Question: After paying privately for 22 months until Dad’s money ran out, we were forced to apply for Medicaid. When we told the facility, we were advised 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 detrimental to his condition. But the nursing home insisted this was necessary. What are our rights here?

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

Many, but not all, nursing facilities separate residents based on level of care and source of pay, 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 give the resident sufficient preparation and orientation to allow for a safe and orderly transfer.

Although we believe that you will be fighting a losing battle to contest the transfer unless you have significant grounds, we suggest you ask your father’s physician and seek the opinion of an elder law attorney.

Question: My mother has been in a nursing home for a year, during which time she has been in and out of the hospital. Part of the time she paid privately, and she is now on Medicaid. At the time of her last hospitalization, the nursing home told us 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, if any, under the regulations of that State 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.

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 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 that have been identified in the assessment. This plan of care is required to be completed within seven days after the completion of the comprehensive assessment, which is done by an interdisciplinary team that includes the attending physician, a registered nurse who has responsibility for your mother, and any other appropriate staff determined by your mother’s needs. To the extent possible, your mother, her family, or responsible person should be included.

The facility is required to review and revise this plan after each assessment, and the services rendered must meet professional quality standards and be provided by qualified persons. A person who enters a facility should not get worse solely because of being in a facility, and the facility must furnish the services and care necessary for the resident to reach and maintain maximum practicable mental, psychosocial, and physical well-being, as set out in the assessment and care plan. The facility must ensure that the resident's activities of daily living (ADLs) do not diminish, unless it is an unavoidable result of the resident's clinical condition, and the resident must receive the right services and treatment to improve or maintain abilities.

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.