I voluntarily sign this backup caregiver agreement to provide assistance, hands on care and assume responsibility for the care of when there is no agency caregiver present. I am familiar with the patient’s care needs and am willing, able, and available to provide the care. Community Home care has assessed this patient and developed a patient specific plan of care. To ensure the patient’s safety, the patient cannot be left unattended. Therefore, in the event that an agency scheduled caregiver is unavailable, and no additional agency caregivers can be located, I will assume responsibility for the care and supervision of the patient. I understand that in the event the agency can not staff the patient with an appropriate caregiver, if care cannot be transitioned to the designated backup caregiver, the agency will call 911 and transfer the patient to an alternate level of care.
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