Elder Care Agreement
Updated 17 October 2025
This Elder Care Agreement outlines the terms and conditions for a care provider to offer services to a patient, including details on care type, schedule, duration, and payment. It covers medication administration, meal provision, allergy management, assistance with daily activities, and transportation. The agreement also specifies termination clauses and emergency contacts.
Elder Care Agreement
[name of care provider] (hereafter “Care Provider”) and the patient or their proxy, [name of patient] (hereafter “Patient”), hereby agree to the following:
Beginning [date], the Care Provider will provide [residence/in-home] care for the Patient at [address] every [days of the week] from [time] to [time 1]. This agreement will last until [date 1], at which time it may be renewed or renegotiated. Either party may end this agreement with [number] days’ written notice.
The Care Provider confirms that the [organization] is a licensed care facility and/or that all care providers have completed [training/certification].
The Patient confirms that [he/she] consents to [residence/in-home care]. If the Patient is physically or mentally unable to communicate [his/her] needs, [name], the medical proxy, is legally equipped and permitted to make decisions on the Patient’s behalf.
The Care Provider will administer [medication] every [day and time(s)] and ensure that the dosage has been successfully received.
The Care Provider will provide [number 1] meals every [day], observing the following nutritional guidelines and dietary restrictions: [nutrition and diet].
The Care Provider has been notified of the Patient’s allergies to [allergens] and will ensure that the Patient is not exposed to said allergens.
The Care Provider will assist the Patient in [eating, bathing, using the toilet, exercising, etc.].
The Care Provider will provide transportation of the Patient to and from [places] on [days] at [times].
The Care Provider does NOT provide the following services: [services].
The Patient will pay the Care Provider [amount] every [frequency]. This amount will cover all services rendered by the Care Provider except holiday hours, overtime, and additional services not outlined in this agreement. In the event that the Care Provider provides holiday hours, overtime, or additional services, [he/she 1] will be paid [amount 1] per hour for the duration of that work.
The Care Provider agrees to follow all legal and medical requirements as outlined by [his/her 1] medical training as well as state and federal law. Both parties agree to treat each other with mutual kindness and respect.
Emergency contacts for the Patient are as follows: [contacts for family, doctor, etc.].
In witness to their agreement to the terms of this contract, the parties affix their signatures below:
____________________________________ _________________________________
[name of care provider] [name of patient]
[care provider signature] [patient signature]
[date 2] [date 3]
About this template
What is this template?
Elder Care Agreement is a free, ready-to-use Health law template you can open, customize, and download on GitLaw. It gives you a professionally structured starting point, so you never have to draft from a blank page. The wording is plain and modern, organized into clear sections that are easy to read, edit, and adapt to your own situation before you share or sign it.
When should you use it?
Reach for this Health law template whenever you need a reliable agreement quickly and want to be sure the essentials are covered. It suits individuals, freelancers, startups, and established businesses alike. Instead of paying for a document drafted from scratch, you can start here, tailor the details to your arrangement, and have a polished draft ready in minutes. Always review the final wording against the laws that apply where you live or do business.
What's typically included?
A well-drafted Health law usually sets out the parties involved, the scope of the agreement, and each side's rights and responsibilities. Expect sections covering key terms and definitions, how long the agreement lasts, how it can be ended, and what happens if something goes wrong. This template brings those building blocks together in a sensible order, so you can focus on the specifics rather than worrying about what to include. Open it to read the full document, then sign up to edit, negotiate, and e-sign it directly in GitLaw.