Before a senior gets admitted to a nursing home, he or she will need to sign a contract or other admission’s agreement. A contract is a legally binding document that defines the conditions under which the senior is admitted. It is important for seniors and caregivers alike to review and understand the contract in its entirety to ensure optimal care, protection and provisions. Some of the most important terms of a nursing home contract define the circumstances under which a resident can be admitted, transferred or discharged and how they will pay for the services provided.
Under federal regulation, 42 CFR 483.12(a)(2), a nursing home facility must allow a resident to stay in the facility under the following conditions: 1. his or her needs cannot be met, 2. the individual’s health improved, 3. the facility services are not necessary, 4. the resident is unsafe in the facility, 5. the individual is a danger to other residents if he or she continues to stay, 6. the resident has failed to pay or apply for benefits to pay after “reasonable and appropriate notice,” and or 7. the facility goes out of business. These are the sole grounds for a nursing home facility to be able to discharge a resident.
A facility may not discharge residents when the resident entered for the purpose of rehabilitation, which has now concluded or the resident or family, etc. refuse to sign an admissions contract. Even though the facility can’t force the individual out, the resident is still responsible to pay privately for the care or apply for public benefits to cover the cost of services.
According to the National Association of Consumer Advocates (NACA), a nonprofit association of attorneys and consumer advocates committed to representing consumers’ interests, there are problems with recent trends in nursing home contracts. Some nursing home facilities are requiring third parties to apply for Medicaid, recertification of Medicaid, and pay any legal fees incurred by the nursing home because of failure to apply for or maintain Medicaid, as well as expanding the definition of “representative” and/or “sponsor” to include legal liability beyond that required by federal and state laws .
In New York State, under 10 NYCRR §415.3(b)(1) & (6), there is no third party liability in these situations. As a condition of admission, expedited admission, or continued stay, there is no third party liability or guarantees. However, nursing homes may seek a third party to sign an agreement on behalf of a resident if that third party has access to the resident’s funds, such as an agent under power of attorney, joint account holder, or court-appointed guardian. Third parties are never personally liable. Their liability on extends to their access and use of a nursing home resident’s funds.
Furthermore, according to 10 NYCRR §415.3(b)(3) – (4), there is no waiver of federal rights. A nursing home may not require a resident to waive the right to Medicare or Medicaid. Also, they may not require a resident to guarantee that he or she will not apply for public benefits to pay for care. This means they cannot require a resident to be a private payer.
For further information on nursing home care, contact a New York elder law attorney. The goal of an elder law attorney is to help secure appropriate medical treatment and advise on a plan to secure payment of nursing home care. Further, they will help protect your loved ones and preserve assets to the greatest extent possible under the law. Their tasks in this situation include, but are not limited to, providing an opinion letter for a nursing home, assisting in review of all nursing home contracts, and advising family on proper signing of a contract. i.e.“Resident Representative” vs. “Responsible Party” and protect a client’s right to privacy.
The lawyers at Tanya Hobson-Williams, PC are skilled in all aspects of elder law and are dedicated to representing its clients with diligence and compassion during emotional times. Contact the experienced New York elder law attorneys at Tanya Hobson-Williams, PC for a consultation by calling (718) 210-4744 or by filling out our contact form.