Tips on Reviewing the Assisted Living Agreement
You have decided to move into an assisted living home/facility. BEFORE you move in, you and the provider will sign a contract called the Resident Agreement. BEFORE you sign this contract, you should read it carefully – if you can, you should have a lawyer who knows about assisted living review the contract with you. The contract must be accurate, easy to understand, legible, easy to read, and written in plain English.
The Resident Agreement will cover all the terms that you and the provider have agreed to, such as: Costs, Services, Discharge Policies, Grievance Procedures, and your Rights and Obligations as a Resident.
TIP: If the contract is hard to read, ask for a large-print copy. If there are parts of the contract that you do not understand, discuss this with the provider. You can make reasonable changes in the language of the contract to fit your needs and preferences, as long as both you or your representative and the provider initial each change.
Services and Service Plans
What basic services are covered?
There may be OTHER DOCUMENTS that are included with the Resident Agreement. These included documents are ALL a part of your contract with the provider.
Often there is a separate document to be signed by a "Responsible Party", "Authorized Representative", "Agent for Resident", or some other language that asks that person to take responsibility for payment for your care. If your friend or family member does not want to use their own funds to pay for your care, any document they sign should say that they are responsible "only to the extent of the resident’s personal funds and/or resources".
TIP: Remember, things you have read in brochures and other advertising information from the provider may not show up in your contract. Check them against each other to be sure that any advertised service you want is included in the actual Resident Agreement.
What services will I receive and how much will they cost?
The contract should contain a statement of the level of care you require, and the services that are included to meet that level. All rates charged to you, including, but not limited to Service packages, fee for service rates, and all other non-service related charges must be clearly stated. In addition to a list of extra services and the cost for each service, there should be a list of services that the facility does NOT provide.
TIP: Some services, such as transportation, may not be provided at all, and you should find out whether the facility will provide transportation, or will help you arrange for an outside transportation service for you to use to get to your health care appointments or other places you need to go. When using a transportation service, it is important to know the fee schedule ahead of time.
Will I get any medical or health care at the assisted living program?
The contract should state whether and how often health care professionals – nurses, doctors, therapists, etc. – come to the facility. The contract should also specify what kinds of health services will be provided to you by staff, such as helping you with medications, calling in your prescriptions to the pharmacy, or arranging for prescription delivery.
TIP: Sometimes the assisted living provider has a pharmacy that they want you to use, and that pharmacy may or may not take your current prescription discount plan. Ask the provider about options for getting your prescriptions, so that you do not have increased medication costs.
When you move into the Assisted Living home the manager must develop a service plan for you within 30 days. Your needs and preferences will be assessed to determine how much help you need to do Activities of Daily Living (ADLs). Normal daily activities include eating, grooming, bathing, dressing, mobility, transfer, and ambulation.
TIP: Providing assistance with ADLs can be an important of your contract, and you should know which ADL activities are included in your monthly cost of care and which ones cost extra. Often there are EXTRA CHARGES for a category of activities called IADLs (instrumental activities of daily living), that includes shopping for food and personal items or handling money, reminders to you to take your medications and helping you get exercise.
Level of Care
What is a Level of Care?
The assisted living contract must state each level of care that the provider is licensed to give, and the kinds of services included at each level. A price list for each level of care must also be included.
TIP: The Assisted Living Manager is required to assess each resident’s level of care and develop a service plan within 30 days of the day the individual moves into the facility. This plan must include the services to be provided to the resident, when and how often the services are to be provided, and how and by whom the services are to be provided.
What if I need a higher level of care as time goes on?
The Assisted Living Manager, in coordination with staff and other health professionals, must reassess you periodically to be sure that your level of care is appropriate. If you need a higher level of care, you or your representative must be notified of the changes, including any increase in the cost of care. Also, your contract and your Service Plan must be amended to reflect the increase in level of care and the change in cost.
TIP: If you choose an assisted living home that does not provide all three levels of care, your contract must include provisions about the discharge procedure for people whose needs go beyond what the provider is licensed to offer.
What happens if I develop dementia or other special care needs?
Even if you do not have any special care needs at the time you sign your contract, you should know what, if any, special care needs your assisted living provider is licensed to offer. The contract section for fees and levels of care should list any special units and the charges for those services.
How often can the assisted living provider change the fees?
The provider must give at least a 45-day written notice prior to any rate increases. However, if your medical conditions changes significantly and you need additional care, the provider may increase the charges without the 45-day notice.
TIP: Remember, a "significant change" in your health status does NOT include day-to-day variations in health status, functioning or behavior, nor does it include short-term illness, such as a cold or the flu, unless these conditions continue to occur.
What if my money runs out and I can’t pay the monthly fees?
Your contract must include the procedures that are to be followed when the assisted living program wants to discharge a person without that person’s consent, INCLUDING a provision that requires the assisted living program to give not less than 30 days written notice to you or your representative BEFORE the effective date of discharge.
NOTE: If you want to terminate the resident agreement, you must ALSO give a written 30-day notice.
TIP: Unlike a person living in a nursing home, you do not have protections against involuntary discharge. The assisted living program can discharge you for any reason agreed to under the Resident Agreement, and does not have to provide a discharge plan.
Is there any exception to the requirement for a 30-day written notice?
If you have a health emergency that prevents you from staying in or returning to the assisted living home, the 30-day notice may not apply. Also, if it would cause a substantial risk to the safety and health of other residents and/or staff in the program, the provider may discharge you without giving the 30-day notice.
Will I get my money back if I can’t return to the assisted living because of my health problems? What happens to any money I paid them in advance?
If you need to be hospitalized because of a health emergency, you may not know immediately whether it means that you will not be able to return to the assisted living. It is very important to keep all records of how and why you had to leave the assisted living program. You contract must include a refund policy that covers both any prepaid fees and other charges, in the event you are discharged or transferred.
TIP: You should also be sure that the contract covers refunds or adjustments to be made when the assisted living changes owners, or when it closes down. You should insist that your contract includes a statement about when any refunds or adjustments in your bill will be made.
Choice, Rights and Responsibilities
Can I have my own room, or do I have to share?
Some assisted living homes have a combination of private and shared rooms. Others have shared rooms only. Your contract should specify how roommate assignments are made, and how the residents are involved in the decision. Your contract must also include procedures that protect both the resident and the residents’ individual property, such as access to locked storage and locks on individual rooms.
TIP: If you share a room, the provider must furnish the necessary dividers, curtains or screens to ensure privacy. The assisted living program shall also tell you about what furnishings and other personal items you may bring to your room, and must give you a list of all the furnishings the program must provide.
What are the rules I have to follow?
Assisted living should facilitate your ability to remain independent and to make choices. However, they must also have rules and procedures designed to ensure a safe place to live. In addition to a daily schedule, the assisted living manager must provide or arrange for appropriate opportunities for socialization, access to spiritual and religious activities, social interaction and leisure activities. You should also be provided with the safety policies for your home, including fire and other emergency procedures.
TIP: If you have important preferences such as being able to having the opportunity to smoke (or being in a smoke-free environment), or if you have special needs, such as dietary restrictions, these should be a part of your Service Plan
TIP: All emergency procedures and safety policies must be posted where staff and residents can read them. If you have a physical disability that requires additional safety measures, you should know which staff are trained to handle the situation.
What can the provider do if I have problems with a roommate?
Problems with roommates or security of personal possessions may be addressed either through the grievance procedure or through enforcing the Residents Rights. Both of these documents are required for all assisted living facilities, and are to be given to every resident, as well as posted in a prominent place in the facility.
TIP: If you know that you must share a room, try to negotiate issues about privacy and personal space with the provider and the roommate or roommate’s representative BEFORE you sign the contract. Find out if the facility’s grievance procedure covers roommate problems.
Will I be able to keep my room or bed at the assisted living home if I take a vacation or have to be in the hospital for a time?
Your contract must include a bed-hold policy both for unavoidable absences (such as hospitalizations or recuperation in a rehabilitation setting) and optional absences (such as vacations, visits to family, etc.). This policy must include the conditions under which the facility will hold a bed, what this costs and who must pay for it, and the circumstances under which the bed will no longer be held.
TIP: Ask the provider whether any fees are stopped or reduced when you are away from the home. Changes in fees for special circumstances should be a part of your contract.
What if the facility grievance procedure does not work for me, and what else can I do if I do not feel comfortable using the facility grievance procedure in the first place?
Assisted living facilities are required to provide information to all residents about their right to have access the complaint procedures of the following agencies:
- Long-Term Care Ombudsman Program of the Department on Aging
- Adult Protective Services of the local Department of Social Services
- Office of Health Care Quality (Assisted Living Complaints Division)
- Protection and Advocacy Agencies
- Maryland Legal Aid Bureau
TIP: Using the Ombudsman to help negotiate problems between residents and the facility or between individual residents is often a successful approach. However, if you want to consult with others about concerns or problems before actually filing a grievance, the residents’ rights include the right to confidentiality and access to writing instruments, postage, and reasonable access to the private use of a telephone within the facility. Residents also have to right to have an attorney and to meet in privacy with visitors of their choice.
NOTE: The State of Maryland has Assisted Living Regulations that state what the Resident Agreement must contain. These are minimum requirements, and they are divided into two categories: General Requirements and Non-Financial Content, and Financial Content. These regulations are found at COMAR 10.07.14.12 and .13.
Warning: This information is valid as of the date of this revision. This is general information and is not legal advice. This information is about Maryland law and regulations, and the laws in other states may be entirely different. For legal advice about your own situation, you should talk to a Legal Services program or to another lawyer.