Recently, after one month in the hospital with end stage...

1 answer | Last updated: Sep 02, 2010
A fellow caregiver asked...

Recently, after one month in the hospital with end stage liver failure, my mother was transferred to a nursing home/rehabilitation facility to receive hospice care. They believed she had weeks to live. She lost the ability to care for herself because of her extremely weakened state. Because she has survived the nursing home's "two week" intensive comfort care limit, she has since been transferred to the "residential" section but is still considered to be under hospice care. When the transfer was being arranged I was assured that Medicare/Medicaid would cover the cost. I submitted all the necessary paperwork so that they could process a Medicaid application for her. I have now been given a "contract for admissions" agreement and asked that we sign it. I don't know where to turn because I know she could never afford to pay for this care should Medicaid refuse. I don't want them to throw her out because I don't feel right signing it either. What can I do?

Expert Answers

Once your mother and your family choose Medicare hospice care, Medicare will cover all her hospice medical treatment while she's in the nursing facility, including medications and nursing to keep her as comfortable and pain-free as possible. But Medicare hospice only covers your mother's care and comfort. It does not cover the cost of her room and board in the nursing facility.

That's where Medicaid can step in, if your mother is eligible. Medicaid can cover the full cost of the nursing home's "residential" fees. What you (and the nursing home) are concerned about is the possibility that Medicaid would decide that, at least initially, your mother is not eligible, or that she has to pay part of the nursing home costs herself. Medicaid might do this if your mother has some income -- such as Social Security benefits, a pension or other regular payments -- or assets. If so, the nursing home is entitled to be paid from that income or assets, at least until your mother qualifies for Medicaid. So, the nursing home wants your mother to sign a contract agreeing to pay for her room and board, if she has the money to do so, until Medicaid pays. This is a perfectly legitimate request.

Problems can arise, though, if the nursing home asks a family member -- rather than your mother -- to sign the residence contract. If your mother is now too ill to understand and sign the contract herself, a family member who has power of attorney  for her can do so on her behalf. This would obligate your mother to pay for her own nursing home costs if Medicaid doesn't. But this would NOT obligate the family to pay any costs out of their own pockets.



Some nursing homes try to get a family member to sign a contract agreeing to personally pay for nursing home costs if Medicaid doesn't, or to pay the difference between what Medicaid pays and what the nursing home charges non-Medicaid residents. But requiring a family member to personally guarantee nursing home costs is illegal under federal law, and you should not allow yourself to be convinced to "voluntarily" sign such an agreement. If you'd like more information on this law and how to prevent the nursing home from pressuring you to sign a contract guaranteeing payment, contact the non-profit National Senior Citizens Law Center, which works to protect nursing facility residents and their families.