Before You Sign That Nursing Home Contract…

Last month, I wrote about problematic nursing home contract clauses, such as a requirement that the person who signs the contract be responsible for payment of the nursing home bill out of his or her own funds. Now I’ll give you some tips on what to do if you see such clauses in a contract you are about to sign.

Imperative, absolutely imperative is to not allow yourself to be cornered time-wise into selecting a nursing home or signing a nursing home contract. Stay ahead of the ball if at all possible. I realize that this may not always be the situation—when I had to find a nursing home for my mother, I had 2 hours! This occurred as I’d been snookered into believing the chosen facility didn’t have an available bed. It did. It’s just that they discovered my mother didn’t have the big bucks to privately pay for extended care. Not being an elder law attorney or geriatric care manager at the time, I didn’t know about financial discrimination nursing homes often engage in and do so without much fear of sanction by various enforcement agencies. So, the best tool you have on your side is to buy yourself as much time as possible in the very pressured process of finding a nursing home for your loved one. But you have to know how to do it.

Most situations requiring eventual nursing home placement begin with an acute medical crisis requiring hospitalization. As soon as all the hospital admission work for your loved one is completed, find out the identity of the hospital’s discharge planner for the unit to which your loved one was admitted. Begin discussions immediately of the choices you have for nursing home care if it becomes evident that your loved one cannot immediately return home. If you can afford it, call a geriatric care manager or elder law attorney on how best to evaluate area nursing homes and guide you through this white-water rapids called “discharge planning”. If your funds are limited, at least call Citizens for Better Care, and ask them to mail you literature on how to evaluation a nursing home: 1-800-833-9548 or (313)832-6387. They have many valuable publications, such as: The Consumer Guide to Nursing Homes in Southeast Michigan, and The Michigan Long-Term Care Reader.

In starting the evaluation process, I always advise clients to take out a map. Draw ever-widening circles around your home until you arrive at a distance that you are unwilling or unable to travel. For most, it’s a distance that can be traveled within 30 minutes. Then plot the nursing homes on the map from the list of nursing homes you got from the hospital discharge planner. Start with those in the circle closest to your home. Call each facility and ask for the admissions director. Go through your list of questions—it could take 20 to 30 minutes per facility.

After you’ve called all geographically viable facilities, look through all your notes. Pare down the stack to five. Make sure those that are in your final five accept both Medicare and Medicaid. Do an on-site visit to each one. Especially take the time to ask visiting family members of residents what they think of the care their loved-one is getting. This is the best barometer. With your list of questions at the ready, go through this on-site evaluation. After you’ve done all final five (ideally, a family member or friend can take on some of these on-site evaluations), pare your list down to three, in order of preference. Give this list to the discharge planner as soon as possible. This optimizes your chances of getting your loved-one into the preferred facility, as the hospital discharge planner can immediately begin calling these facilities to inquire of their bed availability. Because bed availability at each facility changes on a daily basis, you need three facilities as possibilities.

For the final three, get copies of their nursing home contracts. A red flag should go up if the facility refuses you this request—as they have been known to do. You will have to decide whether you still want to go forward with this possible placement, knowing that when the time comes to sign the contract, you will not have adequate time to thoroughly read it and ask questions. If you get a copy, consider yourself fortunate. Take it home. Read it carefully. Look for the problematic clauses cited in last month’s article. Consider buying a half-hour to an hour of elder law attorney time to review the contract and incorporate suggested modifications. The attorney can at least let you know what you might be up against if you fear refused admission due to a modified contract. Many a time a family might want their loved-one to go to a particular facility because they know the care to be good, and choose to put up with a bad contract while learning how to advocate for their loved-one in other ways.

Despite your best efforts, the nursing home might refuse. This will press you to sign the contract on a “take-it-or-leave-it” basis at time of admission—a very hectic time for all concerned. Nonetheless, if you spot a troublesome clause, write your concerns next to it, or include your concern on a separate paper and asked it be stapled to the contract. This at least puts the nursing home on notice that you’re more savvy than most—perhaps discouraging them from pressing you further on other unfair practices. Bottom line is, the nursing home industry generally has all of us over the proverbial barrel, unless we are independently wealthy. There are still things we can do to let them know that we’re less appealing of a target.

As the adage goes, knowledge is power. We can at least minimize and if we are lucky, prevent being taken advantage of, as us elder advocates struggle with how to more effectively intervene on your behalf. Remember, your best available tools right now are TIME and KNOWLEDGE. Use them!

Sue E. Fabian
Geriatric Care Manager
Elder Law Attorney
Licensed Professional Counselor

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