Nursing Home Admissions
Be a Smart Consumer - Know Your Rights
Moving into a nursing home can be an emotional process. Typically, the incoming resident and her family know little about nursing home life and assume that the nursing home's procedures are just the way that it has to be. They sign admission agreement documents without much thought.
However, some nursing home procedures and admission agreements are harmful to residents. The federal Nursing Home Reform Law focuses on a resident's individual needs, allowing the resident to live as independently and safely as possible. In general, a nursing home must provide necessary care in as home-like an environment as possible.
Nursing home admission agreements should reflect these rights and honor the law's resident-centered philosophy. However, studies have shown that admission agreements often contain provisions that conflict with the law or are not fair to residents or their families. In many cases, nursing home staff are unaware of the law and continue to use out-dated forms and policies. If consumers do not know what to expect or are afraid to complain, they can sign away certain rights that are not in their own best interests.
There are six common problems found in nursing facility admission agreements, according to Nursing Home Agreements: Think Twice Before Signing, from the National Senior Citizens Law Center:
1. The agreement limits the care that the resident can receive and, if the resident's needs increase, forces the resident to hire a separate "private duty" caregiver.
The federal Nursing Home Reform Law requires a nursing home to provide the care necessary for a resident to reach "the highest practicable level of functioning," which applies whether the resident's care needs are light or heavy. The nursing home staff should work to design an individualized care plan for any conditions the individual has or is at risk of having. Conditions such as pressure sores, dehydration, weight loss and even falls can be prevented with appropriate care. There should be no need for a resident to separately hire a private-duty caregiver.
2. The agreement claims that visits are allowed only during certain hours.
A nursing home resident has the right to be visited by a family member at any time of day. Frequent visits from family help to create a more home-like environment. If visits are at night, and the resident shares a room, the visit can take place in a lounge or other common area.
3. The agreement claims that the nursing home will not be responsible for a resident's injuries or for stolen or lost personal items.
Some agreements attempt to limit the amount or kinds of damages that the nursing home is required to pay if the resident is injured or is the victim of a crime. It is never in a resident's interest to waive or reduce a nursing home's responsibility. This is particularly true at the time of admission, when neither the resident nor the family know what might happen in the future.
4. The agreement claims that the resident gives up his right to a jury trial and agrees to have all disputes settled by arbitration.
A resident should not waive her right to a jury trial. A jury generally is better than an arbitrator in understanding a resident's point of view. Some arbitration agreements contain provisions that limit the damages that a nursing home might have to pay, or that reduce the resident's ability to investigate the nursing home's actions.
5. The agreement claims that the resident can be evicted for being difficult or uncooperative.
Nursing home residents often cannot help being difficult or uncooperative if they have dementia or other conditions that alter their mental states. Eviction is only allowed for one of six specified reasons, and none of those reasons allow eviction because a resident is difficult or uncooperative.
6. The agreement claims that the "responsible party" agrees to be fully accountable for all nursing home expenses.
The law prohibits a nursing home from requiring a family member or friend to become financially liable, however, some admission agreements have a family member or friend sign as a "responsible party." When a resident cannot handle his own financial matters, a nursing home can require a resident's family member or friend to sign as the resident's agent. The agent is responsible for paying the resident's money to the nursing home as appropriate, never his or her own money.
If a resident or family member sees an objectionable provision in an admission agreement, they should speak up, especially if the resident already has moved into her room in the nursing home. If the resident has not yet moved into the nursing home, the resident or family member should sign an admission agreement only after deleting or modifying the offending provisions. There is the risk that the nursing home will refuse admission, but avoiding that risk is not worth signing an illegal or unfair admission agreement.
The resident or family member can contact the Office of the State Long-term Care Ombudsman at 1-800-282-1206 for assistance and information.