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My mother is combative with dementia and ended up in the hospital. She is unable to walk and can barely transfer. The hospital wanted to send her back home. She does not own a home and does not live with us. The hospital downgraded her status to observation within 12 hours of her stay. They finally found a facility to take her . My concern is the admission paperwork they sent wants us to sign as a representative. Red flags everywhere and even though they say it’s only because she has dementia I’m afraid I will be hit with all her medical bills not covered by Medicare A. She will qualify for Medicaid after admission. Should I sign and admit her?

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According to profile, NO DPOA.

If possible, have it reviewed by an atty - do NOT let them rush you!
If possible, have your mother sign it.

SEE THIS:

https://www.elderlawanswers.com/am-i-financially-liable-if-i-sign-a-nursing-home-agreement-for-someone-else-15051

Follow the links they have in it - there are examples and more detail!
There are warnings in this article about "signing as representative" and that some NHs will sneak in questionable wording. Since you don't have POA, I would be VERY hesitant to sign ANYTHING they are asking you to sign. Them saying Oh it's just standard stuff doesn't cut it.
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What I was told to do was on every signature line do it as “Jane Smith in her limited capacity as DPOA for Anne Jones Smith”.
AND
get a copy of each and every page of all admissions paperwork!
It will be quite the Stack of paper. Get every page.

You can strike out items and initial by those lines or paragraphs. Admissions will not be happy if you do this. So you have to be able to hold your ground on this. I assume you have a valid DPOA.

also please please realize if she applies for LTC Medicaid, she will be required to have basically all her monthly income to be paid to the NH as her copay as of day of her Medicaid application. She will have a small needs allowance- maybe $50 or $60 each mo - and it will kinda be just enough for on site beauty shoppe. So if she has any debts, she will default on them. If she has a home or car, she can continue to own those as exempt assets but she will have no $ to pay a penny on either..... & imho if there’s home or car, you as Dpoa / family / heirs need to make a clear decision to either keep her owing them to beyond her death or sell them before Medicaid LTC gets applied for. LTC Medicaid in almost all states have a maximum of 2k in non exempt assets. So if she has over $2,000 in the bank, she will have to do a legit for Medicaid spend down before Medicaid will have her eligible. Medicaid can require 5 years of her finances to review to see if there r any $ impropriety. Good luck.
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Jennifercrane Dec 2020
If a person applying for Medicaid has assets such as a home, there will be a spend down period. The house will have to be sold (some extenuating circumstances will affect this, such as dues a spouse still reside in it) and assets used until her income and assets are below certain limits. In our state tge income does go to the NH with a $45 allowance to the person applying.
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When you sign anything for your mom, make sure that you are signing as POA....Jane Smith, POA for Mary Jones.  That way you are signing on her behalf.
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babsjvd Dec 2020
Such a good point ! I have just been signing the care plan with my name , I have to sign one this week, timely comment for me..thanks
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Please read each line carefully and do not sign your own name next to any statement that says you will personally pay any debt incurred by your mom or be responsible personally for that debt. Do not sign your name as responsible party. Instead, sign "(mother's name) by family member, her agent". Of course its always best to consult an attorney, but if you can't, please follow that advice.
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Tell them you will only help your mom sign her own name or Sign your mom's name as per your name under and just to make sure, before signing my name, I would have the home write on a piece of their letter head that you are just signing your mom's name with yours underneath but you are no way responsible for any payments whatsoever.

Then have the Home Admissions Person Sign it.

Do this before you sign your mom's name by your name.

If they won't do it then you don't do it.

They have already agreed to the Hospital to take your mom and they will have to keep her
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Take the paperwork to a lawyer that specializes in elder law. She/He can advise you about your responsibilities and how to negotiate this. It is worth the expense.
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Are you POA. If so you sign as her name by your name under POA. If not, tell the home that you cannot sign as you have no legal right to sign. That you are not her POA or guardian. You also have no right to file for Medicaid for her. In that case they need to get State Guardianship (which would mean an appointed fiduciary in charge of her assets, her placement).
Currently your Mom is on her own, I am assuming, with no legal representative to file for medicaid, and no one to sign for a Nursing Home.
A social worker can get legal temporary guardianship for you with a phone call to a judge, so it is on them. If I was not her POA I would not sign. They have no choice then but to get a temporary guardian. Do know if that person is not YOU , that you have no rights to advocate for her.
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Jennifercrane Dec 2020
Not in all states. I could not just call a judge to get someone temporary guardianship. Someone must file for guardianship and request an expedited hearing. A temp guardian ;usually an attorney) will be appointed until a hearing and permanent guardian is appointed. And this is IF the person in question is really incapacitated. Courts take this question seriously. Dementia alone doesn’t always mean incapacity because progression can be rather slow sometimes.
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For peace of mind, spend one hour ($300-400) with a CERTIFIED eldercare attorney about this matter. Make sure you understand the pros and cons of your responsibilities to avoid headaches later.
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I'm sorry if this will sound critical of previous answers to this question. It's standard procedure at intake to ask for someone to sign as a "Responsible Party", not to be confused with Power of Attorney (POA), and one does not need to consult an attorney before making this decision, one only needs to understand the difference between the two.

I have been the Responsible Party for two people within the past few years, neither of which I am related to. One has passed the other is still living. The Responsible Party is NOT liable for medical bills. If the person qualifies for Medicaid that covers everything and whether or not one qualifies depends on that person's assets. She's already qualified so there is no question about that.

The term Responsible Party simply means that you are responsible for making certain decisions about the patient, in this case, a parent. It's especially essential for a dementia patient because they can't make good decisions for themselves. Because of a law that was designed to protect the privacy of patients, otherwise known as the Health Insurance Portability and Accountability Act, or HIPAA , being the Responsible Party actually gives you rights to access to your mother's medical records, and the authority to make decisions on your mother's behalf, that could otherwise be denied you, even if you are a relative.

As the Responsible Party, I receive notifications anytime the patient I am responsible for develops any concerning symptoms. The facility also consults me anytime the patient's condition changes. If you are not listed as a Responsible Party the facility is under no obligation to share medical information with you, in fact, just the opposite.

Again, the Patient Representative is not the same as Legal Power of Attorney. Legal POA gives you control over the patients estate and finances in addition to making other medical decisions. You don't get control over finances and/or the estate as the PR though you will be given the right to obtain patient records and to make decisions regarding your mother's care. Without those rights you pretty much give up most control over what happens to your mother, and can be denied access to medical records. You will not be responsible for her medical bills since she qualifies for Medicaid. If you want to be included in decisions about your mother's care and the quality of that care, you will need to be her PR, which despite the name, gives you more rights without taking anything from you. Consult with a local Ombudsman if you still need further clarification. Each nursing facility contracts with the local Ombudsman program and should be able to provide you with the contact information for that.
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Pasa18 Dec 2020
1heretohelp, if a medicaid application is made while at SNF, who signs? the dementia patient, the personal representative, or responsible party? I discovered that my aunt's signature was on the medicaid application, while I was denied access to medical records although my aunt verbally requested that I be allowed access.
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Sometimes the person asking you to sign does not understand the paperwork themselves! So, them possibly telling you it's "standard" or "everybody signs this" means even less. They could have had only 5 mins of training because the regular person wasn't going to be in that day that you were coming to sign. I'm not even saying it would be deliberate deception - just someone who has no idea what the papers truly mean and was asked to have you sign them. Period. Person will be wanting to get that done and it's really nothing to them. Please have paperwork reviewed by someone who truly gets it. I'm certain it will not be the first time nursing home has had someone do that.
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