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Understanding Assisted Living Agreements
The Purpose of Assisted Living Agreements

Assisted living and residential care facilities are not the same as nursing homes. They are an alternative to nursing homes, one that promotes resident independence.

State governments regulate assisted living facilities and their regulations are different from nursing homes, which the federal government regulates.

The care given by the assisted living staff is clearly defined by the signed contract between the resident and the facility. It's called an admissions agreement and it becomes valid when the resident moves in. It remains in place as long as the person lives in the community. The admissions agreement clearly defines the statements of terms and conditions of the community.

The assisted living agreement allows both parties involved to understand the types of care and services the assisted living facility provides. These include: lodging, board, housekeeping, personal care and supervision services to the resident according to the State Law Regulations Department that oversee senior housing certification and licensure.

The assisted living agreement is effective on the date of admissions and remains in effect until amended by the involved parties or until terminated by the parties in the agreement provisions.

Negotiated Risk Agreement

A negotiated risk agreement (NRA) is not an assisted living admissions agreement, although it is (at times) included as a tool with the service planning assessment.

Opponents see it as a strategy for assisted living providers to avoid liability for poor care. Read the full study of negotiated risk agreements by the U.S. Department of Health and Human Services.

In a 2010 CDC survey of residential care facilities, 59% of the facilities have not developed a formal negotiated risk agreement with residents.

Does this facility develop a formal negotiated risk agreement with any of the residents?
Responses of refusal (< 1%), and don't know (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)
If a formal negotiated risk agreement is not used, does this facility address risky behaviors in some other formal written document?
Responses of legitimate skip (41%), and refusal (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

In some states, facility employees identify potential and actual risks for residents. Residents or family members do not create risk agreements. The Negotiated Risk Agreements, initiated by the facility only, become active after staff reports risky behaviors by a resident. If the resident agrees to discontinue the behavior, there's no formal NRA written.

The same CDC survey of residential care facilities reports tat 63% of the facilities that do not have risk agreements address risky behaviors in some other formal written document. In total, over 75% of facilities have some form of written document for addressing risk.

Assisted Living Agreements

Assisted Living Agreement
Assisted Living Agreement

Assisted Living Federation of America (ALFA) designed a sample of a model resident admission agreement. This is guidance only, not legal advice.

(Providers should consult competent legal counsel experienced in assisted living in developing, revising and reviewing their individual resident agreements. In addition, providers should remember that state law in many states addresses the issue of resident admission agreements. The laws of some states are very specific regarding both form and content of resident admission agreements and should always be consulted when developing or revising admission agreements.)

Residential Agreement

ACCOMMODATIONS AND SERVICES

  • Accommodations
  • Apartment
  • Decoration and Alterations
  • Basic Services
  • Meals and Snacks
  • Activities
  • Common Areas
  • Transportation
  • Health and Personal Care Services
  • Observation
  • Health Needs Which The Community Cannot Meet
  • Assistance with Activities of Daily Living
  • Assistance with Storage and Administration of Medications
  • Health Records
  • Excluded Services

FEES

  • Basic Services Rate
  • Adjustments to Rates
  • Absences from Community
  • Security Deposit

PAYOR INFORMATION AND FUNDING SOURCE

CHANGE OF ACCOMMODATIONS

  • Dual Occupancy
  • Move to New Apartment

ACCESS TO YOUR APARTMENT

YOUR RIGHTS AND RESPONSIBILITIES

  • Rules and Regulations
  • No Proprietary Interests
  • Absences

TERMINATION OF AGREEMENT

  • By You
  • By the Community
  • Death
  • Vacating Apartment and Refund
  • Release From Obligations

PROPERTY OF COMMUNITY

  • No Tenancy Interest or Management Rights
  • Liability for Damage

PROPERTY OF RESIDENT

ADVANCE DIRECTIVES

INCOMPETENCY

WAIVER OF ONE BREACH NOT A WAIVER OF ANY OTHER

ASSIGNMENT

FAMILY VISITS

SEVERABILITY

GOVERNING LAW

ATTORNEYS' FEES

NOTICE

EXHIBITS

DESCRIPTION OF [ROOM, APARTMENT, UNIT] TO BE OCCUPIED BY RESIDENT

SUPPLIES AND SERVICES INCLUDED IN THE COMMUNITY'S

BASIC SERVICES RATE

OPTIONAL SUPPLIES AND SERVICES NOT COVERED IN THE COMMUNITY'S BASIC SERVICES RATE - AND RELATED CHARGES

COMMUNITY RULES AND REGULATIONS

STATEMENT OF RESIDENTS' PERSONAL RIGHTS

Obtain more information written by ALFA in their checklist.

Common Contract Provisions

Assisted Living Contracts

A Uniform Disclosure Statement (UDS) is a legally binding document and an important consumer tool. It's a form, developed by the State You live in, that every assisted living and residential care facility must have. It fills in many of the gaps in the state rules, such as the staffing ratio and supplements the residency agreement or contract. Ask for the disclosure at every facility you visit so you can compare the services each one offers. Once you have made your facility choice, keep the uniform disclosure statement in a safe place. Know that not all states require assisted living or residential care facilities to administer a disclosure statement.

  1. Non-refundable move in fees - A facility can charge the amount as long as the fee's disclosed. Fees are the month's base rate. Do not sign the contract before move-in. You may change your mind. Some facilities play hard-ball and keep the non-refundable fee. Do your homework and make sure the facility is a place you want to move into before signing a contract or paying money.
  2. Binding arbitration clauses - Courts may allow these clauses in assisted living and residential care agreements. An arbitration clause is in a contract that requires the parties to resolve their disputes through an arbitration process. It always binds the parties to a type of resolution outside of the courts, and is therefore considered a kind of forum selection clause. (Wikipedia)
  3. Discounted rate for guaranteed one year stay - You'll think this is a good way to pay less money and save. What happens if you dislike the facility or the care you receive? You may want to move out. A facility could demand the rest of the year payment. Be sure to read the agreement before you sign to understand what happens in a situation like this.
  4. Third party guarantor - If you sign this provision, you'll be personally liable for your loved one's bill. Do not sign a contract as guarantor. If you are power of attorney for a loved one who is moving into an assisted living or residential care, make sure the contract reflects that you are signing as power of attorney, not guarantor.
  5. Get it in writing - You can stay here until you die - is not a promise, unless you get it in writing in your contract.
  6. If the assisted living or residential care facility has a Medicaid contract -- it cannot require you to pay privately for a set period of time before you can go on Medicaid. In some states, this is a "duration of stay" contract and it is neither allowed nor enforceable under the Medicaid rules. Check with your State Medicaid rules and regulations to see if this applies.
  7. Record and photograph your belongings when you move in and at least twice a year while you live in the facility. Unlike nursing homes, these facilities are not required to inventory your possessions, although some will do it for an additional fee. The facility is responsible if anything you own is lost or damaged due to the facility's negligence. The burden is on you to prove the condition and ownership of the item.
  8. The service fee should not change, if the level of care has not changed. The facility must do a pre-admission evaluation of a prospective resident's care needs. The service rate quoted based on that evaluation. Make sure this initial evaluation updates and modifies during the first 30 days after a resident moves in, which may result in the service rate going up or down. Try to get the facility to commit in writing to keep the service fee within a realistic range.
  9. Your monthly fees depend on how much care you need. Assisted living and residential care facilities charge a base rate that covers room and board and usually a certain level of care. If your care needs go up you will pay more. The facility must give you immediate written notice if your service charges go up and you cannot be billed for services already provided. Ask for a meeting with the facility if you do not understand any billing changes and keep asking questions until it makes sense.
  10. Do not sign a revised disclosure statement or care plan you do not agree with. While this will not get you out of your legal obligation to abide by changes (to pay the bill, for example) it may give you a better chance of eventually winning the argument that the changes were wrong or unfair.
  11. If your room door has a lock, use it. If you have valuables in your room, store them in the facility provided locked storage space. Locking your room door will not keep staff out, they all have a passkey, but it will prevent unauthorized entry by non-employees. Source: Ten Tips for Consumers about Oregon's Assisted Living and Residential Care Facilities and excellent read on what to learn about assisted living agreements. Know the facts before you sign.

BEFORE YOU SIGN THE AGREEMENT

Read the contract before signing. Nearly every day a Long-Term Care Ombudsman hear from people who are unhappy with provisions in the contract they signed. Unfortunately, most of these people did not read the contract before signing it.

Many assisted living and residential care contracts are 50 pages or more and written in legalese. If you do not understand the agreement, hire a lawyer. A little time, and money up front can save you a world of hurt later.

Carol Marak
Carol Marak

After seven years of helping her aging parents, Carol Marak has become a dedicated senior care writer. Since 2007, she has been doing the research to find answers to common concerns: housing, aging and health, staying safe and independent, and planning long-term.