Nursing Home Admission Agreement: What to Know Before You Sign

01What's in a nursing home admission agreement

Most admission agreements cover the same core topics, though the wording varies a lot from one home to the next:

• Services and charges. What the daily rate includes, which services cost extra, and how charges change.
• Payment source. Whether your parent is paying privately, through Medicare, Medicaid or insurance, and what happens when that changes.
• The resident representative. Who will handle paperwork and communicate with the home.
• Bed holds and leaves. What happens to your parent's room during a hospital stay or a visit home.
• Discharge and transfer. When the home may ask a resident to leave.
• Resident rights and house rules. Visiting, personal belongings, money held by the home and complaints.
• Dispute resolution. Sometimes a separate arbitration agreement.

Federal rules require the home to tell residents in writing about services and charges, including items Medicare or Medicaid don't cover, before or at admission⁴. Ask for a list if it isn't clear.

02Clauses federal law doesn't allow

For homes certified by Medicare or Medicaid, federal rules forbid admission policies that¹:

• Ask residents or applicants to waive their rights to Medicare or Medicaid.
• Ask for oral or written promises that a resident isn't eligible for, or won't apply for, Medicare or Medicaid.
• Require a third-party guarantee of payment as a condition of admission, expedited admission or continued stay.
• Ask for a gift, donation or other payment as a condition of admission or continued stay for a resident whose care Medicaid pays for, beyond amounts the state allows.

If you see language like this, point it out and ask the home to remove it. A clause that breaks federal rules generally can't be enforced, but it's better to strike it before signing. The long-term care ombudsman can help if the home won't budge³. See nursing home residents' rights.

03Responsible party: signing without owing money

Many agreements ask an adult child to sign as the "responsible party." That phrase can mean different things. Sometimes it means you will handle paperwork and use your parent's money to pay the bill. Sometimes it's written as a personal promise to pay from your own funds.

A home can't require a third-party guarantee as a condition of admission¹. But the home can ask someone with legal access to your parent's income or resources to agree to pay from those funds, without taking on personal liability¹. Before you sign:

1. Read the definition. Find exactly what "responsible party" means in this contract.
2. Sign in a representative capacity. Write your role, such as "agent under power of attorney," next to your name.
3. Cross out personal guarantees. Ask the home to initial the change, and keep a copy.
4. Understand your duties. You may still be responsible for using your parent's money properly and helping with a Medicaid application.

If you act under a power of attorney, see power of attorney for an elderly parent. If no one has legal authority, read guardianship of an elderly parent.

04Arbitration agreements

Many homes include an agreement to settle disputes through private binding arbitration instead of in court. Federal rules for certified homes say²:

• Signing can't be a condition of admission or of continuing to receive care.
• The home must explain the agreement in a way the resident or representative understands, and they must acknowledge that they understand it.
• The agreement must say the resident can decline to sign.
• The resident has the right to rescind the agreement within 30 calendar days of signing.
• The agreement can't stop anyone from talking with surveyors, state officials or the ombudsman.
• The arbitrator and venue must be agreed on by both sides, and the venue must be convenient.

Whether to sign is your parent's choice. Many families simply decline. If you've already signed, you can still rescind within 30 days. Put it in writing and keep a copy².

Think about what arbitration means for your family. It can be faster and more private than court, but it may limit how a dispute about serious harm is heard and what can be recovered. If you aren't sure, it's reasonable to leave the arbitration form unsigned while you get advice, since declining can't affect admission or care².

05Payment terms to look at closely

• Private-pay deposits. Ask when they're refunded and how quickly after discharge or death.
• Rate changes. How much notice the home gives before charges go up.
• Medicare to private pay. What happens when Medicare coverage ends, and how you'll be told.
• Medicaid pending. Whether the home accepts Medicaid, and what it expects while an application is pending.
• Bed holds. The home must give written notice of its bed-hold policy before a transfer and at the time of transfer¹.
• Personal funds. How the home holds and accounts for money it manages for your parent⁴.

For payment planning, see how to pay for a nursing home and when Medicare stops paying for a nursing home.

06Discharge clauses

Federal rules limit when a certified home can transfer or discharge a resident, for example when the home can't meet their needs, their health has improved, safety is at risk, or payment hasn't been made after notice¹. The home generally must give 30 days' written notice with appeal information¹. An agreement can't take those protections away. See nursing home eviction.

07How to review the agreement before signing

1. Ask for a copy early. Request it when you first talk with the home, so you can read it before admission day.
2. Read it at home. Use a highlighter and list every question.
3. Separate the documents. Arbitration, photo releases and other optional forms are often in the same packet.
4. Ask for changes in writing. Strike or edit clauses, and have both sides initial them.
5. Keep copies of everything. Including the signed agreement and any notices.
6. Get help if needed. Call the ombudsman³ or an elder law attorney.

If you're still choosing a home, read how to choose a nursing home and how to check inspection reports.

08Common terms in the contract, in plain language

• Resident representative. A person who acts for the resident, such as an agent under a power of attorney, a guardian or someone the resident chooses⁴.
• Private pay. Paying for care from the resident's own money or insurance, not Medicare or Medicaid.
• Bed hold. Keeping a resident's room while they're away, such as in the hospital, under the home's written policy.
• Ancillary charges. Items billed in addition to the daily rate, such as some supplies, haircuts or phone service.
• Binding arbitration. A private process for settling disputes outside of court, with limited appeal rights.

If a term isn't defined, ask the home to explain it in writing. Clear definitions prevent arguments and confusion for everyone later on.

09After you sign

Keep the signed agreement, the list of services and charges, and every notice the home sends in one folder. Read monthly statements carefully and ask about any charge you don't recognize. If your parent's payment source changes, such as from Medicare to private pay or from private pay to Medicaid, ask for written confirmation of the new terms.

Residents have the right to take part in care planning, see their records and voice complaints without fear of retaliation⁴. Go to the first care plan meeting, which is a good time to raise any concerns from the admission process. See nursing home care plan meetings. If problems come up, the ombudsman can help you resolve them³.

10Short rehab stays and memory care units

Families signing for a short Medicare rehab stay sometimes skim the agreement because they expect their parent to go home soon. But the same contract usually applies if the stay becomes long term, so read it just as carefully. If your parent is moving into a secured dementia unit, ask how the home decides who lives there and what happens if care needs change. Our guide to memory care vs. nursing home explains the differences. If your parent is moving to assisted living instead, see our guide to the assisted living contract.

11When you feel rushed

Hospital discharges often leave families little time. It's fine to say you need to read the agreement before signing. Your parent can usually move in and settle while you finish reviewing the documents, and you can still decline optional forms such as arbitration. If anyone says your parent can't be admitted without a personal guarantee or an arbitration agreement, ask for that in writing and call the ombudsman³. Our hospital discharge planning guide can help you prepare.