Formal agreement between a care recipient and a family member or personal caregiver establishing compensated care duties, hours, and rates — structured to support Medicaid-planning and tax documentation.
The Personal Care / Family Caregiver Agreement is a ready-to-use senior & elder care template you can send for signature in minutes. It is written for 2 signers (client and caregiver) and, by default, expires 30 days after it is sent if left unsigned. It covers medicaid planning, caregiver, personal care. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.
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# Personal Care / Family Caregiver Agreement **Agreement Date:** ___________ **Client (Care Recipient):** ___________ ("Client") **Client Date of Birth:** ___________ **Client Address:** ___________ **Caregiver:** ___________ ("Caregiver") **Caregiver Address:** ___________ **Relationship of Caregiver to Client:** ___________ The Client and the Caregiver (together, the "Parties") enter into this Personal Care / Family Caregiver Agreement ("Agreement") on the date first written above. ## 1. Purpose and Medicaid-Planning Context This Agreement is intended to establish a bona fide employment or independent-contractor relationship between the Client and the Caregiver at fair market value. The Parties understand that: (a) Compensating a family caregiver at fair market value may protect transferred funds from being treated as an uncompensated transfer under Medicaid look-back rules (generally 60 months), provided the services are actually rendered and documented contemporaneously. (b) The compensation rate set forth below is intended to reflect the prevailing rate for comparable personal care services in the Client's geographic area. (c) This Agreement does not guarantee Medicaid eligibility or any particular tax treatment. Each Party is advised to consult a qualified elder-law attorney and a tax professional. ## 2. Scope of Personal Care Services The Caregiver agrees to provide the following personal care and supportive services to the Client: **Primary Services (select all that apply):** ___________ Personal hygiene assistance (bathing, grooming, oral care) ___________ Dressing and undressing ___________ Transfers and mobility assistance (bed to chair, ambulation)