6 Ways Nursing Homes Exploit Patients Through Admission Agreements

Nursing homes are required to have admission agreements for their residents. These agreements define the rights and responsibilities of both the facility and the resident, as well as provide information on services provided by the nursing home. Unfortunately, some unscrupulous nursing homes will sneak provisions into the agreement that can be very detrimental to the patient or the patient’s family.

Therefore, the admission agreement is an important document that should be read thoroughly before signing it in order to ensure all parties understand what is expected of them. It’s important to remember that once signed, this agreement becomes a legally binding contract between both parties. Therefore, it’s essential to carefully review each section of the agreement prior to signing it so you can be sure you understand exactly what rights and obligations you are agreeing to.

The following are six important things to watch out for when reviewing and signing a nursing home admission agreement:

1 – Provisions that make relatives financially responsible for the resident’s care should be avoided

Nursing homes may try to add provisions that make relatives financially responsible for costs of care or services. It is important for anyone signing on behalf of a patient, to make sure you only sign the agreement in the capacity of power of attorney (POA) of the patient. You should never be forced to sign as the “responsible party.”

2 – Watch out for forced arbitration clauses

For any facility that receives Medicare or Medicaid funds, federal law requires that the facility must not require any resident or his or her representative to sign an agreement for binding arbitration as a condition of admission to, or as a requirement to continue to receive care at, the facility and must explicitly inform the resident or his or her representative of his or her right not to sign the agreement as a condition of admission to, or as a requirement to continue to receive care at, the facility. (42 USC Section 483.70(n)(1))

None the less, nursing homes often try to insert a clause in the admission agreement that would deprive the patient and/or the patient’s family of the right to hold the nursing home accountable in court. Arbitration clauses can be difficult to spot, but they are important to look for. An arbitration clause is an agreement in which the resident is forced to have any dispute related to care or services provided by the nursing home (including neglect or abuse that causes injury or death) resolved in secrecy by a hired arbitrator rather than in a court of law. With arbitration, there is a very limited right to appeal any erroneous decision by the arbitrator. The parties must also pay the arbitrator an hourly fee to resolve the claim.

It is important not to agree to such a clause, since it limits the ability of the resident or their family to seek justice through legal action. There is never a reason to sign a forced arbitration clause at the time of admission. It is almost never advantageous for a patient to submit to arbitration; however, the parties can always mutually agree to arbitration if and when a dispute arises if the patient rather than at the time of admission.

3 – Beware of provisions that shorten the time period you have to file a claim

Many nursing homes will sneak in language that shortens the time period to file a claim for negligence or abuse. This is usually done by reducing the statute of limitations, which is the time limit set by law to file a lawsuit or be forever barred from doing so. This shortened time frame is intended to deter patients from being able to hold the facility accountable for its actions. This tactic may not be enforceable, but one should avoid signing any agreement that contains such a provision.

4 – Look out for any provision that attempts to place limits on damages you can recover

Another provision one should look out for is language that seeks to limit the amount of damages a resident or their family can recover in the event of injury or death due to negligence or abuse. Nursing homes may try to insert limits or caps on the amount of compensation a family might receive, so it’s important to make sure any agreement does not contain such language. These caps or limits attempt to limit the patient or the patient’s family from holding the facility accountable regardless of how much human suffering is caused, or how egregious the neglect or abuse is.

5 – Avoid any provisions that place restrictions on visitations

Family members should be able to come and visit on different days, on different shifts, and at different times in order to ensure they are having their needs properly attended to. Nursing home staff are typically very aware of which patients have family that visit, and when such visitors are present because they are concerned that family will witness substandard care. Nursing homes may try to include clauses that limit or restrict the amount of time visitors are allowed in the facility. They may also try to restrict the number of visitors allowed at a given time. It is important that any agreement does not include any such language and that it emphasizes the importance of family members being able to visit their loved ones whenever they choose. Patients and families should not be asked to forfeit their right to have visitors check on the patient whenever they choose.

6 – Look out for clauses that allow discharge without proper cause

Make sure you understand what the contract says about a resident leaving the facility. A patient should not be subject to being discharged at the unfettered discretion of the nursing home. For example, a patient should not be discharged because the facility wants to fill the patient’s bed with another prospective patient for whom they can charge a higher fee. Being evicted or forced to leave should apply only if:

It is necessary for the resident’s welfare
The resident’s health has improved such that nursing home care is no longer required
The health or safety of other individuals is endangered
The resident unreasonably fails to pay
The facility ceases to operate

When signing an agreement with a nursing home, it is important to read the contract carefully and ensure that all of your rights as a patient or family member are protected. Pay special attention to provisions relating to arbitration clauses, time limits for filing claims, attempts to limit damages, visitation restrictions and what circumstances could lead to discharge from the facility. If you don’t understand something in the contract or disagree with any part of it, speak up! Don’t sign anything until you have reviewed every detail thoroughly and can confidently confirm that everything is fair and reasonable.

Frequently Asked Questions Regarding Nursing Home Agreements:

Q: If I sign a nursing home admission agreement, can I be financially responsible for the bills?

A: Yes, that is possible. To avoid being financially responsible, you should make sure you sign in the capacity of the patient’s power-of-attorney (POA) only and ensure there is no language in the agreement otherwise making you responsible for payment. Be careful not to sign as the responsible party, unless you want to be held financially responsible for the nursing home charges.

Q: Can I be forced to sign an arbitration clause as a condition to be admitted to a nursing home?

A: No. For any facility that receives Medicare or Medicaid funds, federal law requires that the facility must not require any resident or his or her representative to sign an agreement for binding arbitration as a condition of admission to, or as a requirement to continue to receive care at, the facility and must explicitly inform the resident or his or her representative of his or her right not to sign the agreement as a condition of admission to, or as a requirement to continue to receive care at, the facility.

Q: Why should I not agree to restrictions on visitations in a nursing home?

A: Nursing homes may try to include clauses that limit or restrict the amount of time visitors are allowed in the facility and also restrict the number of visitors allowed at one time. It is important to visit patients on different shifts, and at different times, so the nursing staff must ensure that the patient is receiving proper care at all times or risk having a visitor report the substandard care. Therefore, it is important that any agreement does not include this type of language and emphasizes the importance of family members being able to visit their loved ones whenever they choose.

Jeff Powless is an attorney and the author of the 2017 book, Abuses and Excuses: How To Hold Bad Nursing Homes Accountable. Abuses and Excuses breaks new ground in helping patients and families hold bad nursing homes accountable, sharing a wealth of insider strategies and insights. It’s an eye-opening account of corporate greed, acts of neglect and abuse, an insidious industry culture of cover-up, and the actual harm that inevitably befalls vulnerable nursing home patients all across the country with shocking frequency.