What form or other do we use to list Moms expenses in Home care setting

Discussion in 'Expenses' started by afk324, Nov 9, 2016.

  1. afk324

    afk324 Newbie

    We have moved our 95 year Mom, to my Sister's home to have her monitored 24 x 7. She pays our Sister for her Room, Board, Med management, Doctor visits. We also have 2 paid for daycare a friend and a relative to handle her needs while my Sister is working. My Sister plans and coordinates the Daycare schedule. They are also paid by my Mothers assets. Should we have my Sister create a statement of care and costs. Is there a specific form for this ? I see that there is form for Nursing homes 21-0779 and a statement on the ASL paperwork defining daily care.
    Thanks in Advance....
  2. Kaylin

    Kaylin Hero Member Staff Member

    I would have your sister write up some sort of statement of care and costs. Using bank statements from your mother to support the fact that she is paying your sister each month for her care would give good evidence as well. Here is an example of a Caregiver Statement your sister can use.


    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.
    Compensation: _$__ amount a month
    ____________________ ____________________
    Dated Client

    _______________________ __________________________
    Dated Caregiver
  3. afk324

    afk324 Newbie

    Outstanding Kaylin.....This a great model for us to create ours. afk324
    Kaylin likes this.
  4. Kaylin

    Kaylin Hero Member Staff Member

    You're welcome!

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