It was not until two years later, after her mom had passed away, that the nursing home threatened to sue Marylou for an unpaid balance for her mother’s care. Marylou discovered that one of the documents she signed was an agreement to guarantee payment for her mother’s care. Marylou’s mom was on MassHealth for most of her stay, and her income was paid to the nursing home each month. If Marylou had not provided a personal guarantee for payment, she would not be facing a lawsuit.
Just recently I met with Tom, whose mother suffered significant injuries from an accident in a nursing home. Tom was inquiring about a potential lawsuit against the facility, but a review of the Admissions Agreement that Tom signed on his mother’s behalf revealed that he waived that right before she even moved into the facility. One of the provisions in the contract was an agreement to submit any dispute to arbitration rather than to a court of law.
Nursing homes are specifically prohibited from requiring residents to agree to arbitration or requiring a third party to guarantee payment for a resident’s care, but they can seek such guarantees on a “voluntary” basis. The problem is that people usually do not realize the significance of what they are “voluntarily” signing.
Had Marylou or Tom consulted an attorney before they signed the Admissions Agreement, they would have known their rights and ensured that any objectionable provisions were removed from the Agreements.
The message here is not that nursing homes are bad. In fact, most facilities train their staffs to properly disclose prospective residents’ rights. You must advocate for your own rights, however, and in order to do that you must first understand that you need independent review and representation in the nursing home admission process.
Nursing home residents are protected under federal and state laws. The Nursing Home Reform Law (known as OBRA ’87) promoted individualized care and protection for residents of any nursing home that participates in Medicare or Medicaid, regardless of their source of payment. Massachusetts nursing home residents are further protected by the consumer protection statutes enacted by the Attorney General (AG). The AG regulations provide that any violation of OBRA ’87 and similar laws intended to protect nursing home residents is a violation of the consumer protection statute, and the resident may be able to collect attorney’s fees and costs in addition to multiple damages.
Here are some of the protections these laws provide:
*Potential residents may not be forced to waive important rights or agree to unfair terms (such as an agreement to provide a third-party guarantee for payment or to submit any dispute to arbitration). The reality, however, is that folks are overwhelmed and want the available bed for their loved one, so they sign whatever they are asked to.
* Nursing homes are prohibited from discriminating against potential residents based on source of payment. They can ensure that they will get paid, but they can not discriminate against someone who will need to apply for Medicaid (MassHealth). The reality is that some nursing homes do give preference to potential residents who have the ability to pay privately. Some facilities will even request a guarantee from the resident or the resident’s family that they will privately pay for a certain period of time – say six months.
* Discharge of a resident for behavior or mental health problems is quite common and it is accomplished by a practice known as “dumping” where the facility sends the resident out for a psychiatric “evaluation,” and then refuses to readmit the resident. In reality, families do not know that the refusal to readmit is a violation of the law and triggers their rights to an appeal.
* A proposed transfer from one room to a non-Medicare certified bed requires 30 days written notice and the resident has the right to appeal and refuse the transfer. In reality, when Medicare coverage ends nursing homes frequently claim that certain beds are non-Medicaid rooms and for private pay only. In some cases, no written notice is issued and the family does not know that one should have been issued, much less that there is a right to appeal.
* For rehabilitation therapies, Medicare reimbursement rules do not require “progress.” The resident must need “skilled nursing services” or “skilled rehabilitation services” and even if the resident is not making progress, the facility has the obligation to provide services to “maintain” the resident’s condition and ensure that the resident’s ability to perform Activities of Daily Living does not diminish.
The reality is that residents are frequently terminated from this benefit because they are not making progress, and the families do not know that they have the right to appeal.
These are just a few of the common issues. If you are faced with the need to place a loved one in a nursing home, be sure to have the contracts reviewed by an Elder Law Attorney before you sign to ensure that you and your loved one are properly protected.