Category Archives: Nursing Home

Another Win!

We have another nursing home win! In this matter, the nursing home worked with the client (before we were hired) to file the Medicaid application for her disabled husband. Client knew little of what was involved with the Medicaid application and relied on the nursing home to complete the application and file it.  During the application process the nursing home kept on telling the client everything was fine. 

After being denied twice for Medicaid and 9 months later, the nursing home gave the client a bill in excess of $100,000 and told her to pay it or else they would discharge her husband. In a move even bolder than that, in a moment of crises as he was being taken to the hospital, they literally had her sign a form as she was rushing out the door to the hospital. That form was an acknowledgement of discharge that could bypass all of the Federal and State regulations for discharge. 

Next was the suit by the nursing home against client and her disabled husband in excess of $100,000. Never mind that it was entirely the nursing home’s fault that the nursing home application was denied, and the fact that client did not sign the nursing home contract, the nursing home and their attorneys still sued the disabled husband and client. We immediately filed a motion to dismiss and asked for sanctions. A few days before the motions hearing, the nursing home attorneys filed a motion to dismiss the matter (with prejudice) and paid our attorney fees. I would consider that to be a win!

Medicaid Mess

Filing for Medicaid

Filing for Medicaid (called Medical Assistance in Maryland) is a very paper intensive process. Often times it is the children of the parent who ends up trying to gather the mountain of information needed for the application process. Given the five year look back requirement, the burden is often high on that family member.

Medical Assistance Penalty Transfers

Because of the strict rules governing Medical Assistance penalty transfers, those transactions that occurred that were innocent at the time could be devastating for eligibility now. It is very common for an aging parent to live with her child and their family.  It is also very common for that parent to co-mingle her social security income and pension income to the child’s bank account to help pay for the house expenses. But, in the eyes of Medical Assistance, that transfer from mom’s account to her son’s account will be treated as a Medical Assistance penalized transfer. This can be a real mess if this type of transfer was routine and had occurred over the course of several years.

The Cost of Transferring Money

A penalized transfer is a penalty imposed by Medical Assistance that provides that for every $6,800 transferred or gifted out of mom’s account it will result in one month of Medical Assistance eligibility which will start only when you file for benefits.  So, in this case, assume that mom’s social security income was $1,500 a month and this arrangement of her giving her income to her son for the family’s expenses occurred over every month over the last 4 years. That’s $72,000 worth of transfers! Those transfers will result in approximately 10 1/2 months of Medical Assistance ineligibility.

Medical Assistance: Application Processing Time

That penalty start date will not even start until you file for Medical Assistance (at a time when the parent cannot have more than $2,500 worth of assets). Given that a Medical Assistance application may take many months to process, you could receive a denial notice 5 months after you apply. In the meantime, the nursing home bills are accumulating at $11,000 a month. Once that application is denied, the nursing home will expect payment in full or threaten to start the discharge process. They will also take a hard look at who signed the nursing contract and if there was a child who signed the contract they will put pressure on that child to pay the outstanding balance.  It is a mess.

Detangling the Medicaid Mess

Our office can help a family unwind and get rid of this mess. Medical Assistance rules are complicated and harsh. However, our office is good at taking complex Medical Assistance “messes” and getting Medical Assistance eligibility. We recently handled a case with facts very similar to the facts mentioned above and obtaining full Medical Assistance eligibility with a determination of zero penalized transfers. Naturally, the client was pleased.

Needless Falls at a Nursing Home or Assisted Living Facility

Standard of Care to Prevent Falls

Nursing homes and assisted living facilities are under a duty to care for their residents. This includes a standard of care when it comes to their residents who are at risk of falling. When a nursing home or assisted living facility breaches that standard of care and a resident is harmed, there may be a legal case against that facility.

Often the fall was completely avoidable and should have been prevented. Nursing homes and assisted living facilities are being paid lots of money to take care of loved ones. It is their responsibility to mitigate falls. It is their job. A single fall can be a life altering event, affecting a person’s quality of life for the rest of his or her life.

The Grand Bargain

Nursing homes and assisted living facilities are supposed to be safe havens for our parents and loved ones when living in the community is no longer viable. In essence you are trusting the facility to take care of your parent at a time when you cannot take care of them yourself. It is a grand bargain: the facility is paid handsomely for their care in return for taking every precaution to make the living arrangements safe. In some case, unfortunately, that trust is blatantly violated.

Nursing Staff Negligence

At some nursing homes and assisted living facilities, the nursing staff and aides are underpaid, untrained, overworked, and have high turnover. Mistakes are often repeated and not corrected. Their mistakes only comes to light when disaster strikes and a family member is willing to fight back and say that is not right.

Nursing homes and assisted living facilities want to limit their exposure to “accidents” and will want the resident to sign an arbitration clause to avoid a court trial. Do not sign the arbitration agreement. Signing an arbitration clause is akin to insuring less of a recovery and less accountability for the facility. Often times the facility will ignore the problem, pretend the issue does not exist, or blame the resident. Nursing homes and assisted living facilities know that their residents often suffer from dementia, are weak or physically unstable. These are not unknowns to nursing home or assisted living management, and they are obligated to take measures to address these risks.

Taking Legal Action for Nursing Home Neglect

How do you know when it is time to get an attorney involved?  The nursing home or assisted living facility has to have breached their standard of care to the resident (i.e., it was their fault, their staff was negligent in their action or inaction, etc.). Next, the resident has to be harmed to a significant extent. How much harm is enough? The harm at issue does not have to be permanent but must be significant.

Nursing home and assisted living facilities are big business in Maryland with the average cost of assisted living facilities at $4,000–$6,000 per month and nursing home costs at $8,000–$11,000 per month on average. Sometimes the facility does not hold up their end of the deal. Do not let the nursing home or assisted living facility get away with their behavior. For the sake of your loved one and countless others at their facility, someone needs to take a stand.

Recommendation #1: Document Everything

Take diligent notes of the negligent behavior (dates, names of those involved, witnesses, etc.). Unfortunately, not everyone has a photographic memory. Always document the issue. This helps establish your case when a judge gets involved.

Feel free to give our office a call for a consultation.