Question: After two and a half years of paying privately at the rate of nearly $4,000 per month, our father ran out of money, and we were forced to apply for Medicaid. After informing the facility, the first thing we were told by the administrator was that Dad would be moved out of his room into a "Medicaid Bed" in another part of the nursing home. Because he is doing well where he is, we felt a move would be very detrimental to his condition. But the nursing home insisted this was necessary. What are our rights in this area?

Answer: If a Medicaid-eligible resident occupies a bed that could otherwise be offered to a person who can private pay, the nursing home will miss out on additional revenue because the costs that are funded by Medicaid are generally significantly less than the amount the facility could generate from a private pay patient.

It is important to understand that most nursing facilities separate residents based on level of care and source of pay by placing them on different floors or in different areas of the facility. Before a facility can transfer your father, the facility must give notice of the pending transfer and the reason for it. This notice must include information about the resident's right to appeal and other important information and generally must be given at least 30 days before the resident is transferred or discharged. In addition, the facility must provide sufficient preparation and orientation to allow for a safe and orderly transfer.

Taking the Next Step: If the bed your father has been using is certified for Medicaid, you may be able to stop the move; however, otherwise, it is our view that you will be fighting a losing battle to contest the transfer unless you have other significant grounds. Because of the complexities involved, we suggest you seek the opinion of an elder law attorney in your area.

Question: My mother has been a resident of a nursing home for a year during which time she has been in and out of the hospital. During some of this time, she was on private pay status and the rest on Medicaid. The nursing home is now telling us that they can't hold her bed while she is in the hospital. What are we supposed to do?

Answer: Before a nursing home can transfer a resident to a hospital, it is required by law to provide the resident, a family member, or a responsible party with information that clearly specifies (1) the bed-hold policy under the plan of that State, if any, during which the resident is allowed to return and resume residence, and (2) the facility's policies regarding bed-hold periods which allow a resident to return.

Each nursing facility is required by law to establish and follow written policies dealing with bed-hold and what happens if the resident's absence from the facility exceeds the bed-hold period under the State plan. Generally, that person must be readmitted to the facility immediately (if a bed exists) or at the time the first bed in a semi-private room is available. If you did not receive these notices, because of the complexities involved, we suggest you contact an elder law attorney in your area.

Question: My mother was admitted to a nursing home after a two-week hospital stay. Although she has been there for nearly ten days, she is not receiving the services that were ordered by her physician. We have tried to make our concerns known to the staff, but all we get is lip service. In the meanwhile, Mom is certainly not getting any better. We need some suggestions.

Answer: Under the law, a comprehensive care plan must be developed for each nursing home resident which includes not only objectives, but also deadlines for meeting the mental, psychosocial, nursing and medical needs of the resident which are identified in the assessment. This plan of care is required to be finished within seven days after the completion of the comprehensive assessment which is done by an interdisciplinary team of professionals including the attending physician, a registered nurse who has responsibility for your mother, and any other appropriate staff personnel who may be chosen based on your mother's needs. To the extent possible, your mother, her family, or responsible person should be included.

The facility is also required to review and revise this plan after each assessment, and the services rendered must meet professional quality standards. A person who enters a facility should not get worse solely because he or she is in a facility. The facility is under an obligation to provide the services and care necessary for the resident to reach and maintain the best mental, psychosocial and physical well being possible as set out in the assessment and care plan. The facility is also under an obligation to make sure that the resident's activities of daily living (ADLs) do not diminish -- unless it is a result of the resident's clinical condition that cannot be avoided.

Taking the NextStep: While the state ombudsman's office might be of assistance in each of the above situations, this may put the family and facility at odds which is not the best policy. Generally, a geriatric care manager can help when these types of issues arise.