Nursing Home Admission Agreements

By David L. McGuffey, Certified Elder Law Attorney

Depending upon the size and affiliation of the nursing facility, an admission agreement (or admission contract) may be from four to ten pages or more. Some contracts are all inclusive. Other contracts are shorter with additional papers that have to be signed separately. Examples of additional paperwork not included in the smaller contract, but have to be signed, would be authorizations to photograph the resident or requests for beautician services.

Contracts may include, but are not limited to the following information:

• Resident's personal and insurance information may be listed.
• Contracts may request your acknowledgment of the payment sources the facility will accept.
• Conditions for collections of non-payment may be listed.
• Room rates and what they include will be listed.
• Bed holding policy and associated charges should be stated.
• Nursing services and therapies provided may be listed.
• Contracts may list charges for therapies, durable medical equipment, pharmacy items, physician services, laundry, beautician or barber services
• Contracts may specify services not included such as telephone, cable, sitters and private nurses, and transportation services such as ambulances.
• Contracts may include a summary of services and expenses Medicare and Medicaid will and will not cover.
• Contracts often state the advance payment policy and requirements for private pay residents, co-payments, or services not provided by Medicare or insurance.
• The refund policy for private pay residents should be listed.
• You may be asked for authorization for the facility to take the resident's picture.
  

  It is becoming a common practice for nursing homes to take pictures of residents. You may find their pictures on medication charts and medical charts. Nurses are to compare the pictures to residents before administering medications or treatment. Pictures on these charts help to insure that the correct person is receiving their medications and treatments

• You will be asked to agree and sign a patient certification and authorization to release information and payment request. These forms are needed and used for Medicare, Social Security, and insurance companies.
• Patient's Rights and Responsibilities - You will be asked to acknowledge that you have received this list. Federal Law requires the nursing home to give you this list.
  

  A patient's responsibility list may include items residents are expected to provide such as transportation, pay ancillary charges, give the facility at least one months notice when applying for Medicaid, and to give the facility notice if terminating their agreement.

• Transfer and discharge policies should be stated.
• Grievance procedure may be stated.
• You will supply the resident's insurance or Medicaid HMO or MCO provider.
• You will be asked to fill out a patient's financial statement. This information will ultimately be requierd if you apply for Medicaid assistance. However, you should consult an Elder Law Attorney BEFORE applying for Medicaid.
• You will be asked if you have applied for Medicaid or received any information from Medicaid.
• The facility wants to know if they will need to assist you in applying for Medicaid. This information enables the nursing home to plan ahead and assist you in a timely manner. If you have applied for Medicaid, the facility would like to know when you expect to finalize the process.
• The nursing home will ask for the resident's primary doctor's name.
• It is crucial to know if the resident's current doctor is willing to visit the resident at the nursing home on a regular basis. If the doctor will not visit the nursing home, the resident's legal representative will need to choose another doctor from the nursing home staff list. The nursing home representative will not usually recommend a doctor. You have two options:
  

  1. If you know the doctors who are listed and feel comfortable with choosing a doctor from those listed, you may do so.
  2. You can wait a few hours to choose a doctor. Within that time you could call the resident's physician for suggestions from him or do other research. The selection of a physician will need to be made within a short period of time. The doctor must be notified as soon as possible so that he can visit the resident within 48 hours of the resident's admission. This is to comply with state regulations.

• Be prepared to talk about signing paperwork to address end of life decisions. Nursing homes ask questions that we are often not prepared to answer. These questions would include: whether or not the resident should be resuscitated in the event of a medical emergency; do you want the resident to have a feeding tube; or do you want antibiotics administered. Different types of paper work address these questions. If the resident is not to be resuscitated, the advocate will be asked to sign a Do Not Resuscitate (DNR) form (see Appendix G). This will become a part of the resident's medical chart at the nurse's station. The advocate should be asked at each Plan of Care meetings if the Do Not Resuscitate should be continued or initiated.
• A Resident's Profile is a questionnaire listing the resident's likes and dislikes, clinical history, cognition, moods, and behavior. This information should be requested by every facility. The information provided could tremendously enhance the resident's quality of life if utilized by the caregivers.
• Authorization for Beautician or Barber shop services.
  

  Nursing homes employ or contract with beauticians and barbers to provide services for residents. The services provided are hair cuts, sets and comb outs, permanents, and manicures (with and without polish). You can request that the services be provided either on a regular basis or as the advocate requests them. Example: You request that Mrs. Smith have her hair cut once a month and has it set and combed out weekly. You may request a permanent every three months. You may add or delete services at any time. All of the beautician and barber services are private pay. The services are included on the nursing homes monthly statement.

• Authorization for laundry services.
  

  Advocates may choose to have the facility launder clothing or do the resident's laundry at home. Personal laundry charges are normally very reasonable. Medicaid patients do not pay for personal laundry to be done by the facility. When families launder clothes at home they avoid additional expense, cut down on loss of clothing, and have an opportunity to mend damaged clothing.

If you are helping your loved one make the transition into a nursing home and you would like to speak with someone experienced with Long-term care financing issues, you may want to contact a member of the National Academy of Elder Law Attorneys. These lawyers help you with issues such as Wills, powers of attorney, Medicaid planning and estate planning. If you live near Chattanooga, TN or Dalton, GA, you can contact us. Otherwise, you can find a local "NAELA" member by going to www.naela.org.