Q. My mom is getting told she must pay for my grandmother’s nursing home bill and my parents don’t have any kind of savings to do that. We don’t want the nursing home to kick my grandmother out. What can we do?
A. While eviction for non-payment is a possibility, there are protections in place under both federal laws governing nursing homes, and under landlord-tenant laws. A discharge notice should afford at least 30 days for the individual and their representatives to resolve the payment issue. Legally this notice must include the reason for discharge, a summary of the resident’s condition, and a detailed future care plan that could be utilized by another facility. Families cannot be forced to take someone home that they cannot care for adequately.
Generally, Medicare will cover a portion of skilled nursing home care, for a limited time. Individuals with supplemental, or Medigap plans, usually have additional days covered. When insurance coverage ends, individuals have to private pay or apply for Medicaid, a joint federal and state program that can provide coverage of long-term care expenses. Discharges based on a denial of further coverage by Medicare or a Medicare Advantage Plan can be appealed.
Some states have filial responsibility laws still on the books that can hold adult children accountable for their parents’ medical bills. Michigan, however, no longer has any such statute. In principle, this means adult children would not be held responsible for nursing home bills. Additionally, the Nursing Home Reform Act (NHRA) prevents nursing homes from requiring anyone other than the resident (or their spouse) to be financially responsible. However, as often is the case, the devil can be in the details of agreements signed during admission, or financial transactions that occurred prior to nursing home care.
According to the National Center on Law and Elder Rights (NCLER) the NHRA prohibits nursing homes from requiring third-party guarantees of payment and co-signers as a condition for admission to a nursing home. Nursing homes can require a resident’s representative, who has legal access to the resident’s funds, to sign an agreement promising to pay the nursing home from the resident’s funds. The agreement cannot make the representative personally liable for the resident’s bill. However, if an adult child or family caregiver co-signs or acts as a guarantor on an individual’s admission agreement which indicates that a third-party could be held financially liable, this could be taken as voluntary agreement.
People can enter nursing homes in times of crisis and family members, friends, and caregivers might be asked to sign an admission agreement as a “responsible party,” for example. The best advice is to read all documents or consult legal advice before signing anything, but often, people feel obligated to sign in order to get the care their loved one needs. They may believe that they are agreeing only to be a contact person or the resident’s agent, with no sense that the nursing home might someday argue that they are personally financially liable for the resident’s debt.
Other issues can arise if a nursing home fails to assist with a resident’s applying for Medicaid, or if the resident is on Medicaid but not paying their “patient pay amount.” If there are assets to be spentdown, this needs to be done in accordance with Medicaid criteria. If assets have been transferred within the past five years, a resident might have a penalty period where they are ineligible for Medicaid. These latter two matters are often best handled by consulting with an elder law attorney for proper guidance.
Other resources to consult include: The Long Term Care Ombudsman program at 269-235-0291; NCLER has a tip sheet Nursing Home Debt Collection: Issues and Defense on their website https://ncler.acl.gov or contact them for a free case consultation at ConsultNCLER@acl.hhs.gov ; and Justice in Aging at https://justiceinaging.org.
Sara Duris is community information liaison of Region IV Area Agency on Aging in Southwest Michigan. Questions on age or independence services? Call the Info-Line for Aging & Disability at 800-654-2810 or visit areaagencyonaging.org. The Generations column appears each weekend in The Herald-Palladium.