• Form

  • Healing Hands Home Care, LLC

    SERVICE AGREEMENT
  • Date
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • HOME CARE SERVICES AGREEMENT

     This Home Care Services Agreement ("Agreement") sets forth the terms and conditions under which Healing Hands Home Care, LLC ("Agency") will provide services for ("Client"). By Client's or Client's Representative's signature at the bottom of this agreement and/or receipt of services, whichever is first, Client agrees to the terms and conditions in this Agreement.

    1. Term of Agreement. The term of this Agreement will start on the first day that Client receives any Service from Agency (the "Effective Date") and will continue on an as-needed basis until the Agreement is terminated by either party, as provided in this Agreement.

    2. Services Provided. Healing Hands Home Care, LLC will provide to Client the services and care outlined in Client's Plan of Care ("Services"). The Services to be provided to the Client will be one or more of the following, as identified by the Client in a separate addendum to this Agreement. Healing Hands Home Care, LLC is in the business of services relating to (non-medical care.)

  • Services Requested (Non-Medical/Non-Skilled)
  • Rates & Scheduling Policy

    Healing Hands Home Care – Rates & Scheduling Policy


    Healing Hands Home Care maintains a 12-hour weekly minimum for ongoing private pay care services.

    Clients requesting fewer than 12 hours per week may be approved under our Short Visit Policy based on availability.

    Short Visit Rate:

    $38 per hour for care plans under 6 hours per week.

     

    Minimum Visit Length:

    All visits require a 2-hour minimum per shift.


    Short visit clients may be scheduled based on caregiver availability and proximity to other assignments.

  • OTHER: Services will be provided by 3HC staff, such as companions home health aide, certified nurse assistant, or other workers. Services will be provided at the Client’s home, facility or where negotiated by the Client. ("Location").

    3. Scheduling. Services will be provided for the hours and days requested by Client, and in accordance with the terms of this Agreement.

    4. Changing Services. Changes to Services may be initiated by Client and/or his/her representative through a phone call or written communication to the Agency. Advance notice of two (2) calendar days will be provided for any change contemplated by this Section 4. Adjustments to rates and billing may be made as a result of changes to Services. 

  • Any such changes to Services and billing amounts shall be stated in writing and provided to Client. Depending on Client's selected method of communication, 3HC may provide written notice concerning billing and Services through email on file for Client or text. Acceptance by Client of new or additional Services will be deemed acceptance by Client of new or different Services rates and agreement to pay for such new or different Services.

    5. Fees for Services. Healing Hands Home Care, LLC will charge the following rates for Services ("Fees"):

  • Hourly Rate for Weekend Services: $
    Hourly Rate for Weekday Services: $
    24 Hour Live-In Services Rate: $
    Travel Charges: $
    Mutual Case: $
    Shower Squad Rate: $ (2 Shower week minimum)

  • Late Charges:

    Late charges of $50 will be applied on the total amount of the invoice before taxes if payment is not received by the indicated due date. 

  • Live-in services are those that are provided for 24 hours at a flat "day rate." employees will be paid for 13 hours of Services for each live-in shift, assuming the employee will receive at least eight (8) hours for sleep time and three (3) hours for meals. During live-in shifts, all food is to be provided to the employee by the Client. To ensure Client safety, the Agency may require that Clients who need active care all hours of the day move to Hourly Care instead of Live-in care as Contractors should not be working more than 13 hours for each 24 hour live-in shift. Travel charges will be assessed at the full Hourly Rate for Services, as applicable, where unusually long travel is required, when employees are traveling on Client's behalf, or when employees are transporting Client. Should an employee provide Services at a location other than the Location (e.g., hospital, rehabilitation facility, or a relative's home), Client agrees to pay for the cost of employee to travel to such location. Employees will be reimbursed for any tolls and $.70/mile or the cost of reasonable public transportation. Client agrees to reimburse Agency for all such employee’s tolls, mileage, or reasonable public transportation costs. A flat rate will be charged to the Client per day to cover any travel charges that may be incurred by the Agency. Any travel costs that exceed the flat rate will be an additional travel charge that the Client agrees to pay for.

  • "Mutual Cases" refer to any case where Healing Hands Home Care, LLC is providing services to two individuals in the home for the full or majority of the duration of a single shift. Typically, mutual cases involve spouses, but they can involve other relatives or non-relatives. If the caregiver is required to provide services such as meal preparation, housekeeping, errands, and personal care to more than one Client for the full or majority of the time, the Company may determine the case to be a Mutual Case and the Client will be charged accordingly. Rates for Services are subject to review from time to time, but increases will be subject to at least a two-week advance notice in writing, which will specify the date that new or increased rates for Services will commence. Acceptance of Services at the new or increased rates shall be deemed agreement to pay the new or increased Services fees.

    Shower Squad: Shower Squad Special requires a minimum of 2 showers per week. We understand things come up and if you do need to cancel please contact 3HC within 24-Hours of service. You will be required to reschedule your shower in the same week of the cancellation(depending on availibility of caregiver) if not you will still be charged for a minimum of 2 showers. If 3HC has to cancel a shower day we will reschedule within same week as well. Client is asked to have clean wash cloths available for each shower. Client is also responsible for having all supplies necessary for a shower. (gloves, body wash, lotions, creams & a basin for bed baths) Clothes or Pajamas should also be available at the time of shower/bed bath.

    6. Sleep Time and Caregivers. Caregivers who work shifts of 24 hours or more and who do not live on the premises of Client must receive adequate sleeping facilities each shift. "Adequate sleeping facilities" will be provided if caregiver has basic sleeping amenities, such as a bed and linens, reasonable standards of comfort, and basic bathroom and kitchen facilities. Caregivers will receive at least 8 hours of sleep on each shift of 24 hours or more, and five (5) of such eight (8) hours of sleep must be consecutive and uninterrupted. Sleep is interrupted when a Client calls the caregiver to duty. If Client needs caregiver’s assistance during the caregivers regularly scheduled sleep time and, thus, caregiver renders Services to Client, Client agrees to pay for such work time at the above Hourly Rate for Weekend or Weekday Services, as applicable. Caregiver’s will notify Agency how long each interruption to sleep occurred and Client will be charged for a corresponding amount of time, at the applicable hourly rates. However, to the extent caregiver is unable to receive at least 5 hours of uninterrupted sleep during a single shift due to Client's call to duty, Client agrees to pay for 8 hours of Services at the Hourly Rate for Weekend or Weekday Services, as applicable.

    7. Paying for Services. Client assumes full responsibility for the payment of any and all sums that become due for Services. 3HC recommends direct debit via EFT from the Client's bank account or for a 3% fee use Visa, MasterCard, Discover and American Express. 3HC will charge Client's credit card or bank account on the invoice date. Agency will send written invoices by email to Client for Services each week ("Invoices").

  • Billing, Deposits & Payment Terms

    Deposit & Prepayment Policy
  • A client deposit is required prior to the start of services to secure scheduling, caregiver assignment, and administrative preparation. The required deposit amount and due date will be communicated before services begin.

    Deposits are applied to the client’s first invoice or first week of services and are not an additional fee.

    If services do not begin as scheduled due to client cancellation, unavailability, or lack of work upon caregiver arrival, the deposit may be retained to cover administrative costs and scheduled caregiver time.

    If Healing Hands Home Care, LLC is unable to begin services due to agency-related circumstances, the deposit will be refunded or applied to a rescheduled start date, at the client’s option.

    After services begin, invoices are issued weekly and are due upon receipt. Accepted payment methods and any applicable processing fees will be disclosed in advance.

  • Statutory Holidays: Statutory holidays will be subject to additional fees. Holiday hourly Rate: Time and a half Cancellation of Services Requires Notice of 24-Hour notice

    RECOGNIZED PAID HOLIDAYS

    New Year’s Day

    Martin Luther King Jr. Day

    Memorial Day

    Juneteenth

    Independence Day

    Labor Day

    Thanksgiving Day

    Christmas Day

    RETAIN SERVICES FEE: “Holding Fee” [TEMPORARY INTERRUPTION IN SERVICES]: If the “client” cannot receive services for a routine schedule day and time, or the services are temporarily interrupted due to the reasons below:

    ☐Closure of floor in residence / hospital due to outbreak of illness

    ☐Gov’t visitation restrictions in residence

    ☐Lock down / Stay at home order issued by gov’t to non-medical caregivers

    ☐Senior admitted to hospital / rehabilitation center

    ☐Senior goes on vacation

    ☐Family visiting would like to take over normal routine visits for a period

    ☐Client is in isolation for due to contracting covid-19 and visitors including caregiver is not permitted to enter premises to continue to provide care services.

    Applicable Fees to maintain routine scheduled visits: Average compensation for the days & hours of previous weeks. A fee of 10% of the routine scheduled time will be charged until the “service provider” is able to return to providing services to the “client”. If the “client” should decide to not hold the reserved allocated day and time the fee will be waived, and this contract will be terminated.

  • By signing this Agreement, Client authorizes Healing Hands Home Care, LLC to automatically charge, on a weekly basis, Client's bank account or credit/debit card for Service Fees. There will be a 3% fee for all credit/debit card use.

    Electronic Funds Transfer (EFT) Information Bank Name:
    Name on the Bank Account:
    Routing Number:
    Bank Account Number:

  • Credit/Debit Card Number:
    Name on the Card:
    Exp Date
    Security Code:

  • Invoices for Services are considered past due 5 days from the date on the Invoice. Interest will be charged at twelve (12) percent on account balances which are unpaid after 30 days. Client agrees to pay all collection costs, including attorneys' fees incurred in collection, if the balance on an account is not paid within thirty (30) days. Agency reserves the right to discontinue providing Services until any outstanding Invoice is paid in full, including any additional charges and accrued interest. Caregivers are not permitted to accept payment on behalf of Agency.

  • Client desires to receive any reimbursement for Services from any third-party payor, Client will have to seek reimbursement for Services from the third-party payor, to the extent Services are covered by any third-party payor. Client will retain any reimbursement provided by a third-party payor since Client will have already paid Agency for Services Fees. In certain situations, Agency may provide services and supporting documents to work with Long Term Care Insurance companies. There may be a fee for such administrative work.

    8. Caregiver’s Responsibilities. Caregivers shall perform the Services, as they may be arranged for by 3HC and the Client.

    9. Client's Responsibilities. Client will not give a caregiver a check, credit card or bank card (ATM, LINK, debit, etc.) for withdrawals, activation, or shopping. Likewise, Client will not provide confidential financial information to caregiver. Any exception to these prohibitions must be provided by Agency in writing. Client will remove all valuables and securely store them in a safe and locked location. Client releases Healing Hands Home Care, LLC from any liability or obligation arising from the unauthorized provision of cash or other items paid or given to Caregiver. Client will not be released from Client's obligation to pay Fees for Services as a result of any unauthorized provision of cash or other items paid or given to Caregiver. Client agrees that it will not directly employ 3HC Caregiver at any time during a one-year period, with said one-year period starting on the date that Caregiver contract with Agency terminates, regardless of the reasons or circumstances for Caregiver’s termination of contract. Client agrees it will encourage Caregiver to terminate his or her contract with Agency. Should Client violate this provision of the Agreement, Client agrees to pay Agency a sum of $10,000.

    10. Insurances. Client agrees to maintain homeowner's insurance and/or other coverage as may be necessary to provide protection for negligent acts of Caregiver. Agency carries, Crime, Liability, Errors and Omissions, workman’s comp, and other insurances to protect the Agency and some aspects of services to the clients.

    11. Background Checks. Agency will conduct a full background check, to the extent permitted by Federal, state and local laws, on all employee’s retained to provide Services under this Agreement.

  • Client acknowledges and agrees that this Agreement by Agency to conduct background checks may serve as a defense to any negligent hiring or negligent retention lawsuit brought by or on behalf of Client.

    12. Supplies and Equipment. Client is responsible for providing all supplies (i.e. cleaning, personal care supplies, including latex gloves, needed for the safe execution of any kind of personal care) and equipment which may be necessary for provision of Services. If Agency makes a payment on behalf of Client to purchase supplies or equipment for Client, the amount of such payment will be added to the Fees on the Invoice.

    13. Conflict of Interest & Non-Solicitation Policy. 

    Healing Hands Home Care, LLC invests significant time and resources in recruiting, screening, training, and supervising caregivers to ensure high-quality and consistent service delivery.

    To protect the integrity of our services and business operations, the following terms apply:

    Non-Solicitation of Caregivers
    Client and/or Client’s representative agrees not to directly hire, solicit, privately contract with, or otherwise engage any caregiver introduced through Healing Hands Home Care, LLC during active services and for a period of twelve (12) months following termination of services.


    Private Arrangements Prohibited
    All scheduling, compensation, and service changes must be coordinated through the agency office. Clients and families may not make private payment arrangements or offer additional compensation outside of agency billing.

    Placement Fee
    If Client chooses to directly employ or privately contract a caregiver introduced by Healing Hands Home Care, LLC within the restricted period, a placement fee equal to three (3) months of projected services (based on average weekly hours at time of separation) will be due immediately.

    Gifts & Financial Exchanges
    Caregivers are not permitted to accept substantial gifts, loans, or financial assistance. Any concerns regarding caregiver conduct should be reported directly to the agency.

    Violation
    Violation of this section may result in immediate termination of services and/or enforcement of applicable legal remedies.

    By signing this Agreement, Client acknowledges and agrees to the above Conflict of Interest & Non-Solicitation terms.

     14. Cancellation or Suspension of Services. Client may cancel a scheduled shift but, to the extent a Caregiver arrives for the work on the scheduled day and no work is available for the Caregiver, the Client agrees to pay the Caregiver for at least hours of pay at the time the cancellation occurred. Agency may suspend Services immediately if Fees are in arrears by two (2) weeks, unless suspending the Services would create a threat of immediate of harm or danger to the Client. Agency will determine in its reasonable discretion whether there is a threat of immediate harm or danger. If suspending Services would create an immediate threat of harm or danger to Client, Agency may suspend Services upon five (5) calendar days' prior notice to you.

    15. Termination of this Agreement. Either Client or Agency may terminate this Agreement upon seven days prior written notice to the other party for any reason. Should the Agency terminate the Agreement, Client is solely responsible for arranging replacement services upon notice of termination of this Agreement, Client assumes all the risks of such replacement services or the inability to secure replacement services. If the agency isn’t notified within 7 days of termination, the client will be charged one week of service. Upon the termination of this Agreement, a discharge plan and summary will be provided to the Client. The discharge plan will include: (a) documentation of discharge planning preparation; (b) notification to the Client's authorized practitioner of the discharge; (c) reasons for discharge and date of discharge; (d) summary of care provided pursuant to this Agreement and progress of the Client, if any; (e) Client's status/condition upon discharge, including a description of any remaining needs for patient care and supportive services; (f) Client or family ability to self-manage in relation to any remaining problems; and (g) recommendations and referral for any follow-up care, if needed.

    16. Governing Law. The laws of the State of Michigan shall govern the terms and conditions of the Agreement, without regard to choice of law principles.

  • 16. Dispute Resolution. In the event of a dispute, claim or controversy arising out of or under the terms or provisions of this Agreement, including the determination of the scope or applicability of this agreement to arbitrate, Agency and Client hereby agree to submit to binding arbitration conducted in accordance with the Consumer Arbitration Rules of the American Arbitration Association ("AAA"). A neutral arbitrator will be appointed from the AAA's National Roster of Arbitrators and fees and compensation of the arbitrator will be in accordance with the AAA's Rules. Judgment on an Award rendered by the neutral arbitrator may be entered in any court having jurisdiction. This clause shall not preclude the parties from seeking provisional remedies in aid of arbitration from a court of appropriate jurisdiction.

    17. Severability. In case of any term, phrase, clause, section, restriction, covenant, or agreement contained in this Agreement shall be held to be invalid or unenforceable and incapable of being reformed, the term and condition will be severable from the rest of the Agreement and shall not defeat or impair the remaining provisions of the Agreement.

    18. Notices. All written notices required to be provided by either party to this Agreement may be provided via text messages, email, written notice by hand-delivery or regular mail, or fax. For purposes of this Agreement, notice will be deemed provided when it is sent (in the case of text messages or email) or when it is received (in the cases of written notice that is provided by hand-delivery or regular mail or fax). Notices that are not required to be in writing may be provided in writing or by telephone. A notice provided by telephone will be deemed received when Agency relays the message to Client or his/her designated representative. Agency will document internally when notice by telephone is provided to Clients.

    19. Waiver. The waiver by Agency of a breach of any provision of this Agreement by Client shall not operate or be construed as a waiver of any subsequent or continuing breach of this Agreement by Client.

    20. Assignment. This Agreement may not be assigned under any circumstances by the Client.

    21. Entire Agreement. This Agreement, including any Addendum or Schedule attached hereto, constitutes the entire agreement between the parties concerning the subject matter of this Agreement and supersedes and replaces all prior oral or written representations or agreements. By signing this Agreement, Client hereby consents to receive the Services in accordance with the terms and conditions in this Agreement. [SIGNATURES ON SEPARATE PAGE]

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