THE NURSING HOME CONTRACT
Nursing homes, like any business, often provide many pages of pamphlets, brochures, hand outs, and other materials. Typically, these promotional materials make claims on the value and quality of the services provided. But all these extraneous materials become essentially irrelevant after the resident enters the nursing home. For the consumer, there is only one document that matters: the CONTRACT.
Often called the “admissions agreement,” the nursing home contract details the rights and obligations of both the nursing home and the resident. What the contract says, and what it omits, can determine the outcome of any dispute or disagreement between the nursing home and the resident. By signing the contract, the resident agrees to all of the terms and conditions in the contract, whether or not the contract has been read or understood.
The nursing home may give you other papers, such as the Resident’s Bill of Rights, a list of services, and/or medical consent forms. Have the nursing home representative explain anything you do not understand.
And, before you sign, you should remember to:
- Ask the nursing home to give you copies of all papers you sign, and be sure the copies
include the nursing home representative’s signature.
- Make sure the contract itself clearly states that these other papers are included as legally
binding parts of the contract.
- Finally, be very careful what you sign, and don’t sign any form that has blanks or spaces
to be filled in later.
PAYING FOR NURSING HOME COSTS
What is the Basic Daily Rate?
The basic daily rate is the standard charge the nursing home bills to all residents, which covers the fundamental services every resident receives, including rent for the room, housekeeping (e.g., bed linen laundry), meals, and general nursing care.
It is important to understand all the services and amenities, which are not included in the basic daily rate. The fees and charges for “supplemental services” often increase the expense of the nursing home dramatically, to the surprise and dismay of the recipient of the bill. Often services expected to be included in the basic daily rate, such as extra nursing services, pharmaceutical needs and telephone services, are extra charges.
Does the basic daily rate include all the nursing care I will need?
Probably not. The basic daily rate includes “basic,” or “general,” nursing services. What is provided with basic or general nursing care may vary from nursing home to nursing home. But the basic daily rate often does not include many common nursing services. Physical therapy, glucose monitoring, incontinent care, hand or tube feeding, etc., might each involve extra fees. In addition, prescription and non prescription medicines are not included in the basic daily rate.
How can I avoid being surprised by added costs?
To understand which additional services (and additional costs) a resident will require, the first place to look is the Resident Assessment. This assessment is required by law, and analyzes what kind of nursing and other care the resident needs. For example, if the new resident is incontinent, the assessment should indicate this fact.
To get an accurate assessment of the costs, make sure you understand what is covered by the basic daily rate. Then, ask the nursing home representative to discuss the resident assessment, which describes all the nursing and therapeutic services the resident requires. Ask the nursing home to explain to you what additional nursing and other services, beyond what is covered by the basic daily rate, are necessary. The nursing home should give you an itemized list of supplemental services, and the costs above the basic daily rate.
Also, decide what additional amenities you want (telephone, beauty care, etc.), and add these costs in. Request the nursing home to give you an estimate of the total bill. You should have this estimate long before the end of the first month so that you know exactly what to expect.
What costs should I expect to pay myself if I am receiving Medicaid or Medicare coverage?
For residents receiving Medicaid:
Medicaid will pay all medical expenses required by qualified recipients. This normally includes not only services provided under the basic daily rate, but all supplemental nursing and medically-indicated services and supplies (including prescription and non-prescription drugs)--charges that would be extra for private-pay residents.
However, Medicaid will not cover non-medical expenses. Amenities and services such as local telephone, and barber or beauty shop services, and some others must be paid for by the resident. Every Medicaid resident should understand clearly what services and amenities they wish to receive which are not covered by Medicaid. This is especially true since the $30.00 monthly income allowance is so limited (see the section “MEDICAID and LONG TERM CARE” for more details).
For residents receiving Medicare:
Medicare coverage is restricted to “skilled care” in nursing homes, and covers only a limited time period. Skilled care coverage includes the basic daily rate, and all additional medically necessary services (therapies, pharmaceuticals, etc.).
Medicare will pay for the first 20 days of skilled care, and will provide partial coverage for days 21 through 100 (with the Medicare resident required to make co-payments for days 21 through 100). Medicare does not pay for nursing home care beyond the first 100 days for each benefit period.
Medicare skilled-care coverage is very limited; Medicare has a restricted definition of what qualifies for “skilled care” coverage. Only a very few people in nursing homes are receiving Medicare skilled-care coverage.
The Medicare patient should be aware of the limits of Medicare coverage, and be prepared to make the sizable co-payments required. If the resident has supplemental health insurance (a “Medigap” policy), check to see whether the policy covers the co-payments of days 21-100.
Back to Nursing Homes Consumer's Guide
