Moving yourself or a loved one into a nursing home can be stressful. You may feel rushed or pressured into signing paperwork quickly. Take time to understand the admissions contract. This will help protect you and your loved ones.
Before you sign an admissions contract
1. Read the contract carefully. Don’t feel pressure to sign it without carefully reviewing it.
2. Take your time. You don’t have to sign it on the day you get the paperwork.
3. Don’t rely on the admissions staff to explain the contract. Staff members may not fully understand legal terms, and they are not required to protect your interests. If possible, have an elder law lawyer look over the admissions agreement for you before you sign it. If you need help finding an elder law lawyer, you can contact the Vermont Bar Association Lawyer Referral Service.
4. You can make changes to the contract. You can cross out contract provisions you don’t agree with. Put your initials next to each change.
Keep in mind: The following information applies to nursing homes. It may not apply to other types of long-term care facilities such as residential care homes or assisted living facilities.
Understand daily costs and extra charges
The contract should clearly state what you will be charged.
- If you are paying privately (out of your pocket), the contract should state:
- the home’s basic daily rate (amount charged to the resident per day)
- what services and items are included in the daily rate
- what services and items are not included in the daily rate and their costs.
- If you are covered by Medicare and/or Medicaid, the contract should state:
- what services and items Medicare and Medicaid benefits cover
- what services or items are not covered by Medicare or Medicaid benefits and their costs.
- Important: The facility cannot require residents who are covered by Medicaid to receive services that are not covered under Medicaid benefits.
Medicaid and Medicare Rights
Nursing homes cannot require you to:
- waive your right to Medicaid or Medicare
- promise that you are ineligible for Medicare or Medicaid benefits,
- promise that you will not apply for Medicare or Medicaid benefits, or
- pay a deposit before you can be admitted or get care if you receive Medicare or Medicaid.
However, nursing homes can refuse to accept Medicaid as a payment source. If you want to find a nursing home that takes Medicaid, you should ask if they take Medicaid when you are looking for a nursing home. You may need to start early and put your name on waitlists for homes that take Medicaid.
Residents’ rights
Nursing homes are not allowed to ask you to
- waive residents’ rights, or
- to agree that it will not be the home’s fault if they lose your personal property.
Options counseling and discharge planning
When you are being admitted into a Vermont nursing home, the home must ask you if you want to learn about other ways you can get long-term care. This is called “options counseling.” They should provide this counseling to you if you want it. If you want to move out of a nursing home, the home should help you figure out how to move to the place you want to go. This is called “discharge planning.”
Forced arbitration
Nursing facilities cannot make you agree to “arbitration” to resolve disputes as a condition for admission. If you agree to resolve disputes through arbitration in the admissions contract, you give up your right to a jury trial to resolve disputes. Arbitrators may not be a neutral decisionmaker. They may want to decide in the facility’s favor to ensure the facility will use them again in the future.
- If the admissions contract includes language that waives your right to a jury trial, consider crossing it out. Then put your initials next to the change.
- If you have signed an arbitration agreement, you can rescind (undo) the agreement within 30 days of signing.
- For more information, see “Nursing Home Arbitration Agreements: Do Not Lose your Rights.”
Third-party financial guarantees
Nursing homes cannot require a third party to be financially responsible for a resident’s nursing home bills. This means that nursing homes cannot ask or require family members or friends to pay the resident’s bills.
Watch out for words in the admissions agreement like “responsible party,” “resident representative,” “agent,” “co-signer,” “guarantor,” “personally liable,” “private-pay guarantor,” and “surety.” If you sign something using these words, you could be agreeing to pay nursing home bills out of your own pocket if the resident can’t pay.
If you are the resident’s representative
The nursing home can ask you to pay the resident’s bill with the resident’s money. If you have financial power of attorney or are the resident’s guardian, it’s legal for the nursing home to require you to use the resident’s money for their care.
But the home cannot ask a representative to pay with their money. If they ask, you have the right to say no. If you sign an admissions agreement as a resident’s legal representative, be sure it is clear in the contract that you are only agreeing to use the resident’s money to pay for the nursing home.
For more information on this topic, see “Can a Nursing Home Force a Resident’s Family and Friends to Pay the Bill?” from Justice in Aging.
Need help?
If you have questions or need help with residents’ rights, contact the Vermont Long-Term Care Ombudsman Project. We’re here to help ensure that Vermont nursing home residents are protected.
Rules and laws
- Admissions and payment policy: Vermont Nursing Home Rule 3.16
- Options counseling: Vermont Nursing Home Rule 3.16(g)
- Note: CFR means Code of Federal Regulations
- Resident rights: 42 CFR 483.10; 42 CFR 483.15 (a)(2)(i)
- Admissions, transfer and discharge rights: 42 CFR 483.15
- Daily costs and charges: 42 CFR 483.10(g)(17)-(18); Rule 3.16(c)-(e)
- Medicaid and Medicare rights: 42 CFR 483.15 (a)(2),(4); Rule 3.16(e)
- Care planning: 42 CFR 483.21(c)
- Forced arbitration: 42 CFR 483.70(m); 42 CFR 483.70(n)
- Third-party financial guarantees: 42 CFR 483.15 (a)(3); Rule 3.16(b); 42 CFR 483.15(a)(3)
