Question: I have been taking care of my husband at home for nearly two years after his stroke. I am no longer able to do handle it myself and can’t afford to hire people to come in and help me. But when I began looking for a bed in a Medicaid nursing facility, I was disheartened by the difficult admission process, the complications involved, and the waiting period because we could not pay privately. I have been placed on waiting lists at six different facilities and have been told that there may be a two-year wait. I don’t think I can last that long. Are there not rules to protect those who can’t afford to pay?

Answer: The nursing home admission process is anything but easy. Since there are no centralized admissions procedures, you must visit a number of facilities, complete applications, and be placed on a waiting list for a bed. This is particularly true where, as here, your husband would become be a Medicaid resident. While in most cases discrimination by a Medicare of Medicaid certified facility against Medicaid-eligible residents is prohibited, the admission process is an exception to that rule.

The Nursing Home Reform Act of 1987 mandates that Medicare or Medicaid certified facilities 1) not require residents or potential residents to waive their rights to benefits under the Medicare or Medicaid programs; 2) provide information about how to apply for and use Medicaid and Medicare benefits; and 3) not charge a Medicaid patient any amount in excess of that required to be paid under the state Medicaid plan as a precondition of admission, to expedite admission, or to allow the continued stay of the individual in the facility.

Since October 1, 1990, federal law has required Medicare and Medicaid certified facilities to establish and maintain identical policies and procedures regarding transfer, discharge, and the provision of services for all residents, regardless of source of payment. However, nothing expressly prohibits unfair admission practices based on source of payment. Today, only a few states have chosen to expressly prohibit this type of discrimination that allows Medicaid-eligible individuals to be refused admission or to be placed on Medicaid-only waiting lists even though beds may be available.

Since the admission procedure is so important and complex, we strongly suggest that you seek the assistance of a private geriatric care manager or elder law attorney in your area who can help you find a suitable facility for your husband. You should always carefully review the admission documents to make sure that the agreement does not restrict or alter residents’ rights that are granted by federal law. In no event should you sign any admission agreement that contains any payment guarantee requirement by you.