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My mother had a stroke during the first week of May. After a weeks stay in a hospital she was sent to a skilled nursing facility for rehab. She was admitted as medicaid pending. The admission agreement, which I signed, said I was not personally responsible for her bill. However, it said that as the fiduciary party, I was responsible for paying the bill out of my mother's bank account. Now my mother has told me not to pay the nursing home for this month's bill because she doesn't like the level of service they have provided. I tried to explain to her that I have to pay the bill out of her money because we have to keep her assets below the medicaid eligibility levels. She has remained adamant and told me that under no circumstances am I to pay the nursing home. Now I'm concerned that her medicaid will be denied and the nursing home will sue me for breach of fiduciary duty.

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If that bill isn't paid all h*ll will reign down upon your mom and by extension, you. If she's unhappy just pay the bill and find somewhere else that she may like better.

However. While there are some nursing homes/skilled care/rehab facilities that are better than others there are universal issues that occur regardless of how nice the facility may be such as waiting longer than you'd care to when you press the call light. And being put on the commode only to have the aide rush out of the room to attend to someone else, leaving you sitting there until the aide comes back. Getting "stuck" if an aide wheels you somewhere and is nowhere to be found when you're ready to leave (meals, activities, etc.). Aides that are unfriendly and unfortunately downright rude. They can also be abrupt and too rough when handling you and/or transferring you.

I have a regular patient I'm seeing and she's in one of the nicest if not the nicest facilities I've ever been in and I've been appalled and frustrated at the staff's behavior and that's when I'm sitting right there! I wonder how the staff treats my patient when I'm not sitting right there. And I'm only there for a brief amount of time.

Your mom does owe this bill. Once she pays it she can file a complaint and having paid her bill she'll have more credibility. No one likes the level of service at a facility. It's institutional living. Your mom's not the only resident so she has to wait in line to get what she needs. It's an awful adjustment to have to make but skipping out on the bill is not the way to express her disappointment.
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Assuming that you have the authority to do so, pay the bill using your mother's money. If she then wishes to pursue a complaint against the nursing home, assist her with that. They're separate issues. I understand that it is difficult and that you would prefer to gain your mother's agreement to this, but if you comply with her unreasonable wishes you are both going to land in very hot water. You've no real choice.
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If mom is currently "Medicaid pending", Medicaid requires that the resident MUST pay their monthly co-pay. This is referred to as their "SOC" or share of cost. The amount will be whatever moms monthly income is LESS her states personal needs allowance. The allowance varies by state from $35-90 a month.

Like my moms mo. Income is $1,800 between her SS & federal retirement and her PNA is $60 so every month she has to pay the NH $1,740.00. She does not have the option not too either. If she doesn't she will be ineligible for Medicaid. It doesn't matter whether she likes or is miffed at the NH.

You kinda need to be aware that if she refuses to pay, the NH can do a 30 day notice (that she has to move)& they can bill her for whatever the private pay rate is as she was not within compliance for Medicaid. Like for my moms NH the Medicaid rate is $145.00 day while private pay is about triple that.

Does mom have the ability to understand what the SOC is and what Medicaid requires.
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Yes, get an elder law attorney. How did you get fiduciary responsibility? Is it a POA or a trust? Since mom just had a stroke, is she competent? If you are fiduciary then you have responsibility to your mother and the nursing home. It is your job to pay the bills with your mothers money, not yours. You can post your question to a legal audience, receive responses free of charge, and perhaps find an attorney to help you at AVVO
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My first question, and one which I can only pose but not answer, is whether the nursing home has grounds to sue you for fiduciary duty. In legal terms, does it have standing to sue?

The question also addresses to whom you owe a fiduciary responsibility, to your mother or to her creditor(s).

An argument could be made that if you signed the admission agreement as fidicuary of your mother's assets, you have an obligation to fulfill by making payment.

Your mother's dissatisfaction would I think be a seperate issue, a legitimate one, but whether or not it invalidates her obligation for payment is questionable.

I think this one calls for a legal conclusion and the advice of an elder law attorney. If you don't have one, inquire whether your local community has free legal counsel on elder law issues, and if you can't afford the cost of a one counsel legal session, contact your local and state bar association or Google pro bono and legal aid for your area.
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