In some cases, you may want a written agreement or contract with the personal assistant you hire. The terms of the written agreement may depend on whether your personal assistant services are paid for by MaineCare or some other program. If your services are paid for by MaineCare or some other program, you should talk to someone with the program about using a job agreement.

Even if you don’t use a written job agreement, you may want to look at the following sample agreement to see if it has issues you want to talk about with your personal assistant, such as job duties and behavior you expect from your assistant.

JOB AGREEMENT BETWEEN:

Employer (Consumer): __________

Employee (Personal Assistant): __________

The Employer and Employee agree to the following general principles.

The Employer will:

___ assign and direct the work.
___ give the employee advance notice when hours or duties change whenever possible.
___ periodically provide feedback to the employee about how he or she is doing on the job.
___ treat the employee with respect.

The Employee will:

___ perform the agreed-upon tasks and duties the best of the employee’s ability.
___ come to work clean and sober and on-time.
___ not make personal phone calls without permission.
___ not ask to borrow money, or for a cash advance.
___ call the Employer as soon as possible if late, sick or unable to work.
___ give the Employer two weeks notice before leaving the job whenever possible.

Hourly wage: The hourly wage is $__________.

If there is a problem with time cards or checks, the worker should call __________ at phone number __________.

Mileage reimbursement:

___ No
___ Yes, at the rate of ___ per mile for driving to shopping or medical appointments.

Hours of work:

The employer and employee will reach an agreement about any changes in scheduled hours, with advance notice. Total number of hours per month for this job are _____.

Monday __________ to __________
Tuesday __________ to __________
Wednesday __________ to __________
Thursday __________ to __________
Friday __________ to __________
Saturday __________ to __________
Sunday __________ to __________

Duties and Responsibilities

Household Tasks and Frequency: D(Daily), W(Weekly), M(Monthly)
If other, please specify:

Domestic Services

___ Clean floors (sweep, vacuum or mop)
___ Wash kitchen counters & sinks
___ Clean stove top
___ Wipe/Clean refrigerator
___ Clean bathroom
___ Take out garbage
___ Dust
___ Change bed linen
___ Make bed
___ Heavy house cleaning
___ Cooking, preparation and meal clean-up
___ Prepare meals
___ Meal clean-up (dishes)

Laundry

___ Routine laundry (wash, dry, fold and put away laundry)

Shopping

___ Shopping for food
___ Other shopping errands

Non-Medical Personal Services

___ Respiration assistance
___ Bowel and bladder care
___ Feeding
___ Routine baths
___ Dressing
___ Menstrual care
___ Ambulation (help with walking)
___ Move in/out of bed
___ Oral hygiene/grooming
___ Rub skin
___ Repositioning
___ Help on/off seats, in/out of vehicle
___ Care/assistance with prosthesis

Accompaniment Services

___ Medical appointment
___ Alternative resources
___ Protective supervision

Paramedical Service

___ Injections
___ Administering medication
___ Other paramedical: __________

Additional tasks

___ Clerical skills such as filing or writing
___ Reading
___ Water house plants
___ Pet care/service animals
___ Other: __________

The Employer and Employee, by signing this document, agree to the terms outlined above. If the agreement changes, both parties will initial and date the changes.

_____________________________________________
Employer (Consumer) signature and date signed

_____________________________________________
Employee (Personal Assistant) signature and date signed

Source: Adapted from materials prepared by the Public Authority for In-Home Supportive Services in Alameda County (California). http://www.ac-pa4ihss.org/content/140.asp