You have found a good nursing home, the bed is available, and the admissions office slides a thick contract across the desk during one of the most stressful weeks of your life. This is exactly when families sign things they later regret. The admission agreement governs money, discharge, liability and your legal rights — and much of it is negotiable or, in places, unenforceable. Read it before you sign, and know these ten clauses.
1. The responsible party / financial responsibility clause
This is the big one. Some agreements try to make the family member who signs personally liable for the resident’s bills. Federal law prohibits a nursing home from requiring a third party to guarantee payment as a condition of admission. You can agree to help manage the resident’s own funds, but never sign a clause that makes you personally responsible out of your own pocket. Cross it out, or sign explicitly "as agent for the resident, in a representative capacity only."
2. Arbitration agreements
Many contracts include a clause that waives your right to sue and forces any future dispute — including one over injury or neglect — into private arbitration. An arbitration agreement cannot be a condition of admission. You are free to refuse it and still be admitted. Unless you have a specific reason to agree, decline it.
3. Discharge and transfer rights
Federal law limits when a home can involuntarily discharge a resident (roughly: the resident’s needs can’t be met, their health improved enough to leave, they endanger others, non-payment, or the facility closes). Check that the agreement restates these limited grounds and the required 30-day written notice with appeal rights. Be wary of any language that lets the home discharge for vague "behavioral" reasons — a common route to dumping residents with dementia.
4. What the daily rate includes — and excludes
The quoted daily or monthly rate is rarely the whole bill. Ask for an itemised list of what is extra: therapies, incontinence supplies, laundry, cable, hairdressing, transport, "level of care" surcharges. Get the base rate and the likely extras in writing so the first invoice is not a shock.
5. The Medicaid conversion promise
If private funds may run out, this clause is decisive. Confirm in writing that the home is Medicaid-certified and will keep the resident and convert them to Medicaid when funds deplete, rather than discharging them. A home that takes you as a private payer but won’t hold the bed after conversion is a slow-motion eviction.
6. Bed-hold policy
If the resident goes to hospital, will the home hold their bed, for how long, and at what charge? Medicaid states set bed-hold rules; private payers negotiate them. Know the answer before an emergency, not after you’ve lost the room.
7. The deposit and refund terms
Check how much deposit is required, what it covers, and exactly how and when it is refunded on discharge or death. Refund disputes are common; clear written terms prevent them.
8. Personal-fund management
If the home holds a resident’s spending money, it must keep it in a separate account, pay interest where required, and provide statements. You are entitled to an accounting.
9. The resident’s rights section
Federal law guarantees nursing-home residents specific rights: to dignity, to participate in care planning, to privacy, to have visitors, to voice grievances without retaliation, and to be free from unnecessary physical or chemical restraint. The agreement should reference these. Their presence is a good sign; their absence, a warning.
10. What you are NOT signing away
You never sign away the resident’s right to Medicaid, their discharge protections, or (as a condition of admission) their right to sue. If a clause seems to, question it.
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Frequently asked questions
Can the nursing home make me personally responsible for the bill?
No. Federal law bars a home from requiring a third party to personally guarantee payment as a condition of admission. You can agree to manage the resident’s own funds, but do not sign as a personal guarantor. Sign in a representative capacity only.
Do I have to sign the arbitration agreement?
No. A nursing home cannot make arbitration a condition of admission. You can decline it and still be admitted, and in most cases declining is wise — it preserves your right to go to court if something goes seriously wrong.
Can they discharge my parent for being "difficult"?
Only within narrow legal grounds, with 30 days’ written notice and appeal rights. Vague behavioral discharges are often improper, especially for dementia-related behaviour. Ask your Long-Term Care Ombudsman to intervene if it happens.
What if I already signed a bad clause?
Some clauses (like a personal-guarantee requirement or forced arbitration as a condition of admission) may be unenforceable regardless of your signature. Keep your copy, and raise concerns with the ombudsman or an elder-law attorney.