Family Caregiver Agreement Template
$19
One price. No app. No subscription.
Write down who cares for Mom or Dad, what's paid and how, so nobody has to guess and nobody keeps score in silence. A template to start the conversation and take to your attorney.
Most care arrangements start with “I'll just help out.” A year later one sibling is there four days a week, another sends money now and then, and nobody has said out loud what's fair.
- Fillable PDF plus an editable document your attorney can mark up
- US Letter
- Instant download after checkout
- Signature page with space for the attorney's review
- Download each file up to 20 times within a year
An organizing tool, not medical or legal advice.
14-day “if it doesn't help” guarantee. Available to US customers.
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How it works
From the kitchen table to a signed agreement
- 01
Talk it through as a family
Use the plain-words guide to settle the questions as a family before your attorney meeting, so the billed hour goes further.
- 02
Fill in the template
Who's involved, the care to be provided, the schedule and hours, and whether it's paid, the rate and how payments are made.
- 03
Have an attorney review it
Have an elder-law attorney in your parent's state review and adjust it before anyone signs or any payment is made.
What's inside
So nobody has to guess
The careto be provided
From rides and meals to medication pickups and bill paying, with the schedule and expected hours, including live-in arrangements.
Paidor unpaid
The rate, and how and when payments are made.
A time andtask log
A simple time and task log to keep with the agreement.
A plain-wordsguide
Questions to settle as a family before your attorney meeting, so the billed hour goes further.
Why families write one
A caregiver agreement, sometimes called a personal care agreement or caregiver contract, puts the arrangement on paper: what care is given, how often, and whether it's paid. It helps families in two ways.
- It makes the work visible. Siblings agree on the jobs and the hours instead of assuming.
- It records payments properly. If a parent pays a family member for care, Medicaid may later review those payments during its look-back period (five years in most states). Payments without a written agreement can be treated as gifts. An attorney can set the agreement up so it holds up for your family's situation.
Formats
Fillable PDF plus an editable document your attorney can mark up. US Letter.
Services. [Caregiver] will provide the following care to [Parent]: transportation to medical appointments; picking up prescriptions; grocery shopping; preparing [number] meals per week. [Caregiver] will record hours and tasks on the attached log.
What you get
What's inside the template
Who's involved
The parent, the caregiver, and any siblings or agents signing.
The care to be provided
From rides and meals to medication pickups and bill paying.
Schedule and expected hours
Including live-in arrangements.
Paid or unpaid
The rate, and how and when payments are made.
Time and task log
A simple log to keep with the agreement.
Backup care
What happens when the caregiver is sick or away.
Reviews and changes
How and when the agreement is reviewed, changed or ended.
Signature page
With space for the attorney's review.
A plain-words guide
Questions to settle as a family before your attorney meeting, so the billed hour goes further.
$19· One price. No app. No subscription.
An organizing tool, not medical or legal advice.
14-day “if it doesn't help” guarantee. Available to US customers.
Is this legally binding?
A template on its own isn't tailored to your state. Fill it in as a family, then have an elder-law attorney review and adjust it before anyone signs.
Do we need this if nobody is being paid?
It still helps. Writing down who does what is the fairest way to split care, and it gives you a starting point if payment comes up later.
Does paying a family caregiver affect taxes?
It can. Payments are usually income to the caregiver, and the family may have employer responsibilities. Ask the attorney or a tax professional.
What does an attorney review cost?
Many elder-law attorneys offer flat-fee document reviews, and hourly rates commonly run about $100 to $500. Arriving with a filled-in draft keeps the time short.
Is this a sample caregiver agreement I can copy for free?
Free samples exist. This template adds the time log, the sibling and backup-care sections, and a guide for the family conversation.
This is a template to help your family discuss and write down caregiving arrangements. It is not legal advice and is not tailored to your state. Paying a family caregiver can affect taxes, employment obligations and eligibility for Medicaid and other benefits. Have an elder-law attorney in your parent's state review the agreement before anyone signs or any payment is made.
Upgrade to the Family Care System
Get the agreement and the tools to share the work
The Family Care System includes this Agreement Template, plus the Medical Binder, a Shared Family Care Sheet (job board and cost tracker with each sibling's share) and a Family Meeting Kit with a script for the first conversation.
Only $20 more ($39).
Get the Family Care System