An admission contract is a legally binding document. Here are important points you need to know before signing it.

The nursing home admission agreement is a document that has the potential to harm you or your relative. It is also often approached by hospitals and nursing homes as a means of getting families to sign over rights and give away their rights to arbitration. Many people have no idea how to approach this document. If ever there was a need for an elder advocate to protect your interests, dealing with this document is certainly that time.

Maria Dante had her dad admitted to Bloomingdale Nursing Home for physical and occupational therapy. Her dad Joseph was a patient in a nearby hospital. He had broken his hip at home.

After 4 days in the hospital, a discharge planner handed Maria a discharge notice stating that her dad would be discharged to a nursing home in 2 days. Maria was also handed a list of 60 nursing homes in the area and asked to choose 3.

Not knowing which facility to pick, she asked the discharge planner to help her decide. The discharge planner informed her that she was not aware of which local facility was good but that “people who went to Bloomingdale had reported a good experience.  She agreed to Bloomingdale, although she did not get to visit.

Her dad was admitted to Bloomingdale on a Friday. It turned out that this facility was understaffed with only temporary staffing on the weekend. This is why we strongly recommend that you get an advocate to help you with assisted living or nursing home placement.

When she visited on Saturday, she was asked by an admissions person to sign the nursing home admission agreement. She informed the admissions person that her dad was on Medicaid and that he would sign the paperwork. The admissions person said that Joe was “out of it” and she should sign the paperwork for him. Maria was assured that signing for her dad did mean that she would be responsible for his bill. Trusting the admissions person, Maria signed the agreement as the responsible person for Joe. She should not have signed even under pressure.

Because Maria signed the admissions agreement:

1. She may be held responsible for any payment

2. She can be sued

3. Her personal assets can be attached

The potential resident, his or her Guardian of Property or Power of Attorney will be asked to sign an admission contract as part of the admission process.

The admission contract is a legally binding document that defines and describes a resident’s legal relationship with the nursing home. Federal law requires the admission contract to specify the services the facility promises to provide in exchange for the payments made by, or on behalf of, the resident. No matter what an administrator or any staff member might say, a facility is legally bound to provide only what is stated in the contract.

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Components of the Contract

These components should be included in the admission contract:
– State the resident’s rights and obligations
– List the services included, the basic monthly fee and all items that cost extra (The facility can increase its charges, but only after it gives 45-day written notice to the residents involved.)
– State the nursing home’s policy regarding the right to apply for Medical Assistance benefits if the resident’s funds are exhausted during a stay in the facility
– State whether the facility is a Medical Assistance (Medicaid), provider
– Specify the nursing home’s procedure for filing a complaint
– Outline the facility’s transfer and discharge policies and how those policy decisions can be appealed
– Provide details about the leave of absence policies
– Provide information on the “bed hold” policy if the resident is admitted to a hospital.
– Provide information regarding an “involuntary discharge.”

Important Note: If a nursing home is a certified Medical Assistance provider, it must accept Medical Assistance payments when a resident’s funds run out.

When you sign an admissions agreement, you are bound by its terms. Here are important points to remember:

1. DO NOT sign an admission agreement in advance of admission or immediately upon admission. Wait at least a week or two so that you have time to evaluate the care. If the care is bad or you were pressured into going to a particular facility, and you are not happy in the first few days or weeks don’t sign the admissions agreement EVER.

2. When your elder is in a hospital prior to admission or if newly admitted, NEVER EVER, NEVER EVER many times over, discuss your elder’s financial situation UNLESS this admission is an admission from a home and said resident will be paying privately. If an elder goes into a nursing home for skilled care or physical therapy, Medicare will pay up to 100 days. There is no reason for the facility to know your finances unless you are staying long term and then only when the 100 days are over. Your financial situation is not anyone’s business ever.

3. Many admission agreements have arbitration clauses in them. This means that you cannot sue or seek retribution in the courts for anything that happens in the facility. You must go to mediation. This limits your capacity for redress if something happens in the facility. Before signing an admission agreement, make sure that the arbitration agreement clause has either been stricken from the agreement or crossed out and countersigned by a facility member of authority. NEVER sign an admission agreement that has an arbitration clause.

4. Never agree to an admission agreement clause that stipulates that your elder’s social security and pension payment will be automatically deposited in a nursing home’s account. Have these payments sent to you and write a check to the nursing home.  This will give you the power to withhold payment if the care is bad.

Remember the power is yours, not theirs. Do not allow the nursing home to force you into any decision that you are not comfortable with. The more power you have, the more power you have to make decisions that are in the best interest of your elder.

As for Maria Dante, she signed the admission agreement as responsible party with the arbitration clause in place. Unfortunately for her and her family, moving Joseph to Bloomingdale was catastrophic. They did not have the right to go to court for redress because she signed the arbitration agreement.

Be careful before signing and admission agreement and make sure that you have an Elder Advocate review it.

My Elder provides elder advocacy services to families. Talk to us about long-term planning, finding the right home for your loved ones, preventing crisis and abuse, and ensuring they receive the best care possible.

Photo Credits Cristian Newman and Anders Nord