Non-Medical Home Care
Duration: This agreement will continue on an as-needed basis until terminated by either party.
Silver Home Care, referred to as "the Agency"
CLIENT, hereinafter referred to as "the Client"
Please review this agreement carefully, as it sets forth the understanding between you ("the Client") or ("Authorized Representative") and Silver Home Care ("the Agency") regarding the services you have requested, and we will provide for you. If you have any questions, concerns, or issues about the content of this Agreement, please contact us for clarification before signing it.
If you are a participant in the Community Health Choices (CHC) program, please be aware that the payment obligations and fees outlined in this agreement do not apply to you. CHC participants are not responsible for any charges related to PAS services rendered within the scope of your service authorization provided by Silver Home Care.
The term of this agreement will begin on the Effective Date and will continue on an as-needed basis until it is terminated by either party. Either party may terminate the agreement by providing notice as outlined below.
We will provide the services as outlined in this agreement. The preferred days, times, and duration of services will be mutually agreed upon by the Client (or their Authorized Representative) and the Agency and specified in the Individualized Service Plan. These details may be adjusted as needed based on client needs and staffing availability, without requiring an amendment to this agreement.
Service Schedule:
Shift 1:
Shift 2:
Shift 3:
Caregiver Assignment and Continuity of Care
While we strive to provide consistent caregiver assignments to promote continuity of care, we cannot guarantee that a specific caregiver will always be available. We will always inform you of any changes in the caregivers scheduled and, when possible, give you the opportunity to meet any assigned caregiver prior to service. Please note that in cases of last-minute changes, meeting the caregiver before service may not be feasible.
Client Rights and Preferences:
Our service rates are based on the level of care required and the estimated hours of service. For a general summary of our pricing, please refer to the attached Agency Rate Sheet. The specific rate for your services is detailed below.
All services are prepaid on a weekly basis, covering anticipated care hours from Saturday to Friday. Each weekly invoice will reflect this prepayment and will be adjusted as needed for any additional hours worked or credits due, with these adjustments applied to the following week's invoice.
Timely payment is important to ensure continuity of service. Payment may be made by check, cash, Cash App, or Venmo. The Agency does not accept checks endorsed to it or to any of its employees.
An account is considered overdue if not paid within 5 days of the billing date.
Cancellations may be made up to 3 days in advance of a scheduled visit without charge. We reserve the right to charge for a scheduled visit if insufficient notice is not given.
If the Agency or Client wishes to amend this agreement:
This Agreement shall be governed by and construed in accordance with the laws of the Commonwealth of Pennsylvania.
Silver Home Care's responsibilities are outlined in the enclosed "Rights and Responsibilities" form.
Your responsibilities are outlined in the enclosed "Rights and Responsibilities" form. You will be required to sign it.
Transportation services are offered only under a separate agreement with Silver Home Care. The Agency must explicitly approve both the provision of transportation services and the specific employee assigned to transport the client prior to the service being provided.
If transportation is approved, the client agrees to release the Agency and its employees from any liability in the event of injury, accident, or damage that may occur during transport. This release of liability applies regardless of the vehicle used.
You may not privately/directly hire an Agency employee for a period of one year following the date that employee last provided services for you. In the event you break this condition, a replacement fee of $2,500 is due to the Agency immediately upon your employment of that individual.
You are responsible for supplying all supplies (e.g., cleaning, personal care, gloves, etc.) and equipment which may be necessary for the provision of services.
The Agency carries business liability insurance up to $3,000,000, covering:
Service rates are based on the time spent on agreed services.
Services provided on the following holidays are billed at 1.5 times the standard rate:
The Client or Authorized Representative is responsible for providing funds or a payment method for any necessary expenses incurred during the caregiver's shift (e.g., shopping, appointments, or other errands). These funds or payment methods must be provided at the time of service to ensure the caregiver can complete the required tasks.
Mail a Check: Payable to Silver Home Care, 680 Lincoln Hwy, Fairless Hills, PA 19030
Digital Payments: (Select one and provide account details)
Credit Card:
A 10% late fee will be applied to any overdue invoices. Checks returned for insufficient funds will incur a $35 fee.
The Agency may terminate this agreement if:
The Agency will provide at least 10 days' notice before termination. For CHC participants, a 30-day notice period applies. Immediate termination may occur in cases of nonpayment or safety risks.
The Client or Authorized Representative may terminate this agreement at any time by notifying the Agency verbally or in writing. We request a minimum of 3 days' notice if possible.
I authorize Silver Home Care and its employees, in the event of an emergency, to obtain such medical treatment as they deem advisable under the circumstances. I agree to assume sole responsibility for all charges related to such treatment. Furthermore, I release Silver Home Care and its employees from any claims or liabilities resulting from the provision of such treatment.
I acknowledge that transportation services are offered only under a separate agreement and must be explicitly approved by Silver Home Care in advance. I release Silver Home Care and its employees from any liability in the event of injury, accident, or damage occurring during transportation, regardless of the vehicle used.
I acknowledge that I am prohibited from privately or directly hiring any Silver Home Care employee during the term of this agreement and for one year following the last date of service provided by that employee. I understand that if this condition is violated, a $2,500 fee will be due immediately to Silver Home Care.
By signing below, I confirm that:
I further acknowledge receipt of the following documents:
I also confirm that I have reviewed and understand the detailed information contained in the Silver Home Care Client Handbook, including but not limited to:
IN WITNESS WHEREOF, each party has signed this agreement on
Authorized Personnel (Agency):
Client or Authorized Representative:
Document Version 1.0 | Effective January 26, 2026
Silver Home Care | 12 Penns Trail, Newtown, PA 18940 | (800) 719-6912 | [email protected]
