Nursing Homes Agree To Revise Admission Policies

Attorney General Spitzer today announced agreements with six nursing homes to clarify admissions policies and strengthen consumer protections for residents and their families.

"Nursing home residents and their families deserve the peace of mind that comes with clear, direct understanding of their rights and the knowledge that they will not be subjected to confusing language in admission contracts," said Attorney General Spitzer. "My office will continue to work with the state's nursing home industry to help protect the interests of our most vulnerable citizens."

Under terms of the agreements, the six nursing homes will revise their admission contracts to include language that complies with state and federal law, to notify all their residents of the changes, and to have residents sign new contracts.

The six nursing homes signing agreements with the Attorney General's Office are:

• A. Holly Patterson Extended Care Facility in Uniondale;
• Hudson Valley Rehabilitation and Extended Care Facility in Highland;
• Kirkhaven in Rochester;
• Lakeside Nursing Home, Inc. in Ithaca;
• River Mede Manor in Binghamton; and, Vestal Nursing Center in Vestal.

The agreements significantly change the homes' admission contracts in three key ways: First, they eliminate so-called "third-party guarantees" that impose financial obligations on families as a condition of admission. Second, the agreements protect against involuntary discharges of residents. Third, the agreement with one of the nursing homes, Kirkhaven, protects residents from being "balance billed" (held personally liable) if their HMO denies coverage in certain situations.

These agreements adopt the same protections announced in a June 2001 action by the Attorney General's Office when nine New York nursing homes agreed to adopt substantial reforms in their admission contracts.

Advocacy groups for the elderly praised the Attorney General's efforts.

Cynthia Rudder, Executive Director of the Nursing Home Community Coalition of New York State, said: "We commend the Attorney General's persistent enforcement of state and federal laws that protect the rights of nursing home residents and their families. Nursing home residents are some of the most vulnerable people in our society and their families feel extreme stress during the admission process. This means that residents and families often sign anything put in front of them by the nursing home, even if it is illegal or not in their best interest."

State and federal laws prohibit nursing homes from requiring third-party guarantees as a condition of admission. Specifically, a nursing home cannot require friends or relatives to sign an admission agreement that makes them liable for payment for a prospective resident's care as a condition for admission to the home.

State and federal laws also limit the ability of nursing homes to discharge residents involuntarily. The homes can only discharge residents for narrowly-defined reasons, including behavior that is deemed dangerous to other residents.

State laws also prohibit any health care provider, such as a nursing home, from billing a patient (other than for applicable deductibles and coinsurance) if the provider participates with the HMO, the patient is an eligible member of the HMO, and the services are covered benefits under the patient's plan.

An investigation by the Attorney General's Health Care Bureau determined that some admission contracts gave the nursing home overly broad discretion in these areas. The bureau, however, found no evidence that the homes had improperly collected funds from residents or third parties, or had improperly discharged any residents. The bureau will continue an in-depth review of the matter.

The investigation was handled by Troy Oechsner, Albany Section Chief, Health Care Bureau, and Assistant Attorney General John Powell.

Consumers and providers with questions or concerns about health care matters may call the Attorney General's Health Care Bureau at 1-800-771-7755.