Opinion ID: 2507315
Heading Depth: 1
Heading Rank: 4

Heading: Problems Underlying the Nursing Home Admission Agreement Process

Text: The process of signing paperwork for medical carespecifically, a contract for admission to a nursing homeis often fraught with urgency, confusion, and stress. People seek medical care in a nursing home for long-term treatment to heal; they rarely view the admission process as an interstate commercial transaction with far-reaching legal consequences. A widely held misconception is that nursing homes are merely places for the elderly to live. In reality, a nursing home is much more than a residential facility. A nursing home provides continuous care for people of all ages who are ill or otherwise incapacitated and in need of extensive, ongoing nursing care due to physical or mental impairment, and rehabilitation care for people convalescing from illness or incapacitation. [13] Because of illness, incapacitation, or physical or mental impairment, people being admitted to a nursing home are usually quite vulnerable. For many people, the initial acceptance of the need for institutionalization is difficult and stress-inducing. This is particularly the case for older adults, because it underscores their dependency and signals the end of their freedom to make many personal choices. Furthermore, the decision to be admitted to a nursing home, and the choice of a nursing home, often is made in the midst of a crisis brought on by a precipitous deterioration in the person's health. The decision is also often impelled by the loss of, or deterioration in the health of, a spouse or care giver, [14] or when their care-giving family is no longer able to adequately manage the demands of home care. [15] A person's admission to a nursing home often follows a period of acute hospitalization. [16] Many of these admissions occur directly from a hospital's discharge planning process. The hospital, and not the person or the person's family, contacts area nursing homes to determine which nursing home facility has the skills, equipment, and/or space to admit the person. [17] Greater consideration is often given to nursing home facilities in close proximity to the person's home or person's family. In the process, the hospital and nursing home discuss the person's medical condition andin essenceinitiate the process of admission to the nursing home without input or knowledge from the person or the person's family. Medical records are transferred and arrangements are made to smooth the person's transfer to the nursing home, so that when the person arrives there is nothing more to be done than signing the nursing home's forms. While this behind-the-scenes process takes much stress off of the person, it might also discourage the person (or person's family) from questioning the content of the forms to be signed, because of the implicit perception that the forms must be signed as a condition of admission. Moreover, in the 1980s, the government changed the way hospitals were paid for their Medicare patients; since the change, discharge planning occurs quicker and sicker. [18] The weakened physical and emotional condition of a person from an acute illness is one of the most significant factors that compels a decision to seek post-hospital nursing home placement. Compounding the dangers of this decision-making time, not only is the person being discharged quicker and sicker, but the hospital treatment itself often further debilitates the person. A person's decision to enter a nursing home is, therefore, often made when the person's decision-making abilities are seriously impaired. Unlike the situation that exists when a consumer signs a contract for a product or service, people entering a nursing home have to sign admissions contracts in the midst of a crisis, without time to comparison shop or to negotiate the best service and price combination. Put simply, there is usually little time to investigate options or to wait for an opening at a nursing home of choice. [19] Time pressure during the hospital discharge process significantly impairs people's ability to seek and carefully consider alternatives. Potential residents and their family members often experience panic when they feel there is insufficient time to consider different facilities, and they may choose a facility they would not have chosen if they had more time to weigh their options. [20] Further, many nursing home facilities lack a coherent admissions process, adding to the chaos and stress surrounding the admission of a resident. [21] The form and actual process of signing an admissions contract compromises the ability of potential residents and their families to make informed decisions. [I]n many, if not most cases, there is no clear admission procedure.... Rather, the time of admission is very likely to be full of confusion and stress for all involved, and the residents (or more likely, their representative or family member) commonly sign all the documents without knowing or understanding what they are signing. [22] In the typical nursing home admission process, residents and their family members do not have time to read and deliberate on the terms of the agreement. [23] Facilities often present the contract after the person decides to apply for admission, rather than beforehand, when the individual or his or her representative can carefully examine the admission contract, and contemplate the meaning and ramifications of its provisions, particularly those that have nothing to do with care and related services and costs. [24] Furthermore, there is often no time for the person to sit down with a facility representative who can answer questions and explain the contract's terms. [25] As we discuss later, admissions agreements typically are pre-printed contracts of adhesion offered on a take-it-or-leave-it basis, giving residents no meaningful opportunity to change or negotiate the terms. [26] Ultimately, people being admitted to long-term care facilities and their families have to sign admission contracts without time to comparison shop or to negotiate the best service and price combination. The pressures of deciding placement at such a time, coupled with physical and/or mental infirmities, facing discharge from the hospital, financial limitations, and/or lack of knowledge about long-term care options make consumers vulnerable and dependent on full disclosure by facilities. [27] In such an environment, it is common that residents or their family members rarely know that the admission contract contains provisions that go far beyond the medical care and other services the facility promises (or is expected) to provide and that, instead, have serious implications for their legal and constitutional rights. B.