We are ready to serve you with a free virtual consultation during the COVID-19 outbreak. Click Here for more information.

Do Care Facilities Discriminate Based on Coverage?

Discrimination In Nursing Home Care

If you believe that you or your loved one experienced discrimination by a nursing home on the basis of insurance coverage (or some other basis), hire an experienced nursing home attorney to handle your case. A Duluth nursing home lawyer can review your case with you, and if necessary, can file a legal complaint or take other legal action directly against the nursing home on your behalf. Your nursing home lawyer can also assist you with filing the necessary paperwork and can represent you or your loved one at any hearing that takes place at the nursing home, before an administrative law judge, or in a courtroom.

According to recent statistics from the United States Department of Health and Human Services, along with the Urban Institute, almost 52 percent of individuals who are 65 years of age or older will need to avail themselves of long-term care services at a nursing home or other long-term care center at some point in their lives. Moreover, the cost of care at one of these facilities might average almost $138,000.

Given the high costs of living across the United States, many individuals—especially low-income Americans—are turning to federal programs like Medicaid—to provide them with the long-term coverage that their needs require. Despite the large number of individuals across the country who rely heavily on Medicaid, as well as the many rules and laws that are currently in place, care facilities, including nursing homes, often find pretextual reasons to discriminate against individuals on the basis of Medicaid coverage (versus other types of insurance coverage).

In fact, these facilities are not supposed to discriminate based on insurance coverage and are not supposed to consider whether a nursing home applicant has applied for Medicaid when deciding whether to accept a particular individual as a resident.

Insurance-Based Forms of Discrimination

Under both federal and state laws across the country, long-term care facilities—including nursing facilities—are precluded from discriminating against residents or potential applicants on the basis of insurance coverage.

Specifically, nursing homes may not require or request that an applicant should not:

  • State orally or in writing that he or she will not apply for Medicaid benefits—and that he or she is not eligible for Medicaid at the time of application
  • Waive any and all rights to Medicaid assistance
  • Provide for a guarantee of payment by some third party

In addition, a care facility may not solicit, charge, receive, or accept any type of consideration (such as money or some type of donation), to admit an individual who is eligible for Medicaid services to the nursing home. Finally, the nursing home or urgent care center must notify the nursing home resident and/or the nursing home resident’s legal representative, in writing, about all of his or her legal rights. The resident must also receive notification about their rights and obligations under Medicaid.

Pretextual Denials by Nursing Facilities and Long-Term Care Centers

Despite all of the state and federal laws that are on the books across the country with regard to insurance-based forms of discrimination, some facilities can (and sometimes do) deny Medicaid beneficiaries’ admissions to a nursing facility, based on some pretext.

In some instances, a nursing facility may deny admission to an applicant on Medicaid who suffers from Alzheimer‘s disease, dementia, or some other mental illness, stating that it does not have the staff or equipment available to treat the individual’s mental illness. Technically, under federal law, a “skilled nursing facility” does not provide treatment and care for mental illnesses, but instead, only provides nursing, medical, and/or rehabilitation services at nursing facilities.

In other cases, the nursing facility might require that a nursing home applicant agrees to a “duration of stay agreement.” As part of this agreement, the prospective nursing home resident agrees (either orally or in writing) that he or she will not complete an application for Medicaid benefits during a specific period of time. At other times, the nursing home may require a prospective resident’s family members to agree that they will themselves assume financial responsibility for their loved one’s care and treatment at the nursing facility.

Since these types of preconditions are not legal, they are not contractually enforceable and may not be enforced by the nursing home at any time. This is true even if the prospective nursing home applicant ultimately signs the agreement and is admitted to the nursing facility.

If a nursing home requested that you or your loved one sign one of these agreements, an experienced nursing home lawyer near you can review the agreement and determine whether or not it is legally enforceable.

Taking Legal Action Against a Nursing Home

If you believe that you or a loved one was not admitted to a nursing facility because you were Medicaid eligible—or you were already a Medicaid recipient at the time of your admission denial—there are several legal actions that you or your nursing home lawyer may take.

First, you or your nursing home lawyer may file a complaint—either orally or in writing—with the nursing home or long-term care center directly. Typically, the main administrator for the nursing home is the go-to person for these types of complaints. The administrator or the board of the director for the nursing home may then reverse their decision. This type of resolution is an informal resolution to a complaint.

If you cannot successfully resolve your complaint, you may then go to the long-term care ombudsman for your state. These individuals are present in every state in the country, and their primary job is to assist people and their families with resolving pending disputes that often arise between individuals and nursing homes and long-term care centers.

Local ombudsmen are also in a position to help individuals who believe that a nursing home denied their application for admission because they were a Medicaid recipient at the time they filed the application. These individuals receive special training and are in a position to assist you with pursuing and obtaining the long-term care that you deserve at a state nursing facility.

In addition to dealing with the nursing home or with a state or local ombudsman directly, you and your nursing home lawyer also have the option of filing a formal complaint with the agency in your state that is responsible for overseeing long-term care centers and nursing facilities located within the state. In most instances, these agencies are a division of the health department for the state in which the nursing facility is located.

Once you make your complaint with the state agency subdivision, the agency will contact the nursing home directly and await a reply. If the health department ultimately determines that the nursing facility is not in compliance with state or federal laws and regulations, it has the right to impose a whole host of regulatory and monetary sanctions directly against the nursing facility.

The state agency may also recommend imposing federal enforcement remedies under the circumstances. In cases in which a state agency recommends federal remedies, the Secretary of Health and Human Services may impose a maximum of $10,000 in civil fines and other penalties every day until the facility begins to comply.

An experienced nursing home lawyer in your state can assist you with your legal filings and is in a position to take prompt action against a nursing facility or other long-term care center that fails to comply with the applicable laws and regulations in your state.

Other Forms of Discrimination by Long-Term Care Facilities

There are other illegal ways that long-term care facilities, including nursing homes, across the country discriminate against applicants and even residents. Some of the most common ways that nursing homes regularly discriminate against elderly individuals include discriminating against members of a protected legal class.

When deciding whether to admit an individual to a nursing facility, the facility is not permitted to discriminate against individuals on the basis of their membership in a protected class. For example, a nursing home cannot discriminate against an applicant based on the applicant’s color, age, race, national origin, sex, age, religion, or any other legally protected classification.

If you believe that you or your loved one experienced discrimination as part of the nursing home application process, you should contact the long-term care ombudsman in your area about the nursing home. You may also want to file a formal written complaint with the state agency that is responsible for overseeing and regulating nursing homes and long-term care facilities in your jurisdiction.

Taking Away Resident Rights

Some nursing homes may also try to take away a nursing home resident’s rights (including both personal and legal rights) while the resident is living at the facility. For example, while a nursing home resident is staying at the facility, the facility may not prevent a resident from managing his or her own money or personal property—at least without some form of written consent provided by the nursing home resident. In addition, a nursing home may not prohibit a resident from accessing his or her own cash, bank account information, and financial documents.

Moreover, a nursing home cannot prevent a resident from taking part in his or her own care and treatment, as developed through a nursing home care plan. In the event a resident suffers from a mental illness or otherwise lacks the mental capacity to participate in his or her own care plan, then the resident can nominate an individual, such as a sibling or adult child, to participate in the plan.

If you believe that a nursing home deprived you of one or more of your rights, an experienced nursing home attorney in your area may assist you with making an internal complaint to the nursing home administrator and/or with filing a complaint against the nursing home with the appropriate state agency.

Nursing Home Abuse and Neglect

Personal Injury lawyer

David Brauns, Nursing Home Abuse & Neglect Lawyer

Nursing homes are also responsible for making sure that they provide residents with the proper care, service, and treatment that they need at all times. When the nursing home fails in this regard and engages in abuse or neglect toward a patient, then the nursing home resident or the resident’s relative may file a complaint with the State regulatory agency that is responsible for overseeing nursing homes. To learn more about how to report nursing home abuse contact our skilled nursing home abuse attorneys at Bruans Law, P.C.

Nursing home abuse and neglect may occur at the hands of various nursing home employees, including doctors, nurses, nursing assistants, physical therapists, dietitians, administrators, and even other individuals who reside at the nursing home. In addition, nursing home abuse and neglect can take on a variety of different forms.

What is elder abuse, it may consist of sexual abuse, physical abuse, mistreatment, and even verbal abuse by a staff member to a nursing home resident. Neglect typically occurs when nursing home staff members behave unreasonably and cause the nursing home resident to suffer a serious injury or illness. To learn more about the types of

Common types of nursing home neglect that are prevalent in nursing facilities across the United States include failing to respond to patient complaints promptly, failing to monitor a patient’s medical condition, failing to provide the proper medication to a patient (including the correct medication dosage), failing to properly care for the patient (including bathing the patient regularly), and failing to maintain the nursing home in a reasonably safe condition at all times, such as by failing to properly clean hallways, patient rooms, and common areas of the nursing facility.

Nursing Home Abuse & Neglect Justice

If you or a person you love is the victim of abuse or neglect in a nursing home, an experienced nursing home attorney can investigate your claim, and if necessary, will file a formal complaint with the state agency that is responsible for regulating nursing homes in your area. If the state regulatory agency determines that the nursing home did something wrong, it may impose monetary fines and other regulatory sanctions against the facility.

Brauns Law, P.C.
3175 Satellite Boulevard, Bldg 600
Suite 330
Duluth, GA 30096
(404) 205-8614

Award Winning Power and Experience