What do I need to know before I sign a nursing home contract?

A fellow caregiver asked...

My mother, who lives in Los Angeles, needs to move into a long-term care facility. The facility's contract is so long that I can't see myself going through it line by line. Should I just sign it?

Expert Answer

Patricia L. McGinnis is the executive director of California Advocates for Nursing Home Reform.

No. Take the contract home, sit down, and read it carefully. If your mother is able, go over it with her. And if you can afford to, it's also a good idea to have the contract reviewed by an elder law attorney or other consumer advocate.

Although state and federal laws regulate nursing home admission agreements, this contract is written by the nursing home to protect its interests -- not yours or your mother's. Some contracts have confusing or misleading clauses. Mark any items you don't understand so that you can ask for clarification.

Keep in mind that the admission agreement is between the care facility and your mother, not you. In California, unless you control your mother's income or assets or you're her legal representative, she's the only person who must sign the agreement. Of course, if she's not able to sign, a legal representative or someone with power of attorney will need to sign on her behalf.

If you have any questions, sit down with the facility director. Use this time to clarify expectations and negotiate care needs and costs.

The biggest problem areas are payment issues. The contract should include a list of all charges, information on resident rights, and consent agreements. Read each of these carefully. The contract should also clearly state whether the facility accepts benefits such as Medi-Cal.

Some facilities may try to get you to pay privately for a period of time before claiming Medi-Cal or Medicaid. This is illegal.

Remember that your mother is the only one with financial responsibility to pay the nursing home bill. Some care facility agreements will attempt to get you to accept financial responsibility as a "responsible party." This sounds innocuous, but it isn't.

Words such as "responsible party," "guarantor," and "financial agent" are red flags -- and will leave you holding the bag if your mother's funding runs out. Make sure the document reads that you are her "agent," not "financial agent."

Likewise, avoid signing agreements that force you into binding arbitration. Accepting this would mean that you give up your right to sue in court. Finally, any agreement that includes a "waiver of liability" statement is illegal. If at some point your mother needs to be transferred to an acute care hospital, California facilities are required to inform you and/or your mother of the right to have the bed held for seven days. This should be clearly stated in the admission agreement.

Finally, keep a copy of the agreement and any additions to it together in one place.