The Centers for Medicare & Medicaid Services (CMS) has released the 2019 federal guidelines for how much money the spouses of institutionalized Medicaid recipients may keep, as well as related Medicaid figures.
In 2019, the spouse of a Medicaid recipient living in a nursing home (called the “community spouse”) may keep as much as $126,420 without jeopardizing the Medicaid eligibility of the spouse who is receiving long-term care. Called the “community spouse resource allowance,” this is the most that a state may allow a community spouse to retain without a hearing or a court order. While some states set a lower maximum, the least that a state may allow a community spouse to retain in 2019 will be $25,284.
Meanwhile, the maximum monthly maintenance needs allowance for 2019 will be $3,160.50. This is the most in monthly income that a community spouse is allowed to have if her own income is not enough to live on and she must take some or all of the institutionalized spouse’s income. The minimum monthly maintenance needs allowance for the lower 48 states remains $2,057.50 ($2,572.50 for Alaska and $2,366.25 for Hawaii) until July 1, 2019.
In determining how much income a particular community spouse is allowed to retain, states must abide by this upper and lower range. Bear in mind that these figures apply only if the community spouse needs to take income from the institutionalized spouse. According to Medicaid law, the community spouse may keep all her own income, even if it exceeds the maximum monthly maintenance needs allowance.
The new spousal impoverishment numbers (except for the minimum monthly maintenance needs allowance) take effect on January 1, 2019.
TO LEARN MORE ABOUT THE BENEFITS OF MEDICAID PLANNING click here.
Home Equity Limits:
In 2019, a Medicaid applicant’s principal residence will not be counted as an asset by Medicaid unless the applicant’s equity interest in the home is less than $585,000, with the states having the option of raising this limit to $878,000.
In order to qualify for Medicaid, a nursing home resident’s income must not be above a certain level. Most states allow individuals to spend down their excess income on their care until they reach the state’s income standard. But other states impose an “income cap,” which means no spend-down is allowed.
ITHACA, N.Y. — Most nursing homes had fewer nurses and caretaking staff than they had reported to the government for years, according to new federal data, bolstering the long-held suspicions of many families that staffing levels were often inadequate.
The records for the first time reveal frequent and significant fluctuations in day-to-day staffing, with particularly large shortfalls on weekends. On the worst staffed days at an average facility, the new data show, on-duty personnel cared for nearly twice as many residents as they did when the staffing roster was fullest.
The data, analyzed by Kaiser Health News, come from daily payroll records Medicare only recently began gathering and publishing from more than 14,000 nursing homes, as required by the Affordable Care Act of 2010. Medicare previously had been rating each facility’s staffing levels based on the homes’ own unverified reports, making it possible to game the system.
The payroll records provide the strongest evidence that over the last decade, the government’s five-star rating system for nursing homes often exaggerated staffing levels and rarely identified the periods of thin staffing that were common. Medicare is now relying on the new data to evaluate staffing, but the revamped star ratings still mask the erratic levels of people working from day to day.
Stan Hugo with his wife, Donna, who is a resident at the Beechtree
Center for Rehabilitation and Nursing in Ithaca, N.Y. Mr. Hugo
tracks staffing levels at the skilled nursing facility.
At the Beechtree Center for Rehabilitation & Nursing here, Jay Vandemark, 47, who had a stroke last year, said he often roams the halls looking for an aide not already swamped with work when he needs help putting on his shirt.
Especially on weekends, he said, “It’s almost like a ghost town.”
Nearly 1.4 million people are cared for in skilled nursing facilities in the United States. When nursing homes are short of staff, nurses and aides scramble to deliver meals, ferry bedbound residents to the bathroom and answer calls for pain medication. Essential medical tasks such as repositioning a patient to avert bedsores can be overlooked when workers are overburdened, sometimes leading to avoidable hospitalizations.
“Volatility means there are gaps in care,” said David Stevenson, an associate professor of health policy at Vanderbilt University School of Medicine in Nashville, Tenn. “It’s not like the day-to-day life of nursing home residents and their needs vary substantially on a weekend and a weekday. They need to get dressed, to bathe and to eat every single day.”
David Gifford, a senior vice president at the American Health Care Association, a nursing home trade group, disagreed, saying there are legitimate reasons staffing varies. On weekends, for instance, there are fewer activities for residents and more family members around, he said.
“While staffing is important, what really matters is what the overall outcomes are,” he said.
While Medicare does not set a minimum resident-to-staff ratio, it does require the presence of a registered nurse for eight hours a day and a licensed nurse at all times.
The payroll records show that even facilities that Medicare rated positively for staffing levels on its Nursing Home Compare website, including Beechtree, were short nurses and aides on some days. On its best staffed days, Beechtree had one aide for every eight residents, while on its lowest staffed days, there was only one aide for 18 residents. Nursing levels also varied.
The Centers for Medicare & Medicaid Services, the federal agency that oversees nursing home inspections, said in a statement that it “is concerned and taking steps to address fluctuations in staffing levels” that have emerged from the new data. This month, it said it would lower ratings for nursing homes that had gone seven or more days without a registered nurse.
Beechtree’s payroll records showed similar staffing levels to those it had reported before. David Camerota, chief operating officer of Upstate Services Group, the for-profit chain that owns Beechtree, said in a statement that the facility has enough nurses and aides to properly care for its 120 residents. But, he said, like other nursing homes, Beechtree is in “a constant battle” to recruit and retain employees even as it has increased pay to be more competitive.
Mr. Camerota wrote that weekend staffing is a special challenge as employees are guaranteed every other weekend off. “This impacts our ability to have as many staff as we would really like to have,” he wrote.
New rating method is still flawed
In April, the government started using daily payroll reports to calculate average staffing ratings, replacing the old method, which relied on homes to report staffing for the two weeks before an inspection. The homes sometimes anticipated when an inspection would happen and could staff up before it.
Payroll records at Beechtree show that on its highest staffed days, it had one aide for every eight residents, but there was only one aide for 18 residents at the lowest staffing level.CreditHeather Ainsworth for The New York Times
“They get burned out and they quit,” said Adam Chandler, whose mother lived at Beachtree until her death earlier this year. “It’s been constant turmoil, and it never ends.”
Medicare’s payroll records for the nursing homes showed that there were, on average, 11 percent fewer nurses providing direct care on weekends and 8 percent fewer aides. Staffing levels fluctuated substantially during the week as well, when an aide at a typical home might have to care for as few as nine residents or as many as 14.
A family council forms
Beechtree actually gets its best Medicare rating in the category of staffing, with four stars. (Its inspection citations and the frequency of declines in residents’ health dragged its overall star rating down to two of five.)
To Stan Hugo, a retired math teacher whose wife, Donna, 80, lives at Beechtree, staffing levels have long seemed inadequate. In 2017, he and a handful of other residents and family members became so dissatisfied that they formed a council to scrutinize the home’s operation. Medicare requires nursing home administrators to listen to such councils’ grievances and recommendations.
Sandy Ferreira, who makes health care decisions for Effie Hamilton, a blind resident, said Ms. Hamilton broke her arm falling out of bed and has been hospitalized for dehydration and septic shock.
“Almost every problem we’ve had on the floor is one that could have been alleviated with enough and well-trained staff,” Mrs. Ferreira said.
Beechtree declined to discuss individual residents, but said it had investigated these complaints and did not find inadequate staffing on those days. Mr. Camerota also said that Medicare does not count assistants it hires to handle the simplest duties like making beds.
In recent months, Mr. Camerota said, Beechtree “has made major strides in listening to and addressing concerns related to staffing at the facility.”
Mr. Hugo agreed that Beechtree has increased daytime staffing during the week under the prodding of his council. On nights and weekends, he said, it still remained too low.
His wife has Alzheimer’s, uses a wheelchair and no longer talks. She enjoys music, and Mr. Hugo placed earphones on her head so she could listen to her favorite singers as he spoon-fed her lunch in the dining room on a recent Sunday.
As he does each day he visits, he counted each nursing assistant he saw tending residents, took a photograph of the official staffing log in the lobby and compared it to what he had observed. While he fed his wife, he noted two aides for the 40 residents on the floor — half what Medicare says is average at Beechtree.
“Weekends are terrible,” he said. While he’s regularly there overseeing his wife’s care, he wondered: “What about all these other residents? They don’t have people who come in.”
This article was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. The author is a reporter for Kaiser Health News.
A version of this article appears in print on , on Page A1 of the New York edition with the headline: Nursing Homes Routinely Mask Low Staff Levels. Order Reprints | Today’s Paper | Subscribe
Nursing home neglect and abuse is often difficult to detect, and families should be on the lookout for common warning signs for physical, emotional and financial abuse.
Common warning signs of physical abuse are:
Untreated bedsores, pressure sores, wounds, cuts, bruises, or welts
Abnormally pale complexion
Bruises in a pattern that would suggest restraints
Excessive and sudden weight loss
Fleas, lice, or dirt on or in the room
Poor personal hygiene, unpleasant odors or other unattended health problems
Torn clothing or broken personal items
Bleeding around private parts
Bruises around the breast/genital region
An unexpected look of fear from the elder when aide may be present
Common warning signs of emotional abuse are:
Intimidation through yelling and threats
Ignoring the patient
Isolating the patient from other residents and/or activities
Terrorizing the patient
Mocking the patient
Financial exploitation is another form of abuse. An unscrupulous caregiver may:
Misuse checks, accounts, or credit cards
Steal money, steal checks, or steal belongings
Authorize withdrawals or transfer of monies
Steal the patient’s identity
No family is exempt from any of these possibilities. Abuse affects the rich and poor. Suffering sustained by the elderly ranges from financial, to emotional and physical. Abuse escalating to physical can result in severe infections, amputations, dehydration and, unfortunately, death. A lawsuit should be filed on behalf of your loved one to get the justice your family deserves. Compensation may cover the costs of treatment and recovery, as well as compensation for non-financial hardships such as pain and suffering.
If you suspect elder abuse of any kind speak up and demand answers of those in charge.
Feel free to contact me for more information or inquire about a lawsuit.
Via Donovan Slack, USA TODAY, and Andrea Estes, The Boston Globe
Don Ruch’s family thought round-the-clock care would help him recuperate, but he ended up in intensive care in septic shock, suffering from “severe” malnutrition, bedsores on his pelvis and back, a burn on his right thigh and a trauma wound. USA TODAY
An analysis of internal documents shows residents at more than two-thirds of Department of Veterans Affairs nursing homes last year were more likely to have serious bedsores, as well as suffer serious pain, than their counterparts in private nursing homes across the country.
The analysis suggests large numbers of veterans suffered potential neglect or medication mismanagement and provides a fuller picture of the state of care in the 133 VA nursing homes that serve 46,000 sick and infirm military veterans each year.
More than 100 VA nursing homes scored worse than private nursing homes on a majority of key quality indicators, which include rates of infection and decline in daily living skills, according to the analysis of data withheld by the VA from public view but obtained by USA TODAY and The Boston Globe.
Four VA facilities – nursing homes in Bedford, Massachusetts; Chillicothe, Ohio; Tuscaloosa, Alabama; and Roseburg, Oregon – lagged private nursing home averages on 10 of 11 indicators. At all four, about a third of residents were given anti-psychotic drugs – almost twice as much as in the private sector. The FDA has said such drugs are associated with an increased risk of death in elderly patients with dementia.
“They should be assessing individuals and doing what they can to manage it,” said Robyn Grant, director of public policy and advocacy at the National Consumer Voice for Quality Long-Term Care. “And if it’s not working, they should be trying different things.”
The VA, which has argued that its residents are typically sicker than those in private facilities, has tracked the detailed quality data for more than two years but has kept it secret, depriving veterans of potentially crucial health care information.
VA ‘evaluating’ what information to release
VA Press Secretary Curt Cashour has declined to answer questions about whether or when the agency planned to release the quality information, as well as nursing home staff data the VA has compiled dating to 2004. He also declined to say when the VA would release inspection reports the agency has kept secret for more than a decade.
“We cannot work with this administration or any administration to fix the VA if we don’t have the information,’’ Jones said.
Acting VA Secretary Peter O’Rourke told the CBS affiliate in Dallas last week that VA officials were “evaluating exactly what is the most appropriate for us to put out there and that will support continuous improvement and then also will provide good decision-making information for veterans.”
He called the USA TODAY and Globe reporting on the VA nursing home ratings “fake news.”
Federal regulations require private nursing homes to disclose voluminous data on the care they provide. The federal government uses the data to calculate quality measures and posts them on a federal website, along with inspection results and staffing information. But the rules don’t apply to the VA.
Playing ‘hide the ball’ with nursing home data
The VA has used similar data internally to track quality at its nursing homes as far back as 2011, according to a report in October that year from the nonpartisan Government Accountability Office. At that point, the agency monitored at least two dozen factors, including how many residents had bedsores or were in serious pain. But none of the information was released.
The VA launched another tracking system in May 2016. It now measures 11 indicators – the same as those used for private nursing homes – and assigns star ratings based on the indicators, which can be clues to larger problems with overall quality. For example, high rates of falls or bedsores may indicate neglect.
WHEN IT COMES TO BEDSORES, PRESSURE SORES, DECUBITUS ULCERS IT’S OFTEN HELPFUL TO READ WHAT OTHERS HAVE ASKED. YOU MAY BE ABLE TO BENEFIT FROM SOME OF OUR FREQUENTLY ASKED QUESTIONS BELOW.
If the patient was at a hospital first and then a nursing home which do we sue?
It always depends on individual and medical circumstances but the possibility exists that both are liable. Often an injury begins in a hospital, may not be reported and/or is overlooked or neglected on intake at the second facility where it may get worse or lead to infection and other medical issues.
What if the patient is too ill to appear in court?
This is not an issue and often the case with bedsore victims. For bedsore and pressure sore lawsuits there’s a legal team that includes experienced bedsore litigators, and medical professionals that can testify based on patient medical records and treatment or lack of and improper treatment. As well as other expert witnesses that look into hospital procedures, policy and practices and determine if any federal violations were evident or standards of procedure were not met. Medical records and pictures of wounds are used.
How much does it cost to sue?
There is no fee to you unless we win. When we accept a case we put in the resources and hours of our bedsores legal team because we are confident of a successful outcome based on the facts of the case. If we take on your case it’s because we see huge upside financial potential for the victim or family of the victim. We work on contingency–no upfront fee or time billed to you. When you win we get an agreed upon portion of the award. NOTE: Most firms generally work this way for these lawsuits as it is usually cost prohibitive for client on hourly or other fee basis as expenses get incurred for expert witnesses, medical experts, trial prep, trial, review etc.
Will beginning a lawsuit get better care for the victim?
Once a hospital or nursing home knows a bedsore lawsuit is possible, often the care and treatment of the patient improves. This is because now they know they are under scrutiny and may be even further liable legally if not giving the proper care and medical attention after the sores have been documented by family and bedsore lawyers. Additionally, our law firm will let you know the standards of care that is necessary for you or your loved one. We can even help guide you on the best way to discuss issues with the doctor or staff and get the desired results.
I want to sue – does it take long? Does my dad have to appear in court?
Timing of a case varies. With expertise and experience and a hands-on approach we move swiftly. The size of our firm allows us to focus on cases so they don’t get lost in the shuffle. Unlike some other law firms, our legal team of attorneys, paralegals, research assistants, medical experts and more, have the experience and knowledge to avoid time lags. Many times cases are seattled before even going to court. Of course, the plaintiff has a say in this decision and we do what is best for our client.
Do I need money to sue-what does contingency mean?
You will not need to lay out any money. We handle all of our bedsore and pressure sore negligence or malpractice cases on a contingency fee basis. That means that we only charge a legal fee if we are successful and recover money for you. Our fee is typically 33 1/3% of the net recovery after the costs and disbursements that we advance are deducted. The contingency fee may be even lower depending on the facts of the case and the reason the sores happened. With a free consultation, a bedsore law firm that advances all of the necessary costs, and a contingency fee arrangement, you get our reputable law firm with no out of pocket expenses.
How do I know if I have a good bedsore lawsuit? The nurse said the sores were caused by my father.
Don’t put much credence in the opinion of anyone that isn’t a legal expert. Even a medical professional or doctor doesn’t have the legal knowledge and they or facility administrator may even try to persuade you against a bedsore or pressure sore lawsuit. Such tactics aren’t new. Don’t be a victim twice. Consult with legal professionals when medical ones let you down. Then you can use your best judgement on how to proceed with your lawsuit.
Rochelle Youner, who lives at the Hebrew Home at Riverdale, a nursing home in the Bronx, walked up to a kiosk in a common area of the home’s first floor and pressed a button below a small icon depicting a baseball glove.
“That’s the real stuff — that’s a mitt, all right,” Ms. Youner, 80, said, smelling the leathery fragrance emitted from the kiosk, which attempts to bring the ballpark, or at least the smell of it, to the residents.
Many of the Hebrew Home’s residents were born and raised in the Bronx and are lifelong fans of the Yankees, with memories of visiting Yankee Stadium stretching back to the eras of Mantle and DiMaggio, and even earlier to Gehrig and Ruth.
But many of these older fans also suffer age-related memory loss. So the home, which often finds seasonal pegs for its reminiscence therapy programs, has timed its latest program to opening day at Yankee Stadium on Monday by erecting the kiosk with the therapeutic goal of recreating the distinctive smell of the ballpark.
“Too bad we can’t be there in person,” Ms. Youner said.
This is the point of the kiosk: to once again take these fans out to the ballgame.
For residents who followed the Dodgers, the scents recalled childhood days at Ebbets Field in Brooklyn, and for Giants baseball fans, they brought back afternoons at the Polo Grounds in Manhattan, in the days before both teams decamped for the West Coast.
The kiosk features six ballpark scents — hot dogs, popcorn, beer, grass, cola and the mitt — in separate push-button dispensers installed at a height accessible to residents in wheelchairs.
It was recently installed in the permanent “Yankees Dugout” exhibition of team memorabilia at the nursing home, which includes seats, a turnstile and a locker from the old Yankee Stadium.
The olfactory exhibit, called “Scents of the Game,” is meant to evoke long-forgotten memories from the home’s 785 residents, many of whom have Alzheimer’s disease or dementia.
Many have difficulty with short-term memories but with some prompting can summon long-term ones, such as detailed recollections of childhood visits to ballparks decades ago, said Mary Farkas, director of therapeutic arts and enrichment programs at the Hebrew Home, where baseball has also been used in art therapy and poetry workshops.
Prompting these ballpark memories helps connect many residents with the joy they felt at the time and also helps stimulate their cognition, Mrs. Farkas said.
Dr. Mark W. Albers, a neurologist at Massachusetts General Hospital in Boston, who studies the effect of scent on patients with neurodegenerative disease, said the Hebrew Home’s memory exhibit touches on fairly new territory in sensory therapy in trying to resurrect positive recollections in a small population of patients who share certain common memories.
Memory loss in older patients can often cause “an erosion of familiarity” and be accompanied by feelings of disorientation, he said. Unearthing pleasant memories from earlier years through sensory stimulation may help patients feel more stable, Dr. Albers said.
Of course, he added, memories of Yankee Stadium might bring back very different emotions for fans like him, who root for the Boston Red Sox.
For Renee Babenzien, 89, the hot dog aroma triggered recollections of vendors selling franks with mustard and sauerkraut.
“The way they smelled at the game,” she said, “you couldn’t help but stop the guy walking up the aisle selling hot dogs.”
Al Cappiello, 68, smelled the fragrances and recalled the sensory explosion he experienced the first time he walked into Yankee Stadium as a boy.
“I couldn’t believe the colors,” he recalled. “The green grass, the brown dirt of the infield — man, I was in heaven.”
Up until then, he said, watching the Yankees meant watching games on a black-and-white television set, with the action being called by Mel Allen, the Yankees broadcaster.
And so, during his first time at the stadium, Mr. Cappiello recalled, “I told my brother, ‘I don’t hear Mel Allen,’ and he said, ‘No, that’s only on TV.’
He did see Yogi Berra, tossing a ball with teammate Johnny Blanchard, and he managed to get Berra’s autograph.
Ms. Youner also recalled being surprised by how different the ballpark seemed in person.
“The first time I walked into the ballpark, I noticed that everything was bigger — even the basepaths were so much wider,” she said.
For Terry Gioffere, 90, who grew up in the Bronx, the smells evoked memories of watching her hero, Roger Maris — although in more recent decades she became a Derek Jeter disciple.
For Joan Jackson, 84, the smells took her back to her first trip to Yankee Stadium, at age 6, but also reminded her of the role that the stadium played in helping her raise five children in the Bronx after her husband died in 1973.
“I had to do something to lift the kids up, so I said, ‘Let’s do something fun and go to Yankee Stadium,’” she recalled. “The kids fell in love with baseball,” she said, and going to games helped hold the family together.
Even Joe Pepitone, a star for the Yankees in the 1960s who spoke at the kiosk’s recent unveiling, said the smells reminded him of playing in Yankee Stadium as a rookie first baseman in 1962.
He had anticipated that the stadium would smell like hot dogs and sauerkraut, he said, “and sure enough, there was that smell of the ballpark, and you could smell it all over.”
For Frances Freeman, who grew up in Brooklyn rooting for the Dodgers, the kiosk’s beer smell did provoke a reaction. The 103-year-old woman steered her wheelchair to the beverage table and grabbed a beer.
Since scent and memory are intimately linked, using the smells of the ballpark presented “a chance to reach the residents in a special way, as a tool to unlock doors in their memories,” said David V. Pomeranz, the Hebrew Home’s chief operating officer.
Mr. Pomeranz said the kiosk idea grew out of a discussion he had with Andreas Fibig, chief executive of International Flavors and Fragrances, a Manhattan-based company that creates scents for perfumes and other products, as well as flavors for food and beverages.
The company did not have to venture to any ballpark to capture the smells — its perfumers created them from the firm’s vast catalog of fragrances, said Matthias Tabert, the company’s senior manager for strategic insights.
Scents are especially powerful in stirring memories because they register with the brain in a more direct and primal way than other senses, Mr. Tabert said. “So when you smell something, it triggers memories almost instantaneously and serves almost like time travel, to bring you back to a seminal moment.”
Some ballpark staples did not make it into the array of scents, such as peanuts and Cracker Jack. Though both could be developed as fragrances with no traces of real peanuts, the home decided against it to avoid alarming people with peanut allergies, Mr. Pomeranz said.
For Al Schwartz, 91, the scent kiosk reminded him of first visiting Yankee Stadium in the late 1930s, when 60 cents could buy a seat in the bleachers and $1.10 a seat in the grandstand.
Mr. Schwartz said the smells reminded him of the joy of watching Joe DiMaggio snare a fly ball and the sadness of learning in 1979 that Yankees catcher Thurman Munson had died in an airplane crash.
Mr. Schwartz said he attended at least two monumental events at Yankee Stadium. His aunt took him on July 4, 1939, when Lou Gehrig announced his retirement because of a terminal disease and called himself “the luckiest man on the face of the earth.”
Mr. Schwartz also recalled a 1942 charity exhibition in which Babe Ruth made a post-retirement appearance and struggled to hit a home run against the great pitcher Walter Johnson in front of 70,000 fans.
“The crowd kept on him, and he finally hit it out of the park, to right field,” he recalled. “The best part was seeing him run around the bases, that way he used to.”
Read the agreement carefully before signing.
Nursing Home Agreements can be complicated and confusing
Admitting a loved one to a nursing home can be very stressful. In addition to dealing with a sick family member and managing all the details involved with the move, you must decide whether to sign all the papers the nursing home is giving you. You don’t need to decide at the moment or alone. Nursing home admission agreements can be complicated and confusing, so what do you do?
It is important not to rush, but rather to read. If possible, have your attorney review the agreement before signing it. Read the agreement carefully because it could contain illegal or misleading provisions. Try not to sign the agreement until after the resident has moved into the facility. Once a resident has moved in, you will have much more leverage. But even if you have to sign the agreement before the resident moves in, you should still request that the nursing home delete any illegal or unfair terms.
Two items commonly found in these agreements that you need to pay close attention to are a requirement that you be liable for the resident’s expenses and a binding arbitration agreement.
The Responsible party
A nursing home may try to get you to sign the agreement as the “responsible party.” It is very important that you do not agree to this. Nursing homes are prohibited from requiring third parties to guarantee payment of nursing home bills, but many try to get family members to voluntarily agree to pay the bills.
If possible, the resident should sign the agreement him- or herself. If the resident is incapacitated, you may sign the agreement, but be clear you are signing as the resident’s agent. Cross out the words ‘responsible party’. Don’t think because it is printed the whole document will need to be re-done. Signing the agreement as a responsible party may obligate you to pay the nursing home if the nursing resident is unable to. Look over the agreement for the term “responsible party,” “guarantor,” “financial agent,” or anything similar. Before signing, cross out any terms that indicate you will be responsible for payment and clearly indicate that you are only agreeing to use the resident’s income and resources to pay.
Many nursing home admission agreements contain a provision stating that all disputes regarding the resident’s care will be decided through arbitration. An arbitration provision is not illegal, but by signing it, you are giving up your right to go to court to resolve a dispute with the facility. The nursing home cannot require you to sign an arbitration provision, and you should cross out the arbitration language before signing.
The following are some other provisions to look out for in a nursing home admission agreement.
Private pay requirement. It is illegal for the nursing home to require a Medicare or Medicaid recipient to pay the private rate for a period of time. The nursing home also cannot require a resident to affirm that he or she is not eligible for Medicare or Medicaid.
Eviction procedures. It is illegal for the nursing home to authorize eviction for any reason other than the following: the nursing home cannot meet the resident’s needs, the resident’s heath has improved, the resident’s presence is endangering other residents, the resident has not paid, or the nursing home is ceasing operations.
Waiver of rights. Any provision that waives the nursing home’s liability for lost or stolen personal items is illegal. It is also illegal for the nursing home to waive liability for the resident’s health.
New Obama-era rules designed to give nursing home residents more control of their care are gradually going into effect. The rules give residents more options regarding meals and visitation as well as make changes to discharge and grievance procedures.
The Centers for Medicare and Medicaid finalized the rules — the first comprehensive update to nursing home regulations since 1991 — in November 2016. The first group of new rules took effect in November; the rest will be phased in over the next two years.
Here are some of the new rules now in effect:
Visitors. The new rules allow residents to have visitors of the resident’s choosing and at the time the resident wants, meaning the facility cannot impose visiting hours. There are also rules about who must have immediate access to a resident, including a resident’s representative. For more information, click here.
Meals. Nursing homes must make meals and snacks available when residents want to eat, not just at designated meal times.
Roommates. Residents can choose their roommate as long as both parties agree.
Grievances. Each nursing home must designate a grievance official whose job it is to make sure grievances are properly resolved. In addition, residents must be free from the fear of discrimination for filing a grievance. The nursing home also has to put grievance decisions in writing. For more information, click here.
Transfer and Discharge. The new rules require more documentation from a resident’s physician before the nursing home can transfer or discharge a resident based on an inability to meet the resident’s needs. The nursing home also cannot discharge a patient for nonpayment if Medicaid is considering a payment claim. For more information, click here.
CMS also enacted a rule forbidding nursing homes from entering into binding arbitration agreements with residents or their representatives before a dispute arises. However,a nursing home association sued to block the new rule and a U.S. district court has granted an injunction temporarily preventing CMS from implementing it. The Trump Administration is reportedly planning to lift this ban on nursing home arbitration clauses.
In November 2017, rules regarding facility assessment, psychotropic drugs and medication review, and care plans, among others, will go into effect. The final set of regulations covering infection control and ethics programs will take effect in November 2019.