life care

Understanding Life Care Agreements

Life is a beautiful gift! We get to experience many joyful moments and moments of sadness add to the fullness of life. We gain knowledge and wisdom as we age and pass on our expertise to our loved ones.  However, as we age, we can become forgetful, experience physical ailments, and a deteriorating mental health. There are apparent tell-tale signs when help is needed, such as driving issues, trouble with banking and finances, forgetting medications, multiple falls, and more. For some individuals, assistance in daily living activities may be necessary, or even full-time aid.  In this article, we will talk about personal care and life care agreements.

This blog is for educational purposes only and should not be considered legal advice. The use of the Paths Law Firm website does not constitute a client-lawyer relationship.

What is a life care agreement?

Also called independent care agreements, life care agreements are written contracts stipulating the care given to an elderly person in exchange for compensation.  The two types of life care agreements include personal care agreements and institutional care agreements

What is a Personal Care Agreement?

A personal care agreement, referred to as an elder care contract, personal services agreement, family care contract, caregiver agreement, and several other terms, is a private agreement between an elderly individual and a caregiver. The caregiver can be anyone the senior chooses; however, it is usually a family member or close friend. 

This agreement protects both the care recipient and care provider. This type of agreement also helps family members involved understand all the responsibilities and expectations of the caregiver. A personal care agreement is most often for the life expectancy of the care recipient. These agreements help avoid uncertainties potentially resulting in misunderstandings and disagreements.

Also, they assist in making sure the senior is in compliance with Medicaid in the event long-term care is required through a facility in the future. Having an agreement like this has become essential as the work of caregiving has advanced both legally and socially. Having the caregiver’s responsibilities and expectations in writing will help to keep the family in harmony.

life care agreements

What is an Institutional Care Agreement?

Institutional Care or Continuing care agreements are retirement communities or centers providing seniors with care and broad living choices. Care provided can range from minimal help with independent living, assisted living to full-time care. These communities have various agreements or contracts. There’s generally a significant entrance fee as well as a monthly fee for services. These contracts are also life care agreements because most individuals enter these centers expecting to live out their days there.

What is the value of a life care agreement?

There are a variety of reasons to create a life care agreement. First, most elderly individuals prefer spending their last days at home, and getting into a life care agreement can assist in this endeavor. Additionally, because it’s usually a close friend or family member who gives the care, there’s already a level of intimacy and trust established between the two parties. This agreement defines the boundaries and the type of relationship. Given how there’s payment for services, the arrangement becomes a business arrangement. Lifecare contracts identify payments made to the caregiver are legal business expenses, not just property or a gift of money. 

personal care agreements

What are the components of a life care agreement? 

When drafting a life care agreement, the date services begin must be part of the document. The contract cannot have a retroactive date. Any services administered before the personal care contract is in place cannot be included and therefore not paid. The agreement should provide the length of time services are to be performed. The care recipient may opt for a short-term contract or one lasting the remainder of their life.

The agreement should include detailed descriptions of all services the caregiver is taking on. The list of services should be comprehensive, as well as specific. For example:

  • Preparing food
  • Running errands 
  • Personal care assistance
  • Transportation
  • House cleaning and laundry
  • Companionship
  • Medication management
  • Financial management such as paying bills
institutional care

How much does a life care assistant make?

The amount of compensation a caregiver receives for life care services is dependent on the number of hours worked and the average hourly pay for a care assistant in the area. A reasonable compensation amount for life care assistance is between $12 and $15 per hour, depending on the caregiver’s experience and geographical location. Payment can be daily, weekly, bi-weekly, or monthly. Also, compensation is not limited to money; many contracts include property transfers instead of cash payments.

Clauses to Include in a Life Care Agreement

When creating a life care agreement, it is essential to include specific clauses to protect the parties involved. Below are some examples; however, it is good to work with an experienced elder law attorney to ensure the document is legally sound.

  • Modification Clause: You may want to include a section discussing the terms of altering the agreement. 
  • Termination Clause: Consider including a termination clause if either the elderly care recipient or caregiver is not in terms with the agreement.

How does a Life Care Agreement Impact Medicaid?

A life care agreement can help an older person minimize their assets or income, get care from a loved one, and aid them to qualify for Medicaid-funded nursing home care. What’s more, they help in keeping the financial resources of the family available.

For seniors to qualify for Medicaid, there are asset and income restrictions one will need to pass. These restrictions apply in all 50 states. The income and assets of candidates are required to be under Medicaid’s limits. Medicaid has a 5-year look-back period where they review all transactions the applicant has made. This evaluation occurs once the application is submitted, and the look-back period starts on the application date. If at any time during the 5-year look-back period, the applicant has given cash gifts or transfers assets under market value, it can disqualify them from receiving Medicaid benefits.

If there’s a life care agreement in place, it will indicate the compensation made to family or friends (under market value) for the care given was a reasonable business expense. Thus, one wouldn’t have violated the terms and conditions of Medicaid eligibility.

medicaid and life care

The Pros and cons of a life care agreement

As with any type of agreement, there can be pros and cons. If you decide that a care agreement is the right thing to do for you or your loved ones, it is essential to weigh your options and discuss your plans with an attorney to ensure you are protected.

Pros of a Life Care Agreement 

  1. Flexibility: A life care agreement provides flexibility as needs change to include where the caregiver provides services. The caregiver can provide services in the home of the elderly person or a senior home.
  2. Â Helps Family Members Assist One Another: This type of agreement enables the care recipient to compensate the caregiver for their services. What’s more, there’s a level of comfort and trust that already exists when a family member or close friend provides care.
  3. Legal Spend Down for Medicaid: This contract provides a way to reduce assets or income legally to be eligible for Medicaid. Other than this, it also provides an opportunity to keep those resources inside the family.

Cons of a Life Care Agreement

  1. Can be Vague: If the responsibilities and boundaries are not specific enough in the life care agreement, confusion and misunderstandings may occur.  
  2. Friction between the family member and elderly: Emotions may brew and create issues between the caregiver and senior. For instance, the elderly person may feel the caregiver should render care without reimbursement, or the adult child caregiver may feel they are being coerced.
  3. Can create vulnerability – If the care recipient uses their home as the form of payment to the caregiver, the senior could end up without care or their home if conflicts arise.
agitated elderly woman

In Closing

Aging comes with its fair share of challenges. Understanding life care agreements can mitigate the impact of care as we age. Lifecare agreements can help remove worry and risk for the care recipient. At Paths Elder Law, we have been working with seniors and their families for close to 30 years, helping them protect assets and their future well-being. If you or a loved one needs legal assistance with planning for care or creating a life care agreement, contact Paths Elder Law.  Our caring staff is here to help.

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Administrative Assistant

Ryan D. Foley

Ryan Foley at Paths Law

Administrative Assistant

Ryan D. Foley

Ryan graduated from the UMKC School of Law in 2018 and passed the Missouri Bar that year. Prior to law school, Ryan attended the University of Missouri – Columbia where he attained a degree in Business. He is a Kansas City native, growing up in the Northland where he achieved his Eagle Scout rank by doing a project for his high school. During his time in law school, Ryan was introduced to the practice area of Elder Law by one of his professors and has been

Ryan enjoys working with and educating clients to provide advocacy and support during the unfamiliar and often overwhelming probate process. Ryan understands the challenges faced by individuals when faced by the uncertainty and complexity of government systems or even handling a Trust during a time of grief, and he strives to make the process as easy as possible.

Administrative Assistant

Makaylee A. Morelli

administrative assistant at Paths Law

Administrative Assistant

Makaylee A. Morelli

Makaylee is currently working on her bachelor’s in political science and hopes to soon start law school as an aspiring attorney. In her free time, she loves to spend time with her friends and family but most importantly her dogs Taffyta, Tallulah Belle, and Harry. Their favorite thing to do is go on coffee dates and get pup cups.


Kathleen E. Overton

Kathleen Overton, attorney at Paths Law


Kathleen E. Overton

After starting her career as a disability attorney, Kathleen transitioned into estate planning at a mid-sized regional law firm. Kathleen joined Paths Law Firm in 2021 when she decided to return to a boutique law firm that provides excellent service and quality to clients. Because of her background as a disability attorney, she brings a thorough understanding of public benefits to each client meeting. At Paths Law FIrm, Kathleen focuses on traditional estate planning and business entity formation, providing tailored advice unique to each client’s situation.

Public Benefits Assistant

Tena K. Dooley

Public Benefits Assistant

Amanda D. Martin

I have my Associates in Applied Science and have over 20 years of office management experience. I have two daughters and one grandson.

During my time away from the office I enjoy spending time with my family.  I enjoy almost everything outdoors and my hobbies include fishing and gardening.


Sydney R. Morris

Paths Law elder law in Kansas City



Sydney is currently enrolled at the University of Missouri-Kansas City pursuing an accounting degree and plans to later attend law school.

In her free time, Sydney enjoys spending time with her nephews and volunteering at her local church.



Christy L. Phillips

client service manager at Paths Law


Christy L. Phillips

Phone: 816-640-8635
Email: [email protected]

Christy has 3 years of experience in Elder Law working for seniors and their families as a Benefits Coordinator processing Medicaid and VA applications. Prior to joining Paths Law Firm Christy worked in the finance industry for over 10 years.


Christy’s experience in the finance industry has been extremely beneficial to her role as Benefits Coordinator. There have been many influences that went into her decision to select the field of Elder Law. Christy has a special place in her heart for the elderly and attributes this to her relationship with her grandparents.

When asked why she loves what she does, Christy said that at Paths Elder law, she gets the opportunity to help clients in more ways than one. Her favorite part of her job is getting clients approved for Medicaid or VA benefits as it is a huge relief for them and their loved ones.

Christy was raised in Ogden, Utah, and moved to Independence, MO, when she was ten years old. She has two children that keep her busy and fill her life with joy! Christy’s daughter cheers for Avila University, and her son plays competitive baseball for the Bucks and races BMX locally for the Motorcycle Closeout Team.

When Christy is not working, she enjoys crafting and making homemade gifts for her loved ones and raising her kids to be healthy, happy, and positive humans.


Practice Areas

  • Medicaid Benefits
  • VA Benefits


Professionalc Memberships and Affiliations

  • Missouri Notary


René A. Fracassa

Rene A. Fracassa, Paths Law



René has worked along side Rusty for 35 years. Not only is she part of the Paths team, she is also his wife. René spends her time working with the accountant to keep all of the finances in order, as well as general office management.

In addition to helping run the office, she helps manage the family and grandkids, tries to keep everyone fed, and has a passion to teach Bible Studies. Her former career in Event Planning trained her to juggle all the activity. She understands Rusty’s passion to serve people from the first mention of law school. It is a great pleasure for her to be an important part of every area of his life.



Hilary R. Tichota

Hillary at Paths Law



Hilary plays a vital role in the daily operations of the office. In addition to her regular office duties, Hilary has a heart of gold.

For more than 5 years, Hilary has operated the front desk at Paths, running the office and catering to clients. Hilary recently moved into the role of Community Relations Coordinator. She has a passion for people and a focus to share our business practices with the community’s seniors, businesses, and clients. She especially has a heart for seniors, showing they are loved through her visits, treats, the “Pen to Pal” program, and volunteering services at various senior living communities. She is a wonderful wife and mother of two. Most activities with seniors involve her great talent for any type of craft.



Jennifer A. Bronson

Jennifer, senior paralegal



Jennifer has been in the legal field for over 25 years and considers Paths her second home.

When she’s not running the office or working for our clients, she’s spending time with her first passion – her children.


Russell A. Fracassa (Rusty)

attorney at Paths Law elder law


Russell A. Fracassa (Rusty)

Phone: 816-640-8635

When asked what he wants to do, his reply was “I just want to sit at the kitchen table and work directly with people.” Rusty enjoys working with clients providing experienced advocacy and supporting them through their unfamiliar and overwhelming situations. Due to all the challenges faced by seniors, it is essential to work with an experienced elder law attorney who has expertise in the law, issues, and concerns affecting seniors and their families.

Rusty brings nearly 30 years legal experience and expertise working for seniors and their families as an elder law attorney in Kansas City and surrounding. Prior to law school, Rusty was a practicing accountant. This provides invaluable experience in his current practice of law. Rusty decided to put his focus on helping the elderly, vulnerable adults, and their families navigate challenging life, end of life, and death events.

Rusty understands the challenges faced by individuals whose capacity is declining and how upsetting the loss of a loved one can be. He understands he may not be able to eliminate his client’s grief from loss, but he strives to provide clients with peace of mind. Rusty works directly with client’s long term care issues, including Medicaid, Veteran’s Benefits, Estate Planning, Asset Protection, and Special Needs Planning.

In 2010, Rusty’s faith and love led him and part of his family to China as Christian missionaries. He and his wife, went permanently, but ended up dedicating 3 years to that ministry. They returned to Missouri to help with grandchildren after a family tragedy and later began anew with Paths Elder Law. The goal is providing compassionate care through legal advocacy.

When Rusty is not practicing law, he enjoys spending time with his family, grandchildren, and excessive eating at local restaurants.


Practice Areas


  • Wills and Trusts
  • Estate Planning
  • Asset Protection
  • Medicaid Benefits
  • VA Benefits
  • Probate
  • Guardianship and Conservatorships
  • Education


BSBA and Master’s in Accounting, Master’s in Inter-Cultural Studies, and Doctorate in Juris Prudence

  • Rockhurst University
  • Liberty University
  • University of Missouri – Kansas City

Admissions to Practice

  • Missouri

Professional Memberships and Affiliations

  • State Bar of Missouri
  • National Academy of Elder Law Attorneys (long-time Member)
  • Elder Counsel (Charter and Ongoing Member)
  • Missouri Association of Trial Attorneys (Past Member)
  • Kansas City Metropolitan Bar Association
  • Missouri State Bar Committees – Elder Law, Estate Planning, Probate