Admission Agreements
Buyer Beware! An Admission Agreement is a legal contract. As a
legal document, it states the responsibilities of both the facility and
the resident. Admission agreements vary widely from facility to facility.
Before signing the agreement, read and study it carefully.
- Ask to take a copy home to study.
- Make sure that you read all documents that are referred to in the
Agreement such as house rules and visiting policies.
- Develop a list of all your questions about what is contained in the
agreement.
- Make sure that all your questions are answered to your satisfaction
before signing.
- Use the agreement as an opportunity to clarify expectations and to
negotiate care needs and costs.
- Consider having the document reviewed by an attorney or consumer advocate.
What Needs to Be in an Admission Agreement?
The law requires
that admission agreements describe the types of services
that the facility will offer and their costs. The agreement must also
state how, when and to whom the rates will be charged, how changes in the
rates will be determined, and any conditions for refunds. Other aspects
that are required to be covered in the admission agreement are:
- Description of residents' rights
- Right of residents to execute advance directives (e.g., Power of
Attorney for Health Care)
- Eviction conditions and notification procedures
- Visiting policies
- Theft and loss policies
- Procedure for making complaints or grievances
- House rules or policies that may be contained in a resident handbook
- Availability of special telecommunication devices for residents who
are deaf, hard of hearing, or who have other disabling conditions
- Other services not provided directly by the facility but offered
at the facility through another provider, (e.g., hair grooming)
- Authority of the licensing agency to inspect the facility and to
review records
- Provisions for terminating the agreement.
- Explanation of facility’s responsibilities and residents’ rights when a facility closes and residents are evicted: Relocation evaluation for each resident, approved closure plan when 7 or more residents are relocated, and 60–day written notice requirements.
What Can the Facility Charge for Services?
The facility can charge
whatever the market will bear! However, any fee charged, whether prior
to or after admission, must be clearly stated in the Admission Agreement.
Some facilities charge a flat or fixed rate for all services. However, most facilities combine a fixed rate with extra charges for more care or services and/or for changes in care levels.
- Increased charges are often triggered by an assessment of the
resident's needs conducted by the facility—a level of care point
system. Check carefully the type and frequency of services offered
for the fixed rate and how the point system works. For instance, many
residents are surprised when they receive charges for more than one shower
a week or for having food trays brought to the room when they are sick.
- It is common for facilities to charge higher rates for specialized
dementia care or for hospice care. Again these charges must be clearly
stated in the Admission Agreement.
- If the resident is on Supplemental Security Income (SSI), the SSI
rate covers the full charges for all basic services. Extra charges
for a resident on SSI can only be made for special food services or a
private room.
Can the Facility Require Families of Residents on SSI to Pay More?
No. Families cannot be required to supplement the SSI rate as a condition for placing or keeping a person at the facility.
- Families or other parties can make voluntary contributions
to the facility on behalf of the resident. These voluntary contributions
are not part of the formal admission agreement, and if not paid, cannot
be grounds to evict a resident.
- In order to protect the resident's SSI and Medi-Cal eligibility,
voluntary contributions must be made directly to the facility, rather
than to the resident, and must be used only for care and supervision
services, not for shelter or food.
Can the Facility Charge Upfront Fees?
Maybe. But all upfront fees must be stated clearly in the Admission Agreement.
- Residents on SSI cannot be charged pre-admission fees.
- If the facility charges a pre-admission fee, the resident or the resident’s
representative must be provided with a written statement describing the
costs associated with the fee.
- Refunds of all or a portion of a preadmission fee are required if the person does not enter the facility. A portion of the preadmission fee must also be refunded if the individual leaves during the first three months of residency.
- It is becoming common practice for facilities to charge first and
last month's rent. The last month's rent must be safeguarded and separately
accounted for by the facility. Note: The facility cannot charge
a security or damage deposit or a cleaning fee.
Can the Facility Raise Rates?
Yes. The Admission Agreement must state how rates may be changed. Rate increases generally require a 60-day written notice. However, if written into the agreement, rate increases for level of care changes can take place in a matter of days. The facility must provide written notice of the level of care rate increase within two business days after initially providing services at the new care level. The notice must include a detailed explanation of additional services and itemization of charges. The resident and/or the resident’s family member or responsible person should ask to review the process, criteria and assessment results used in determining the change in care levels. For residents on Supplemental Security Income (SSI), the SSI annual cost of living increase can also become effective immediately once the facility is notified of the increase by the government.
Are There Other Things That You Need to Know About Admission Agreements?
- Read carefully the house rules or policies. Do they seem reasonable
to you? Pay special attention to policies that might impact your lifestyle
choices, (e.g., restrictions on leaving the facility) or your quality
of life, (e.g., quiet hours or times to go to bed, set or flexible meal
times, etc.).
- Also review the facility's policies regarding visitors. Visiting
policies should be designed to encourage the involvement of family and
friends. Again, will the stated policies meet your needs? If not, is there
flexibility in how policies are interpreted and implemented?
- The facility cannot require a resident to use a particular pharmacy
or medical supply provider.
- More and more facilities are including in their Admission Agreements
legal language to protect the facility's liability such as a requirement
to arbitrate all disputes. This can eliminate the resident's right
to take appropriate legal action such as filing a lawsuit. The law already
allows someone to seek arbitration when advised by counsel that it is
the most prudent strategy.
When Does the Admission Agreement Take Effect?
In order for the document
to be legally binding, it must be entered into voluntarily, signed
and dated by both the facility and the resident (or the resident's
agent or legal representative). This also applies to any attachments to
the admission agreement, such as a copy of the house rules. Any future
changes in the agreement must also be in writing, signed by both parties
and dated.
- The original of the admission agreement must go into the resident's
file at the facility and a copy must be provided to the resident (or his/her
agent or legal representative).
- Keep a copy of the Admission Agreement on file and refer to
it to answer questions and resolve concerns.
- If someone other than the resident signs the agreement, make sure
that this person does not become a "legally responsible party" - one held
personally responsible for paying the facility's fees.
How Do You End the Agreement?
The resident or resident's agent or legal representative gives a written 30-day notice to end the agreement and to leave the facility. The agreement will automatically be terminated upon the death of the resident unless stated otherwise in the agreement.
Note: In accordance with Title 22 Regulations, (CCR 87507(h)), the resident or responsible person will not be liable for any payment beyond that due at the date of death unless agreed to in writing or ordered by the court. If this is stated in a resident’s admission agreement, make sure you are aware of the amount that you or your loved ones will be charged after the resident’s death.
What About Refunds?
Most facilities will not refund a resident if the person decides to move out or has to move out because of illness unless the resident gives a 30-day written notice (some admission agreements state a 60-day written notice is needed).
Consumers should always make an argument for a refund.
- Review carefully the conditions stated for receiving a refund
in the admission agreement. The law requires a refund in only two
situations: upon the death of the resident, and when the state licensing
office requires the resident to relocate due to a health or safety risk.
- Request a refund for all the days that the resident has paid for
but not used the room or apartment.
- Remove all personal items from the room as soon as possible so that
the room is available for occupancy by a new resident. Check to see if
another resident has occupied the room.
- Support the argument for a refund by citing circumstances like a stroke
that make giving proper notice impossible.
- And, in all cases, demand a refund where the facility might be responsible
for the resident having to leave the facility prematurely, (e.g., a fall
requiring surgery and rehabilitation).
- Request refund of proportional month’s rent and proportional refund of any pre–admission fee of over $500 paid in the past two years when a facility closes and residents are evicted and relocated.
The most pertinent laws and regulations are found in California Health and Safety Code Sections 1569.880 through 1569.888 and California Code of Regulations, Title 22, Div. 6, Sections 87507 and 87463. You can also find pertinent information in California Health and Safety Code Sections 1569.159, 1569.2, 1569.312, 1569.313, 1569.54, 1569.651, 1569.655, 1569.657, 1569.682 , and in Department of Social Services, Community Care Licensing Policy Memoranda, January 15, 1998, May 14, 2001, and July 29, 2005.
Page Last Modified: May 11, 2009
