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									This brochure courtesy of Legal Services of Northern Virginia. If you have questions about this material or this subject, we would like to hear from you.
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                                                  NURSING HOME CONTRACTS

TABLE of CONTENTS


INTRODUCTION              1

PAYING for NURSING HOME COSTS                      4

WHO SHOULD SIGN the CONTRACT                       8

RESIDENTS’ RIGHTS                 11

TRANSFER and DISCHARGE                    15

WAIVERS in Nursing Home Contracts                  17

MEDICAID and LONG TERM CARE                        19

IMPORTANT TERMS                   23

WHERE TO GO for HELP              29
INTRODUCTION


        There are a variety of elder care living options available today. Independent Living is the term used to describe the life style of
people who can maintain their own home or apartment and care for themselves. Assisted Living is increasing in popularity, and offers
additional daily support from staff, helping the assisted living resident with such matters as bathing, dressing, meal preparation, or other
“activities of daily living.” Persons affected by the first stages of Alzheimer’s Disease typically do not need 24 hour medical assistance
or nursing home care, but need assistance in daily living activities.

       But individuals who need not only assistance in activities of daily living but also daily medical assistance, may require the level of
care provided in a Nursing Home. Such individuals are not so acutely ill as to require hospitalization, but instead need a lower level of
medical care. This is when a Nursing Home (also called a “Nursing Center”) becomes a primary alternative.

       This brochure provides information about signing a nursing home contract. It describes what to look for and what to look out for
before one enters into such a contract. It does not discuss quality of care issues. Quality of care is a very important element in selecting a
nursing home, but there are other resources available to help individuals and families evaluate nursing homes for those issues.

       The Arlington County Bar Association Committee on the Legal Problems of the Elderly conducted a study of almost every
nursing home contract in the Northern Virginia area. We looked at state and federal laws designed to protect consumers when signing a
nursing home contract. Although we found some compliance with the law, we also found problems with the nursing home contracts.
This brochure explains the problems, and what you can do to protect yourself.

* * * * * * *

       Selecting a nursing home is a difficult experience. Families are rightfully concerned with quality of care, health issues, and the
emotions of a family member having to accept living in a nursing home. Attention to contractual concerns is the last item one thinks
about at such a time. But this subject cannot be ignored.

       The Arlington County Bar Committee on the Legal Problems of the Elderly wants you to know that there is help in the community
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to assist individuals and families in interpreting and evaluating nursing home contracts. Reading this brochure is the first step.



THE NURSING HOME CONTRACT

        Nursing homes, like any business, often provide many pages of pamphlets, brochures, hand outs, and other materials. Typically,
these promotional materials make claims on the value and quality of the services provided. But all these extraneous materials become
essentially irrelevant after the resident enters the nursing home. For the consumer, there is only one document that matters: the
CONTRACT.

        Often called the “admissions agreement,” the nursing home contract details the rights and obligations of both the nursing home
and the resident. What the contract says, and what it omits, can determine the outcome of any dispute or disagreement between the
nursing home and the resident. By signing the contract, the resident agrees to all of the terms and conditions in the contract, whether or
not the contract has been read or understood.

       The nursing home may give you other papers, such as the Resident’s Bill of Rights, a list of services, and/or medical consent
forms. Have the nursing home representative explain anything you do not understand.

   And, before you sign, you should remember to:

       1. Ask the nursing home to give you copies of all papers you sign, and be sure the copies include the nursing home
representative’s signature.

       2. Make sure the contract itself clearly states that these other papers are included as legally binding parts of the contract.

       3. Finally, be very careful what you sign, and don’t sign any form that has blanks or spaces to be filled in later.

PAYING FOR NURSING HOME COSTS

       What is the Basic Daily Rate?

       The basic daily rate is the standard charge the nursing home bills to all residents, which covers the fundamental services every

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resident receives, including rent for the room, housekeeping (e.g., bed linen laundry), meals, and general nursing care.

        It is important to understand all the services and amenities which are not included in the basic daily rate. The fees and charges for
“supplemental services” often increase the expense of the nursing home dramatically, to the surprise and dismay of the recipient of the
bill. Often services expected to be included in the basic daily rate, such as extra nursing services, pharmaceutical needs and telephone
services, are extra charges.

       Does the basic daily rate include all the nursing care I will need?

        Probably not. The basic daily rate includes “basic,” or “general,” nursing services. What is provided with basic or general
nursing care may vary from nursing home to nursing home. But the basic daily rate often does not include many common nursing
services. Physical therapy, glucose monitoring, incontinent care, hand or tube feeding, etc., might each involve extra fees. In addition,
prescription and non prescription medicines are not included in the basic daily rate.

       How can I avoid being surprised by added costs?

       To understand which additional services (and additional costs) a resident will require, the first place to look is the Resident
Assessment. This assessment is required by law, and analyzes what kind of nursing and other care the resident needs. For example, if the
new resident is incontinent, the assessment should indicate this fact.

        To get an accurate assessment of the costs, make sure you understand what is covered by the basic daily rate. Then, ask the
nursing home representative to discuss the resident assessment, which describes all the nursing and therapeutic services the resident
requires. Ask the nursing home to explain to you what additional nursing and other services, beyond what is covered by the basic daily
rate, are necessary. The nursing home should give you an itemized list of supplemental services, and the costs above the basic daily rate.

        Also, decide what additional amenities you want (telephone, beauty care, etc.), and add these costs in. Request the nursing home
to give you an estimate of the total bill. You should have this estimate long before the end of the first month so that you know exactly
what to expect.

       What costs should I expect to pay myself if I am receiving Medicaid or Medicare coverage?

For residents receiving Medicaid:

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        Medicaid will pay all medical expenses required by qualified recipients. This normally includes not only services provided under
the basic daily rate, but all supplemental nursing and medically-indicated services and supplies (including prescription and non-
prescription drugs)--charges that would be extra for private-pay residents.

        However, Medicaid will not cover non-medical expenses. Amenities and services such as local telephone, and barber or beauty
shop services, and some others must be paid for by the resident. Every Medicaid resident should understand clearly what services and
amenities they wish to receive which are not covered by Medicaid. This is especially true since the $30.00 monthly income allowance is
so limited (see the section “MEDICAID and LONG TERM CARE” for more details).

For residents receiving Medicare:

       Medicare coverage is restricted to “skilled care” in nursing homes, and covers only a limited time period. Skilled care coverage
includes the basic daily rate, and all additional medically necessary services (therapies, pharmaceuticals, etc.).

       Medicare will pay for the first 20 days of skilled care, and will provide partial coverage for days 21 through 100 (with the
Medicare resident required to make co-payments for days 21 through 100). Medicare does not pay for nursing home care beyond the first
100 days for each benefit period.

       Medicare skilled-care coverage is very limited; Medicare has a restricted definition of what qualifies for “skilled care” coverage.
Only a very few people in nursing homes are receiving Medicare skilled-care coverage.

       The Medicare patient should be aware of the limits of Medicare coverage, and be prepared to make the sizable co-payments
required. If the resident has supplemental health insurance (a “Medigap” policy), check to see whether the policy covers the co-payments
of days 21-100.

WHO SHOULD SIGN THE CONTRACT?

Guardians, Guarantors, and “Responsible Parties”

        Can the nursing home require that someone other than the applicant/resident sign the contract?
        No. Federal and state laws forbid nursing homes from requiring third party signatures as a condition for admission or continued
stay in a nursing home. The nursing home would like to have a family member involved with the care of the resident (for making
medical decisions in case the resident needs emergency medical services, for example), but only the applicant/resident should sign the

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contract.

        Nursing home contracts often have places for a third person to sign (after the resident and the nursing home representative). This
third party is often referred to as the “responsible party.” The contracts do not always make clear the nature of the responsibilities and
obligations of this third party signatory. Federal and state regulations, however, are clear. A nursing home may not obligate a third party
to pay the resident’s bills out of their own financial resources as a condition for allowing the resident to enter or continue to stay in the
nursing home. No one, other than the resident, should sign the admission agreement.

       If the applicant/resident is incapacitated should the Guardian or Agent under a Power of Attorney sign the nursing home contract?

        An agent (either a Guardian or the agent named in a Power of Attorney) acting on behalf of the principal (the nursing home
resident) can agree to accept the authority and responsibility for handling the principal’s financial matters, which usually include paying
the resident’s bill out of the resident’s own financial resources. When the agent signs the contract, the signature of the agent should
include the words “as agent,” expressly designating the signer as one acting as agent on behalf of the principal.

       Should someone sign a Power of Attorney form if one is included as part of the admission agreement to the nursing home?

        Some nursing home contracts contain a Power of Attorney form within the document. Never sign a Power of Attorney form
offered by a nursing home. The Power of Attorney is a very important legal document, and should be entered into only with the advice of
legal counsel--speak with an attorney about a Power of Attorney. Although it is a good idea to have a Durable Power of Attorney, the
Power of Attorney form that is part of an admission agreement is usually a guarantor agreement attempting to make the Agent personally
liable for any amounts of money the applicant/resident may owe to the nursing home.

       What should I do if my family member needs to go into a nursing home, but is unable to sign the contract?

        Frequently, the new resident going into a nursing home is coming from a hospital, and might be incapacitated and unable to sign
the contract. Under these circumstances, the nursing home might insist that someone sign the contract, as a precondition, before the
nursing home will admit the new resident. If it is a member of your family, and there is no guardianship or power of attorney, should you
sign the contract?

         It would be best to avoid signing the contract, even in this situation. But, if you have no choice, and must sign the contract to
obtain admission for your family member, you should sign and include a note protecting yourself from potential personal liability. That
is, sign the contract, but, each time you sign, also write in the sentence: “In signing this contract, it is understood that I do not accept any
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personal responsibility for the charges, fees, or any other expenses incurred by the resident.”

        Occasionally, there might be an expense or fee you can accept--such as a charge for some special service for your convenience or
the resident’s comfort--and you can sign a separate agreement for that expense, and that expense only.
RESIDENTS’ RIGHTS

       What is the “Residents’ Bill or Rights?”

       Both federal and state law include a list of rights to which each resident of a nursing home is entitled, and the obligations nursing
homes must fulfill. The laws also obligate nursing homes to inform residents of these rights. The nursing home representative should
provide a list and explanation of these rights.

       The rights of residents protected by law span a variety of subject areas. These subject areas include:
       1. Privacy and Respect
       2. Medical Care and Treatment
       3. Freedom From Abuse and Restraint
       4. Activities
       5. Personal Possessions.
       6. Grievances and Complaints
       7. Transfer and Discharge
       8. Financial Affairs

Privacy and Respect:

       Will I lose all my privacy upon entering a nursing home?

        No. The nursing home is obliged to protect your privacy as much as reasonably possible. Residents have the right to privacy in
their accommodations, medical treatment, financial matters, and in their telephone, mail, and personal communications and meetings with
family, friends, resident groups, etc.

Medical Care and Treatment:
      Do I have to obey the orders of the nursing home doctor?
      No. Residents have the right to manage their own medical care. Each resident has the right of access to appropriate medical

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treatment, to be fully informed, and to participate in planning their own medical treatment. The resident also has the right to choose a
personal attending physician and to refuse treatment.


Freedom From Abuse and Restraint:

       I have heard stories about restraints used on nursing home residents. Can nursing homes use restraints whenever they wish?

        No. Federal and state law requires that nursing home residents enjoy freedom from physical or chemical restraints, unless such
restraints are medically necessary. Only a physician can prescribe restraints and he or she must document why they are necessary. The
nursing home is required to protect the resident from any form of physical or mental abuse from the staff or other residents.
Activities:

       While in the nursing home, may I pursue my own religious practices, and attend services?

        Yes. Each resident has the right to freely participate in social, religious, political, or other activities within the nursing home and
in the community. Such activity is at the discretion of the resident, and the resident cannot be compelled to participate against his or her
wishes.

       Remember, though, nursing homes are not required to make extraordinary efforts to accommodate special religious or lifestyle
choices. If you would like a special accommodation, such as a Kosher diet, for example, make sure the nursing home offers this before
you move in.

Personal Possessions:

       Will I be able to have my own furniture, or other personal affects, with me?

       Each resident has a right to the use and enjoyment of their own personal property, to the full extent that such use is practical and
reasonable, and for so long as it does not interfere with the rights of other residents.

Grievances and Complaints:

       What happens if I have a complaint against the nursing home, and they do not respond to my satisfaction?
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       Every resident has the right to present grievances and complaints to the nursing home, and to local and state
regulatory agencies and other authorities. Every resident has a right to receive a response from the nursing home regarding each
complaint. The nursing home cannot retaliate in any way against a resident for making complaints, or for any other assertion of
residents’ rights.

        There are outside agencies with responsibilities for protecting the rights of nursing home residents. One of the most important of
these is the Long Term Care Ombudsman. The Northern Virginia Long-Term Care Ombudsman investigates complaints and offers
assistance to residents and their families with any serious problem encountered in either nursing homes or adult care residences. (See the
Section, “WHERE TO GO for HELP,” at the end of this booklet).

Transfer and Discharge:

        The circumstances might arise in which the nursing home may wish to transfer a resident within the facility, or even to discharge
the resident. Federal and state law limits nursing homes as to if or when a resident can be moved against their wishes. See the next
section in this booklet, “TRANSFER and DISCHARGE,” for a detailed examination on this important issue.

Financial Affairs:

       Will I lose control of my financial resources when I enter a nursing home?

\       The resident has the right to manage his or her own financial matters. Resident rights also include the right to periodic
accountings by the nursing home for each resident’s bills and all other transactions with the nursing home.
        In addition, if the resident chooses to delegate some control of his or her financial assets to the nursing home, the home must not
only make full periodic accounting of these funds, but also guarantee a variety of other protections, such as avoiding the commingling of
funds (that is, mixing a resident’s money with other bank accounts).

TRANSFER and DISCHARGE

       Can the nursing home force me to leave after I have been admitted, or transfer me against my wishes?

Federal and state law restricts the circumstances in which a nursing home can discharge a resident. Basically, the law provides that a
nursing home may not discharge a resident without their cooperation unless the move is necessary for medical reasons, or is necessary for

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the welfare of the resident or other residents, or for non-payment of the resident’s bill. Unless a discharge is justified for one of these
reasons, the nursing home may not discharge the resident. Under non-emergency circumstances, you are entitled to 30 days advance
notice in case of a discharge or transfer.

       Whether or not you can be transferred within the facility depends on the contract, and also whether or not medical needs are
involved. Ask about the nursing home’s transfer policy.

        If my medical condition requires that I be admitted to a hospital, will the nursing home give my room to someone else?

        The conditions under which a resident may return to his or her accommodations at the nursing home after a temporary absence is
called the “bed hold policy.” If you can afford to pay, the nursing home will usually hold your bed for your return. Medicaid will not pay
the nursing home to hold the resident’s room. However, if the hospitalized Medicaid resident wishes to return to the nursing home,
Medicaid rules require the nursing home to make the first available Medicaid bed available to the resident.

        What if I wish to leave the nursing home for several days to visit friends or family?
       Leaving the nursing home to visit family or friends overnight is called “therapeutic leave.” Again, the nursing home’s bed hold
policy determines what will happen to your accommodations. Remember, Medicaid does not pay to hold your bed while you are absent
from the nursing home.


TRANSFER and DISCHARGE--WHEN and HOW:

        When a transfer or discharge is based on one of the allowed criteria, the nursing home is required to follow certain procedures. In
non-emergency situations, the nursing home is required to give written notice of the transfer or discharge. The nursing home must also
assure that the transfer or discharge will not be made in less than 30 days from when the resident receives the notice. The resident is
entitled to at least 30 days notice of a transfer or discharge.

        The notice must also state the reason for the transfer or discharge, and it must state that the resident has the right to appeal the
transfer or discharge decision. Appeals are made to the Department of Medical Assistance Services, Appeals Department. The right to
such an appeal is available to every resident, whether they are private pay or on Medicaid.

       See the section “WHERE TO GO for HELP” at the end of this booklet for information on who to contact to appeal an adverse
discharge by a nursing home.
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WAIVERS

        An important factor to consider in looking at a nursing home contract is the matter of contractual waivers of liability. A waiver in
a nursing home contract is a paragraph that attempts to protect the nursing home from any legal responsibility for accidents, thefts, and/or
other problems the resident might encounter while living in the nursing home. State and federal law does not address liability waivers for
personal property, so this is largely a matter for negotiation between the nursing home and the resident.

       What if something of mine gets lost, broken or stolen?

         If the contract appears to contain a waiver for personal property or valuables, consider carefully what personal funds and property
the resident will keep, and the responsibilities of the nursing home in handling or protecting such funds or property. Nursing home
contracts frequently contain liability waivers absolving the home of some or all of the obligation to compensate the resident for lost or
stolen property. Explain the resident’s situation to the nursing home representative, and get a full explanation of what will happen if
something happens to the resident’s property or funds. Find out if any other resident has had a problem with this in the past.

       What if I am injured?

         Sometimes, a nursing home might try to include a waiver in the contract relieving the nursing home of liability for personal
injuries suffered by the resident in the nursing home. Although no specific state or federal law regulates this type of waiver, such a
blanket waiver of liability for personal injury of residents is likely to be legally unenforceable, and would probably not protect a nursing
facility from obligations to compensate an injured resident. Ask the nursing home representative to delete such a waiver from the
contract before you sign it.

MEDICAID and LONG TERM CARE

       Federal Medicaid regulations require participating nursing homes to explain the application procedures for Medicaid benefits to
prospective residents. Unfortunately, most nursing homes do a poor job in explaining Medicaid to residents. Medicaid is complicated,
and you need to be prepared for the eligibility process.


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       The following are some very basic rules. They are a start to understanding eligibility, but you will need further and more detailed
information.

         What is “Medicaid?”
        Medicaid is a federal and state program which provides health insurance coverage to eligible applicants who need health care
services, including nursing home care. Eligibility for Medicaid is determined by looking at your assets and your income. Frequently,
people who are not eligible for Medicaid at the beginning of their residence in a nursing home become eligible after they have spent much
of their personal assets paying the bills themselves. This process is referred to as “spend-down.”

        What if I have an income, but not enough to pay for my nursing home care--Must I sign over this income to the nursing home?

        Medicaid will subsidize your nursing home expenses, but you need to follow Medicaid regulations. Medicaid requires that a
recipient assign their monthly income to pay nursing home expenses. Medicaid then pays the difference up to the Medicaid rate. The
nursing home must accept this as payment in full. You are allowed to keep a personal allowance, currently in the amount of $30.00 a
month. In addition, Medicaid allows you to keep enough income to pay any Medigap insurance premium.

       What resources can I keep under Medicaid long term care coverage?

        Medicaid only allows the applicant/resident to keep $2,000 in exempt resources. Also, you are allowed to put aside an additional
burial allowance. If you have more than $2,000 in a bank account, or in real estate, or in stocks, or other assets, Medicaid will not begin
to cover the nursing home bill--even if you owe money to the nursing home or to others. Medicaid only looks at what is in the applicant’s
name, not what outstanding debts the applicant has. Normally, applicants for Medicaid coverage “spend down” excess resources to
become eligible.

       Are there different eligibility rules of Medicaid nursing home coverage for a married applicant as opposed to an unmarried
applicant?

       Yes, there are major differences in the requirements of eligibility for a married applicant, as opposed to an unmarried applicant.
For a married applicant, the spouse who stays at home (called the “Community Spouse”) may be able to keep some of the income of the
applicant spouse. This is particularly true if the community spouse’s personal income is low.

        On the other hand, the married couple’s resources (whether held solely by the applicant, solely by the community spouse, or
jointly by both spouses) are considered available to pay for long term care. Resources must be spent down to a predetermined level
                                                                      12
before Medicaid will start paying.

        However, the home for a married couple (the community spouse’s residence) is considered an exempt resource, and need not be
sold to meet eligibility criteria for long term care coverage.

       How do I apply for Medicaid assistance?

       You apply for Medicaid assistance through your local county or city Department of Human Services or Department of Social
Services. You must apply at the office of your last residence before you entered a nursing home. For example, if you are currently in a
nursing home in Arlington County, and you were living in Fairfax County before entering the nursing home, you need to apply for
Medicaid at the Fairfax County Department of Family Services.

       Does the nursing home have any control in whether or not I apply for Medicaid?
       No. The nursing home has no authority to tell you if, or when, you can apply for Medicaid. Federal and state law prohibit nursing
homes from requiring private pay residents to waive their rights to apply for Medicaid benefits in the future. Nursing homes are also
prohibited from requiring you to pay out of your own resources for some period of time before you apply for Medicaid. Your only
concern should be meeting the eligibility requirements for Medicaid assistance, should you need to apply.

       What is meant by a “Medicaid Certified” Nursing Home Bed?

       In order to receive Medicaid in a nursing home the recipient must be in a Medicaid certified bed. Even if you meet the income
and resource criteria, you must be in a certified bed before Medicaid pays. Long before you apply for Medicaid you should tell the
nursing home that you intend to apply for Medicaid coverage, and they should insure that you are placed in a Medicaid certified bed.

        Sometimes nursing homes use this fact as a means of controlling whether they will accept Medicaid coverage when an applicant
applies. Remember, if a nursing home requires anyone to pay privately as a condition of eligibility, this is illegal.

       Will I receive substandard care under Medicaid coverage?

      No. Federal law makes it illegal for nursing homes to discriminate as to care and services to any resident based on the source of
payment, whether by private pay or Medicaid.



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IMPORTANT TERMS

        Persons entering into a nursing home contract should understand the meaning of the words and phrases relevant to the contractual
stipulations. The following definitions give a brief description of some of the more common and/or important terms.


Adult Care Residences
        An adult care residence in Virginia is a long term care residence for persons needing some help with their activities of daily living,
but not the kind of daily medical services available in nursing homes. Depending upon the level of care needed services in adult care
residences are categorized as either Residential Living or Assisted Living. The Virginia Department of Social Services is responsible for
regulating adult care residences.

Nursing Home
        A nursing home is a long term care facility for those who need less care than that provided in a hospital, but more care than is
available in their home or local community. Services can include administering medicines, special diets, treatments and therapies as
prescribed by a doctor, and total nursing care. While many adult care residences have nurses on staff, nursing homes provide more
comprehensive medical care than adult care residences.

        The state of Virginia, through the Virginia Department of Health, regulates nursing homes. Minimum standards are established
for the physical facilities, staffing qualifications, and services to be made available to residents. The federal government also regulates
nursing homes receiving federal Medicare or Medicaid funding, which includes most nursing homes. The federal Omnibus Budget
Reconciliation Act of 1987 enacted many regulations aimed at nursing homes, and were intended to correct problems faced by nursing
home residents.

Private Pay Residents
       Many residents of nursing homes can afford to pay for their care out of their own financial resources. This is called “private pay.”
Long term care insurance is another source of private pay.

Medicaid Residents
       Residents who must rely on the federal Medicaid program to pay part or all of the bill are often referred to as “Medicaid
residents.” Medicaid provides benefits for disabled persons who need long term nursing home care but cannot afford it themselves.
Charges and billing for Medicaid recipients can differ from the charges to and billing for private pay residents.
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Medicare Residents
       Some patients in nursing homes are there receiving temporary “skilled care” under Medicare coverage. Medicare provides limited
coverage for nursing home care (see the section “MEDICAID and LONG TERM CARE” for more information).

Residents’ Rights
        Federal law, and the laws of most states, including Virginia, include an extensive and detailed list of specified “residents’ rights,”
a set of rights nursing home residents are granted by law. There is also a series of obligations on the part of nursing homes to provide
certain services and care for their residents. Nursing homes are required by law to inform all residents of these statutory and regulatory
rights.

Incapacitated Person
       An incapacitated person is an adult who has been found by a court of law to be incapable of handling some or all of his or her own
financial and/or personal affairs, and needs someone else to make some or all decisions for them. If a person is determined to be
incapacitated they cannot legally execute a Durable Power of Attorney.
       A finding by a court that an individual displays poor judgment is, by itself, not sufficient evidence that the individual is an
incapacitated person.

Guardian
       A guardian is a person appointed by the court who is responsible for the personal affairs of an incapacitated person, including the
responsibility for making health care and medical treatment decisions. The guardian also has authority to decide where the incapacitated
person lives.

Conservator
       A conservator is an individual appointed by the court who is responsible for managing the estate and financial affairs of an
incapacitated person. A court might appoint the same person, or two different people, to serve as guardian and conservator for an
incapacitated person.

Power of Attorney
       A power of attorney is a document signed by a person (the “Principal”) giving another individual (the “Agent”) the authority to
handle some or all of the Principal’s legal affairs. Such affairs can include receiving income, paying bills, buying and selling property,
and other matters.


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      A power of attorney becomes void if the Principal loses his or her capacity or competence, but a “Durable Power of Attorney” is
one which remains in force even after the Principal becomes incapacitated or incompetent.

      A “Medical Power of Attorney” specifically grants the authority for the Agent to make decisions concerning the Principal’s
medical treatment.

        A “Health Care Declaration” is a document executed by an individual that specifies what treatment the doctor is to provide or not
provide under certain medical conditions when the individual is unable to speak for him or herself. It is the same as a “Living Will” and
it usually provides direction as to end of living decisions made by the declarant.

Guarantor
       A Guarantor is an individual who agrees to accept liability for the debt of another in the event that the debt might not get paid.
Such a person (often called a “Co-Signer”) assures a third party “I will pay this obligation if my friend cannot.”

“Responsible Party”
        The term “responsible party” has no set legal definition; its intended meaning must be construed by the context of the contract in
which it is used.
        When entering a nursing home or retirement community, the administration of the home or community might wish to have
available a third party to help in the caring of the resident (to make decisions in the event that the elderly person becomes incapacitated or
incompetent, for example). Such a person (often a family member or long time friend) can be referred to as the “responsible party.” This
relationship is not as formal as that of a Guardianship or a Power of Attorney, and does not require a court order or the execution of a
legal document.
Transfer
        A change of living arrangements within a nursing facility is called a “transfer.” Such a change might be for medical purposes,
transferring a resident from a skilled care floor of the facility to a non-skilled care part of the facility.

Discharge
      A discharge occurs when the resident leaves the nursing facility, either by choice or involuntarily.

The Department of Medical Assistance
       The Department of Medical Assistance (“DMAS”) is the state agency in Virginia which administers the Medicaid program, and
has a number of other regulatory responsibilities important to nursing home residents. For example, a nursing home resident who wishes
to appeal an adverse discharge decision by the nursing home should contact the “Appeals Division” of DMAS.
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Elder Law
       “Elder law” is the area of legal practice that specifically addresses the concerns of elderly clients. Elder law attorneys specialize in
serving aged persons, assisting with such matters as estate and legal capacity planning, health and long term care issues, Medicare and
Medicaid, and other matters of concern for the elderly.

WHERE TO GO FOR HELP


Northern Virginia Long-Term Care Ombudsman Program
12011 Government Center Parkway
Suite 720
Fairfax, Virginia 22035-1104
(703) 324 - 5411

        The Long-Term Care Ombudsman assists residents of nursing homes, and other consumers of adult care residence services, in
resolving disputes and with other serious problems.

AREA AGENCIES ON AGING

       Your local Agency on Aging provides information on a wide variety of issues and concerns of the aged, including information on
nursing homes and other adult care residences.

Alexandria Agency on Aging
2525 Mount Vernon Avenue, Unit 5
Alexandria, Virginia 22301-1119
(703) 838 - 0920

Arlington Agency on Aging
1801 North George Mason Drive
Arlington, Virginia 22207-1999
(703) 228 - 5030


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Fairfax Area Agency on Aging
12011 Government Center Parkway
7th Floor
Fairfax, Virginia 22035
(703) 324 - 5411

Loudoun County Area Agency on Aging
751 Miller Drive, S.E., Suite D2
Leesburg, Virginia 22075
(703) 777 - 0257

Prince William Area Agency on Aging
7987 Ashton Avenue
Suite 204
Manassas, Virginia 22110
(703) 792 - 6400


LEGAL ASSISTANCE

      If you have questions concerning your legal rights, your local bar association can refer you to an attorney.

Arlington County Bar Association
1425 N. Courthouse Road
Room 1800
Arlington, Virginia 22201
(703) 228 - 3390

Fairfax Bar Association
4110 Chain Bridge Road
Room 303
Fairfax, Virginia 22030
(703) 246 - 2740
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Alexandria Bar Association
520 King Street, Suite 202
Alexandria, Virginia 22314
(703) 548 - 1105

        These bar associations have specific listings of attorneys specializing in elder law--the field of legal practice addressing
specifically the legal concerns of the aged.


Statewide Lawyer Referral in Virginia:
1 - 800 - 552 - 7977


       Free legal assistance in a variety of civil legal matters is available to aged residents of northern Virginia through:


       Legal Services of Northern Virginia
       6606 Leesburg Pike, Suite 500
       Falls Church, Virginia 22041

In Arlington, call                    703-532-3733

In Fairfax Counties, call             703-246-4500

In Alexandria, call                   703-684-5566.

In Loudoun County, call               703-777-7450.

In Prince William County, call        703-368-5711.

TTY                                   800-828-1140 or 800-828-711


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       Legal Services of Northern Virginia staff includes legal counsel for the elderly in Arlington and Fairfax Counties, and paralegal
services for the elderly in Alexandria and Prince William County.

*******

       Nursing home residents who wish to appeal an involuntary discharge from a nursing home in Virginia should contact:

       Department of Medical Assistance Services
       Appeals Division
       600 Broad Street, Suite 1300
       Richmond, Virginia 23219
       (804) 371 - 8488

IMPORTANT

        The information in this booklet is general, and cannot take the place of advice by a lawyer who knows all about your particular
situation.

       This publication is the result of a joint effort by:

               Legal Services of Northern Virginia
               6606 Leesburg Pike, Suite 500
               Falls Church, Virginia 22041
               703-778-6800

                      and
               The Arlington County Bar Association
               1425 N. Courthouse Road
               Room 1800
               Arlington, Virginia 22201
               703- 228-3390

   And funded by a grant from The Virginia Law Foundation.
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