Carer Partnership Agreement As the relative and/or carer of:
* This agreement is only valid for this hospital episode. w This agreement will be for the duration of the patient stay and will be monitored/ reviewed accordingly. There may be circumstances when the carers agreement is adjusted or suspended and this would be discussed with all relevant parties. w Please understand this agreement may be revoked in the light of any NHS Guidance or National Policy w Is there a Lasting Power of Attorney (LPA) agreement for Health in place and has it been seen? Yes o No o
It has been agreed that: Primary carer (name)
Additional carer (name)
w I will inform the staff that I am entering or leaving the ward outside of normal visiting hours and I understand that, at times, I may be asked to leave the ward or bay if there is a clinical necessity. w I agree that, if I am assisting with feeding, You will need to discuss any additional requests or requirements with the Ward Manager or Nurse in Charge . o Can stay with the person they care for during the day and / or night as required. (delete as appropriate) o Can visit outside of normal visiting times. o Can provide assistance in washing and dressing. o Can provide assistance in feeding. o Can be actively involved in team meeting discussions, and planning the discharge where appropriate, about the person they care for. o Provide support to the person they care for when having procedures / treatments in the hospital.
Signed (carer)
Authorised by
Ward Manager Nurse in Charge
o o
Ward
Date
Once completed a copy of the agreement should be provided to the carer/s together with the carers card. A copy of the agreement should be retained at the Trust.
washing or mobilising that staff may work alongside me to fulfil their clinical responsibility.
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