Nursing Home Admission Agreement Review
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ELDER LAW
Nursing Home Admission Agreement Review in Kentucky
Nursing home admission paperwork is handed to families at the worst possible moment. A parent is being discharged from hospital, a bed is available today, and someone pushes a thick contract across a desk and asks an adult child to sign it.
Most people sign. Almost nobody reads it. And a meaningful number of adult children discover months later that they personally agreed to pay a bill running to tens of thousands of dollars, because of one line describing them as the responsible party.
An admission agreement review takes very little time and can prevent exactly that. Federal law gives residents and families real protections in these contracts, and admission agreements do not always reflect them.
If you have been handed admission paperwork, send it to us before you sign. Call (502) 348-2108.
What the Review Covers
A nursing home admission agreement is a contract governing payment, the services provided, the circumstances in which a resident may be transferred or discharged, and how disputes are resolved. It is usually long, densely drafted, and presented as non-negotiable.
The review reads it against the protections federal law provides to residents of facilities participating in Medicare or Medicaid, identifies terms that are unenforceable or unfavourable, and tells you clearly what you would be agreeing to and in what capacity you are being asked to sign.
Where terms need to be struck or amended, we say so, and in our experience facilities frequently accept changes when they are raised, because the offending provisions often should not be in the agreement to begin with.
The Responsible Party Trap
If you read nothing else on this page, read this. It is the most common and most costly problem in nursing home admissions.
A facility cannot require you to guarantee payment personally
Federal law is explicit. A facility participating in Medicare or Medicaid may not require a third party to guarantee payment as a condition of admission, expedited admission, or continued stay. That protection exists precisely because families sign under pressure at a moment of crisis. An adult child signing an admission agreement is not required to become personally liable for their parent care.
What a facility may ask
A facility may require a person who has legal access to the resident income or resources, such as an agent under a power of attorney, to agree to use those funds to pay the facility from the resident own money. That is a materially different obligation from a personal guarantee, and the distinction turns on how the agreement is worded and how you sign it. Signing in a representative capacity, clearly identified as agent or attorney-in-fact, is not the same as signing as a guarantor.
This is why the signature page matters as much as the contract. We look at exactly what you are being asked to sign, in what capacity, and what the agreement says about your personal obligations. Where the language creates personal liability, it can usually be struck.
What We Look For
Personal guarantee and responsible party language
The provisions that would make a family member personally liable, and the signature block that would achieve the same result by describing you as something other than the resident agent.
Arbitration clauses
Facilities may ask residents to agree to binding arbitration, but under federal rules a facility cannot make signing an arbitration agreement a condition of admission, must explain it, and must allow a period in which the resident may rescind it. Whether to agree at all is a decision worth making deliberately rather than by default.
Required private pay periods
A facility cannot require a resident to waive Medicaid or Medicare eligibility, or to promise a period of private payment before applying, as a condition of admission.
Transfer and discharge provisions
The circumstances in which the facility says it may move or discharge a resident, measured against the limited grounds federal law actually permits and the notice residents are entitled to.
Bed-hold and readmission terms
What happens if the resident goes into hospital, whether the bed is held, who pays for it, and what readmission rights exist.
Charges beyond the basic rate
What is included in the daily rate and what is billed separately, along with how the personal needs allowance is handled.
Signing on Behalf of a Parent
The capacity in which you sign is the single most important practical detail, and it takes ten seconds to get right.
If you hold a durable power of attorney, you sign as agent, and the signature should make that explicit, naming your parent and identifying yourself as their attorney-in-fact. You are binding your parent, not yourself.
If you do not hold a power of attorney, you generally should not be signing at all, and the fact that a facility is asking you to is a signal that something needs addressing. This is often the moment families discover no documents were ever put in place. See durable power of attorney, and be aware that if capacity has already been lost the route may be a guardianship petition.
Keep a complete copy of everything signed, including every attachment and any separate arbitration agreement. Families frequently have no copy at all, which makes any later dispute considerably harder.
Why This Matters for the Medicaid Application
Admission is usually the beginning of a Medicaid process, and decisions taken now affect it.
01
Do not agree to spend down before advice
Facilities and discharge planners often tell families to spend assets before applying. Much of what people are told to spend can frequently be preserved, and money spent cannot be recovered. Speak to us first.
02
The private-pay promise
Any suggestion that admission depends on paying privately for a set period should be examined rather than accepted. Federal protections limit what a facility may require in this area.
03
Application deadlines and cooperation
The agreement may impose obligations about applying for benefits and providing documentation. These are usually reasonable, but they should be understood, because failing them can create liability.
04
Income and the personal needs allowance
Once Medicaid is paying, most of the resident income goes to the facility, less a personal needs allowance and any protected income for a spouse at home. The agreement should reflect that rather than contradict it.
05
Estate recovery afterwards
Kentucky recovers from the estates of recipients under 907 KAR 1:585, using a definition that reaches beyond probate property. Planning for that is part of the wider picture. See Medicaid planning.
The weeks around an admission are when the most money is lost and the most can be saved. Call (502) 348-2108 before decisions are made.
If You Have Already Signed
Plenty of families come to us after the fact, sometimes after receiving a bill addressed to them personally. That is not the end of the matter.
Bring the agreement. An obligation a facility was not permitted to require as a condition of admission may not be enforceable against you, and how you signed, and what the document actually says, will determine where you stand.
If a separate arbitration agreement was signed, check the date. Federal rules require a period during which a resident may rescind such an agreement, and that window may still be open.
And if a discharge or transfer is being threatened, residents have specific rights to notice and to appeal. Those rights are time-limited, so raise it immediately rather than waiting to see what happens.
- Locate the complete signed agreement and every attachment
- Check how you signed: personally, or expressly as agent
- Look for responsible party, guarantor or personal liability language
- Check whether a separate arbitration agreement was signed, and when
- Keep every bill, notice and item of correspondence from the facility
- Note any discharge or transfer notice and its date immediately
- Confirm whether a power of attorney was in place at the time of signing
Admission Agreement Reviews in Bardstown and Louisville
Thomas Hamilton has practiced elder law in Kentucky since 2014 and is a member of the Kentucky Bar Association Elder Law Section and the National Academy of Elder Law Attorneys. Admission agreement reviews are a small piece of work that regularly prevents a very large problem.
We work with families across Nelson, Bullitt, Washington, Marion, Larue, Hardin, Anderson, Spencer and Jefferson counties, from 117 E. Stephen Foster Avenue in Bardstown and the First Trust Centre, 200 S. 5th Street in Louisville.
Reviews can usually be turned around quickly, because we know these situations do not wait. The initial consultation is free. Schedule a consultation.
Mistakes Families Make at Admission
Signing as responsible party
The single most expensive signature in elder law. A facility may not require a third-party guarantee of payment as a condition of admission, but agreements are still presented that appear to create one.
Signing without a power of attorney
If you have no legal authority, you should not be binding your parent, and you risk binding yourself instead. It is also a signal that documents are missing and need attention urgently.
Agreeing to arbitration by default
It should be a deliberate decision. It cannot be required as a condition of admission, and there is a period in which it may be rescinded.
Spending down on advice from the facility
Discharge planners are not benefits lawyers. A great deal of what families are told to spend can often be protected, but only before it is spent.
Keeping no copy
Families routinely have no copy of what they signed. Ask for the complete package including attachments, and keep it.
Missing a discharge notice deadline
Transfer and discharge rights carry short appeal windows. Acting immediately is what preserves them.
FREQUENTLY ASKED QUESTIONS
Common Questions About Nursing Home Admission
Can a nursing home make me personally responsible for my parent bill?
Not as a condition of admission. Federal law prohibits a facility participating in Medicare or Medicaid from requiring a third party to guarantee payment as a condition of admission, expedited admission or continued stay. A facility may require someone with legal access to the resident funds to agree to use those funds to pay, which is a different obligation. How the agreement is worded and how you sign determines which applies.
Should I sign the arbitration agreement?
It is a decision to make deliberately rather than by default. Under federal rules a facility cannot require an arbitration agreement as a condition of admission, must explain it in a form the resident understands, and must allow a period during which it may be rescinded. If one has already been signed, check the date, because that window may still be open.
Can the facility require us to pay privately before applying for Medicaid?
A facility cannot require a resident to waive their right to apply for Medicare or Medicaid, and federal protections limit what may be required as a condition of admission. Any suggestion that admission depends on a promised period of private payment should be examined rather than accepted.
We were told to spend down my mother savings before applying. Is that right?
Often not, or at least not to the extent suggested. Discharge planners and facility staff are not benefits lawyers, and a substantial portion of what families are told to spend can frequently be preserved through proper crisis planning. Because spent money cannot be recovered, this is one of the few situations where a delay of a day or two to get advice is genuinely worth it.
We already signed. Is it too late?
No. An obligation that a facility was not permitted to require as a condition of admission may not be enforceable, and much depends on the exact wording and on the capacity in which you signed. Bring the complete agreement and any bills or notices you have received.
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CONTACT
Do Not Sign Until Someone Has Read It
A short review before you sign can prevent a personal liability that follows you for years. Call attorney Thomas Hamilton at (502) 348-2108 or use the form below.
Phone:
Address:
117 E. Stephen Foster Avenue, Bardstown, KY 40004