This form is a sample of an agreement between an elderly or disabled client and a Caregiver who operates as an independent contractor and provides personnel to assist Client to live at home and to have as much control over the home environment and life as possible under the circumstances. Caregiver's personnel also assist Client with the activities of daily living, scheduling medication, assistance with mobility, accompanying Client on errands and appointments, and such other services as agreed between Client and Caregiver.
In this agreement, Client waives damages for simple negligence of Caregiver, but not gross negligence or misconduct that is intentional or criminal in nature. Courts generally will not enforce waivers of this type of misconduct since such a waiver would be deemed to be against public policy because it would encourage dangerous and illegal behavior.
Caregiver Form Template For Ages 1.5-5 Scoring In Houston
Category:
State:
Multi-State
City:
Houston
Control #:
US-00458BG
Format:
Word;
Rich Text
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Background on the caregiver and the caregiving situation. Caregiver's perception of health and functional status of the care recipient. Caregiver's values and preferences with respect to everyday living and care provision. Health and well-being of the caregiver. Consequences of caregiving on the caregiver.
Description of Measure: This 18-item, caregiver self-report measure was devised by the American Medical Association as a means of helping physicians assess the stress-levels of family caregivers accompanying chronically ill older adult patients to their medical visits.
The CSNAT is an evidence based, comprehensive tool comprising a set of domains (broad areas of support need) in which carers commonly say they require more support. It acts as a prompt for carers to indicate where they need more support.
A Caregiver Assessment is a systematic process of gathering information that describes a caregiving situation and identifies the particular problems, needs, resources and strengths of the family caregiver.
What is a carer's assessment? Don't be put off by the word 'assessment' – it's certainly not a test of your abilities as a carer. It's a chance to let your local council or trust know how your caring responsibilities affect you physically and emotionally.
Caregiver difficulties scale (P-CDS) Each item was scored on a 5-point (0–4) Likert scale indicating the frequency/extent of each caregiving experience as perceived by the caregivers, with a final total score ranging from 0 to 100.