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Posted: October 29, 2008

Taking Care When Admitting a Parent to Nursing Home Care

Read the Fine Print

Making the decision to place your parent in nursing home care is often an emotional and exhausting experience, as many families of the 1.5 million Americans currently residing in the nation's 16,000 nursing homes have doubtlessly found out before you.

Once it's your turn to make the move on Mom's or Dad's behalf, you will be worried about the kind of care your parent will receive and their emotional reaction to the move. And one of the last things you'll want to worry about is the paperwork, but the nursing home contract is one of the most important things to merit your attention.

The "Admission Agreement" is a legally binding contract between the patient and nursing home defining the services to be provided by the nursing home and laying out the responsibilities of the patient. Because this is a legal commitment, it is important that you and your parent know exactly what needs to be signed. Regardless of whether you've had a chance to read and understand what the contract says, once it is signed, your parent (and in some cases you) will be bound by the contents of the agreement.

Who Signs the Agreement?

Because the Admission Agreement obligates both the patient and the nursing home, whenever possible the patient should be the one to sign the agreement. Individual state laws, as well as federal laws, forbid a nursing home from requiring that a third party – even an adult child – sign the admission agreement in order for a patient to be admitted.

If your parent is not able to sign the contract because he is either unable to understand or unable physically to sign, then his legal guardian or his "agent" (acting with a valid Power of Attorney document) can sign on his behalf.

If you are in the position of having to admit your parent to a nursing home as his or her agent, you will essentially be committing that your parent will perform the "duties" he or she has agreed to by signing the contract.

The most important of these duties, of course, is to pay the agreed-upon charges promptly and in full.

Know What You Are Signing – And Why

If you are in the position of having to sign the agreement because your parent cannot, and if you are either your parent's guardian or legally appointed agent, AND if you are careful to sign the document properly, you will be agreeing to accept the responsibility for paying the patient's bills from the patient's own resources, not your own.

In order to be certain that you are signing as agent and thereby not making yourself personally responsible for your parent's bills, you should always consult with an attorney about the proper wording to use when signing any contract as agent. Elder law attorneys specialize in this area and are probably the most helpful.

In the difficult situation where your parent is unable to sign the nursing home admission agreement and there is no power of attorney or guardianship in place to provide you with a financial shield, and if the nursing home is refusing your loved one's admission without a signed agreement, you may feel that you have no choice but to sign. If you feel you must sign the nursing home admission contract, you must be even more careful to avoid personal financial obligation.

If you don't have power of attorney, and if you are not a legally appointed guardian, consult with an attorney before you sign anything on behalf of your parent. If you fail to do this, you may find yourself legally obligated to pay your parent's nursing home expenses from your own pocket, even if your parent has the funds to pay for care.

The "Responsible Party" Pitfall

If your parent signs the agreement, be very cautious about adding your signature as the "Responsible Party."

Too many nursing home agreements are not clear about the responsibilities of this so-called "Responsible Party." In most cases, however, somewhere in the fine print you will find that the "Responsible Party" agrees to pay if the patient does not. While a nursing home has every right to be paid for the care it provides, you should be careful to avoid this loophole.

Remember that if your parent has signed the agreement, then there is no valid reason for the nursing home to require you to also sign. Be careful if the nursing home representative explains that the "Responsible Party" is simply the family member to be contacted for emergency medical decisions or other important communication; in this case, a note to that effect in your parent's medical chart and a copy of your power of attorney or guardianship document should suffice.

Review the Agreement Carefully

The occasion of your parent literally being admitted to a nursing home is stressful in itself, and is not the time to review a nursing home admission agreement for the first time. Your mind and your heart will be with your parent, and not with the serious legal business at hand. Plan ahead, if at all possible.

In most cases, you will know in advance that your parent will be entering a nursing home. You will probably have a chance to tour and select the facility. During the tour is the time to ask for a complete admissions paperwork package. You will then have an opportunity to focus and review the documents carefully before you or your parent sign.

Be especially cautious if the agreement states that all parties agree to submit future disagreements to arbitration rather than the courts. We cannot give legal advice here, but many jurisdictions have ruled that such a clause is not legal. You may have the right to strike through this clause with your pen, eliminating it from the agreement. Always seek legal advice before you take this step.

When You Sign

Before you or your parent sign the admission agreement, be very careful to examine each page for blanks or spaces that have not been filled in. Never sign a contract that has blank areas that the nursing home representative says will be completed later. The nursing home representative should complete and sign each page first, and then you or your parent should sign. Stick to this routine, no matter what the representative urges.

Be sure that the nursing home representative has signed in every appropriate place, and then ask for copies of everything. Do not leave the nursing home without these copies, and do not be put off by a promise to have them ready for you to pick up later.

As stressful as placing a parent in nursing home care is, it will be a lot less stressful down the road if you follow the foregoing steps. And remember that an attorney can be a very valuable ally in helping you through this stage.

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Molly Shomer is a family caregiving specialist and licensed geriatric care manager. She is a nationally recognized expert on eldercare issues and the author of The Insider's Guide to Assisted Living. Her website is www.eldercareteam.com, and she can be reached at molly@eldercareteam.com.

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