Signing example
Sign an aged care service agreement online
An aged care service agreement signed by a family member has to show on what authority she signed, that she saw every page of services, prices and rights, and that the provider countersigned after checking that authority. This eight page Support at Home agreement does all three: the daughter types her authority, initials pages 2 to 7 behind an emailed code, and the care manager signs last.
The document, with its fields
The pages as a signer sees them, with the signature, name, title and date fields placed where each party has to complete them.
Aged Care Service Agreement
1. The parties
| Provider | Bellarine Home Care Services Pty Ltd, ABN 58 631 772 409, a registered provider of aged care services, of 12 Moorabool Street, Geelong VIC 3220 |
|---|---|
| Client | Albert Kowalczyk, born 11 January 1940, of 6 Pakington Street, Geelong West VIC 3218 |
| Representative | Teresa Kowalczyk, the Client's daughter, of 21 Ryrie Street, Geelong VIC 3220, signing on the Client's behalf |
| Start date | 19 October 2026 |
| Program | Support at Home, under the Aged Care Act 2024, at the classification in the Client's notice of decision |
2. Who signs, and on what authority
Mr Kowalczyk has asked that his daughter manage his care arrangements. She signs this agreement for him under the authority she types below. The Provider checks the original document before services start and keeps a copy on file. Mr Kowalczyk remains the person receiving care, and the Provider will continue to talk to him directly about his care and his preferences, whoever signs.
3. What this agreement is for
This agreement sets out the services the Provider will deliver in Mr Kowalczyk's home, what they cost, how they can change, what Mr Kowalczyk's rights are and how to complain or end the agreement. It is written to be read with the care plan agreed at the assessment visit on 29 September 2026, which describes his goals and the way he likes things done. If this agreement and the care plan differ about a service, the care plan applies to how the service is delivered and this agreement applies to its price.
4. Mr Kowalczyk's goals
| 1 | To keep living at home in Geelong West, close to his church and his daughter |
|---|---|
| 2 | To shower safely without a fall, after his hip replacement in May 2026 |
| 3 | To keep walking to the shops on Pakington Street twice a week with support |
| 4 | To have his medicines and his wound checked by a nurse without travelling to a clinic |
5. The services
| Service | What it includes | How often |
|---|---|---|
| Personal care | Help to shower, dress and apply compression stockings, with a shower chair and rails already fitted | Monday to Saturday, 45 minutes each morning |
| Nursing | A registered nurse checks the healed hip wound, reviews medicines and blood pressure, and liaises with the GP | Fortnightly, 1 hour |
| Domestic assistance | Vacuuming, bathroom and kitchen cleaning, changing the bed and one load of washing | Weekly, 2 hours, Thursday |
| Social support | A support worker walks with him to the shops and helps carry his shopping | Tuesday and Friday, 1.5 hours |
| Meals | Five frozen meals delivered each week from the Provider's meal partner | Weekly, Monday |
| Allied health | Physiotherapy review of mobility and falls risk, with a home exercise program | Once now, then every 3 months |
6. Care workers
Services are delivered by the Provider's own employed care workers and nurses, not by subcontractors, except meals and physiotherapy, which are delivered by partner organisations the Provider manages and is responsible for. The Provider tries to send the same two care workers for personal care so Mr Kowalczyk sees familiar faces, and tells him in advance when a different worker will come. Every worker has a current worker screening clearance and has completed training in manual handling, infection control and the Aged Care Code of Conduct.
7. What is not included
The services do not include home modifications, equipment purchases over $500, gardening, transport to medical appointments or respite care. These can be added later by agreement in writing, within the Client's available funding, and the price of each is quoted before it starts.
8. When services happen
Morning personal care starts between 7:30 am and 8:15 am. Other services are booked at times agreed with Mr Kowalczyk and confirmed in a weekly schedule the Provider posts to him and emails to the Representative every Friday. If a care worker will be more than 20 minutes late, the Provider phones Mr Kowalczyk before the booked time.
9. Cancelling a visit
| Who cancels and when | What happens |
|---|---|
| Client, with at least 24 hours' notice | No charge |
| Client, with less than 24 hours' notice | Charged at the full price of the visit, once in any month; later short notice cancellations in the same month are not charged if they are for a medical reason |
| Client in hospital | Services stop with no charge from the day the Provider is told, and restart on discharge |
| Provider | No charge, and the Provider offers another time in the same week |
10. Changing the services
Mr Kowalczyk or the Representative may ask to change, add or reduce services at any time. The Provider agrees the change in writing, with its price, before it starts. The Provider will not change the services without that agreement, except in an emergency to keep Mr Kowalczyk safe, and then it tells the Representative the same day.
11. Reviewing the care plan
A care manager reviews the care plan with Mr Kowalczyk at least every 12 months, and sooner if his needs change, he returns from hospital, or he or the Representative asks for a review. If his needs grow beyond what his funding can pay for, the care manager helps him ask for a reassessment.
12. Records of each visit
Each care worker records the time they arrived and left and what they did, on the Provider's mobile app. Those records are the basis of each invoice, and the Representative may ask to see them at any time.
13. Prices
Prices include GST where it applies. They are the Provider's published prices, which do not exceed any price limit set under the Support at Home program, and they apply from the start date until changed under clause 15.
| Service | Weekday | Saturday | Unit |
|---|---|---|---|
| Personal care | $84.00 | $118.00 | per hour |
| Nursing, registered nurse | $132.00 | $165.00 | per hour |
| Domestic assistance | $76.00 | $106.00 | per hour |
| Social support | $78.00 | $109.00 | per hour |
| Physiotherapy | $150.00 | n/a | per visit |
| Meals | $14.50 a meal, of which the Client pays $7.50 for the food | per meal | |
Visits are charged in 15 minute units for the time spent with Mr Kowalczyk. No travel time, no administration fee and no exit fee is charged. Care management is included in the service prices above.
14. What Mr Kowalczyk pays
Most of the cost is paid from Mr Kowalczyk's Support at Home funding. He pays a contribution for some services at the rate set out in his letter from Services Australia, which the Provider applies exactly and shows on each statement. He pays nothing towards clinical services such as nursing and physiotherapy. The food cost of the meals is always his to pay. The Provider will not ask him to pay any amount that is not shown on a statement.
15. Changing prices
The Provider may change its prices no more than once a year, and gives at least 30 days' written notice before the new prices apply. If the change means the services no longer fit within the funding, the care manager meets with Mr Kowalczyk and the Representative to agree what to adjust before the new prices start.
16. Monthly statements
A statement for each month is posted to Mr Kowalczyk and emailed to the Representative by the 15th of the following month, showing every service delivered, its price, what was paid from his funding and his contribution.
17. Mr Kowalczyk's rights
The Aged Care Act 2024 sets out a Statement of Rights for every person receiving aged care. The Provider must act compatibly with those rights, and a copy of the full Statement is given with this agreement. In plain terms, Mr Kowalczyk has the right to:
- make his own decisions about his care and his life, with support if he wants it, and have those decisions respected;
- be treated with dignity and respect, and have his identity, culture and faith valued;
- be safe, and receive care that is high quality and delivered by people who are trained and screened;
- have his privacy respected and his personal information protected;
- be told what services cost and what he will pay, before he agrees to them;
- have someone of his choosing support him and speak for him;
- stay connected with his family, friends and community;
- make a complaint, or give feedback, without fear of losing his services or being treated differently.
18. Choosing who supports him
Mr Kowalczyk may change who supports him at any time. If he wants someone other than his daughter to be the main contact, or wants to deal with the Provider himself, he tells the care manager and the Provider updates its records the same day. Nothing in this agreement takes away his right to be told about, and to decide, his own care.
19. Restrictive practices
The Provider does not use any restrictive practice, such as locking doors, holding a person or using medicine to manage behaviour, in home care. If a care worker believes Mr Kowalczyk is at risk, they call the care manager and, if needed, emergency services.
Mr Kowalczyk attends St Mary's on Sundays and has asked that no services be booked before midday on that day. Care workers respect his routines, his preference to be addressed as Mr Kowalczyk, and his wish to speak Polish when a Polish speaking worker is available.
20. The Provider's responsibilities
- Deliver the services in clause 5 safely, at the agreed times, by trained and screened workers.
- Meet the Aged Care Quality Standards and follow the Aged Care Code of Conduct.
- Hold public liability and professional indemnity insurance, and workers' compensation for its workers.
- Report serious incidents as the law requires and tell the Representative about any incident involving Mr Kowalczyk on the same day.
- Keep accurate records of the services and the money, and give copies on request.
21. Mr Kowalczyk's and the Representative's responsibilities
- Give the Provider the information it needs to deliver safe care, including changes in health, medicines or hospital admissions.
- Provide a safe place for workers to work, including keeping pets secured during personal care and keeping paths clear.
- Treat workers with courtesy and without harassment or discrimination.
- Pay any contribution and the food cost of meals within 14 days of each statement.
22. Privacy
The Provider collects personal and health information about Mr Kowalczyk to deliver his care. It handles that information under the Privacy Act 1988 and the Australian Privacy Principles, shares it only with people involved in his care, his GP and as the law requires, and stores it securely for at least seven years after services end. The Representative may see his records under the authority she holds.
23. Keys and entry
A key to the front door is held in a key safe beside it, with a code known to the care workers rostered to Mr Kowalczyk. The code is changed if a worker leaves the Provider or if Mr Kowalczyk asks.
24. Emergencies
If a care worker arrives and Mr Kowalczyk does not answer, they phone him, then the Representative, then the care manager, and enter with the key safe code if he still cannot be reached. If he is unwell or injured they call 000 first. The Provider keeps his GP, his medicines list and the Representative's numbers on file for this purpose.
25. Feedback and complaints
The Provider welcomes feedback and treats every complaint as a chance to improve. Mr Kowalczyk, the Representative or anyone on his behalf may complain in any way that suits them.
| Step | How |
|---|---|
| Talk to the care manager | Leonie Farquhar, 03 5221 4830, or in person at any visit |
| Write to the Provider | feedback@bellarinehomecare.example. The Provider acknowledges a complaint within 2 business days and aims to resolve it within 30 days, telling the complainant what it found and what it will do |
| Contact the regulator | Aged Care Quality and Safety Commission, free on 1800 951 822, or online. A complaint to the Commission can be made at any time, including without first complaining to the Provider |
| Ask for an advocate | Older Persons Advocacy Network, free on 1800 700 600, who can help raise a concern or speak on his behalf |
Making a complaint will never affect the services Mr Kowalczyk receives or the way he is treated.
26. Ending the agreement
| Who ends it | How |
|---|---|
| Mr Kowalczyk or the Representative | At any time, by telling the Provider in writing. Services stop on the date asked for, at the earliest 14 days after notice, or straight away if he moves into residential care or to another provider. No exit fee is charged |
| The Provider | Only for a reason the law allows, such as Mr Kowalczyk no longer needing care, his care needs no longer being able to be met safely in his home, or a serious and continuing risk to workers that cannot be managed. The Provider gives at least 14 days' written notice, helps him find another provider and keeps delivering services until the new provider starts |
When the agreement ends, the Provider gives a final statement within 30 days and any unspent funds are dealt with under the program rules.
27. General
This agreement, the care plan and the Statement of Rights are the whole agreement about the services. It can be changed only in writing agreed by Mr Kowalczyk or the Representative and the Provider. It is governed by the law of Victoria. Nothing in it limits any right Mr Kowalczyk has under the Aged Care Act 2024 or the Australian Consumer Law. It may be signed electronically, and a copy of the certified PDF is given to Mr Kowalczyk, the Representative and the Provider.
28. Before signing
The care manager read through this agreement with Mr Kowalczyk and his daughter at his home on 29 September 2026, explained each section, and left a printed copy with him. He was told he may take as long as he needs to consider it and may ask a friend, advocate or lawyer to look at it first.
29. Key details
| Item | Detail |
|---|---|
| Services start | Monday 19 October 2026 |
| Care manager | Leonie Farquhar, 03 5221 4830 |
| After hours | 03 5221 4800, answered 24 hours |
| First care plan review | By October 2027, or sooner if needs change |
| Representative | Teresa Kowalczyk, daughter |
30. Order of signing
The Representative signs first, after typing her authority on page 1 and initialling pages 2 to 7. The Provider's care manager signs second, after checking the authority document, and services start on 19 October 2026.
Given with this agreement
The care plan dated 29 September 2026, the Statement of Rights, the Provider's price list, its privacy policy and its feedback and complaints brochure, all left in printed form with Mr Kowalczyk and emailed to the Representative.
Who signs what
- Teresa Kowalczyk, for her father as representative
- Relationship and authority typed on page 1 · Initials at the foot of pages 2 to 7 · Signature block on page 8: Name and a stamped Date · Verified by an emailed six digit code
- Leonie Farquhar, care manager, Bellarine Home Care Services
- Signature block on page 8: Name, Title, Company and a stamped Date · Email link
The signing journey
Step 1
Nine fields in all
One text field, six initials and a two line block for the representative; one four line block for the provider.
Step 2
Representative first, behind a code
Sign in order is on. Teresa's link asks for a six digit code from her own inbox, and the care manager is not invited yet.
Step 3
She states her authority
On page 1 she types Daughter, enduring power of attorney dated 3 March 2025, so the basis for signing is in her own words on the agreement.
Step 4
Six pages initialled, one signature
Her single drawing fills the initials on pages 2 to 7, covering services, schedule, prices, rights, responsibilities and complaints, and her block on page 8.
Step 5
The provider checks, then signs
Leonie's invitation arrives once Teresa has signed. Clause 30 says she checks the authority document first, then types Care Manager and the company name.
Every field, and who fills it
Teresa Kowalczyk types her relationship and authority on the ruled line in clause 2, initials the bottom right of each of pages 2 to 7, and signs a block on page 8 headed For Albert Kowalczyk, by his representative, with Name and a stamped Date. Leonie Farquhar signs the block beside it for Bellarine Home Care Services with Name, Title, Company and Date. The services, the prices from $76 to $165 an hour and the start date of 19 October 2026 are printed.
How to adapt this envelope
A client who signs for himself becomes the first recipient and the authority line is removed. Where two adult children hold the power of attorney jointly, both are recipients before the provider, each typing their authority and initialling. A provider delivering in several homes can keep the same field layout and change only the printed care plan and goals.
What makes this valid in Australia
The Electronic Transactions Act 1999 recognises an electronic signature that identifies the signer and shows intention, by a reliable method. The Aged Care Act 2024 sets the Statement of Rights and the obligations of registered providers, and the Support at Home program sets how home care is funded. Whether the representative may sign at all depends on her authority under state law, which is why she states it and the provider checks it.
What makes this signing flow work
The authority is on the page
When someone signs for a parent, the first question is by what right. A text field on page 1, filled by the representative, puts the answer in the signed PDF next to the clause explaining that her father remains the person the provider talks to about his care.
Initials on prices and rights
Pages 2 to 7 hold the services, the cancellation rules, the hourly prices, the Statement of Rights summary and the complaints contacts. Six initials show she had each one in front of her, and page 8 carries her block instead.
The representative's own email on the certificate
The certificate prints her name and email address with Email link plus emailed one-time code, which shows the agreement was opened from her inbox and not from the provider's office or her father's account.
Questions people ask
Can a family member sign an aged care agreement for a parent online?
Only with authority to do so, such as an enduring power of attorney or a guardianship order. The signing itself can be electronic under the Electronic Transactions Act 1999. This agreement has her type the authority she relies on, and the provider checks the document before countersigning.
Does the parent still have a say if the daughter signs?
Yes. Clause 2 says the provider keeps talking to Mr Kowalczyk directly about his care, and clause 18 says he can change who supports him at any time. The Statement of Rights, summarised on page 5, gives him the right to make his own decisions with support.
Why initial six pages of an eight page agreement?
Page 1 already carries her typed authority and page 8 carries her signature block. Initials on pages 2 to 7 cover everything in between, including the prices and the rights. One drawing fills all six spots, so it adds no effort for her.
What does the certificate show about the representative?
Her name and email address, the verification method Email link plus emailed one-time code, the time she signed, her IP address, the time she accepted the electronic signing consent and its version, and the hash of the document she signed.
Can the agreement be changed after both have signed?
The certified PDF cannot be edited, because the certification breaks if anything changes. Clause 10 says changes to services are agreed in writing, so a change is a short new document sent as its own envelope, signed the same way.
What happens if the representative declines?
The envelope moves to declined and the provider is emailed with any reason typed. The care manager is never invited, no agreement exists, and services cannot start under it. The provider can talk it through and send a revised agreement as a new envelope.
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