Live-In Caregiver Contract (Elderly)

for Your State

This Live-In Caregiver Contract is used when live-in care is necessary for an elderly person. This contract sets out the specific duties the caregiver will perform which may including housekeeping and cooking tasks. This form is for use in all states and is ready for immediate download.

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This Live-In Caregiver Contract is for use when live-in care is necessary for an elderly person. This contract could be used by a husband or wife, son or daughter, siblings or other kin to ensure that the duties of a live-in caregiver for an elderly person are specifically set out in writing. The contract sets out the specifics of the arrangement including the names and contact information of the employer and caregiver, the household where the services will be performed (names of members, number of bedrooms, etc.) and the caregiverís responsibilities, including any housekeeping, cooking or pet care tasks. It also sets out the caregiverís salary, hours of work, overtime, vacation and sick leave which will be paid and other benefits including medical coverage. It is important that this type of business transaction be memorialized in writing. A written Live-In Caregiver Contract for an Elderly Individual will prove invaluable if there are disagreements, misunderstanding or concerns about the individualís care.

This Live-In Caregiver Contract for Care of an Elderly Individual contains the following provisions:
  • Employer/Caregiver: Sets out the names, address and phone numbers of both the employer and caregiver;
  • Duties and Responsibilities: Sets out the address where the duties will be performed, household members and if any members have disabilities and the specific duties the caregiver will perform;
  • Duration, Wages and Benefits: Sets out the duration of the contract, salary, hours of work and rate of any overtime pay, vacation and sick leave hours and any medical or other benefits provided;
  • Accommodations: Sets out the accommodations provided for caregiver including the cost per week if applicable;
  • Signatures: The employer and caregiver must sign and date the contract.

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This attorney-prepared packet contains:
  1. General Instructions
  2. Information
  3. Live-In Caregiver Contract for Care of an Elderly Individual
State Law Compliance: This form complies with the laws of all states
Number of Pages5
DimensionsDesigned for Letter Size (8.5" x 11")
EditableYes (.doc, .wpd and .rtf)
UsageUnlimited number of prints
Product number#29195
This is the content of the form and is provided for your convenience. It is not necessarily what the actual form looks like and does not include the information, instructions and other materials that come with the form you would purchase. An actual sample can also be viewed by clicking on the "Sample Form" near the top left of this page.
 
 
Live-In Caregiver Contract
(Elderly Individual)

 

 

 
Employer Name
Caregiver Name
     
     
Employer Address
Caregiver Address
     
     
Employer Telephone (Home)
Employer Telephone (Work)
 
 
     
     
 
 
Duties and Responsibilities
Address of house at which Caregiving Services provided
Description of Household (no. of rooms, members, etc.)
     
     
Nature of Disability (if any):      
Care Responsibilities/Duties (Describe)
     
Housekeeping Responsibilities/Duties (Describe if applicable, including Pet Care if applicable)
     
Duration, Wages and Benefits
Gross Wages
Frequency of Pay
Employment Start Date
Duration of employment
$      per
 
     
      
Hours of Work
Overtime Rate
Vacation
Sick Leave
      hours per week
$      per hour paid after       hours/week
      weeks with pay per year
      paid sick days per year
Schedule of Hours (list)
Days Off (provide details)
Paid Federal Holidays
Other Holidays (list any)
     
      days per week
 Federal Holidays
     
Other Leave (describe)
Medical Coverage (describe)
Other Benefits (describe)
Airfare Included?
     
     
     
 No
 Yes (details)
 
 
 
     
Accommodation
Room and Board Included?
Cost per Week
Furnished Private Room
Locked Room?
Private Bath?
 Yes
 No
$     
 Yes
 No
 Yes
 No
 Yes
 No
General Terms
The Employer hires the Caregiver as a Live-in Caregiver in accordance with the terms and conditions of this Contract.
The Employer agrees to (i) pay the Caregiver the wages and other benefits outlined above, (ii) provide the accommodation outlined above, (iii) abide by applicable State labor standards, (iv) provide the employee with information regarding wages and types and approximate amounts of deductions from pay, and (v) provide a Record of Employment on termination of employment.
The Caregiver agrees to provide the Live-In Caregiver services in accordance with the duties and responsibilities outlined above.
The Employer certifies that the wages and working conditions reflect applicable provincial employment standards and prevailing wage rates.
The Employer and the Caregiver agree to abide by all applicable State labor standards regarding written notice of termination of employment.
Amendments to this contract must be made in writing and agreed to by both parties.
Signature of Employer
Signature of Caregiver
I have read this agreement, understand it, and agree to it
I have read this agreement, understand it, and agree to it
x      
x      
     Employer Signature
     Caregiver Signature
     Date:
     Date:
 

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