Nursing Home Power of Attorney (POA) Agreement

This Nursing Home Power of Attorney Agreement (the "Agreement") is entered into and made effective this day of , by and between [Your Company Name], having its principal place of business at (hereinafter referred to as the "Principal") and [Second Party] of address (hereinafter referred to as the "Agent"), collectively referred to as the "Parties".

1. APPOINTMENT OF ATTORNEY-IN-FACT

The Principal hereby appoints the Agent as Attorney-in-Fact with authority to make health care decisions, including decisions about nursing home placement and to take control over all the Principal’s affairs during any period of incapacity. This power of attorney is durable and shall not be affected by the Principal's incapacity.

2. RESPONSIBILITIES OF THE AGENT

The Agent agrees to act in the best interest of the Principal, respecting the Principal's interests, desires, values, and preferences. The Agent, in managing the Principal's affairs, shall not be liable for any loss resulting from the proper exercise of judgement. The Agent is authorized to delegate authority where appropriate, but always remains responsible for the overall welfare of the Principal.

3. COMPENSATION

The Agent may receive reimbursement for reasonable expenses incurred on behalf of the Principal in the performance of duties under this Agreement. Any additional compensation must be expressly approved by the Principal in writing, in advance.

4. TERM AND TERMINATION

This Agreement shall become effective immediately upon execution and shall remain effective until it is either terminated by the Principal's express written direction or upon the death of the Principal.

5. GENERAL PROVISIONS

This Agreement constitutes the entire agreement between the Parties, and supersedes all prior oral or written agreements, understandings or arrangements relating to the subject matter of this Agreement. This Agreement shall be governed by and construed in accordance with the laws of .

IN WITNESS WHEREOF, the Parties hereto have executed this Nursing Home Power of Attorney Agreement as of the day and year first above written.

SIGNATURE OF THE PRINCIPAL

[Your Company Name]

SIGNATURE OF THE AGENT

[Second Party]