Contracting for skilled care in the ALR

The written contract

It is always an exciting time when a new resident chooses to move into your community! Many hours of work from your team have paid off and now you welcome a new member to the “family”- but it’s not done yet! The state Pennsylvania requires a written contractual agreement for every new person moving into an Assisted Living Facility. Check out the regulations below as to what needs to be included in the residency contract:

2800.25. Resident-residence contract.

(a) Prior to admission, or within 24 hours after admission, a written resident residence contract between the resident and the residence must be in place. The administrator or a designee shall complete this contract and review and explain its contents to the resident and the resident’s designated person if any, prior to signature.

(b) The contract shall be signed by the administrator or a designee, the resident and the payer, if different from the resident, and cosigned by the resident’s designated person if any, if the resident agrees. The contract must run month-to month with automatic renewal unless terminated by the resident with 14 days notice or by the residence with 30 days notice in accordance with § 2800.228 (relating to transfer and discharge).

(c) At a minimum, the contract must specify the following:

(1) Each resident shall retain, at a minimum, the current personal needs allowance as the resident’s own funds for personal expenditure. A contract to the contrary is not valid. A personal needs allowance is the amount that a resident shall be permitted to keep for his personal use.

(2) A fee schedule that lists the actual amount of charges for each of the assisted living services that are included in the resident’s core service package in accordance with § 2800.220 (relating to service provision).

(3) An explanation of the annual assessment, medical evaluation and support plan requirements and procedures, which shall be followed if either the assessment or the medical evaluation indicates the need for another and more appropriate level of care.

(4) The party responsible for payment.

(5) The method for payment of charges for long distance telephone calls.

(6) The conditions under which refunds will be made, including the refund of admission fees and refunds upon a resident’s death.

(7) The financial arrangements if assistance with financial management is to be provided.

(8) The residence’s rules related to residence services, including whether the residence permits smoking.

(9) The conditions under which the resident-residence contract may be terminated including residence closure as specified in § 2800.228.

(10) A statement that the resident is entitled to at least 30 days advance notice, in writing, of the residence’s request to change the contract.

(11) A list of assisted living services or supplemental health care services, or both, to be provided to the resident based on the outcome of the resident’s support plan, a list of the actual rates that the resident will be periodically charged for food, shelter and services and how, when and by whom payment is to be made.

(12) Charges to the resident for holding a bed during hospitalization or other extended absence from the residence.

(13) Written information on the resident’s rights and complaint procedures as specified in § 2800.41 (relating to notification of rights and complaint procedures).

(d) A residence may not seek or accept payments from an SSI resident in excess of one-half of any funds received by the resident under the Senior Citizens Rebate and Assistance Act (72 P. S. §§ 4751-1—4751-12). If the residence will be assisting the resident to manage a portion of the rent rebate, the requirements of § 2800.20 (relating to financial management) may apply. There may be no charge for filling out this paperwork.

(e) The resident-residence contract must include whether the residence collects a portion of a resident’s rent rebate under subsection (d).

(f) If the residence collects a resident’s rent rebate under subsection (e), the resident-residence contract must include the following:

(1) The dollar amount or percentage of the rent rebate to be collected.

(2) The residence’s intended use of the revenue collected from the rent rebate. (g) A statement signed by the resident, and the resident’s designated person if applicable, at the time of admission, informing the resident that the information required in subsections (e) and (f) is to be kept in the resident’s record.

(h) The resident, or a designated person, has the right to rescind the contract for up to 72 hours after the initial dated signature of the contract. The resident shall pay only for the services received. Rescission of the contract must be in writing addressed to the residence.

(i) The residence may not require or permit a resident to assign assets to the residence in return for a life care contract/guarantee. A life care contract/ guarantee is an agreement between the legal entity and the resident that the legal entity will provide care to the resident for the duration of the resident’s life. Continuing care communities that have obtained a Certificate of Authority from the Insurance Department and have provided a copy of the certificate to the Department are exempt from this requirement.

(j) A copy of the signed resident-residence contract shall be given to the resident and a copy shall be filed in the resident’s record.

(k) The service needs addressed in the resident’s support plan shall be available to the resident every day of the year.

(l) The resident-residence contract shall identify the assisted living services included in the core service package the individual is purchasing and the total price for those services. Supplemental health care services shall be packaged, contracted and priced separately from the resident-residence contract. Services provided by or contracted for by the residence other than supplemental health care services must be priced separately from the service package in the resident residence contract.

Top Takeaway:

  • (a) Prior to admission, or within 24 hours after admission, a written resident residence contract between the resident and the residence must be in place. The administrator or a designee shall complete this contract and review and explain its contents to the resident and the resident’s designated person if any, prior to signature.

While the regulation allows a period of 24 hours after admission to have the contract completed it would behoove the facility to have it signed prior to the resident moving into the community. Once the resident has taken possession of the apartment they are officially in your care. We have seen reports of residents or their responsible parties refusing to sign AFTER they have moved in and the facility was forced to evict them.

Pro Tip:

Walk through the entire document, section by section with the client. You should take your time, read everything to them and make sure they understand what they are agreeing to. If they have any questions politely answer and do not make them seem like a hassle. Remember, this experience will set the tone for their entire residency.