What is a Home Care Agreement?
What Is a Home Care Agreement?
Care contracts, also called home care contracts or home care agreements, are documents signed between caregivers (usually family members) and the State in which the patient resides. These contracts are put in place in order to receive Medicaid payments for home care. It is very important to note that Medicaid does not pay for 100% of certain provider services, but will pay a portion of these services. This is why contracts are required between the care provider and the State. The care providers are under contract with the State to utilize a certain number of hours each week to take care of certain tasks and duties for the patient , and the State pays the caregiver on an hourly basis. A home care agreement allocates some of the patient’s assets to the caregiver in order to pay them for their services. This is in line with Medicaid’s rules that only allows for a certain amount of assets for which a patient is eligible. A home care agreement allows a caregiver to receive extra assets for which to live off of and trade in exchange for the services they provide to the patient. Of course there are many more complexities surrounding this issue, which is why a person needs to obtain proper legal counsel before executing any home care agreement or contract.
Elements of a Home Care Agreement
Well-drafted home care contracts are essential for establishing clear expectations and protecting both the caregiver and the recipient of the services. In this article, we’ll provide a complete guide to the essential components of a home care agreement. The sections that should commonly be found in a comprehensive home care agreement include:
Services Provided
This section of the agreement should set forth the exact nature of services performed for the individual. Although caregiving duties may naturally change over time, it is important that they be specifically defined to avoid misunderstandings. Some of the services that may be specifically itemized in the agreement include:
● Grocery shopping
● Meal preparation
● Medication reminders or assistance with medications
● Bathing
● Assistance with personal care (i.e. dressing, hair brushing, oral hygiene)
● Light housekeeping
● Laundry
● Companionship
● Transportation
Some clients may expect and even prefer to go grocery shopping and prepare their own meals while others prefer to have these tasks done for them. Providing assistance with medications may also vary between clients. It is very important to be clear and accurate when itemizing services for your client to avoid disagreements later on.
Payment Terms
The payment terms section requires the caregiver to disclose their rate of pay for services and how often pay is due (i.e. weekly, bi-weekly monthly). It also indicates how the client will make payment. Payment methods may include:
● Cash
● Checks
● Direct deposit
A payment method clause protects you from having to accept payments that may not be safe or secure. For instance, you may not want to accept payment in the form of a personal check because a bounced check could leave you and your client without means to pay for necessary foods and services.
Duration
The duration of the agreement may be highly flexible. It may be listed as being "until cancelled" or "indefinite". Even if your home care contract is indefinite, it is important to include an indefinite duration clause that states that the agreement can be terminated by either the caregiver or the client at any time.
Confidentiality
Both caregivers and clients must realize that sensitive and private information will be shared between parties. Information must be kept completely confidential. The exceptions to this rule may include:
● Any information that must be disclosed under law (i.e. healthcare information, tax information)
● Information required by a legal entity (i.e. social security, auto insurance)
● Information that is requested from an entity or person outside of the parties to this agreement (i.e. via subpoena)
Termination
Although the agreement has specified that it is a terminable-at-will agreement, it is heavily recommended to include a termination clause that lists the conditions for which the agreement can be terminated. The termination clause should include:
In addition, the termination clause should list the conditions for terminating the agreement. Such conditions may include:
Liability
It is nearly impossible to predict how a home care agreement will hold up over time. Having a liability section in your contract protects you in the event that the agreement becomes invalid or unenforceable. Having this section allows you to modify the agreement rather than losing the contract in its entirety.
Advantages of a Home Care Agreement
Outlining responsibilities and expectations up front can truly be beneficial for both agency and the client. The advantages of having a home care agreement in place includes:
Client Protection
Having a home care agreement in place protects the client, as well as the home care agency. Without it, there could be misunderstandings about what hours care will be provided, if the agency can be flexible with scheduling, etc.
Legal Purposes
A home care agreement can be useful in the event legal issues arise. For example, it may be worth its weight in gold in a dispute with the family over how many hours per week your agency is responsible for providing.
Set Expectations
Everyone involved in the home care relationship benefits from a home care agreement. For the providers, you have a clear understanding of your role and the hours that you are responsible for. For your clients, you’ll have the peace of mind that extra hours won’t be expected without proper notice. Contracts give home care agencies a clear understanding of the other party’s obligations.
Ensure Clear Communication
When everyone is on the same page, including the agency staff, the home care provider and the client, there are fewer misunderstandings and less room for miscommunication.
How to Write a Home Care Agreement
For existing clients, we suggest you consult with one of our attorneys for the drafting of the home care agreement. Laws in general are complex, and the laws and issues surrounding elder law and seniors is particularly complicated by idiosyncrasies that vary from person to person and situation to situation. While there is no shortage of boilerplate home care agreements available online, we highly dissuade the use of these agreements due to the complex nature of issues that can arise from the drafting, revision and execution of these documents. The home care agreement serves as a legally enforceable contract between you and your client, and can have significant effects on current and future asset transfers, care agreements, and in-home caregiving arrangements. As explaining above, there are a multitude of issues facing each agreement; while boilerplate agreements can seem to save on some time in the drafting, they often do not delve into the issues that specifically pertain to your circumstances. Unfortunately, cutting corners can have looping and unanticipated consequences that will cost far more in the long run.
The first step is to have a listing of all services to be provided available prior to drafting. While there may be many things you do for your client, we typically recommend that you start small and grow specifically into the needs of your client. However, at the very least, a listing of all existing needs should be discussed prior to agreement drafting. Next, the timing, frequency and length of visits should be discussed to ensure that your agreement takes into account all potential issues that will need to be addressed. After this, discuss compensation. Is the compensation hourly? A flat rate? Weekly? What happens during holidays? What about payment for vacations and sick days? How long is this agreement going to last? After enough discussion on these issues, a template home care agreement will be drafted, and a consultation will once again be had to review and discuss any potential changes.
We suggest revisiting the home care agreement every few years, along with the primary care doctor. WPA recommends a review process every two and five years. A review every two years allows both the provider and the client to keep abreast of any potential legal changes that may affect the agreement. It also allows the client to feel more secure in knowing what is covered under the terms of the agreement. A review every five years keeps the agreement current with the needs of the client. There may have been a number of changes within the last five years that need to be addressed through revisions or updates to the agreement.
Home Care Agreement Mistakes
When setting up a home care agreement, care or the scope of services may be too broad. For example, if a nurse is home-bound, the agreement should reflect that the caregiver cannot take the patient out. Or, if a live-in caregiver is going to help with a child, the agreement should set forth a maximum number of hours of childcare and that child is not attending a day-care program. The caregiver also needs to understand the benefits for which they may be eligible under private health or long-term care insurance. Many policies will provide for informal, self-employed home care workers and could be a cost effective way to pay for their living expenses in exchange for providing services .
A common mistake is for the terms and duration of payment to be either too short or too long. The caregiver may find themselves without necessary funds in a short period of time and may have to move. On the other hand, if the caregiver is not performing satisfactorily, it may be difficult to terminate the contract as it may provide for them to live at the residence indefinitely.
A more universal problem is not updating the agreement on a regular basis. Family circumstances are not constant, so the agreement should be reviewed on a regular basis to ensure compliance.
Legal Issues
A home care agreement isn’t just a way to set the stage for quality caregiving. It also serves as your legal cover as a family caregiver. At BrightStar Care, we’re not only there for our clients’ medical needs—we’re available for all of the legal considerations that crop up in the elderly population.
Contract
A home care agreement provides a legal contract that the client, the family, and the caregiver should all sign. Even if they don’t technically need a contract (meaning the elder isn’t in need of crisis care), the agreement provides an additional measure of protection from the care provider and care receiver. It also outlines the services provided, any required or recommended information, and the amount that will be billed.
Licensing
Most states require licensure for home health agencies. Although the requirements vary from state to state, these licenses provide the right to provide those services under the law.
Regulatory Agencies
The U.S. Department of Health and Human Services rules apply—at least in some regard—for home care services. In addition to the rules and regulations established by the Department of Health and Human Services, some states have regulatory agencies that oversee the home care industry.
Tax Benefits
When acting as family caregivers, you might not know that you could qualify for tax benefits. A tax form for home and medical care allows you to claim such expenses as mileage, prescription medications, and doctor visits. Both the care giver and the receiver can file the expenses as deductions on their taxes.
Home Care Agreement FAQs
Home care agreements are contracts between a client and a home care service agency that set the terms and conditions of service. If you are about to sign such a contract, here are some commonly asked questions to consider.
What is the modification or termination of a home care agreement?
Home care agreements may be modified in writing or terminated by either the provider agency or the client. Both parties must agree to any modifications. An example of a modification may occur when the client requires additional services that were not covered in the original contract. The modification would entail adding the additional services to the initial contract. Both client and the provider agency must sign the new contract with the changes.
Either the client or the agency may terminate the contract within the time frame stipulated in it. Depending on the circumstances and behavior of the parties, one may be prohibited from rejecting additional services. If the client is having difficulty with an aide such as rude behavior or absences, the client should discuss the situation with the agency and request replacement . If there are repeated complaints the client may have cause to terminate the contract.
When does a dispute arise as the result of a home care agreement?
When there is a dispute concerning an agreement it is usually over the services being provided by the agency. The most common form of dispute involves the adequacy of the services. It is usually based on the fact that the provider agency did not provide the agreed upon care or tried to expand it to the point where the client was charged more. When a client fails to notify the agency of a modification in the scope of care, a dispute will likely arise. In this situation, the agency provides only the services that were agreed upon under the original contract. A client who has agreed to a contract for a 6 week respite stay could not demand a full year of service without incurring additional fees.
How can a home care disputes be resolved through a home care agreement?
A dispute resolution clause in the contract allows for an alternative to litigation to resolve a dispute. When an arbitrator is used to resolve a dispute, the parties may agree that the decision of the arbitrator is binding.
