____

    _____

    Medical or dental appointments

    _____

    _____

    Beauty or personal care appointments

    _____

    _____

    Social visits to family and friends

    _____

    _____

    Faith-based visits

    _____

    _____

     

     

     

    Social Pursuits

     

     

    Going on walks or sitting outside

    _____

    _____

    Reading out loud

    _____

    _____

    Playing games (board, card, etc.)

    _____

    _____

    General companionship and conversation

    _____

    _____


Additional timelines and instructions are attached in the Adult and Senior Care Rules and Daily Schedule.

 

  1. COMPENSATION

    Regular rate of pay = $_______ per hour

    + Overtime rate of pay = $_______ per hour (for more than 40 hours in a week)

    Total compensation = $_________ per week
     

Wages will be paid: 

 

________ Weekly (Every Friday)

________ Bi-Weekly (Every other Friday or 26 times per year)

 

 

Fair Labor Standards Act Notes: With very few exceptions, domestic employees are classified as "non-exempt" (protected) workers, which entitles them to pay for every hour they work at a rate that may not be less than the federal, state and, if applicable, local minimum wage rate. Additionally, overtime (time-and-a-half) must be paid for each hour over 40 in a 7-day workweek. Generally, live-in employees are exempt from overtime requirements, however, certain states such as CA, HI, MD, MA, NY, MN and ME have special overtime requirements for live-in employees. California requires daily overtime if the caregiver works more than 9 hours in a day.

Call Care.com® HomePaySM (888-273-3356) for details.

MILEAGE AND GENERAL EXPENSES
Any miles driven while on the job using the employee's car will be reimbursed at the IRS Mileage Reimbursement Rate, which covers the cost of gasoline as well as general wear and tear on the car. Employee will maintain a mileage log and submit to employer for reimbursement at the end of the pay period. The 2014 IRS mileage reimbursement rate is 56* cents per mile.

All other pre-approved, work-related expenses will be reimbursed at cost. Employee will keep all receipts and submit to employer for reimbursement at the end of the pay period.

TAX-ADVANTAGED BENEFITS
In addition to the wages stated above, employer will contribute to the following employee expenses. These amounts are considered "non-taxable" compensation (up to the limits noted below), meaning neither employer nor employee will pay any taxes on this portion of the compensation (check any that apply):

 

  Health insurance at $__________ per month (up to total amount of premium)

 

  Public transportation at $__________ per month (up to $130*/month)

 

  Parking at $____________ per month (up to $250*/month)

 

  College tuition at $___________ per month (up to $5,250* per year)

 

  Mobile phone service at $__________ per month (up to total amount of bill)


We do/do not have workers’ compensation coverage (circle one).

Tax-Advantaged Benefits Notes: Families are generally not required by law to provide these benefits. They are additional perks that can be discussed between the family and caregiver.

*Rates and limits vary in some locations and are subject to change. Call HomePay (888-273-3356) for more information.

 

  1. PAID TIME OFF
    Employee will receive the following paid time off:

    Family Sick Leave (_____ hours per year). ____ week(s) notice is requested for any appointments, etc. which may cause the employee to miss work.
    Vacation (______ hours per year). Employee will provide vacation request at least ___ week(s) in advance. (See Adult and Senior Care Rules for how this vacation will be determined)

    Paid Time Off Notes: People who employ adult and senior care are generally not required by law to provide paid time off. However, there are exceptions in some areas, such as:
     
  • San Francisco and Washington, DC require employers to provide paid sick leave once an employee has accrued a certain number of hours.
  • The state of New York requires employers to provide 3 days of paid time off after one year of service.
  • New York City requires employers to provide 2 days of paid sick time after one year of service.
  • Some states, such as California, require employers who offer paid vacation to allow unused accrued hours to carryover from one year to the next.


Please reference your local and state law to ensure compliance.

 

  1. HOLIDAYS
    Employer will provide the following PAID Holidays (check any that apply):
New Year's Day

 

 

  Martin Luther King, Jr.'s Birthda
  President's Day

 

 

  Memorial Day

 

  July 4 th

 

 

  Labor Day

 

 

  Thanksgiving Day  

 

 

  Christmas Day

 

 

 

Employer will also provide the following UNPAID holidays (check any that apply):

 

  New Year's Day

 

 

  Martin Luther King, Jr.'s Birthday

 

 

  President's Day

 

 

  Memorial Day

 

 

  July 4th

 

 

  Labor Day

 

 

  Thanksgiving Day  

 

 

  Christmas Day

 

 

 

 


Holiday Pay Note: People who employ adult and senior care are not required by law to provide paid holidays.

 

  1. TAX WITHHOLDING/REPORTING
    Employee will complete Form I-9 (available at www.uscis.gov/forms) and provide the required documentation verifying employment eligibility within three days of hiring.

    Employer will withhold the required Social Security and Medicare taxes from the employee's pay, along with income taxes per the employee's instructions on Form W-4 and all other applicable state taxes.

    All tax withholdings will be remitted to the state and federal tax agencies on or before the household employment tax deadlines. In addition, employer will match the employee's Social Security and Medicare contributions and make contributions to the state and federal unemployment insurance funds on behalf of the employee.

    Employer will provide employee with Form W-2 (available at www.irs.gov/Forms-&-Pubs) at the end of the year (by January 31).

    Employer will report employee's earnings to the Social Security Administration so that employee receives appropriate retirement benefits.

    Tax Withholding/Reporting Notes: For help with the tax process, call HomePay (888-273-3356).
     
  2. CONFIDENTIALITY
    Employee understands that any and all private information obtained about the employers, patients or their dependents during the course of employment, including but not limited to medical, financial, legal and career, are strictly confidential and may not be disclosed to any third party for any reason.
     
  3. GROUNDS FOR TERMINATION
    The following are grounds for immediate termination:
  • Allowing the safety of the dependent(s) to be compromised
  • Inconsistent or non-performance of agreed-upon job responsibilities
  • Concerning issues in background checks
  • Dishonesty
  • Stealing
  • Misuse of family automobile
  • Breach of confidentiality clause
  • Persistent absenteeism or tardiness
  • Unapproved guests
  • Smoking or consumption of alcohol while on duty
  • Use of an illegal drug
  • Overuse of cell phone or computer while on duty
  • Negotiating terms of employment with senior directly
  • Failing to report any additional monies or gifts given to caregiver by senior
  • ________________________________________________________
  • ________________________________________________________
  • ________________________________________________________

 

  1. Social Media Policy
    Employee understands that no information about his/her location, plans for the day or pictures of family members should be shared on any social media network. Employee will also not tell strangers to the family (i.e. caregiver’s friends) where she is spending the day, unless the family has authorized.
     
  2. Raises and Reviews
    Upon the first 90 days, the Employee will have an initial review with the family to check-in and gauge how relationship is going.

    After ___ year(s), the Employee is eligible for a raise of $___or ___%. This will be based on
    ______________________________________________________________________________
    ______________________________________________________________________________
    ______________________________________________________________________________

    Raises and Reviews Notes: Employers are not required to give caregivers annual raises, but it is a common practice. Start with the rate of inflation (check the Bureau of Labor Statistics website for the Consumer Price Index, www.bls.gov/cpi/) and then add between two and five percentage points based on performance.


Employer hereby agrees to be fully bound by the terms of this contract.

Employer Signature: _____________________________________

Printed Name: __________________________________________

Employer Address: ______________________________________  

Employer Telephone Number: _____________________________

Employer Email: ________________________________________

Date: __________________________________________________

 

Employee hereby agrees to be fully bound by the terms of this contract.

Employee Signature: _____________________________________

Printed Name: __________________________________________

Employee Address: ______________________________________  

Employee Telephone Number: _____________________________

Employee Email: ________________________________________

Date: __________________________________________________

 

NEXT STEPS TO HIRE A CAREGIVER:

 

Julia Quinn-Szcesuil is an award-winning freelance writer and a mom to two girls. She lives in Massachusetts and has written for local and national publications.


* This document and the information in it is presented to be used solely as an example and general guide and is not intended as legal advice. By using this document, the user hereby agrees to release and hold harmless Care.com and Breedlove & Associates, LLC from any liability arising under or relating to this "Sample Adult and Senior Care Contract" document, whether arising in contract, equity, tort or otherwise.

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