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NHRA Prohibts Unfair Nursing Home Admission Practices
Jan L. Warner & Jan Collins

Question: I retired two years ago and moved in with my mother (now age 84) because her health had been failing. Since then, she has had a series of strokes and now needs total care. Mother is now in the hospital, and the discharge personnel tell me that unless I can afford to hire private sitters for her, she will need to go to a nursing home when she is discharged. Her assets are meager (a house worth $75,000, a small checking account, and income of just $765 per month), so I am seeking a Medicaid nursing facility. Each place that I have interviewed tells me a different story about the Medicaid qualification process. Exactly what are the nursing admission rules, and how will I know the best thing to do?

Answer: Unfortunately, the nursing home admission process is anything but easy. Since there are no centralized filing procedures, those who need a nursing home bed must visit a number of facilities, complete applications, and be placed on a waiting list. This can be very frustrating, especially when a family member is in a hospital and their Medicare days are running out. Frequently, the family is caught between a hospital demanding the patient be removed and the nursing homes saying no beds are available. This is particularly true when the individual will be a Medicaid resident.

According to the Nursing Home Reform Act (NHRA) of 1987, Medicare- or Medicaid-certified facilities must: 1) not require residents or potential residents to waive their rights to benefits under the Medicare or Medicaid program; 2) not require oral or written assurances that potential residents are not eligible for, or will not apply for, benefits under the Medicare or Medicaid programs; 3) provide oral and written information about how to apply for Medicaid and Medicare benefits, how to use such benefits, and how to obtain a refund for previous payments covered by benefits; 4) not require a third-party guarantee of payment as a condition of admission, to expedite admission, or as a condition of continued stay in the facility; and 5) in the case of a Medicaid recipient, not charge more than required under the state Medicaid plan as a precondition of admitting or expediting the admission of a person to the facility, or as a requirement for the personís continued stay.

That said, while discrimination by a Medicare- or Medicaid-certified facility against Medicaid-eligible residents is generally prohibited, the admission process is an exception to that rule. Nothing in the NHRA expressly prohibits unfair admission practices based on source of payment, and only a handful of states specifically prohibit this type of discrimination.

Still, the hospital is obliged to make sure that your mother is discharged to an appropriate facility. Given the complexities involved in the admissions process, we suggest a team approach, including not only a private geriatric care manager (, click HERE, to talk with the hospital discharge planner as an advocate for your mother, but also an experienced elder law attorney in your area (,click HERE, to make sure that your motherís rights, as granted by federal law, are not abridged.

Need more advice or help with this topic? Click here to get information about taking the "Next Step".

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