In home caregiver contract

Discussion in 'Tips and Resources' started by suse, Sep 12, 2012.

  1. suse

    suse Jr. Member

    I have looked and looked for an actual inhome caregiver contract but have only found suggestions of what it should include. The closer I get to having my husband's application ready to send (but not there yet) the more stressed I become. I do feel I have gained a tremendous amount of knowledge from this website and forum for which I am so very grateful. Since I tend to overdue and become very anal an actual copy of a caregiver contract would be so helpful to more thing I can scratch off the list. Thank you, thank you, thank you!!!

  2. suse

    suse Jr. Member

    Please....can anyone out there either post an actual home caregiver contract or tell me where I can find it. I have looked and looked. Thanks so much.

  3. vetadmin

    vetadmin Administrator Staff Member

    Just draw up a simple contract stating the amount being paid, signed by both parties, and who the services are being provided to, and by whom.

    NANAPATOK Newbie

    Suse, this is a Caregiver Contract I drew up...tried to cover a little bit of everything. It's just amazing how much a Caregiver actually does when you start thinking about it. You could just delete or add to make it fit your situation. Hope this helps! Pat

    This CARE SERVICES AGREEMENT documents the prior verbal agreement and/or understanding made by and between the Client (the person requiring care services) and the Caregiver (the person providing care services) of said agreement. Services are to include the following itemized services and any others deemed necessary or desirable for the health and well being of the Client.
    · Monitoring health status to include physical and emotional condition. Coordination of doctors' appointments, transportation to appointments, consulting with doctors, keeping prescriptions up to date, picking up prescriptions, organizing and administering all medications.
    · Securing health care professionals, doctors, nurses, and home care providers as necessary.
    · Assistance with bathing, dressing, personal hygiene, grooming, and health care as needed.
    · Assessing personal needs and desires as to social, physical, entertainment, hobby, and personal pursuits as needed and or/requested by Client.
    · Assisting with instrumental daily activities to include care of pets and securing the home regarding "safety" measures as needed.
    · Financial management including weekly and monthly bill paying, daily money management, and taking care of other financial matters.
    · Dealing with other third parties to coordinate matters detailed herein.
    · Safeguarding client's rights with regard to benefits and other programs client is entitled to.
    · Manage and run home by providing all following services and any others necessary for a well-maintained home environment: planning, cooking, and serving all meals, cleaning, laundry, transportation, errands, shopping, lawn care, landscape maintenance, and minor home repairs.
    The weekly or monthly compensation paid to the Caregiver is subject to change at any time as agreed between the Client and the Caregiver. The initial arrangement is as follows.
    Hours/Days: Full time, seven days a week, 24 hours a day
    Compensation: $amount a month
    ____________________ ____________________
    Dated Client

    _______________________ __________________________
    Dated Caregiver
  5. vetadmin

    vetadmin Administrator Staff Member

    Nana, thanks for posting and sharing this!
  6. care4vets

    care4vets Newbie

    Re: In home caregiver contract -- what's on the affidavit

    I know it has been a while since your post, but in order to help those in a similar situation, I wanted to advise that the VA may ask for an Attendant Affidavit. I can't seem to find one online, so I don't know if they have them as files for printing. It seems they send them out to the claimant.

    I'm guessing that if Care Givers send the exact same information that's on the form, then that would lessen the possibility of being sent one (and thus slowing the process down by several months). If I knew before applying what I know now, I would have sent exactly what was on the form.

    Here's what's on the form:
    Top right of page:
    Veteran's Name (last, first, middle):
    VA Claim or SSN:
    Claimant's Name:
    Claimant's Address (street):
    City, State and Zip Code:

    Main Body of form:

    My name is______________________, and I provide health care for the above claimant.

    The services I provide are:
    (then there are "YES" and "NO" check boxes for each)
    Assistance with bathing
    Standing and sitting
    Getting in and out of bed
    Dressing and undressing
    Taking medication
    Other (please describe): {there are 3 lines for this}

    For these services, I am paid by the claimant _______ per day/week/month/year (please circle only one).

    I began employment on ____________________________________.

    Signature of Provider
    Street Address
    City State and Zip Code
    Phone number (including area code)

    In a separate box at the bottom of the paper is the following:
    I CERTIFY, under the penalty of law, that the above information is true and correct, that I do pay the above referenced sitter the amount listed for the services listed. (If claimant signs with his/her mark, the mark must be witnessed by two witnesses).

    Signature:________________________ Date:____________________
    Witness:__________________________ Date:____________________
    Witness:__________________________ Date:____________________

    Be sure to include tasks like transportation, pharmacy pick-up, cooking and cleaning in addition to the above under “other” if they apply (while the VA doesn’t use those tasks to factor into someone’s needs for A&A, they do realize those are tasks a caregiver provides and therefore deserves compensation). Something they DO factor into a claimant’s need for A&A, in addition to those items on the list in the affidavit, is if they require grooming assistance, not only with bathing as listed above, but trimming nails and keeping their hair clean. If you assist with those matters, it is of utmost importance to include it on the caregiver form and also have the physician state this, as well.

    I cannot stress enough the importance of being clear and detailed! Not only for care givers, but the doctor. It is very important to list all of the tasks and how the claimant requires help. From personal experience, once we were able to get the physician to be very clear in his descriptions, my friend was awarded A&A. He thought they would take his word for it that she needed assistance. The VA, though they trust doctors, need the claimant’s needs to be spelled out with specific details. It took nearly two years of back-and-forth with the VA before my friend was granted A&A (she was first rated as Housebound, after a FULL YEAR of being in-process, but after we provided more detailed specifics, they changed the rating to A&A. Unfortunately, my friend missed out on A&A retroactively for the first year, with its extra $3,000 of benefits, because the doctor was not specific enough with the dated material for the first year).
    Hope this helps!
  7. vetadmin

    vetadmin Administrator Staff Member

    Thanks for coming back and sharing this!
  8. care4vets

    care4vets Newbie

    Thanks to another poster, here is the link for the Attendant Affidavit:

    I highly recommend submitting it when filing the claim (or at least have identical info on your caregiver contract), as the VA may send it anyway and you don't want any months-long delays.
  9. So this is relevant to my Grandfather's situation. He requires 24/7 care, and we have hired seven people to take shifts. This is a small town, and this agreement is very informal. They work their hours and we cut them a check every couple weeks.

    This accounts for 1/2 of his monthly expenses, so we're definitely listing this as an expense for his calculated income.

    Does this mean we should have them all sign a contract and/or send in an affidavit like the one in this thread?

    Thanks everyone,

  10. vetadmin

    vetadmin Administrator Staff Member


    I don't think it is necessary to have them all sign an affidavit, but you do need to make sure that you are paying by check only and have a full accounting of all expenses paid. If they VA wants any type of confirmation, they will ask for it.
  11. Got it, thank you so much for your continued help!
  12. aid4momga

    aid4momga Newbie

    Hi all,

    Interesting thread re in-home caregiver contracts.

    But what comes to my mind is .... if family members are the caregivers, is any kind of contract necessary? In other threads, I saw that family members do qualify.

    So, if a contract is not necessary in that case, how can a contract be required for non-family members?

    Appreciate any and all feedback on experiences or advice.


  13. vetadmin

    vetadmin Administrator Staff Member

    It's not required, but in some cases it can be helpful in the event it becomes necessary to file against accrued benefits that had not been paid out. Sometimes the VA will ask for proof and SS# of private caregivers. but again, it is not necessary.
  14. oscodaeagle

    oscodaeagle Newbie

    I have a question regarding family members providing 24/7 care. My 95 year old Mother and widow of a proud US Army Veteran stays with us in our home and we provide all care. To be eligible for Homebound benefits, does she need to pay us a check each month or just state the amount of money she would have to spend if outside Home Care services were obtained? Initially in her application, she included the statement of the care received by us as family members and what it would be costing her if she had to pay for this level of care from an agency outside of the home.

    Also, if she is determined eligible for benefits, is the benefit sent directly to her to keep for her use for future care costs or is it sent to the family members providing care and then counted as income to them?
  15. suse

    suse Jr. Member

    She needs to be paying you with a check so payment can be verified. If she has any income the caregiver costs need to $0 out the income for full payment from VA....if not $0 out she would receive part pension but not all, assuming. All other eligibility qualifications are met. Yes, caregivers would need to be getting a 1099 at the end of the year. VA will verify this information through IRS. Any recurring medical expenses can also help $0 out income. Prescriptions, even ongoing, may but don't count on it. Debbie, I hope I have answered this correctly.
  16. vetadmin

    vetadmin Administrator Staff Member

    Yes, you did. Thanks Suse!
  17. Kappy

    Kappy Newbie

    So confused! So zero dollars, does that mean after rent, food daily living?
    Let's play with this. Suppose my dad gets 2000.00 each month from social security. He pays 1300 in rent. He pays 300.00 in food. He pays 200.00 in supplemental insurance. That leaves 200.00 left. Is the 200.00 what needs to be spent on aid and attendance to qualify to even request the benefit?

Share This Page