2021-02-21_nmoreau_Client Consent Agreement - Montreal 2020.docx

Client Consent Agreement

Client(s) Name: Anne Darche and Gaetan Bouchard

This agreement is entered into on February 21st 2021 between the aforementioned Anne Darche and Gaetan Bouchard (hereafter referred to as “Client”) and Home Care Assistance (Montreal) Inc. (HCA).

Consent to Receive Services

HCA is hereby authorized to provide companionship services to the Client. Client understands that HCA is a non medical agency that does not provide medical treatments. Client waives any issues of medical liability on HCA’s part for the provision of these non-medical services. A general description of services to be performed is outlined as a part of the initial assessment and updated as modifications become necessary.

HCA Caregiver Agreement

Client understands that HCA spends a significant amount of time, money and resources in the process of recruiting, screening, hiring and training its caregivers and therefore, each HCA caregiver is a valuable asset to HCA. Client further understands that each caregiver who provides home care services for the Client (as designated on weekly billing invoices) is prohibited from accepting private employment from Client directly (or indirectly through another organization / agency) while said caregiver is employed by HCA or for a period of three (3) years following caregiver’s termination of employment with HCA. Accordingly, should Client desire to employ an HCA caregiver who has provided home care services for Client in violation of such restrictions, Client agrees to pay HCA a one-time placement fee of TEN THOUSAND DOLLARS ($10,000.00), which amount shall be due within ten (10) calendar days of employment of such caregiver.

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Rates & Hourly Minimums Initials Until notice is given by HCA to the contrary, the rates for care are as follows:

Meal & Rest Periods

Caregivers are entitled to a thirty (30) minute break for each five (5) hours worked.

Live-In care is defined as a twenty-four (24) hour shift which requires that a caregiver get at least six (6) – eight (8) hours of  sleep at night and four (4) hours of break time spread throughout the day for meals and personal time. All meals within reason  are to be provided for the caregiver by the client. Client understands that if a caregiver has any special dietary restrictions or  preferences that are not reasonable for client to adhere to, client is not obligated to do so. In general, however, caregiver and  client share the same meals. A place to obtain a mostly uninterrupted sleep period is required. This is a room other than the

client’s bedroom, but maybe a sleep sofa, cot or a bed. Unless otherwise agreed, or in the case of

Revised Date: 01/2020

Client Consent Agreement

an emergency, the caregiver will not leave client premises during a scheduled shift. Client understands that circumstances  beyond company’s control (e.g. client or caregiver short term illness, change in client sleep patterns, etc.) may require  additional hours to be provided at the hourly rate specified above

Security of Caregiver

Caregivers are instructed not to put themselves at risk of bodily harm or injury in the provision of companionship services.  Thus, Client understands and acknowledges that, if a Caregiver is made to reasonably feel threatened and/or is in  physical danger while performing companionship services, the Caregiver is entitled to leave Client’s premises without  exposing the Caregiver and/or HCA, its affiliates, successors, assigns, directors, trustees, officers, shareholders,  employees, agents and representatives, to any liability and the Client remains liable for the full payment of fees.

Driver Release; Limitation of Liability

In recognition of the relative risks and benefits of services provided by Company, Client agrees to the fullest extent of the law,  to limit the liability of Company, its affiliates, successors, assigns, directors, trustees, officers, shareholders, employees, agents  and representatives, for any and all claims, losses, costs, damages of any nature whatsoever or expense from any cause or  causes, including attorneys’ fees and costs, and costs of expert witness fees and costs, so that the total aggregate liability of  Company to the Client shall not exceed the total fees payable to Company for services rendered. It is intended that this limitation  apply to any and all liability or cause of action however alleged or arising. Further, Client releases Company, its affiliates,  successors, assigns, directors, trustees, officers, shareholders, employees, agents and representatives, from any claims for  liability which the Client may acquire by reason of damage, loss, injury and/or suffering which arises from the operation and/or  use of a vehicle by a Caregiver, whether that may be owned by the Client or a vehicle provided by the Caregiver or Company.  Client also agrees not to hold Company, its affiliates, successors, assigns, directors, trustees, officers, shareholders,  employees, agents and representatives, liable for any intentional acts of Caregivers acting beyond the course and scope of  their duties to provide companionship services.

Fall Risk

Client understands that even with the provision of twenty-four (24) hour, around-the-clock companionship services, Clients may potentially experience a fall. Client understands that Clients with dementia, Alzheimer’s or any condition that causes mental confusion are especially at high risk for experiencing falls. Client further understands that HCA will do its best to minimize fall risks, and agrees to hold HCA, its affiliates, successors, assigns, directors, trustees, officers,

shareholders, employees, agents and representatives, blameless in the event of a fall.

Certification of Authority

If someone other than Client(s) (hereafter referred to as an "Authorized Agent") signs this agreement on behalf of Client(s), said Authorized Agent hereby certifies that he/she has the authority to enter into this agreement on behalf of said Client(s) and bind Client(s) to the terms hereof. Furthermore, said Authorized Agent accepts full responsibility solidarily with Client(s) for the payment of all fees incurred for services rendered to Client(s) pursuant to this agreement.

Client or Authorized Agent has read and fully understands the content of this agreement and agrees to the terms contained herein. 

Client or Authorized Agent Date 

Capacity of Authorized Agent in Relation to Client

Revised Date: 01/2020

Service Type | Rate | Period | Notes

Hourly Care - 40 hour Minimum weekly


Minimum commitment of 2 week of service.

*UPFRONT 80 HOURS DEPOSIT for Covid + and 40 hour minimum/week | $50/h | per hour | Payment: HCA accepts payment by pre-authorized  bank debit or e-transfer only. A credit card may be  requested as backup. 
Cancellations received less than forty-eight (48) hours before a scheduled visit will result in that shift being charged. All schedule changes should be  coordinated with the HCA office to ensure accurate  staffing and billing. 
Note: Client who sends caregiver home early will be  charged the full shift.

Live-In Care – Individual | n/a | per day | Payment: HCA accepts payment by pre-authorized  bank debit or e-transfer only. A credit card may be  requested as backup. 
Cancellations received less than forty-eight (48) hours before a scheduled visit will result in that shift being charged. All schedule changes should be  coordinated with the HCA office to ensure accurate  staffing and billing. 
Note: Client who sends caregiver home early will be  charged the full shift.

Live-In Care - Couple | n/a | per day | Holiday Rate 
HCA recognizes eight (8) holidays per year consisting of  New Year’s Day, Easter Sunday, Victoria Day, S t- Jean  Baptist, Canada Day, Labour Day, Thanksgiving Day and  Christmas Day. On these days for the entire twenty-four  (24) hour period, our holiday rate will apply. Our holiday  rate is one point five (1.5) times the regular rate for all services. 
Parking – When services are rendered at a hospital, client may incur a caregiver parking charge

Mileage (if Caregiver’s vehicle is used) | $0.70 | per KM | Holiday Rate 
HCA recognizes eight (8) holidays per year consisting of  New Year’s Day, Easter Sunday, Victoria Day, S t- Jean  Baptist, Canada Day, Labour Day, Thanksgiving Day and  Christmas Day. On these days for the entire twenty-four  (24) hour period, our holiday rate will apply. Our holiday  rate is one point five (1.5) times the regular rate for all services. 
Parking – When services are rendered at a hospital, client may incur a caregiver parking charge

CTM Interventionist | $51 | per hour | Holiday Rate 
HCA recognizes eight (8) holidays per year consisting of  New Year’s Day, Easter Sunday, Victoria Day, S t- Jean  Baptist, Canada Day, Labour Day, Thanksgiving Day and  Christmas Day. On these days for the entire twenty-four  (24) hour period, our holiday rate will apply. Our holiday  rate is one point five (1.5) times the regular rate for all services. 
Parking – When services are rendered at a hospital, client may incur a caregiver parking charge

Non-Scheduled Care Manager Visit | $60 | per visit | Holiday Rate 
HCA recognizes eight (8) holidays per year consisting of  New Year’s Day, Easter Sunday, Victoria Day, S t- Jean  Baptist, Canada Day, Labour Day, Thanksgiving Day and  Christmas Day. On these days for the entire twenty-four  (24) hour period, our holiday rate will apply. Our holiday  rate is one point five (1.5) times the regular rate for all services. 
Parking – When services are rendered at a hospital, client may incur a caregiver parking charge

Holiday Rate 
HCA recognizes eight (8) holidays per year consisting of  New Year’s Day, Easter Sunday, Victoria Day, S t- Jean  Baptist, Canada Day, Labour Day, Thanksgiving Day and  Christmas Day. On these days for the entire twenty-four  (24) hour period, our holiday rate will apply. Our holiday  rate is one point five (1.5) times the regular rate for all services. 
Parking – When services are rendered at a hospital, client may incur a caregiver parking charge