The contract should provide clear information about a number of costs — both the specific charges and the payments to outside suppliers, as outlined here.
By law, a basic daily or monthly rate must include itemized charges for:
- Room and board
- Housekeeping and linen service
- General nursing care
- Medical records
- Personal care
Services considered optional or outside the basic plan — such as intensive medical care, therapeutic care, and some medications — are usually not included in the daily rate.
Nursing homes can legally increase room rates and other charges, but only after residents are given at least 30 days of notice.
In contrast, Congregate Living Health Facilities are not subject to the same notice requirement, so the contract the resident signs should describe how and when rates and charges can be increased.
Services and items that are not covered by Medicare or Medi-Cal must be explained and itemized in writing. If a resident requires services that will be covered by Medicare or Medi-Cal, a facility may not require a cash deposit to cover its cost — although such deposits are legal if the individual will pay for the care out of pocket. A nursing facility may request that Medicare co-insurance and any other required charges be paid as they become due, but not before.
A person other than the resident cannot be required to pay for care unless that person specifically agrees to do so in the contract signed when the resident enters the facility. Even this is tricky—and often illegal. Under federal law, a nursing home may not require a family member to agree to be the financially responsible party for a nursing home resident, and are not even supposed to ask if a family member wants to become a responsible party.
Filing Complaints About Care or Services
The contract should clearly specify how to resolve problems that may arise with care and services at the facility. Be wary of signing contracts that mandate binding arbitration, which means residents and family members give up the right to sue in court. California law requires that an arbitration agreement must be on a form separate from the admission agreement. If you do not want to commit to arbitration, you can refuse to sign the document requiring it.
The contract may not waive the facility’s liability if a resident’s personal property is lost, stolen, or damaged because of the facility’s negligence. The facility is also liable for injuries caused by its employees’ misconduct or negligence.
Rules and Policies
Facility rules and policies should include procedures for handling resident account funds and other property and for discharging and transferring residents.
The facility should outline the policy for holding beds for residents who need to leave intermittently for hospital care. California law specifies that beds in nursing homes must be held for at least seven days; Congregate Living Health Facilities generally hold beds for longer periods, usually at a reduced payment rate.
Residents’ Rights and Responsibilities
The facility should provide a written statement of residents’ rights, including the right to specify wishes for medical care through an advance directive or Do Not Resuscitate (DNR) order. A facility cannot require patients to give blanket consents regarding medical treatments. The contract should spell out facility-specific policies, such as what property residents are allowed to bring with them and the amount of storage space provided.