Companion Agreement

As of May 18, 2012

COMPANION to Gregory

INTRODUCTION

This role is to be a COMPANION to Gregory who has been diagnosed with Young Onset Alzheimer’s Disease.We have been coping with this for close to ten years now and while Gregory is very healthy and still fairly independent, he has begun to fail enough that I feel a "companion" would help to make our life easier and Gregory’s safer as well as allow me to continue with my responsibilities away from home. 

At this point in time he has difficulty with language and cognition. His life skills are at best sufficient. At times he gets confused and is unable to take care of himself. For example I have been helping him put together his breakfasts and sometimes his lunch while at other times he does well by himself. 

He doesn't always know what clothes to choose to reflect the season or weather. He used to go for long walks by himself, never got lost, but recently got lost in our condo building when trying to return a shopping cart to the lobby. 

I remind him periodically, and especially before we go out, to make sure he uses the restroom. He easily gets confused especially when unexpected or unusual situations occur, for example if he was home alone when the building’s emergency system announces an evacuation. 

At times it is difficult to know what he understands and what he THINKS he understands. For example you say turn OFF the light, and he will say OK and turn it ON.

It would be in the best interests of all parties for the Companion to have some knowledge of Dementias and or to do some reading on the subject before and during the period of employment.

COMPANION AGREEMENT

This Agreement is effective as of _________________, between Michael, “ORGANIZER” of this Agreement and partner to Gregory “CLIENT,” and  _________________________________________________, “COMPANION.”

JOB DESCRIPTION: 

Gregory (and I) need to have a companion with whom he can spend time while I am away. Sometimes it will be for a few hours and sometimes it will be for a morning, afternoon, or evening. The Companion and Client can stay home, go places, eat out, cook at home, watch TV or a DVD, go to a movie, grocery shop with a list from me, swim at LA Fitness, do a jig saw puzzle, or just “be quiet together.” 

The student/companion can do his homework while Gregory is working on his activities, napping, or reading but for the most part should be available to interact with Gregory according to Gregory’s needs. As necessary, the companion will answer simple questions, give simple directions, and depending on the time of day help with Gregory’s getting dressed or getting ready for bed. 

Some help with simple meal preparation might take place - like making a sandwich or salad or warming up a dinner I've prepared. After conferring with the Organizer, the companion could be more ambitions with meals if he/she desired. At times eating lunch or dinner at a neighborhood restaurant will be good. Meals will be provided for the companion, at home or out, when the client takes a meal.

The type of person who would be ideal for this position must be "gay friendly," intelligent, sensitive to Alzheimer's needs, trustworthy. In turn we can offer an "interesting" experience with a kind, gentle, loving family in a clean, comfortable, attractive, intellectual environment/home setting. 

MOST IMPORTANTLY the companion will be responsible for Gregory's SAFETY and WELL BEING as well as insuring and respecting Gregory’s sense of self and worth. A balance will need to be insured between being responsible and making decisions for Gregory but not treating him like a child. 

The companion and Gregory will have to be together at all times while outside the home (for example waiting outside the bathroom at the movies rather than letting Gregory alone while the companion remains at the seats.) At home they can be in separate parts of the condo unit.

At this time the companion will NOT be responsible for any medical or bodily function type of care but might have to "suggest" to Gregory the steps in cleaning himself up if he spills on his shirt or slightly messes his pants  (rarely happens but has been known to.)

For the most part, I do not see the role of companion to Gregory as any more major than that of a friend dropping by for a visit or taking him out to dinner while I am not at home. The key factor in the companion’s responsibilities and of utmost importance, is G's safely and with support in the areas of cognitive ability and life skill functioning, provided in a respectful way. 

Whenever the Companion is unsure of what to do, he/she should text or call the Organizer on his cell phone: xxx-xxx-xxxx. In case of emergency the Companion should take necessary actions and then notify the Organizer.

DUTIES: 

The Companion agrees to perform faithfully, industriously, and to the best of his/her ability, experience, and talents, all of the duties that may be required by the express and implicit terms of this Agreement, to the reasonable satisfaction of the Organizer. Such duties shall be provided at such place(s) as the needs may require from time to time, variously including (our address) and the surrounding Evanston, neighborhood. Travel outside of Evanston should NOT take place. Transportation in any vehicle should NOT take place.

STIPEND: 

A stipend of $10.00/arranged hour will be paid to the Companion in cash at the end of each round of duty. In the event of expenses like sharing a movie or dinner out, the Companion’s way will be paid. No other responsibilities will be taken on by the Organizer nor benefits given the “Companion.”

REIMBURSEMENT: 

The Organizer will reimburse the Companion for agreed upon “out-of-pocket” expenses as documented by paid receipts. Also, when appropriate, the Companion can assist in Gregory’s using his charge card to pay for mutual activities including 15-20% tip at restaurants and by signing Gregory’s name with the Companion’s initials following.

SCHEDULING: 

The Organizer will attempt to schedule each duty at least one week ahead and is able to work around the Companion's class schedule, regular job schedule, and other commitments.

Once the Companion commits to a specific date and time of duty, it is expected that  the commitment be fulfilled unless an unforeseen emergency occurs. 

The Organizer will promise between four and eight hours duty each week with the possibility of more hours as necessary and as accepted by the Companion. 

Should the Organizer need to cancel a scheduled duty, with or without notice, a minimum of four hours stipend, at $10.00 per hour, will be paid the Companion at the next scheduled/executed duty. 

In rare case, emergency scheduling may be requested by the Organizer and will depend on the Companions availability. 

In rare case, emergency cancellation by the Companion will be accepted and understood. The cancelled duty, however, will go unpaid.

The Companion will attempt to give the Organizer as much notice as possible if he/she will not be available for a future or extended time period. 

CONFIDENTIALITY:

The Companion agrees to keep confidential any of the information or knowledge gained either directly or indirectly from his/her interactions with the Client and/or the Organizer even after termination for up to five years.

TERM/TERMINATION:

This agreement shall be for an unspecified term on an “at will” basis. It may be terminated by either party for any reason without explanation and may be done so in person, by voice mail, or on written (e-mail) notice of at least one week prior to a scheduled involvement. 

The relationship between Organizer, Client, and Companion will be terminated immediately if there is a breach of behavior as set out,  stated or implied in this agreement.

RETURN OF PROPERTY:

On termination, any property related to the relationship between Companion, Organizer, and/or Client shall be returned to the appropriate person as soon as possible including such items as keys to the unit, loaned items, left items, etc.

ORGANIZER GENERAL INFORMATION:

Organizer, Michael and Client, Gregory 

Address

Home Phone: xxx-xxx-xxxx  Cell Phone: xxx-xxx-xxxx

E-Mail: mhorvich@me.com

APPLICANT INFORMATION

GENERAL INFORMATION:

Companion:

Address:

City, State Zip:

Home Phone:

Cell Phone:

E-Mail:

BACKGROUND CHECK:

Most recent place of employment, date, phone number, person to contact:

Previous place of employment, date, phone number, person to contact:

A background check will be conducted. Any known criminal violations or record?     YES   NO If  YES, please describe:

EDUCATION:

Please notify department giving recommendation that Organizer will be calling:

Level of education completed:

Currently working on:

University:

Department:

Area of Study:

Person to contact:

COMPANION PERSONAL RECOMMENDATIONS:

Please notify persons giving recommendations that the Organizer will be calling:

Name:

Phone:

Relationship:

Name:

Phone:

Relationship:

COMPANION MEDICAL/EMERGENCY INFORMATION:

Any known medical conditions that need be known by the Organizer?

YES   NO     If YES, please describe:

In case of medical emergency, notify:

This Agreement written by Michael with suggestions from www.rocketlawyer.com  May  2012