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 “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. 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 ____________, between ___________________ and __________________, has the following terms of employment:
1. START DATE Employee will start employment on ________________ and continue until either party elects to terminate the relationship.
2. WORKSITE ADDRESS Work will be performed at ______________________________________________________________.
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 Resume: _____ End: _____ Daily Hours
_____
Sun. Begin: _____ am/pm End: _____ am/pm Resume: _____ End: _____ Daily Hours
_____
Mon. Begin: _____ am/pm End: _____ am/pm Resume: _____ End: _____ Daily Hours
_____
Tue. Begin: _____ am/pm End: _____ am/pm Resume: _____ End: _____ Daily Hours
_____
Wed. Begin: _____ am/pm End: _____ am/pm Resume: _____ End: _____ Daily Hours
_____
Thu. Begin: _____ am/pm End: _____ am/pm Resume: _____ End: _____ Daily Hours
_____
Fri. Begin: _____ am/pm End: _____ am/pm Resume: _____ End: _____ Daily Hours
_____
*If the employee is required to be at the worksite for 24 consecutive hours or more, federal law allows an employer to exclude up to 8 hrs of sleep time if employer provides adequate sleeping arrangements, employee is able to sleep uninterrupted by work tasks for at least 5 consecutive hours and the employee accepts the arrangement. Employers in California are NOT allowed to exclude sleep time.
Based on the above schedule, employee ________ accepts does not accept a sleep time exclusion.
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4. JOB RESPONSIBILITIES
Here are some of the things you will be responsible for during this job:
Social Pursuits
Going on walks or sitting
outside
Reading out loud
Playing card or board games
General companionship and
conversation
Bedroom
Help with getting in and out of
bed
Change bed sheets
Straighten room
Personal Care
Assist with transfers from
chairs, bath, etc.
Assist with bathing
Assist with toileting
Assist with dressing
Assist with walking
Assist with exercises
Assist with personal grooming
Observe and record any health or
behavior changes
Meals and Nutrition
Plan ___ meals and ___ snacks a
day
Prepare and serve food
Assist with feeding
Clean, dry and put away dishes
Wipe counters and stove
Grocery shopping
General Duties
Clean bathtub, toilet and sink
Empty trash cans and take out
garbage
Sort recycling items
Care for pets
Wash, dry, fold and put away
laundry
Vacuum carpets and sweep floors
General dusting & cleaning of home
surfaces
Secure home when leaving
Water plants and/or maintain garden
Shovel and/or de-ice steps
Health Care
These services should be provided by a licensed therapist or nurse. It is
advised to see a current license and make a copy.
Speech therapy
Wound care or bandaging
Rehabilitative or therapeutic
physical
Occupational therapy
Medication prompting
Providing Transportation*
Employee will be provided a
vehicle
Beauty or personal care
Social visits to family and friends
Medical and dental appointments
Arranging for alternative
transportation
Faith-based events
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* If a vehicle is not provided, any miles driven while on the clock using the employee’s car will be reimbursed at the IRS Mileage Reimbursement Rate of 62.5 cents per mile. This covers the cost of gasoline, as well as general wear and tear on the vehicle. Employee will maintain and mileage log and submit to employer for reimbursement at the end of the pay period.
Additional timelines and instructions are attached in the Senior Care Rules and Daily Schedule
5. NOTES ABOUT THE PERSON RECEIVING CARE
The person you will care for, _________________________, can cannot be left alone and has been diagnosed with _______________________________________. This can cause these changes in his/her behavior: _____________________________________________________________________________ _____________________________________________________________________________________
Please include any essential information about dementia, Alzheimer’s, food allergies, chronic pain, or other conditions.
6. 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
at worksite address in blocks of ___
hours in advance of the
Weekly (Every Friday)
Bi-Weekly (Every Other
Friday or 26 times per year)
Method of Payment: ________________ (Cash, check, CashApp, PayPal, Venmo, Zelle)
Please reference the Labor Law Rules addendum for additional notes on overtime and any exemptions
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.
Health Insurance at $__________ per
month (up to total amount of premium)
Public Transportation at $__________ per month (up to $300/month)
Parking at $____________ per month (up to $300/month)
College Tuition at $___________ per month (up to $5,250 per year)
Cell Phone service at $__________ per month (up to total amount of bill)
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7. TAX WITHHOLDING/REPORTING
Employee will complete Form I-9 (available at www.uscis.gov/forms ) and provide the required documentation verifying employment eligibility within 3 days of hire. Employer will withhold the required Social Security & Medicare taxes from the employee’s pay, along with income taxes per the employee’s instructions on Form W-4 and state withholding form (if applicable).
Employer will pay Social Security & Medicare taxes as well as federal and state unemployment insurance taxes. Employer will provide employee with Form W-2 by January 31st after the calendar year concludes. Employer will report employee’s earnings to the Social Security Administration so that employee receives the appropriate credits.
For help with the tax and payroll process, please call HomePay at (888) 273-3356.
8. PAID TIME OFF
Employee will receive the following paid time off:
Sick Leave: _____
hours per year. Advanced notice is requested for any appointments which may
cause the employee to miss work.
Vacation: ______ hours per year.
Employee will request to use vacation time at least ___ week(s) in advance.
(Please see Senior Care Rules for how approval of vacation will be determined).
Paid Time Off Notes: Families are not required by federal law to provide paid time off. However, there are several cities/counties/states that mandate paid sick leave and/or vacation. Please call 888-273- 3356 for details.
9. HOLIDAYS
Employer will provide the following PAID Holidays:
New Year’s Day
Martin Luther King, Jr.’s Birthday
President’s Day
Memorial Day
July 4th
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: Families are not required by law to provide paid holidays.
Page 4 of 12
10. GROUNDS FOR TERMINATION
Employer may terminate employee for any legally permissible
reason including, without limitation:
• Allowing the safety of the senior to be compromised
• Inconsistent or non-performance of agreed-upon job responsibilities
• Concerning issues in background check
• Dishonesty
• Stealing
• Misuse of family automobile
• Breach of confidentiality clause
• Persistent absenteeism or tardiness
• Allowing unapproved guests to enter the home
• 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 the senior directly
• Failing to disclose any additional monies or gifts given to caregiver by
senior
•
__________________________________________________________________________________
•
__________________________________________________________________________________
11. 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 he/she is spending the day, unless the family has authorized.
12. RAISES & REVIEWS
Upon the first 90 days, employee will have an initial review with the family to
check in and gauge how the relationship is going. Afterwards, employee will
receive a formal review ______________________.
At this time, employee will be eligible for a raise based on the
following factors:
•
__________________________________________________________________________________________
•
__________________________________________________________________________________________
•
__________________________________________________________________________________________
•
__________________________________________________________________________________________
Raise and review notes: Employers are not required to give caregivers raises, but it is common practice. Check the Bureau of Labor Statistics website for the Consumer Price Index (www.bls.gov/cpi) to see the rate of inflation as a starting point.
Page 5 of 12
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: ___________________________________________________________
Page 6 of 12
LABOR LAW NOTES
Overtime
With very few exceptions, senior caregivers are classified as “non-exempt”
workers, which entitles them to be paid for every hour they work. Overtime
(time-and-a-half) must be paid for each hour worked over 40 in a 7-day workweek.
Generally, live-in employees are exempt from overtime requirements, however, the states of CA, HI, MD, MA, MN, ME, NJ, NV, NY and OR have special overtime requirements for live-in employees. Your caregiver is considered a live-in employee if their primary residence is the home of the person they are caring for, or if they work 120 hours or more per week.
The state of California also has a daily overtime requirement if the caregiver works more than 9 hours in a day. Call HomePay at (888) 273-3356 for details.
Companion Worker Designation
The Department of Labor allows employers to be exempt from minimum wage and
overtime if they hire a companion caregiver. It’s a very narrowly defined worker
whose primary role is to provide “fellowship and protection.” This means the
caregiver’s duties are usually restricted to reading, taking walks, playing
games, etc.
If the caregiver spends more than 20% of his/her time on Activities of Daily Living, such as cleaning the house, assisting with meals, transferring, etc., they would not fit the definition. It’s also important to note that, even if the worker qualifies as a companion, some states will not allow families to take the overtime exemption.
Please call HomePay if you believe you are hiring a companion and we’ll be happy to explain these rules further.
Page 7 of 12
SENIOR CARE RULES
This is a document that both Employer and Employee will work with and develop together. The goal is to fill out this document at the start of the working relationship, but update it as the senior’s needs develop and change -- and the trust grows deeper between family members and caregiver.
Date: _________
Family Philosophy:
Describe yourselves and how you want your parent or loved one to be cared for.
Explain what is important to you (i.e., caring and compassionate treatment,
retaining mom or dad’s dignity, monitoring medications carefully, etc.). How
independent is your loved one? Will s/he have a large say in day-to-day needs or
does s/he need direction? Describe how much involvement you will have and how
much managing you will want to do of your loved one’s daily schedule.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Family History:
Share a little bit about your family and the history of your loved one (Were
they married for 50 years? What was their career or their favorite hobby?), so
the caregiver gets to know them.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Specific Diagnoses:
Does your loved one have a medical diagnosis like diabetes, congestive heart
failure or dementia? Let your caregiver know the specifics and history here.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Attention:
Can your loved one be left alone? Some seniors have certain illnesses that
require supervision at all times. If this is the case, be very clear with your
caregiver about this. What steps should your caregiver take if another caregiver
or family member is late to relieve him or her of their duties?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Page 8 of 12
Medication Monitoring:
Will the caregiver need to prompt your loved one to take medication at
designated times? What happens if your loved one refuses to take the medication?
See the Daily Schedule for Senior Caregivers for proper medication schedules and
dosages.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Physical or Cognitive Impairments:
Let your caregiver know of any physical or cognitive impairment your loved one
has. How is their hearing? Do they need eye glasses? Does arthritis make getting
out of bed difficult? Will your loved one know how to follow the caregiver’s
instructions without help? If your loved one gets confused or anxious, let your
caregiver know and share common triggers and best practices for calming them
down.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Typical Reactions to Receiving Care:
If your loved one is very independent, make sure your caregiver knows when and
how to approach with offers of help. Do they reject assistance with one
activity, but accept it with another? Do you have any tips to offer?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Handling Behavioral Issues:
This is typically a necessary area to cover if your loved one has Alzheimer’s or
another form of dementia. As mentioned above, you’ll want to let your caregiver
know what kinds of situations can trigger difficult behaviors (such as
aggression or another emotional state) in your loved one. Triggering situations
can be time of day, certain activities, the caregiver’s emotional state and much
more.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Additional Care:
What doctors is your loved one currently seeing or what types of additional care
or therapies (such as physical therapy) are in progress or anticipated? Do the
providers come to the house or will the caregiver need to bring your loved one
to appointments?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Page 9 of 12
In-Home Entertainment Options:
Does your loved one have a favorite television show? Does he or she like to
read, be read to, listen to specific music, play cards, do puzzles, listen to
the radio or do crafts? Do they have regular visitors in the home?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Visitors:
Does your loved one have regular visitors in the home? Who is allowed/not
allowed? Are there any restrictions on how long your loved one can have
visitors?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Sleep Preferences:
Talk about your loved one’s typical sleep patterns and needs. Explain any
particular rituals or habits they like to follow. Do they need a nap after lunch
or following a doctor’s appointment? Should the room be dark? Do they want the
temperature warm or cool?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Communication:
Would you like to hear from the caregiver throughout the day or get overall
daily or weekly updates? What particulars do you want to know about immediately?
What can wait? Do you want a phone call, text or email? Do you want a written
record of the day? How would you like to discuss concerns that arise? Is the
caregiver allowed to discuss your loved one’s care with other relatives? Which
ones?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
In an Emergency:
What do you want your caregiver to do in an emergency? After calling emergency
services, who else should be notified? List names and numbers here.
Name: _______________________________ Phone Number:
_______________________________
Name: _______________________________ Phone Number:
_______________________________
Name: _______________________________ Phone Number:
_______________________________
Name: _______________________________ Phone Number:
_______________________________
Page 10 of 12
SAMPLE DAILY SCHEDULE:
12:00am
_____________________________________________________________________________
1:00am
_____________________________________________________________________________
2:00am
_____________________________________________________________________________
3:00am
_____________________________________________________________________________
4:00am
_____________________________________________________________________________
5:00am
_____________________________________________________________________________
6:00am
_____________________________________________________________________________
7:00am
_____________________________________________________________________________
8:00am
_____________________________________________________________________________
9:00am
_____________________________________________________________________________
10:00am
_____________________________________________________________________________
11:00am
_____________________________________________________________________________
12:00pm
_____________________________________________________________________________
1:00pm
_____________________________________________________________________________
2:00pm
_____________________________________________________________________________
3:00pm
_____________________________________________________________________________
4:00pm
_____________________________________________________________________________
5:00pm
_____________________________________________________________________________
6:00pm
_____________________________________________________________________________
7:00pm
_____________________________________________________________________________
8:00pm
_____________________________________________________________________________
9:00pm
_____________________________________________________________________________
10:00pm
_____________________________________________________________________________
11:00pm
_____________________________________________________________________________
Medication Prompting
Medication: ___________________________________________________________
Dose: ___________________________________________________________
Scheduled times to take:
___________________________________________________________
Prescribing doctor: ___________________________________________________________
Additional notes: ___________________________________________________________
Medication: ___________________________________________________________
Dose: ___________________________________________________________
Scheduled times to take:
___________________________________________________________
Prescribing doctor: ___________________________________________________________
Additional notes: ___________________________________________________________
Page 11 of 12
Medication:
___________________________________________________________
Dose: ___________________________________________________________
Scheduled times to take:
___________________________________________________________
Prescribing doctor: ___________________________________________________________
Additional notes: ___________________________________________________________
Medication: ___________________________________________________________
Dose: ___________________________________________________________
Scheduled times to take:
___________________________________________________________
Prescribing doctor: ___________________________________________________________
Additional notes: ___________________________________________________________
Employer has completed these rules to the best of their ability and agrees to the terms.
Employer Signature: ___________________________________________________________
Printed Name: ___________________________________________________________
Date: ___________________________________________________________
Employee herby agrees to be fully bound by the terms of these rules.
Employee Signature: ___________________________________________________________
Printed Name: ___________________________________________________________
Date: ___________________________________________________________
* 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 Senior Care Contract” document, whether arising in contract, equity, tort or otherwise.
Page 12 of 12
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Tax Year: 2023