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Paying for Long-Term Care | Elder Law Advice

Posted by Sivia Law on May 22, 2019 12:00:00 PM

old-lady-with-nurse

It is hard enough for our Elder Law clients to make the decision to enter a loved one into long-term care – but add complex contracts, lack of legal understanding, and emotional unrest and it becomes easy for your client to become overwhelmed. What happens when the loved one doesn’t qualify for Medicaid, or cannot pay for services through other means? After the contracts are signed, and the loved one is tucked in to their new residence, who might be on the hook for financial expenses?

Nursing Home Contracts

Contracts can be very intimidating for our Elder Law clients, particularly when dealing with the need for placing a loved one into another’s care. When a loved one needs long-term or nursing care, someone will have to take on the responsibility to read, understand, and sign a contract with the facility for their services. That person can be the individual, a family member, a Power of Attorney for the individual, a social worker, or any other person assuming the responsibility for the individual. Thankfully, being responsible for an individual does not necessarily require financial responsibility, too.

Nursing home contracts cover the facility’s expectations for payment, rules, and other details. These contracts educate the individual and/or their representative of what to expect from the facility as well – such as services provided, covered expenses, and other costs. Within these contracts are also requirements regarding financial responsibility that must be carefully reviewed. A responsible party could find themselves financially liable for their loved one’s bill if they improperly sign such provisions.

While nursing home contracts are no longer permitted to solicit alternative sources of payment, some such contracts still exist. Signing such a provision puts a client at odds for a lengthy and expensive court battle to show that their agreement to accept financial responsibility was invalid. The applicable rules can be found at 42 CFR 483. More specifically, 42 CFR § 483.15 covers Admission, Transfer, and Discharge Rights; § 483.15(a)(3) specifically states that long-term care facilities are prohibited from requesting or requiring that a third party take on financial responsibility for their loved one’s care.

Remember, just because a facility is not permitted to seek out a financially responsible party other than the resident, this does not mean that someone cannot willingly take on such responsibility. In other words, any competent person can sign a loved one into care and take on the burden of ultimately footing the bill – but, the last thing anyone would want to do is take it on accidentally. Be sure to advise clients to read and understand all contracts, but certainly take care with regard to contracts for costly medical care services for an individual in your care. Encourage clients to seek your guidance before signing nursing home contracts. Blindly signing a contract because it seems like the only way to get your loved one the services they need is not their only option. A facility, understandably, will seek out satisfaction of debts from whomever they are legally entitled to pursue.

Financial Responsibilities

Whoever ends up taking on the financial liability for long-term care costs will be responsible for securing payment from wherever possible to cover the expenses. This process typically entails lining up Medicaid assistance, selling assets, and making sacrifices along the way. Financially responsible parties will be expected to liquidate whatever assets are available to cover the bill. If the assets are not substantial enough to cover what is owed, the facility can seek repayment from the individual’s estate upon death.

Residents in long-term care also have legal rights to appropriate care. 42 CFR § 483.15(c) discusses various rights regarding transfers and discharging. Long-term care facilities cannot transfer or discharge a resident unless they meet certain criteria. Discharge or transfer is permitted when:

  • The facility cannot meet the needs of the resident,
  • The resident’s health has improved to where services are no longer needed,
  • The resident poses safety or health risks to others,
  • The resident fails to submit the necessary paperwork to qualify for Medicaid or Medicare, is denied such benefits, and refuses to self-pay, or
  • When the facility ceases to operate.

Thus, a facility must try to work with residents and their families to provide the best solution for all. Residents are entitled the opportunity to appeal a decision to end services. If a family feels that their loved one has been unfairly denied further services, contact the state ombudsman for long-term care and consider other remedial action.

Taking steps to place a loved one into care is not easy – mentally or logistically. There are many hurdles to overcome during the process. We can help clients who feel overwhelmed by the process or feel that they are not succeeding on their own in working with Medicaid, long-term care facilities, healthcare providers, or the like. Loved ones deserve the care they need and there are resources to help make them affordable – without a family member footing the bill himself.

 

You're not in this alone. Let our expert legal team help. Call one of our Elder Law attorneys today: 618.659.4499

Topics: Elder Law, elder law lawyer, elder care

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