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Enter the full legal name of this party exactly as it appears on their ID or business registration.
Enter the full legal name of this party exactly as it appears on their ID or business registration.
An Elder Care Agreement (Personal Care Agreement or Caregiver Contract) is the binding written contract between an elderly or disabled individual (or their legal representative) and a family member or professional caregiver who will provide personal care services in exchange for compensation. Without a written agreement, the IRS may treat payments to family caregivers as gifts — disqualifying the care recipient for Medicaid benefits if they apply within the 5-year Medicaid look-back period. A properly structured, written care agreement with fair market value compensation allows care payments to be treated as legitimate expenses, not gifts. This document is essential Medicaid planning. Fill out this free elder care / personal care agreement template online, e-sign it digitally, and download a legally valid PDF. no account or lawyer needed. Sections: Parties, Care Terms.
MEDICAID PLANNING NOTICE: If the Care Recipient anticipates applying for Medicaid (Medi-Cal) within 5 years, this Agreement should be reviewed by an elder law attorney to ensure compliance with the Medicaid look-back rules. Compensation must reflect fair market value for the services provided.
This Personal Care Agreement (the "Agreement") is entered into as of ______________ by and between ______________, located at ______________ (the "Care Recipient"), and ______________, located at ______________ (the "Caregiver"), who is the Care Recipient's ______________.
Caregiver agrees to provide the following personal care and support services to Care Recipient (the "Care Services"): ______________. Caregiver shall provide approximately 0 hours of Care Services per week. Caregiver shall provide Care Services in a professional, compassionate, and competent manner, consistent with the needs and dignity of the Care Recipient.
In consideration for the Care Services, Care Recipient agrees to pay Caregiver the following compensation: ______________ of $0.00. Payment shall be made: ______________. The compensation rate was established based on fair market value for comparable care services: ______________. This compensation is intended to qualify as legitimate employment compensation and not as a gift.
The Parties acknowledge that compensation paid to the Caregiver under this Agreement may be subject to income tax and self-employment tax. The Care Recipient may be required to issue a Form 1099-NEC if annual payments equal or exceed $600. Each party is responsible for consulting a tax professional regarding their respective tax obligations arising from this Agreement.
The Care Recipient retains full autonomy and decision-making authority over their own affairs, finances, medical care, and daily life. This Agreement does not grant Caregiver any power of attorney, authority over the Care Recipient's finances, or right to make medical decisions. Caregiver shall act at all times in accordance with the Care Recipient's wishes, preferences, and dignity.
Caregiver agrees to maintain the confidentiality of all personal, medical, and financial information of the Care Recipient encountered in the performance of Care Services, and shall not disclose such information to any third party without the Care Recipient's prior written consent, except as required by law.
This Agreement is effective from ______________ and continues on an ongoing basis until terminated. Either party may terminate this Agreement upon 30 days' written notice. The Agreement may be modified in writing by mutual consent of both parties. Any modification to the compensation rate should reflect prevailing fair market value at the time of modification.
This Agreement shall be governed by and construed in accordance with the laws of the State of ______________, without regard to its conflict-of-laws principles.