As you prepare to admit your older relative to an assisted living facility, it is important to know what documents you will be expected to provide the manager at the time of admission. It is also important to understand the contract, called a Resident Agreement, that you or your relative will be required to sign.
If you need help finding a lawyer, you may call the Maryland State Bar Association at 410-685-7878 for a referral to Elder Law attorneys in your area. If your older relative has limited resources, he or she may be eligible for free or reduced-fee legal assistance from Maryland Legal Aid. Call 410-296-6705 or, for long distance callers, 1-800-367-7563 to determine if your relative is eligible to have his or her Resident Agreement reviewed by an attorney at the Assisted Living Project.
Documents for Admission
Documents Related to Decision-Making
If any of the following documents have been completed for your older relative, provide a copy of each to the facility manager:
- Financial Power of Attorney: The person named in this document is responsible for handling only the person's financial affairs described in the document (this may include payment of bills) if the patient is unable, or does not wish to do so.
- Advance Directives: These documents allow a person to make health care decisions in advance, so that those decisions may be carried out in the event that the person is no longer able to give informed consent. The advance directive may specify the type of care the person wants, and/or it may name another individual to give informed consent for medical treatment.
- Order for Guardianship of the Person: This document indicates who was appointed to make medical decisions for a person who was determined by the court to be “disabled” and therefore unable to make medical decisions.
- Order for Guardianship of Property: This document will indicate who was appointed to make financial decisions for a person who was determined by the court to be unable to make financial decisions.
- Do Not Resuscitate (DNR) Order: This document states that the person does not want to be revived if cardiac arrest occurs or if the person stops breathing.
Other Documents and Information
- Social Security card
- Health insurance information
- Emergency contact information
- Any medical information not included in the Physical Assessment, such as a list of allergies.
Before your older relative moves in, you or your older relative and the provider must sign the Resident Agreement, a contract that lists the services that will be provided, the fees and the responsibilities of each party. Request a copy of the Resident Agreement ahead of time so that you can review it at home. Ask a lawyer to review the document as well. Resident Agreements differ for each provider. While providers are not required to get these contracts approved by the state, there are regulations listing key elements that must be included.
- What is the amount of the monthly fee?
- What services are provided for the monthly fee?
- What entrance fees (if any) are required?
- What are the extra fees and what do they cover?
- What is the policy on refunds (in case of transfer, discharge, etc.)
- When fees increase, how much notice does the resident receive and how is the information communicated?
- What are the billing arrangements?
- Who is responsible for payment?
- What are the costs for renting or purchasing necessary medical equipment or supplies?
- What happens if the resident's funds run out?
- Is there a charge to hold the bed if the resident is hospitalized? How long will the bed be held?
- What are the responsibilities of all parties to the agreement (provider, resident, resident's representative)?
- What levels of care are the facility licensed to provide?
- What level of care has been assigned to the resident? (In general, residents are initially assigned a Level One, but this level is reassessed once the staff have an opportunity to evaluate the individual in the residential setting. If the level needs to be changed, the Resident Agreement may be amended.)
- How will the level of care be reassessed, and by whom? If the individual's level of care exceeds the facility's licensed level, what will happen?
- What services will the resident receive, and what services are not provided?
- What assistance will be provided with activities of daily living?
- What type of living unit will the resident have? Private? Semi-private?
- Are bathroom facilities shared with others?
- What procedures are in place for changing room assignments and for changing the number of residents in a room?
- What are the procedures regarding resident privacy, for example are staff permitted to enter residents' rooms, and under what circumstances?
- How are residents' belongings safeguarded?
- What are the procedures to handle emergencies?
- How does the facility provide or arrange for medical care and health monitoring for the resident?
- What is the grievance procedure?
- What are the procedures for transferring or discharging residents?
- How and under what circumstances can the Resident Agreement be modified?
- Is there an appeal procedure for involuntary discharge?
- What are the conditions under which the provider would terminate the Resident Agreement?
- What procedures are followed upon the death of the resident (funeral, burial)?
Once your relative is living in the facility, if there are any significant changes in his or her needs, the contract must be amended to reflect those changes.
Signing the Resident Agreement
It is important that the appropriate person sign the Resident Agreement.
- If your relative is capable of understanding the documents and there is no legally designated decision-maker (power of attorney or guardian of property), your relative is the appropriate person.
- If a family member or friend has informally agreed to pay bills for the resident, he or she should sign.
- If your relative is not capable of understanding the documents and there is a formal arrangement for decision-making (Power Of Attorney or Guardian of Property), the power of attorney or guardian of property should sign the documents.
- If your relative is not capable of understanding the documents and there is no power of attorney or guardian of property, the surrogate decision-maker identified under Maryland law may be asked to sign the documents.
If you sign the Resident Agreement as a “responsible party” or “representative,” be sure the document states whether you are paying for your relative's assisted living care using his or her funds, or your own funds. Sometimes relatives learn only after signing the agreement that they have obligated themselves to pay out of their own funds.
Before Signing the Resident Agreement
- Ask an attorney to review it.
- Make sure you understand the entire document. If you have questions or concerns, make sure they are clarified before the agreement is signed!
- If any changes are made in the document, write your initials and the date next to each change; the manager should do the same.
For information about wills, estates and probate or to learn how to register a will, the Maryland Register of Wills offers information and links to local registers.