IS IT LEGAL FOR A NURSING HOME TO REQUIRE THAT BEFORE YOU ENTER THE HOME, YOU MUST HAVE A RESPONSIBLE PARTY, SPONSOR OR GUARANTOR SIGN THE ADMISSION CONTRACT? 
It is very common for a nursing home to require the signature of a responsible party on the admissions contract before admitting a patient., This practice is prohibited by law. The Nursing Home Reform Act of 1987 strictly prohibits a home from requiring a third-party guarantee as a condition to admission or continued stay.

IS IT LEGAL FOR A NURSING HOME TO REQUIRE YOU TO SIGN A CONTRACT AGREEING TO PAY PRIVATE PAY RATES FOR A CERTAIN PERIOD OF TIME BEFORE CONVERTING TO MEDICAID? 
It is common for nursing homes to require applicants to agree to remain private-pay patients for specified periods of time (usually 2 or 3 years) before applying for Medicaid. This would allow the nursing home to receive the higher private pay rate for that period. This can be a substantial financial benefit to the home and a detriment to the patient. The Medical Fraud and Abuse Amendment makes it a Federal criminal offense to charge, solicit, accept or receive any gift, money, donation or other consideration as a precondition of admitting a patient, or as a requirement for the patient's continued stay, when a patient would otherwise be eligible to have services paid for by Medicaid. It is, therefore, prohibited by law for a nursing home which participates in the Medicaid program to ask patients to sign such agreements. The Nursing Home Reform Act strengthens the protection by specifically making it illegal for Medicaid certified nursing facilities to charge, solicit, accept, or receive; in addition to any amount otherwise required to be paid under the plan, any gift, money, donation, or consideration as a precondition of admission, expedited admission or continued stay in a home. Remember, however, that all nursing homes do not participate in the Medicaid program. But those who do are bound by all the laws and regulations affecting Medicaid. Some nursing homes may not require a duration of stay agreement in writing, but will say that a "Medicaid bed" will not be available for a certain period of time. If the nursing home participates in Medicaid, it cannot legally restrict the number of "Medicaid beds" in the nursing home.

IF YOU ARE A PRIVATE-PAY NURSING HOME PATIENT, CAN THE NURSING HOME TRANSFER OR DISCHARGE YOU IF YOU DEPLETE YOUR ASSETS AND BECOME ELIGIBLE FOR MEDICAID? 
If the nursing home participates in the Medicaid program, the nursing home cannot transfer or discharge a private-pay patient who becomes eligible for Medicaid. Some nursing homes place a provision in their admissions contract which requires patients to pay for care from private funds for a certain period of time before conversion to Medicaid will be "accepted." This type of requirement is prohibited by law and unenforceable. A patient can be transferred or discharged for failing to pay. Conversion to Medicaid is not "failing to pay" within the meaning of the law. Because of this a patient who has been paying the cost of care from his or her own funds and then uses up those funds cannot be discharged based on a claim that there are no "Medicaid beds" available.

Ohio law defines "nursing home" as a place where a person resides for more than 24 hours and receives nursing care. Patients are admitted from home or from a hospital for continued or rehabilitative care. In either case, nursing home patients require nursing care on a daily basis pursuant to a physician's orders.

NOTE: About 40 to 45 percent of people who reach age 65 will stay in a nursing home at least once in their lifetime, according to Health Care Financing Administration statistics. Half of those admitted to a nursing home will stay less than six months. One in five will stay in a nursing home for a year or more, and one in 10 will stay for three or more years.

SOURCES OF PAYMENT.
Payment for nursing home services is derived from a variety of sources: private funds, Medicare (however, only for an extremely short period of time), long-term care insurance (which is typically the best planning method available), or Medicaid, which is available for low-income individuals and has many financial restrictions.

NONDISCRIMINATION.
A nursing home may not exclude a patient because a patient is a Medicaid applicant or recipient, or because of race, color, sex, creed, or national origin.

MEDICARE OR MEDICAID RECIPIENTS. Recipients Nursing facilities may not require a person to waive the right to Medicaid or Medicare. A nursing home may not require oral or written assurance that patients have not or will not apply for Medicare or Medicaid benefits.

PAYMENT GUARANTEES. 
Under Federal law a nursing home may not require a third-party to incur or to guarantee personal financial responsibility for a patient's care.

PATIENT ASSESSMENT. 
Under Federal law a nursing home must conduct a comprehensive, accurate, and standardized assessment of each patient not more than 14 days after the date of admission. The assessment must include the patient's • ability to perform daily life functions; • Significant impairments in functional capacity; • Mental and psychosocial status; and • Dental condition. The assessment is used to develop a patient's comprehensive plan of care with measurable objectives and timetables.

PATIENTS' RIGHTS. 
The Omnibus Budget Reconciliation Act of 1987, effective October 1, 1990, and Ohio laws effective December 13, 1990, granted certain rights to nursing home patients designed to improve their quality of life and care. In General. When nursing home, the patient retains the right to control his or her daily life. Personal, financial and health care rights for patients, as well as nursing home responsibilities, are covered in the Ohio Revised Code, the Ohio Administrative Code, and Federal law. Reasonableness. Some patient rights hinge on physician orders, reasonableness, and nursing home policies. "Reasonable" is an important word in determining whether a patient's rights have been violated. Explanation of Rights. A new patient must have Ohio and Federal patient rights explained and provided upon admission. Posting of Rights. Ohio patient rights must also be posted at the nursing home.

MEDICAL RIGHTS. 
Upon admission, a patient has the right to receive adequate and appropriate medical treatment, nursing care, and ancillary services without discrimination. Choice of Physician. If a patient has a private, primary care physician, the patient has the right to use that physician. If not, the nursing home can assign the home's physician or provide a list of physicians who visit the home. NOTE: If physician does not visit as scheduled, the patient has the right to withhold payment for that visit. Choice of Pharmacist. A patient may use a pharmacist of his or her own choice. Participation in Medical Decisions. A patient has the right and is encouraged to participate in the medical decisions affecting his or her life. These include the rights to: • communicate with physicians; • attend care conferences; and • obtain current and complete information about his or her medical condition and treatment. Refusal of Treatment. A patient can refuse medical treatment and can refuse to serve as a medical research subject. Report of Change in Health Status. A patient has the right to have any significant change in health status reported to his or her sponsor within 12 hours of the nursing home staffs knowledge of the change. Self-Administration of Medication. A patient has the right to self-administer medication with a physician's approval.

PERSONAL RIGHTS. 
A patient has the right to a safe and clean living environment. Responses to Reasonable Requests. A patient has the right to have reasonable requests responded to promptly. Abuse. A patient has the right to be free from physical, verbal, mental, and emotional abuse. Corporal punishment and involuntary seclusion are also prohibited. Hygiene. A patient has the right to have clothes and bed sheets changed as often as needed. A patient has the right to bed and bath linens that are clean and in good condition. Restraint. A patient has the right to not be chemically or physically restrained without his or her written consent or a physician's orders. Civil Rights. A patient has the right to exercise all civil rights, including the right to vote, to observe religious obligations, and to maintain individual cultural heritage. Alcohol and Tobacco. Unless medically restricted, a patient has the right to consume alcoholic beverages at his or her own expense. The patient may also use tobacco in compliance with the nursing home's house rules. Wake up and Sleep Time. Because a nursing home is the patient's home, a patient has the right to wake up and go to sleep within reasonable limits. Room or Roommate Change. Prior to a room or roommate change, a patient has the right to a notice and an explanation for the change. Leaving and Returning to the Home. A patient has the right to leave the nursing home at any time. A patient does not have the absolute right to return. If a patient leaves the home for hospital or therapeutic leave, he and his family must be given a written notice of bedhold days (the number of days that the bed will be held before it is given away).

PRIVACY RIGHTS. 
A patient has the right to confidential treatment of personal, financial, and medical records, and the right to approve or to refuse the release of those records. Examinations, Treatment, and Care. A patient has the right to privacy during medical examinations, treatment, and during personal or body care. Interaction With Others. A patient has the right to private and unrestricted communication, such as receiving and sending sealed, unopened correspondence. The patient also has the right to private telephone conversations and to private visitations. Spouses. A patient has the right to private visits from his or her spouse and, if both are patients of the same home, to share a room.

ECONOMIC AND FINANCIAL RIGHTS. 
A patient has the right to be free from financial exploitation. Room Rates. A patient has the right to know basic room rates, to receive a 30-day notice of a room rate increase, and to receive an itemized bill. Management of Funds. The patient may manage his or her financial affairs or may delegate the responsibility to someone else. If the patient elects to have the nursing home manage his funds, he or she has the right to a complete record of the funds and a receipt for deposits and withdrawals. If the patient asks a nursing home to manage the funds, those funds in excess of $50 must be placed in an interest-bearing account.

NOTE: The nursing home must give written notice if it believes that Medicare will not pay for the care or services. The Medicare beneficiary cannot be held liable for the cost of the stay if notice is not given. The beneficiary can require the home to submit the claim to Medicare. The home cannot bill the beneficiary until the insurance company has denied the claim. The home cannot ask for payment of the coinsurance prior to the 20th day of the stay and cannot ask for an advance deposit, processing fee, or admission fee.

MISCELLANEOUS RIGHTS. 
Patients have several other statutory rights. Notice of Transfer or Discharge. The patient must receive a written notice of discharge by certified mail, return receipt requested, at least 30 days before a proposed transfer or discharge. The written notice must include: • the reasons for the transfer or discharge; • the address to request a hearing to challenge the discharge; • the name, address, and telephone number of the Ohio long-term care ombudsman program; and • if the patient has a developmental disability or mental illness, the name, address, and telephone number of the Ohio Legal Rights Service. Advocates and Ombudsmen. A patient has the right to contact advocates and ombudsmen. The Ohio Department on Aging can provide the names and addresses of regional long-term care ombudsmen programs. For information, write to the Department at: Ohio Department on Aging 50 West Broad Street Columbus, OH 43266-0501 Or call 1-800-282-1206. Grievances. A patient has the right to file a grievance with the nursing home's grievance committee. The patient may also complain to the Ohio Department of Health and to other persons not associated with the operation of the home, such as the long-term care ombudsman. Further, a patient has the right to be free from restraint, interference, coercion, discrimination, or reprisal because he or she has complained. Transfer and Discharge. A patient has the right not to be transferred or discharged without just cause. The patient can be discharged for non-payment, for no longer needing nursing home care, or for the health or safety of the patient or others.

SELECTION OF FACILITY. 
While no state or Federal statutes directly govern how or what to look for in a nursing home, common sense should guide a prospective long-term care consumer. One should exercise as much diligence and research as one would when selecting any kind of living arrangement. Licensing and Certification. In the State of Ohio, the Ohio Department of Health licenses and certifies nursing facilities for Medicaid and Medicare. Check to see if the nursing home is licensed.

ANNUAL SURVEYS. 
The Ohio Department of Health annually surveys nursing facilities to ensure they are following the Ohio and Health Care Financing Administration mandates for treatment and care. Survey results must be available for the public to review at the home. Content of Surveys. The survey is a tool to indicate the types of problems, if any, a home may have had at the time of the survey. For example, surveyors will check to see if patient privacy rights are maintained? Did staff knock on room doors before entering? Did staff pull curtains during treatment? Were patients clothed appropriately? Surveyors will check to see if the proper dosage of medicine was administered at the proper time and if the plan of care was followed for a patient's medical treatment. Effect of Survey. At the end of the survey, a document is drafted and sent to the nursing home listing deficiencies. The home must then provide a plan of correction to maintain its license, or else face sanctions.

CHECKLIST OF QUESTIONS. 
The following is a checklist of questions and observations for a visit of a prospective nursing home:

Disclosure of Information. • Does the home provide and post a copy of Ohio's patient rights provisions? • Are copies of the nursing home's policies, procedures, and rules available? • Are the addresses and phone numbers provided to patients and posted for: • The local health department; • The Ohio Department of Health; • The county and Ohio Department of Human Services; • The area agency on aging; • The Ohio Department of Aging; and • The Ohio and regional long-term care ombudsmen? Is information available about Medicare and Medicaid eligibility?

Financial Issues. • Does the nursing home provide an itemized bill to the patient and to the person paying the bill? • Does the nursing home make patients aware of additional charges, such as for the beauty shop or activities and outings? • Does the nursing home provide a 30-day notice of room charge increases? • Does the admissions contract between the patient and the nursing home indicate charges, when charges are increased, and when payment is due? • Is the patient allowed to manage his or her own financial affairs? • If the patient requests the nursing home to handle the patient's finances, are funds in excess of $50 placed in an interest-bearing account? • If the patient requests the nursing home to handle the patient's finances, does the patient receive an accounting for any financial transactions deposits or withdrawals from his or her account? • What is the procedure for making a patient's funds available to the patient? • How does the nursing home handle lost or stolen items?

Patients' Rights. • How does the nursing home handle room transfers? Is adequate notice given? • is a phone available for private conversations? A phone in a secretary's office or in a hallway is not appropriate. • Is there a patient council? • Is there an active grievance committee? If so, who are the members? • Are the visiting hours reasonable? Is the family allowed and encouraged to visit at any other reasonable hours? • Can the patient decorate his or her room? Can the patient bring furniture or other possessions from home? • What is the nursing home's policy on a living will? Durable Power of Attorney for Health Care? Will the home honor a "Do Not Resuscitate/No Code" order?

Staffing Issues. • Was the administrator available and approachable? • Do the staff members show genuine interest in the patients and treat them with dignity? • What is the employee turnover rate? • How many registered nurses are on duty during the day? At night? • How many licensed practical nurses are on duty during the day? At night? • How many aides are on duty during the day? At night? • What percentage of the nurses are pool nurses?

Medical Issues. • How does the nursing home handle dental and orthodontic needs? • Are speech, physical, rehabilitative, and occupational therapies available? If so, how often? • Does a qualified pharmacist monitor each patient's drug regimen? • Does the home provide transportation for patients to visit dentists, physicians, and therapists? • How often does the staff physician actually see a patient? • Can a patient select a physician of his or her choice? • if a patient's health changes, how long does the staff wait to contact the family? • Can medicine be purchased from a pharmacy other than the nursing home's pharmacy? • How long does it take to respond to a call bell? • What is the home's policy on physical or chemical restraints?

NOTE: Nursing home patients have the right not to be chemically or physically restrained without specific physician orders.

Environmental and Safety Issues. • Is the nursing home odor-free, neat, and clean? • Are the rooms well-lit and at a comfortable temperature? • Is the furniture attractive, comfortable, safe, and in good repair? • Do privacy curtains surround the bed? • Is the paint on the walls in good condition? • Are the hallways cluttered? • Are call bells within reach and in working order? • Is the floor level to prevent falls? • Are the bathrooms equipped with handrails, non-slip surfaces in the tubs and showers, and call bells? • Are there doors for privacy? • Are smoke detectors, automatic sprinkler systems, and automatic emergency lighting visible? • How often do fire drills occur? Is there a workable emergency evacuation plan and, if so, how is it explained to patients? Are portable fire extinguishers visible? • Are exits well marked?

Dining Issues. • Is the kitchen clean? • How is the food presented? • Are meals served at normal hours? • Are snacks available? • May the family bring in food? • Are special meals prepared for those on special diets? • Are substitutes offered if a patient does not like a food item? • Do patients who need assistance with eating receive help? • Is the dining room comfortable and cheerful? • Can wheelchairs fit under the tables?

Miscellaneous Issues. • is there a social services and/or activities director? If so, what are that person's qualifications? • Does the home provide religious, recreational, cultural, and intellectual activities or access to such activities? • Are patients encouraged to engage in activities? • Does the home provide activities for patients who are bound to their rooms, bedridden, or handicapped? • Are the activities posted? • Is there a lounge, library, and/or game room? • Is there an outdoor area where patients can sit or stroll? • What is the patient population like? • Are dialysis machines or ventilators available? • Is there a staff member who speaks the patient's language or who can "sign" to the hearing impaired? • How frequently are care conferences held for the patients? Are family members encouraged and allowed to attend?