Nursing Home Contracts and the Elderly

Caregiver at Nursing HomeIt is important to find the right facility if your spouse or loved one needs long-term skilled nursing home care. You want to make sure they receive proper, personalized care in a clean, safe, and friendly setting. You also want a nursing home contract that guarantees this care without breaking the bank.

When you admit your loved one to a nursing home, you will need to sign an Admission Agreement on their behalf.

An Admission Agreement is a legal contract that states the responsibilities of both the facility and the resident. They can vary widely from facility to facility, so read and study the agreement carefully before you sign it.  The facility must make blank copies available to the public, but it is allowed to charge for copying or mailing.

Before you fill out an Admission Agreement, you should do the following:

  • Ask to take a copy home to study.
  • Make sure that you read all documents that are referred to in the agreement such as house rules and visiting policies.
  • Develop a list of questions about what is contained in the agreement.
  • Make sure that all your questions are answered to your satisfaction before signing.
  • Use the agreement as an opportunity to clarify expectations and to negotiate care needs and costs.
  • Consider having the document reviewed by an attorney or consumer advocate.
  • Do not personally guarantee to pay for the services rendered to the applicant.

What Needs to Be in an Admission Agreement?

It is required by law that Admission Agreements describe the types of services that the facility will offer, along with their costs. It must specify billing and payment procedures, and state how, when, and to whom the rates will be charged. It should lay out how changes in the rates will be determined, and any conditions for refunds.

What Can the Facility Charge for Services?

The facility can charge whatever the market will bear. But any fee charged must be clearly stated in the Admission Agreement, whether prior to or after admission.

Some facilities charge a flat or fixed rate for all services. Most facilities combine a fixed rate with extra charges for more care or services and/or for changes in care levels, however. Facilities receiving state funds from Medicaid negotiate their contracts with the state Medicaid division.

Can the Facility Raise Rates?

Yes, but the Admission Agreement must state how rates may be changed. Rate increases typically require a sixty (60) day written notice. If they are written into the agreement, however, rate increases for level of care changes can take place in a matter of days. The facility must provide written notice of the level of care rate increase within two (2) business days after initially providing services at the new care level. The notice must include a detailed explanation of additional services and itemization of charges.

You should ask to review the process, criteria, and assessment results used in determining the change in care levels.

If you have concerns about a nursing home contract or Admission Agreement please contact us at Aaron J. Goldberg, PLC.



“Used with permission 2016”


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Attorneys with Aaron J. Goldberg, PLC are members of the Vermont Bar Association and the National Academy of Elder Law Attorneys.