Caregiver Form Sample For Elderly In Hennepin

State:
Multi-State
County:
Hennepin
Control #:
US-00458BG
Format:
Word; 
Rich Text
Instant download

Description

The Caregiver form sample for elderly in Hennepin establishes a clear agreement between a client and a caregiver regarding the provision of personal assistance services. It outlines the responsibilities of the caregiver, including assistance with daily living activities, medication scheduling, and mobility support. The form includes details about the scheduling of services, requiring 48 hours notice for any changes, and stipulates that either party can terminate the agreement with two weeks written notice. It also clarifies that the caregiver operates as an independent contractor, not as an employee of the client, and specifies the compensation arrangement. This form serves as a useful tool for attorneys, partners, owners, associates, paralegals, and legal assistants to facilitate clear communication and understanding regarding the caregiver-client relationship. By providing a structured format, it helps ensure that both parties are aware of their rights and obligations, ultimately promoting a safe and supportive environment for elderly clients. Additionally, the form reinforces the importance of legal consultation and negotiation of terms to protect the interests of both the caregiver and client.
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  • Preview Personal Care Service Agreement - Caregiver for Elderly or Disabled - Consent
  • Preview Personal Care Service Agreement - Caregiver for Elderly or Disabled - Consent

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FAQ

Call Hennepin County Front Door. You'll talk to a county staff member about your options. These include referrals and information. Call 612-348-4111.

Where can I learn more about the Elderly Waiver? More information is available on the Minnesota Department of Human Services website, mn/dhs, and in Minnesota Statutes 256B. 0915. Information is also available by calling the Senior Linkage Line at 800-333-2433 or going to MinnesotaHelp.info.

For all other questions about our Home-Based or PCA Services, please call us at (612) 706-5511 or email actg@actg.

800-333-2433 The Senior LinkAge Line provides help to older Minnesotans and their families and caregivers, helping them connect to local services, find answers and get the help they need.

To qualify financially, an elder must have limited assets or a low monthly income. Assets can be no greater than $3,000 or the elder's income must be less than $1,234 a month.

How to submit forms and documents and update your information Update information and upload documents to InfoKeep. Upload to MNbenefits. Fax to 612-288-2981. Mail to: Hennepin County Human Services Department. P.O. Box 107. Minneapolis, MN 55440.

The Community Alternative Care (CAC) Waiver provides funding for home and community-based services for children and adults who are chronically ill. The CAC Waiver is designed to serve persons with disabilities who would otherwise require the level of care provided in a hospital.

Apply online at MNsure Website. If you need assistance applying online, please contact the MNsure Contact Center at 855-366-7873 (855-3MNSURE).

Disability HUB MN offers assistance for people under 65 with disabilities. Call 1-866-333-2466. Hennepin County Front Door allows you to talk to a county staff member about your options, including referrals and information.

Call 612-348-3000, Monday through Friday, 8 a.m. to p.m.

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Caregiver Form Sample For Elderly In Hennepin